I recently asked my readers about the top issues they face in relation to their condition of musculoskeletal. What issues were they searching for answers to regarding back or neck pain or hip pain, knee pain, ankle, or shoulder discomfort?
Here’s a great query I got from John:
“I’m receiving physical therapy for the lower back discomfort and sciatica which is thought to originate caused by my piriformis. My PT sessions have been a mix of different exercises and massage. Eight sessions later and no change whatsoever. I’m still experiencing discomfort when I sit or walk long distances. What should I do? Do I require to have an ultrasound scan or MRI to determine whether there’s any damage or tear in the piriformis?”
The first thing is, John, I’m so sorry that you’re experiencing pain but not seeing any improvement after a long number in physical therapy. In the case of back hurt and sciatica it’s crucial to have an extensive physical and movement exam by your PT before beginning any treatment. This will require regular testing and retesting of movements and range of motion to identify, firstly the location where the pain originates and, then, which movements can trigger your symptoms and help relieve them. If you don’t take this initial step, you may miss the root of the pain and focusing on symptoms.
This type of test is crucial to determine whether physical therapy is able to help you with your issue. If the physical therapist went through the prescriptions from your doctor and then delved into generalized treatment plans – that’s the first sign of a problem there. This could be the reason why after just eight sessions, you’re still experiencing no improvement in your health.
In your situation it’s likely that the massage was intended to alleviate your symptoms – possibly your tight, aching piriformis which is thought to be the cause of your back discomfort and sciatica. This is totally acceptable but it’s crucial to integrate targeted, therapeutic movements to make the most out of the massage (massage) was able to do. That’s why movement is the true “medicine.”
Manual therapy is intended to improve blood flow improve the condition of your soft tissues (muscles as well as ligaments) to be better able to take on and execute the exercise or movement that is likely to have an effect that lasts for a long time. If massage or exercise aren’t done in a particular and precise manner, they won’t be able to achieve the desired effect.
It’s possible this is occurring to you. If you’re not sure about what you’re doing it to accomplish and what the expected impact is – odds are your exercises weren’t prescribed to you correctly. If you think this might occur, then it’s well worth the effort to seek out an alternative, possibly specialist physical therapist before you begin to take diagnostic tests that may send you into a maze of unneeded procedures or surgeries.
Let’s say for a second that you have received specific and top-quality physical therapy and it’s just not working. It happens occasionally however it shouldn’t about 20 percent of the time. This is in the vast majority of issues with musculoskeletal health like back tension and sciatica.
In my opinion, it’s best to be identified before the eight sessions. According to my experience, it takes anywhere from five to six (quality) sessions of PT to determine whether a problem can be addressed through natural methods. If not, the referral to a different specialist is needed.
Are you still there? I’m not sure. However, to answer your question regarding whether or not you require the services of an MRI and ultrasound…
If targeted, high-quality physical therapy is exhausted, then one or both of the diagnostic tests could represent the next stage to giving valuable information about what else is taking place. Ultrasounds are a painless diagnostic instrument developed to look at soft tissues and organs. It can be a great method to check your piriformis in the event that you’re sure this is where the problem originates.
However, piriformis syndrome is only responsible for around 30% of sciatica cases. A tears in your piriformis does not cause pain radiating through your leg. In the majority of cases, sciatica is caused by nerve impingement that occurs in the lower lumbar spine (low back). If treatment options that are conservative, such as physical therapy, has not been thoroughly examined – an MRI may be beneficial to determine how severely the nerve is injured or pinched and if the need for surgery or a procedure is necessary.
However, in general, research has demonstrated over and over again the fact that spine surgery is only effective if you have severe and progressive neurological impairments and signs. For instance you may be suffering from symptoms such as foot drop while your leg seems to be becoming less numb and weaker every minute.
However, physical therapy while it might be more difficult to perform, it has comparable, if not superior results than surgery and is much more secure. However, the caveat is that you must locate a reputable physical therapy.
I hope this can help you to answer your query. The most important thing is to never give up!
In the coming months, I’ll be answering questions similar to this each week in my blog articles. If you’ve got any concerns about musculoskeletal pains or pains you’d like answers to, contact me using the contact information below.
Dr. Carrie Jose, Physical Therapist and Pilates expert, runs CJ Physical Therapy & Pilates in Portsmouth and is a writer for the Seacoast Media Group. To get in touch, or request a free copy of her guide to back pain, email her at [email protected] or call 603-605-0402.
We understand how important it is to choose a chiropractor that is right for you. It is our belief that educating our patients is a very important part of the success we see in our offices.