Screwed something up during the harvest a little over a month ago. Not the first time but the sciatica symptoms are not diminishing like they usually do. Not debilitating but damn close at times.

Question: If I go straight to PT, can they isolate the root cause and develop treatment plan, or do I need to see an ortho / sports medicine guy(gal) first?

I appreciate the knowledge. Thanks!

This message has been edited. Last edited by: pace40,

Since most sciatica is due to disc protrusion you should get an MRI to determine the proper course of treatment. (former DC)

PT is not going to be able to officially diagnose you, although they are free to think what it is. PT is therapy (treatment), not diagnosis. PT won't touch you with neurological symptoms and without seeing a doc first and get referred. And, as mentioned above, with your symptoms and especially them not getting better, an MRI would be a prerequisite.

Go to the doctor, he will have an X-ray or mri to check out the offending disk.

I've had sciatica on the right side for some forty years. IME: Once you have it, you have it, and it's never actually going away.

Best one can do, again: IME, is mitigate it with exercise. As long as I stretch and exercise on a regular basis it doesn't bother me. Sometimes I can faintly tell it's still there, waiting to ambush me, but, that's it.

If I stop working out and stretching it will return. It has returned--a couple times so badly I was all but immobilized.

Mine’s getting worse. I have an appointment in October with a neurologist. Hoping to find a non-surgical solution. I guess we’ll see.

Ensigmatic, I stretch, exercise, and walk religiously. My weight is pretty much on point for my height, but I know from previous images that I have two degenerated discs in my L-spine. I’ve had them for a long time, and had a remarkably active life. I know it’s much easier to keep it than recover it. Doing what I can.

Thanks Doc's. Much appreciated.

Ortho first appointment is mid-November, sports doc will see me Fri. AM...Sports med it is.

quote:

Originally posted by ensigmatic:
Best one can do, again: IME, is mitigate it with exercise.

My plan is to exercise and stretch my way out of it but since I'm not sure of the cause, not sure of correct stretches and exercises. I do know that the wrong ones make it worse. Don't want drugs or surgery.

quote:

Originally posted by pace40:
My plan is to exercise and stretch my way out of it but since I'm not sure of the cause, not sure of correct stretches and exercises. I do know that the wrong ones make it worse. Don't want drugs or surgery.

You'll want to start with a doctor, but you can express your preference from the start for no surgery or drugs. The doctor will respect that, though if the MRI shows that you have a serious disc issue, they may advocate for surgery as the best/only realistic option. But they can't force you to have surgery or take drugs. (Painkillers - even hardcore opiate ones - don't tend to work very well on nerve pain anyway...) The doctor can diagnose the specific issue, then refer you to PT to learn the right types of stretches and exercises for that specific diagnosis.

I went though this about a decade ago with sciatica, and again about 5 years ago with a similar nerve pain issue in my neck/shoulder. Surgery was not warranted either time, and I've never taken any drugs for it.

PT solved it both times, but it started with going to a doctor.

Like ensigmatic, stretching and exercising allowed me to resolve my sciatica issue 99% and keep it from returning. But every body is different, and not all sciatica is caused by the exact same thing.

I recommend an inversion table. They can be bought for around $125. 5 minutes a day for two weeks, inverted at a 45 degree angle. Best self care money I ever spent.

Go ahead and see your regular doc. Get a referral to a good PT experienced in these kinds of issues. There's nothing wrong with getting images, but be aware that most people over about age 40 will have multiple things show up on the images that may have nothing to do with the pain.

I had a couple of herniated discs at age 45, eventually resulting in successful surgery after about a dozen years of trying everything else first.

The 2 best physical exams I had were a PT and the back surgeon's PA. The best study was the EMG nerve conduction test.

The PT pushed, twisted, and manipulated my position to elicit the pain, which gave a precise identification of the nerve and location causing the pain. The surgeon's PA did the sMe thing and came to the same conclusion.

The EMG identifies which nerve is involved and where. It is valuable information.

The MRI then verified those 3 results to guide the surgeon on where to work vs what to leave alone.

Note that some PTs are oriented towards different arenas. The first few rounds of PT for me were with well a regarded sports injury rehab practice but they weren't right for my problem. The PT who did the good exam was the right guy, but you can't fix a bad disc with exercise. Maybe you can delay the need for surgery, or even reduce the pain enough to not need surgery. Or maybe it isn't a disc and you will get good results.

You might have piriformitis, which can cause similar symptoms.

Frankly, I'm leaning towards some version of a piriformis syndrome because...

1) it was fine until strenuous work and
2) the pain starts in my butt and radiates from there.

However, since I did not even sleep in a Holiday Inn, I'll let the Doc figure it out. That said, poking and prodding is fine, cutting and injecting is out.

quote:

Originally posted by L90814:
I recommend an inversion table. They can be bought for around $125. 5 minutes a day for two weeks, inverted at a 45 degree angle. Best self care money I ever spent.

I like this idea. Laying down is one of my favorite exercises.

K, I'm no doctor, but...LOL Longstanding lumbar symptoms, if that is where the problem is (you didn't describe the location or distribution of pain or neurological symptoms), may not solely be primarily a bad disc at one or more levels.

Disc problems aren't static and almost always degenerate/worsen with time, especially for an older person. Could be a stenosis issue (part of the differential diagnosis) at the level(s) of the nerve impingement. X-ray, MRI and CT scan normally defines that pretty well. Symptoms from age-related osteoarthritis will make a mess of trying to treat degenerative disc disease.

It's so wide open with such a small amount of info...If they pin it down and start talking surgery, of which there are different types now, too, if nothing too drastic a reputable, local spinal surgeon may suffice. If something more exotic, it's worth traveling to a major university hospital, or similar to get the best outcome possible. If you seek out the best you've done your part. Good luck.

See a Dr
Get an MRI
Try meds and PT conservative therapy.
If no improvement go for an LESI
Lumbar epidural steroid injection
Surgery is last ditch for me.

quote:

Originally posted by L90814:
I recommend an inversion table.

Inversion tables are great and all, but, they will not, IMO, do a lot to mitigate against future flare-ups.

For that you need strength training and stretching to provide better support for your posterior chain and to help prevent undue pressure on the lower back.

When I first got sciatica my doctor at the time, a DO, had me lay on his table, then "Tighten up your stomach." I did. He poked and prodded it. "Relax." I did. Then he tried lifting one of my legs straight up. "Your abdominal muscles are too weak and your hamstrings too tight. Strong abs support your back. Tight hams put undue pressure on it. Strengthen your abs and stretch your hams." (Paraphrasing him.)

I did those two things and, lo and behold: Sciatica mitigated to essentially gone.

I made the mistake of stopping doing those things, once. *BAM*! Sciatica was back with a vengeance. That happened twice.

Since 2005 I've done much more than that and, since October of last year even more again. I used to work out mostly on machines. Now I do at least one or two compound lifts that work the entire posterior chain every workout session: Deadlifts, Romanian deadlifts, squats, front squats, rows, bench presses, and vertical presses.

Plus I stretch every day.

And I've learned to stop lifting stupidly... mostly.

That being said: If you have herniated or bulging discs, other spine damage, or certain joint problems some of the exercises I do may not be wise.

quote:

Originally posted by 1flynDO:
See a Dr
Get an MRI
Try meds and PT conservative therapy.
If no improvement go for an LESI
Lumbar epidural steroid injection
Surgery is last ditch for me.

I agree with the order but would add that timing may be important.

Only thing that I would add, is that I wouldn't wait too long before trying an epidural steroid injection. My reasoning is that after an injury (such as a herniated disc), you will have pressure on a particular nerve root, along with inflammation and swelling. That nerve root is encased in a sheath that does not stretch. The nerve shares this space (tube) with small artery and vein. It doesn't take much swelling inside that sheath (tube) to quickly decrease blood flow to that little nerve. Chronically decreased blow flow to that nerve can cause permanent nerve injury that won't be relieved by surgery. Epidural steroids injection (at the right location) can decrease inflammation and swelling.

This is thought to be one of the reasons that people report mixed results from back surgery. I suspect the duration of chronic decreased blood flow (chronic ischemia causing nerve injury/damage) is a factor in the chance of success of surgery.

Try conservative therapy. Most people have back pain. Most of the time it will resolve it self. It may take a month or two. You can only get 3 max 4 LESI injections in a year.

If you get one takes about 3-5 days to see and feel results. If not 100 percent get a second within 30 days.

Agree with strengthening your core. Planks can help with that. Start with 15-30 sec and work slowly increasing time.

Again try meds like gabapentin, oral steroids, muscle relaxants and PT. The can do ultrasound on the area to help the muscles relax. If you got questions email me

I wouldn't self diagnose. Get some imaging (MRI and/or CT with and without contrast) and get a tentative diagnosis. I would then meet with a competent orthopedic specialist to get an idea about whether more conservative treatment options would be effective. Get a second and third opinion.

You can make an injury worse with PT or chiropractic adjustments, so you want to rule out that scenario if you can.

This message has been edited. Last edited by: HKAngusKL,

If there’s not a new conspiracy theory out there by 10:00, I start one.

Is there any evidence of a connection between sciatica, S/I joint pain, and associated issues and the MRNA vaccine? Other associated issues (e.g. myocarditis) have been demonstrated; I had no problems in this area before the pandemic and 3 shots.

Bracing for negative responses, but I can’t get it out of my head (or butt, or hip, or leg or foot).