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anyone try PT for sciatica and had sucess?

Posted by elliott on 8/06/01 at 08:23 (055614)

Many who have suffered from TTS seem to get sciatica (as mentioned in wendyn's FAQ), in particular due to a bulging disc such as L4-L5 (as opposed to a tight piriformis muscle, for which stretches exclusively probably would be more likely to work). Of those who have had this, who has tried physical therapy? Aside from the PT's advice on things like posture, the main thing they try is the 'rack' treatment, i.e. traction, where they tie you up at the waist and chest and pull, and keep you that way for half an hour twice a week for 3 months. My neuro gave it little chance of working, and this seems to bear itself out with the people I know, but one person in my office went through the treatment and said that after 3 months or so it cured her (the skeptics' counterargument is she would've got better by herself anyway). Another sufferer I know has a relative who started treatment which didn't work and left him in agony for months after (didn't follow up to see if permanant). Anyone here tried it?

My neuro gives odds of only around 20% that my L4-L5-induced sciatica will go away by itself. I've been doing power yoga for several months now (with all the recommended sciatica poses I'm able to do--still can't quite do a freestanding headstand yet), which do help but have not cured. Mainly have butt and hamstring pain while sitting in any cushioned chair, and it's hard to live with it forever. The odds of surgical success are supposedly very high (although the percentage of patients returning a year or two later with continuing troubles is not insignificant). But I'm a little fed up right now with surgeries that seem to just make you worse. Any thoughts appreciated.

Re: anyone try PT for sciatica and had sucess?

Mary Ann S on 8/06/01 at 17:35 (055686)

Elliott, I had a herniated disc in 1998. I did not have surgery. I was treated by a D.O.I went to PT and was given exercises to do at home and there which were aimed at strengthening the back and abdominals. I don't know anything about the 'rack' treatement you mention. He encouraged a lot of rest,anti inflammatory medication,weight loss and walking(by the way that is when I developed PF from poor shoe support but that is another story.) I am completely better but do continue to use good body mechanics and exercise and know when I haven't been doing this. I know this doesn't work for everyone and surgery might be needed.

Re: anyone try PT for sciatica and had sucess?

LisaCO on 8/06/01 at 23:11 (055721)

Yes, I have had sciatica too. Mine is due to scoliosis--I have a moderate, full 'S' curve to my spine. This was not diagnosed until relatively recently, so most of the damage to my vertebra and discs is permanent. I have a wedge-shaped disc at L4-L5 and sometimes I get sciatica because of it. I consulted with an orthopedic surgeon after I was diagnosed by my chiropractor, and the surgeon felt that I was not bad enough to need surgery and suggested continuing long-term chiro treatment to deal with the symptoms. I have seen a PT for my PF and achilles tendonitits, but my chiro is the only one who treats my back. Getting effective treatment for the PF has been as helpful as the chiro's care in getting the sciatica under control. (I have no sciatic pain at all now)

I did have traction as a part of the chiro treatment--but not like you describe it. The table I was on is hinged at my waist and allows the lower half to drop away, and rotate somewhat. My ankles were strapped to the end of the moving part of the table. The chiro would use my upper body weight and his hand to keep my torso in place while he would drop my legs down and gently stretch my back. The whole treatment would only take 2-3 minutes ( but with 10 minutes of moist heat beforehand). I did have to have several weeks of more conservative adjustments before he would put me on traction. It hurts, but I always feel fantastic afterward. I only need this treatment every six months or so now.

I do agree with what your neuro said about this going away on it's own--I could never have generated the forces needed to adjust my way out of this by myself. I suffered for 3 months before I got treatment, and it took that long again to get real relief from the (awful) pain. BTW--I have been doing piriformis stretches religioulsy for years--flexibility has never been my problem. Do you know if your sciatic pain is due to a problem with your spine, or a corollary to the TTS? If you have a structural problem with your back (like me), conscious efforts to control your posture will not get you far.

I think my traction treatments helped me a great deal. But, the durations you mention frighten me. I don't think I could have survived more than 5 minutes of this at a time. I am sure that I could not have dealt with a steady diet of traction for months on end! A second opinion would not be a bad idea...

Re: anyone try PT for sciatica and had sucess?

Donna SL on 8/07/01 at 05:11 (055731)

Hi Elliott,

I had lower back, and hip pain, for over 6 months. Around a month ago I had a lumbar x-ray, and MRI that showed I had 3 bulged disc. L5-S1, L4-L5, and L3-L4, and also mild scoliosis, and stenosis.

My chiropractor started doing the same treatment that Lisa had. I think the official name is Flexion Distraction. The only thing he hasn't done is put the moist pack on first. I've also started having acupuncture in the back. I'm finally starting to get some reduction of symptoms. I had regular PT when the pain first started, but it didn't really help.

That rack treatment sounds a little scary, and lengthy. The flexion distraction treatments only last 2-3 minutes, yet are very effective. It's supposed to take pressure off the disk so they can heal. I've read that it helped many people avoid surgery. I usually only go once a week. Lumbar stabilization exercises that you do at home help maintain the treatments.

If you haven't seen a chiropractor, and were only treated by a PT, I recommend that you see one.

Donna

Re: chiros

elliott on 8/07/01 at 08:53 (055749)

I know that's a hot issue too. I've heard of cases where chiros left people much worse (although the same can be said of surgeons, I suppose). Chiros have a philosophy that your back should be perfect, and will therefore give alignments until it is (which can be viewed as dangerous by some and treatments never-ending), wheareas PTs accept that people aren't perfect and try to solve the pain problem. Some claim chiros can do damage to your disc with their manipulations. I know a runner with the same L4-L5 sciatica who went for many months to a chiro. After 3 months nothing, after 5 months pain-free, after 7 months complete return of all symtpoms as bad as ever. (He tried PT and that didn't work either.) He couldn't take the sciatic pain in his leg anymore and had surgery a few weeks ago. All anecdotal, of course, but I'm not sure I buy in to the chiropractor for this. Appreciate everyone's comments and will think it over.

Re: chiros

Donna SL on 8/07/01 at 13:20 (055790)

Elliott,

I don't know about other chiropractors, but I know that's not my doctors philosophy. He has never pushed me to have any manipulations. I came to him initially to only perform ART on my lower extremities. When I told him I was having back pain that was not improving he was very conservative, and asked if I had tried PT, exercises, etc. When I told him that didn't really help, he only worked on the areas that were hurting to assist in healing. He wasn't interested in rearranging me, or making me perfect. I would think most good, ethical chiropractors would take a conservative approach, and only do what's necessary to relieve someone of pain.

Also, most chiros are trained in a variety of modern physical therapies, and will use many different techniques to help someone. My chiro for example knows of course chiropractic manipulation, but he is also trained in ART, myofascial release, osteopathic manipulations, etc., and will apply the appropriate technique for the problem. I would choose a chiropractor over any PT to work on my back, etc., becaue of their intense training of the spine, nervous system, anatomy, etc.

I would think most good medical professionals would, or should have a similar philosophy in that if it's not broke, don't fix it. Also, most ethical back surgeons, will encourage someone to try all conservative methods, including seeing a chiropractor, before resorting to surgery.

Donna

Re: chiros

LisaCO on 8/08/01 at 00:09 (055874)

I ditto what Donna says about chiros. My chiro treats me with the goal to keep my mobility and flexibility at it's best, and to aviod deterioration to the point that I need surgery. My back was damaged when I first came to him - so it would never have worked to try to make my back 'perfect' again. I have learned that there are ethical, thoughtful doctors carefully hidden amongst their automaton peers in every discipline in medicine. ( I wish I had known the difference a few years earlier, though.) Searching out a good doctor requires more than an examination of credentials; you have to spend time with them to examine their philosophy as well.

I was very skeptical when I went looking for a chiro--so I asked people I knew who had back problems and past surgeries. I even called a local orthopedic surgery center and spoke with a PA about what I should look for in a good, conservative chiro. Most of them recommended that I look for a graduate of the Palmer School. I used that criteria to limit my list to 3 candidates, and then did a phone consult with each. I expected to do a full consultation with the 2 best, but ended up staying with the first chiro I met with. NO regrets! I had very frequent visits when my pain was bad, and have tapered off since--now I need it about 2X a month. Our current goal is to get me to where I need adjustments only quarterly.

Re: anyone try PT for sciatica and had sucess?

Mary Ann S on 8/06/01 at 17:35 (055686)

Elliott, I had a herniated disc in 1998. I did not have surgery. I was treated by a D.O.I went to PT and was given exercises to do at home and there which were aimed at strengthening the back and abdominals. I don't know anything about the 'rack' treatement you mention. He encouraged a lot of rest,anti inflammatory medication,weight loss and walking(by the way that is when I developed PF from poor shoe support but that is another story.) I am completely better but do continue to use good body mechanics and exercise and know when I haven't been doing this. I know this doesn't work for everyone and surgery might be needed.

Re: anyone try PT for sciatica and had sucess?

LisaCO on 8/06/01 at 23:11 (055721)

Yes, I have had sciatica too. Mine is due to scoliosis--I have a moderate, full 'S' curve to my spine. This was not diagnosed until relatively recently, so most of the damage to my vertebra and discs is permanent. I have a wedge-shaped disc at L4-L5 and sometimes I get sciatica because of it. I consulted with an orthopedic surgeon after I was diagnosed by my chiropractor, and the surgeon felt that I was not bad enough to need surgery and suggested continuing long-term chiro treatment to deal with the symptoms. I have seen a PT for my PF and achilles tendonitits, but my chiro is the only one who treats my back. Getting effective treatment for the PF has been as helpful as the chiro's care in getting the sciatica under control. (I have no sciatic pain at all now)

I did have traction as a part of the chiro treatment--but not like you describe it. The table I was on is hinged at my waist and allows the lower half to drop away, and rotate somewhat. My ankles were strapped to the end of the moving part of the table. The chiro would use my upper body weight and his hand to keep my torso in place while he would drop my legs down and gently stretch my back. The whole treatment would only take 2-3 minutes ( but with 10 minutes of moist heat beforehand). I did have to have several weeks of more conservative adjustments before he would put me on traction. It hurts, but I always feel fantastic afterward. I only need this treatment every six months or so now.

I do agree with what your neuro said about this going away on it's own--I could never have generated the forces needed to adjust my way out of this by myself. I suffered for 3 months before I got treatment, and it took that long again to get real relief from the (awful) pain. BTW--I have been doing piriformis stretches religioulsy for years--flexibility has never been my problem. Do you know if your sciatic pain is due to a problem with your spine, or a corollary to the TTS? If you have a structural problem with your back (like me), conscious efforts to control your posture will not get you far.

I think my traction treatments helped me a great deal. But, the durations you mention frighten me. I don't think I could have survived more than 5 minutes of this at a time. I am sure that I could not have dealt with a steady diet of traction for months on end! A second opinion would not be a bad idea...

Re: anyone try PT for sciatica and had sucess?

Donna SL on 8/07/01 at 05:11 (055731)

Hi Elliott,

I had lower back, and hip pain, for over 6 months. Around a month ago I had a lumbar x-ray, and MRI that showed I had 3 bulged disc. L5-S1, L4-L5, and L3-L4, and also mild scoliosis, and stenosis.

My chiropractor started doing the same treatment that Lisa had. I think the official name is Flexion Distraction. The only thing he hasn't done is put the moist pack on first. I've also started having acupuncture in the back. I'm finally starting to get some reduction of symptoms. I had regular PT when the pain first started, but it didn't really help.

That rack treatment sounds a little scary, and lengthy. The flexion distraction treatments only last 2-3 minutes, yet are very effective. It's supposed to take pressure off the disk so they can heal. I've read that it helped many people avoid surgery. I usually only go once a week. Lumbar stabilization exercises that you do at home help maintain the treatments.

If you haven't seen a chiropractor, and were only treated by a PT, I recommend that you see one.

Donna

Re: chiros

elliott on 8/07/01 at 08:53 (055749)

I know that's a hot issue too. I've heard of cases where chiros left people much worse (although the same can be said of surgeons, I suppose). Chiros have a philosophy that your back should be perfect, and will therefore give alignments until it is (which can be viewed as dangerous by some and treatments never-ending), wheareas PTs accept that people aren't perfect and try to solve the pain problem. Some claim chiros can do damage to your disc with their manipulations. I know a runner with the same L4-L5 sciatica who went for many months to a chiro. After 3 months nothing, after 5 months pain-free, after 7 months complete return of all symtpoms as bad as ever. (He tried PT and that didn't work either.) He couldn't take the sciatic pain in his leg anymore and had surgery a few weeks ago. All anecdotal, of course, but I'm not sure I buy in to the chiropractor for this. Appreciate everyone's comments and will think it over.

Re: chiros

Donna SL on 8/07/01 at 13:20 (055790)

Elliott,

I don't know about other chiropractors, but I know that's not my doctors philosophy. He has never pushed me to have any manipulations. I came to him initially to only perform ART on my lower extremities. When I told him I was having back pain that was not improving he was very conservative, and asked if I had tried PT, exercises, etc. When I told him that didn't really help, he only worked on the areas that were hurting to assist in healing. He wasn't interested in rearranging me, or making me perfect. I would think most good, ethical chiropractors would take a conservative approach, and only do what's necessary to relieve someone of pain.

Also, most chiros are trained in a variety of modern physical therapies, and will use many different techniques to help someone. My chiro for example knows of course chiropractic manipulation, but he is also trained in ART, myofascial release, osteopathic manipulations, etc., and will apply the appropriate technique for the problem. I would choose a chiropractor over any PT to work on my back, etc., becaue of their intense training of the spine, nervous system, anatomy, etc.

I would think most good medical professionals would, or should have a similar philosophy in that if it's not broke, don't fix it. Also, most ethical back surgeons, will encourage someone to try all conservative methods, including seeing a chiropractor, before resorting to surgery.

Donna

Re: chiros

LisaCO on 8/08/01 at 00:09 (055874)

I ditto what Donna says about chiros. My chiro treats me with the goal to keep my mobility and flexibility at it's best, and to aviod deterioration to the point that I need surgery. My back was damaged when I first came to him - so it would never have worked to try to make my back 'perfect' again. I have learned that there are ethical, thoughtful doctors carefully hidden amongst their automaton peers in every discipline in medicine. ( I wish I had known the difference a few years earlier, though.) Searching out a good doctor requires more than an examination of credentials; you have to spend time with them to examine their philosophy as well.

I was very skeptical when I went looking for a chiro--so I asked people I knew who had back problems and past surgeries. I even called a local orthopedic surgery center and spoke with a PA about what I should look for in a good, conservative chiro. Most of them recommended that I look for a graduate of the Palmer School. I used that criteria to limit my list to 3 candidates, and then did a phone consult with each. I expected to do a full consultation with the 2 best, but ended up staying with the first chiro I met with. NO regrets! I had very frequent visits when my pain was bad, and have tapered off since--now I need it about 2X a month. Our current goal is to get me to where I need adjustments only quarterly.