Jose Said:

Can sciatica pain be in the top of my thighs?

We Answered:

I'm assuming you mean on the FRONT of the thighs. Although technically not sciatica because it's not the sciatic nerve, the femoral nerve can give this presentation. It can occur in much the same manner as sciatica, but it's just a different nerve.

If you mean the back of the thighs, yes this can occur anywhere along the course of the sciatic nerve. If your legs are feeling better, but now it's just the top of the thigh that hurts, this is a sign of improvement. The closer the pain moves towards the spine, the better the indicator of a good recovery. This is called the centralization phenomenon and is a well documented predictor of good outcomes.

The muscle relaxers will not help...go to PT if it does not resolve on it's own.

You do not necessarily need any diagnostic imaging at this time. A good physical exam is just as valuable as an MRI unless you have had a history of cancer, are under the age of 18, over the age of 65, have had a recent trauma, cannot urniate, or are demonstrating significant neuological deficits.

Jaime Said:

Another sciatica question- Do most insurances pay for treatments?

We Answered:

I have really good health insurance and they do not cover chiropractics so I would say that medicaid probably won't cover it either.. I"m not sure about the massage either.. I would guess not since that would not be a medically necessary procedure.

Morris Said:

Has anyone else had physical therapy for sciatica while pregnant?

We Answered:

Sciatica can be caused by a couple different reasons in those who are pregnant. The most common in the general population is a bulging or herniated disc. In pregnant women, it can also be caused by stress across the sacroiliac joint (due to laxity of the ligaments), etc. So your treatment will first be based upon your examination findings.

It could, but not necessarily include the following: stretching, positioning, repeated movement, posture correction, massage, use of a pregnancy belt. However, know that there are certain things that cannot be done if you are pregnant...use of theraputic ultrasound and electrical stimulation do not have know results in those who are pregnant, therefore most clinicians do not use them.

Treating someone who is pregnant can be difficult because there are limitations on treatment and because the baby will continue to grow...causing more stress on the back. Sometimes it becomes a matter of keeping it from getting worse.

Your first visist will focus primarily on the assessment. Good luck.

Jessica Said:

I've been through 4 rounds of physical therapy and am not bad enough for surgery?

We Answered:

Remember that there are different approaches to physical therapy much like there are different approaches to medicine.

Your case is certainly complex. I'm not sure what you mean by "rupture"...but I am assuming you have a disc extrusion or sequestration...in otherwords, that the nuclear material has breeched the annunal wall of the disc. If this is the case, PT can only show you how to manage your symptoms as this is usually a surgical case, or the body will reabsorb the nuclear material with time.

If your discs are still intact, but bulging or even small protrustions/herniations, this may be reducible...especially if your symptoms are not constant. However, you do need to see a physical therapist who knows much about mechanical pain. I suggest seeing a PT with MDT experience (mechanical diagnosis and therapy)...simple stretching, heat, massage, ultrasound and stabilization will not help this type of problem.

Your problem is certainly complex, and sometimes is hard to treat one problem without aggrevating the other...I would suggest focusing on the neck and back first, then move to the shoulder when approapriate. trying do to too many things at once leads to ambigious answers and results.

Some other things you need to ask yourself are? How willing am I to follow my home program? How satisfied am I with my job? Am I willing to give up smoking (if you smoke)? Do I have any history of anxiety or depression?. These are all factors that, besides mechanical response to pain, are highly indicative of how well you will respond to treatment. We may not have the answers as to why these things are predictors of disability/chronic pain, but we know that they are simply that...predictors. The more of the above factors you have (aside from mechanical response), the more appropriate you are for a comprehensive pain management program including cognitive behavioral therapy aside from simply just physical therapy.

If you do not have these above factors and are simply looking for a PT with MDT experience, I recommend you go to: http://www.mckenziemdt.org

Russell Said:

Does physical therapy help a great deal w/sciatica?

We Answered:

The majority of cases are able to be helped, but there are some exceptions. Most cases of sciatica are coming because of disc related problems. The disc itself can refer pain down the leg, or you can have actual nerve root compression from a disc that is protruding onto one of the nerve roots of the sciatic nerve. The vast majority of cases are correctable and display what is called "directional preference." This means that there are certain ways that one can move which will cause a lessening and/or "centralization" of the symptoms. Then, this motion is used to help restore function of the spine. This is a central tenant in the evaluation done by physical therapists who are certified in "Mechanical Diagnosis and Therapy."

However, some people have a problem that is deemed irreducible. Fortunately, these are relatively easy to pick out, so not a lot of time is wasted in therapy. People who fail to demonstrate centralization of their symptoms over the course of a few visits are likely to not respond well to PT. Even more outstanding are the patients who have pain that radiate all the way to the toes whenever they are standing, but lie down and the symptoms go away. They often have full flexibility of their spine and can stretch is all the way backwards while lying down without any pain, but the second they stand up, the pain returns. THESE are the people who tend not to do well with PT and likely have a completely extruded disc. In these cases, the disc is so attenuated, it's lost it's elastic mechanism and can no longer contain the contents of the disc. When it's loaded, (ie, you stand), the pain comes back right away.

My suggestion is to see a PT who is certified in Mechanical Diagnosis and Therapy. You can go to www.mckenziemdt.org . This way, you can learn what you can do to help yourself. For those with reducible disc derangements, the vast majority are significantly better within two weeks. If it looks irreducible, this will be known before a lengthy course of care...but you need to be evaluated to find out.

Claire Said:

Worse after physical therapy?

We Answered:

you should put heat or ice on your injuried area some time when you work out the muscle spasm you will hurt more if you are expriencing tingling or numbness you should seek a doctor work through it but let your therapist know be careful sometimes those symptoms can mean more serious problems