That is great to know! If you go back to one of my prior reply, I suggested reading up on piriformis syndrome. I guess this last visit confirms some things. If you need to have a chat about it and the rehabilitation you could or should do, send me a PM. I'll give you my cell and we can chat :xyxthumbs: (it's a lot easier than typing all that stuff)
It is a sad reality that your condition is one that is seen very commonly and the treatment plan of care also seem to vary greatly, especially if you take into consideration the professional vs. non-professional advises. My offer to guide professionally does still hold true, so feel free to inbox, but I feel that at this time I should make a thread summary to help other afflicted from similar issues, and to demystify a couple of the "this worked for me".
Before doing that, I should give you my credentials, right? Most of you know me for my detailing work, but very little of you know that I am a physical therapist by training. I've owned a thriving private out patient clinic for over 18 years and specialize in orthopedic conditions. The alphabet soup of the credentials after my name would mean little to you guys but the fact that I hold a post-professional doctorate in orthopedic manual physical therapy may. Let's put it this way, I have more letters in my credentials than my first and last name combined. So now that we have the formalities out of the way, what is up with this "sciatica" problem. First off the diagnosis is a generalized latin based term describing an event distributed through the sciatic nerve (somewhere from the lumbar and sacral plexus to the peripheral nerve). As a single entity, the diagnosis is not a diagnosis because it does not describe the root cause. Is it disc, foraminal, muscular, organic etc.. ?? Is it mechanical or structural?? As such, the treatments tossed around are nothing more than a shot in the dark (hence the reason why I offered to have a personal chat). Identifying the root cause prevents just letting nature take it course.
As far as treatments offered, they can be subdivided in 2 categories 1) Active 2) Passive. Active treatments are treatments that you actively participate in to assist in improving the tissue function (mechanical and metabolic function). The 3 primary Active treatments are 1) Limiting your exposure to the injurious factors 2) Nutrition and hydration 3) Exercises. Comparatively, passive treatments are any interventions that you are not participating in. If you are just sitting or laying there and something is happening to you, then it is a passive treatment. This includes but is not limited to medication (oral, topical or injectable), surgery, chiropractic care, massage therapy, accupuncture, therapeutic modalities (like heat, ice, TENS, Interferential currents, russian galvanic stimulation, iontophoresis, phonophoresis, ultrasound therapy, cold laser etc....). To summarize passive treatments for you guys, they are palliative treatments.... basically put, they are "Feel Good" therapies. Do passive treatments cure the root cause of the condition? Absolutely not, but may give you a physical or mental reprieve which may have been well needed (hence the reason we use them clinically).
So why are you in pain? The reason is simple.... the tissues in questions did not have the strength, endurance, capacity or tolerance for what ever event or combination of events that it was presented with. Most of those sciatica diagnosis come associated with a chronic overuse or chronic repetitive dysfunctions. We do have an uncanny ability to abuse our body and are surprised when they break down. Pain is the escalating way our body is using to communicate the event. It does to a certain extent help guide the recovery effort but does little to identify the root cause of the chronic abuse. The louder the pain the more your body will react to prevent the events (indiscriminately if they are necessities or not). It starts with compensatory mechanics and leads into neurogenic muscle guarding and further escalate into muscle spasms (due to a nutritional deficiency in the tissue, from overuse). Nutritional spams compared to neurogenic muscle guarding are quite different from one another and the intervention to one does not imply the same treatment for the other, hence the reason I did not give a "cook book" answer of exercises to do. All the suggested exercises are appropriate if done with the right intensity, duration, frequency etc... which is to be properly matched to the stage of recovery and tissue response.
So are you dogging chiros or masseuses or acupuncturists? Nope but you have to understand that if a muscle is in a weakened state that a passive treatment would do little to increase its strength, endurance, conditioning, coordination etc.. The previously mentioned are very effective in providing symptom modifications (same as MDs with their slew of medication) but does very little to build the tissues in question. If they did, then I would skip the gym and my training to go see my massage therapist.
Do therapeutic modalities and topical ointment work? Yes! To provide symptom modifications. None of that stuff is curative. Don't get me wrong, if your body was on the verge of recovery and you applied biofreeze (which allowed better rest of the affected muscle), and that was enough to press the reset button then it may feel that it was the cure but in essence your body was reset below threshold. As soon as you kick the hornet's nest again you will have a recurrence and usually the symptoms get progressively more often and last longer, until the point where the body just say "screw it", then comes constant pain. A lot of people rush to surgery but according to all the research (I am an evidence based clinician) surgery is no better than conservative management (unless structural neural impingement exists)
Am I going to be in pain for 6-9 months? The answer is ...???.... It all depends on what you do, when you do it etc... From a theoretical base, the tissues (muscle, tendons, ligaments, disc etc..) in absence of the any intervention should return to "normal" within 1 year (based on collagenous healing), PROVIDED you are not constantly flaring it up. If you keep flaring it, it may never heal (think festering wound). In the presence of an "attempt" at intervention you are looking at 6-9 months, and according to research spinal based disorder should return to premorbid state in 6-9 weeks with the proper intervention (combination of active and passive).
What about that inversion table? the biofreeze? the TENS unit? the Saunders self traction unit? ..... and the "as seen on TV"? In one word, they are passive, passive, passive and passive treatments which are good for symptom modification. Will they help? Yep, for a short period of time (think putting a glaze on a swirled out car). Does it fix the problems? Nope!
If you look at the world of detailing we use the same principles as what I described previously. True treatments of the condition falls under the following 3 ACTIVE treatments
1) Limiting the exposure (we advocate parking a car away from exposure to the elements)
2) Nutrition and hydration (We advocate plenty of water, high lubricity pH neutral soaps, regular decontamination etc.. lots of expensive products used in a balance way on a maintenance regiment..... there is a lot of to say about the chemistry and balance of that chemistry)
3) Exercises (not activities, not hobbies, not work etc... EXERCISES). You cannot maintain or build a tissue without proper work invested, and cannot maintain a car without proper methodical regular car care.
There are 4 commandments in the world of rehabilitation. They are commandments and not suggestions
1) Do not create more pain (or make the condition worst). You are more than welcomed to create soreness but not pain (the lecture on difference between soreness and pain would need a thread of its own)
2) Do your exercise often enough to make a difference. Please don't make the mistake of exercising on a pre-conceived schedule (unless you have accumulated a knowledge base similar to mine). Go with what your body is telling you (not your brain)
3) Modify. We do test spots starting from least aggressive to more aggressive, well this is the same.... but MAKE SURE to progress the program to retrain the tissues for functional relevance
4) Do the right things at the right time for the right reasons....
I could go on and on and on but let's admit that this is dry as dust, and boring as all get up.... and this post is way too long already!
For all of you looking for a cookie cutter answer, unfortunately there is none. Each treatment is individualized, the same as we individualize our "game plan" on each cars, regardless if it is the 200th BMW you polish!
Again, my offer to have a voice chat is still out there
I didn't know (till these last couple of months) that it was humanly possible to hurt so bad and still be alive. And after today we got a refresher course!!!!!!
:surrender:
rops:
last week.... and bought a new KIA Sportage. New color for 2014 "Black Cherry". Which was LOADED with the dreaded DISO! 