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-   -   Physical therapy/Sciatic nerve (https://board.crossfit.com/showthread.php?t=77743)

David M Welton 09-16-2012 09:30 PM

Physical therapy/Sciatic nerve
 
I injured my sciatic nerve on Aug 20th and just started PT last week. I went twice and im going twice this week. After that I was told I was going back to work. I have heard that a sciatic nerve injury could take up to 6 months to heal. I was wondering if going to the PT only 4 times will even help. I still have a lot of pain some days and most days I can deal with it with meds. What should I do? I work in law enforcement and im worried I can hurt my back even more if the doctors just put a "band-aid" on my injury. Thanks for the help.

Brian Strump 09-17-2012 02:04 PM

Re: Physical therapy/Sciatic nerve
 
There are alot of variables....mainly does the doctor know what he's doing, and do you follow through with what you're told to do and not do.

Who told you that you injured your sciatic nerve? Did you get an MRI?

Is this a Work Comp case? If so, I wouldn't plan on getting the optimal care for your injury. Every states policies are different, most do not favor the injured.

In 4 visits you may or may not see results....You would hope to at least seen some temporary improvement in that time.


[QUOTE=David M Welton;1094157]I injured my sciatic nerve on Aug 20th and just started PT last week. I went twice and im going twice this week. After that I was told I was going back to work. I have heard that a sciatic nerve injury could take up to 6 months to heal. I was wondering if going to the PT only 4 times will even help. I still have a lot of pain some days and most days I can deal with it with meds. What should I do? I work in law enforcement and im worried I can hurt my back even more if the doctors just put a "band-aid" on my injury. Thanks for the help.[/QUOTE]

David M Welton 09-17-2012 02:48 PM

Re: Physical therapy/Sciatic nerve
 
Yeah I got hurt at work and I have been doing everything they told me to do. I was told that I would not get an mri because they could tell somehow I did not need one. The doctor told me that I had injured my sciatic nerve because I felt pain down my leg. I have gone twice now to the pt and I dont feel any better then I did before I went. Thanks...

Brian Strump 09-17-2012 06:23 PM

Re: Physical therapy/Sciatic nerve
 
Unless you have some motor deficit, or major sensory issues we wouldn't recommend an MRI until 4-5 treatments.

You are not getting an MRI because it's a Workers Comp case....and that is one of the biggest scams in each state. It's almost as bad as the VA hospitals.




[QUOTE=David M Welton;1094345]Yeah I got hurt at work and I have been doing everything they told me to do. I was told that I would not get an mri because they could tell somehow I did not need one. The doctor told me that I had injured my sciatic nerve because I felt pain down my leg. I have gone twice now to the pt and I dont feel any better then I did before I went. Thanks...[/QUOTE]

David M Welton 09-17-2012 08:43 PM

Re: Physical therapy/Sciatic nerve
 
Thanks for the help! With my back still hurting like it does I don't see how only going two more times will heal my back enough to be cleared to go to work. I guess we will see...

Brian Strump 09-18-2012 04:50 AM

Re: Physical therapy/Sciatic nerve
 
We are in agreement David. The thing that needs to change is you need to use your own insurance, and find your own doctor. The treating doctor needs to have treatment approved before they just continue treating you as needed....as you can imagine, many try to scam the WC system into getting disability.

There's a reason why less and less medical professionals accept Work Comp cases now.



[QUOTE=David M Welton;1094443]Thanks for the help! With my back still hurting like it does I don't see how only going two more times will heal my back enough to be cleared to go to work. I guess we will see...[/QUOTE]

David M Welton 09-19-2012 12:23 AM

Re: Physical therapy/Sciatic nerve
 
Thanks for your help again. I went to the pt today and they pretty much told me I would need at least another week to see if it gets better. Lets see what the doctor has to say on Friday...

David M Welton 09-21-2012 11:33 AM

Re: Physical therapy/Sciatic nerve
 
I was told yesterday at my Physical therapy I might have lower vertebrae lock up. They pretty much told me the last month of treatment was a waste because they were trying to fix the wrong problem!!!!! Are you serious!? I go back to my workmens comp doctor today at one to see what they say. I hope I can finally get some xrays or an mri done. What do you guys think? Thanks!

Michael Keller 09-24-2012 03:06 AM

Re: Physical therapy/Sciatic nerve
 
David, you need an MRI, period.

I worked in law enforcement for 14 years and now private security, and between wearing the gun belt and riding in a cruiser for 8-12 hours per day, back issues are very common. I have bulging/degenerated/herniated discs at L4-L5-S1, and are a result of the above plus all the SWAT work I did. Don't let them refuse the MRI. X-Ray will not show what the doc needs to see.

Exercise, stretching, ice, and epidural spinal injections are your friend, but surgery is not. I manage mine by doing this, but it never goes completely away, and I refuse to do surgery, it is too risky for spinal issues unless you have weakness in your legs.

Brian Strump 09-24-2012 10:29 AM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Michael Keller;1096142]David, you need an MRI, period.

I worked in law enforcement for 14 years and now private security, and between wearing the gun belt and riding in a cruiser for 8-12 hours per day, back issues are very common. I have bulging/degenerated/herniated discs at L4-L5-S1, and are a result of the above plus all the SWAT work I did. Don't let them refuse the MRI. X-Ray will not show what the doc needs to see.

Exercise, stretching, ice, and epidural spinal injections are your friend, but surgery is not. I manage mine by doing this, but it never goes completely away, and I refuse to do surgery, it is too risky for spinal issues unless you have weakness in your legs.[/QUOTE]

Yes, if money was no object, and the test's are cheap.

Even if it wasn't through WC, most insurance companies will require you go through a trial of treatment(either meds, or rehab) prior to authorizing it.

Also, most imaging is very overused. They may tell you if it's a herniation, but that's it. If you're not getting surgery, the exact location of the herniation, or whether it's herniated or not, should not matter much during the initial phases of a rehab program.

Would it be nice to have, sure.....but it will not be dictating most rehab programs.

Michael Keller 10-01-2012 05:56 PM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Brian Strump;1096226]Yes, if money was no object, and the test's are cheap.

Even if it wasn't through WC, most insurance companies will require you go through a trial of treatment(either meds, or rehab) prior to authorizing it.

Also, most imaging is very overused. They may tell you if it's a herniation, but that's it. If you're not getting surgery, the exact location of the herniation, or whether it's herniated or not, should not matter much during the initial phases of a rehab program.

Would it be nice to have, sure.....but it will not be dictating most rehab programs.[/QUOTE]

My Physiatrist required it before spinal injections. He has to have the exact location of the herniation to get the injections into the best spot for them to work most effectively. I've been through several rounds of injections over the course of the last 12 or so years, and they have worked wonders for me. Without an MRI, he would be blindly guessing on the best location to inject.

I do agree they are often overused, but they are also often needed. I did not have to go through any rehab program because he was familiar with what I already do, and agreed the PT would not be able to do anything I wasn't already doing.

Brian Strump 10-01-2012 06:31 PM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Michael Keller;1098006]My Physiatrist required it before spinal injections. He has to have the exact location of the herniation to get the injections into the best spot for them to work most effectively. I've been through several rounds of injections over the course of the last 12 or so years, and they have worked wonders for me. Without an MRI, he would be blindly guessing on the best location to inject.

I do agree they are often overused, but they are also often needed. I did not have to go through any rehab program because he was familiar with what I already do, and agreed the PT would not be able to do anything I wasn't already doing.[/QUOTE]


For injections, of course.

I would disagree, that depending on your condition, if you've gotten "several rounds" the only wonder they work was to temporarily relieve some of your pain. Some require injections as a last resort, however that should only be used as a last resort.

David M Welton 10-02-2012 11:26 AM

Re: Physical therapy/Sciatic nerve
 
Update on my injury... I had my lower back put back into alignment by a chiropractor during my physical therapy today. It hurt pretty bad. still no mri. My xrays came back with nothing bad but I still have pain in my lower back down to my butt and left foot. Im really hoping today fixed the problem. What would the pain level be like if it was a slipped disk? My pain level now is around a 3-4 and if I do a lot of walking or sitting in the car a lot it gets up to an 8 some times. Thanks!

Brian Strump 10-02-2012 12:12 PM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=David M Welton;1098171]Update on my injury... I had my lower back put back into alignment by a chiropractor during my physical therapy today. It hurt pretty bad. still no mri. My xrays came back with nothing bad but I still have pain in my lower back down to my butt and left foot. Im really hoping today fixed the problem. What would the pain level be like if it was a slipped disk? My pain level now is around a 3-4 and if I do a lot of walking or sitting in the car a lot it gets up to an 8 some times. Thanks![/QUOTE]

Everyone's pain threshold is different. If we don't see holding improvement after 3-4 visits to start, we'd consider an MRI in your case. If you had muscle weakness, we probably would have ordered it already.

Aaron Wayne Campbell 10-02-2012 02:42 PM

Re: Physical therapy/Sciatic nerve
 
David - I had very similar symptoms to yours - pain in left lower back, radiates down my butt and leg. Tingling in my left foot. Muscle spasms in my butt and obliques. My original injury was in July. Got an MRI in August - herniated disc l4-l5 with left L5 nerve root impingement. A common injury.

Found a good PT - doing "McKenzie" exercises and stretches, working on my core. Have had to adjust work outs significantly. Have made a lot of progress, now 3 months out. If I do what I'm supposed to, I do pretty well, and hope to continue improving. Haven't needed injections.

I agree to avoid surgery at all costs - only if you develop leg/foot weakness or bowel/bladder problems. I agree MRI is probably not essential, but may be helpful.

David M Welton 10-02-2012 10:26 PM

Re: Physical therapy/Sciatic nerve
 
Aaron- Did you always have pain or did it come and go? My pain comes and goes. I never know how im going to feel when I wake up. If I walk a lot or sit it hurts bad at the end of the day...I would say it hurts around 3-4 days out of the week. Other days I can deal with it talking my meds. Thanks...

Aaron Wayne Campbell 10-03-2012 09:15 AM

Re: Physical therapy/Sciatic nerve
 
David at first my pain was severe and always there. The moment it happened - during a deadlift, I actually fell to the ground and didn't get up for about 30 mins. Now the pain is up and down, and not in my leg anymore. Sitting long periods makes it worse, like long car rides. I got a lumbar pillow I use at work and in the car that helps some, keeping the curve in my lower back (lordosis). If you do have a pinched nerve from a herniated disc, the pain should move out of the leg and into the back as it is improving (and hopefully eventually go away). It ought to hurt worse when you bend at the waste - arching your back. This opens up the vertebrae and alows the disc to push backwards towards your nerve roots. Staying in lordosis (back extended) should help. That's what McKenzie is all about. Again, I recommend a good PT. Ice seems to help a lot. I wrap an ace wrap around myself or stuff it under my pants to hold it tight against my back. Staying active and doing my PT helps the most. I take motrin about twice per day and occassional tramadol. Was taking flexeril for muscle spasms but haven't needed it lately.

David M Welton 10-04-2012 03:16 PM

Re: Physical therapy/Sciatic nerve
 
Today was day two with the chiropractor during my physical therapy. PAINFUL! I felt somewhat better on weds but after today it felt like I had reinjured my back. The chiropractor told me this would happen but man it hurts! We will see what happens tomorrow at my next Doctors apt.

Megan Zetter 10-05-2012 06:33 AM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=David M Welton;1098766]Today was day two with the chiropractor during my physical therapy. PAINFUL! I felt somewhat better on weds but after today it felt like I had reinjured my back. The chiropractor told me this would happen but man it hurts! We will see what happens tomorrow at my next Doctors apt.[/QUOTE]

What is the chiro doing? What is the treatment?

David M Welton 10-05-2012 09:36 AM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Megan Zetter;1098924]What is the chiro doing? What is the treatment?[/QUOTE]

He called it the "Lumbar roll" He had me lay on my side with my upper leg bent towards my chest and he pressed on my lower back causing it to pop.

David M Welton 10-17-2012 12:06 PM

Re: Physical therapy/Sciatic nerve
 
Tomorrow is my last day of pt and I don't feel that much better then I did before I started. I have good days where the pain is at a 2 and my bad days the pain gets to 6. I have bad days maybe 2-3 times a week. I have gone to the pt 11 times now and on Tues they just now told me I also have pulled/torn muscle in my back. I have my docs apt on Monday to go back to work on light duty. Should I ask for more physical therapy or just go on light duty and hope it heals within the month im going to be on light duty? Just really mad that it has been two months and I still have pain. Thanks...

Ronald Kim 10-17-2012 03:10 PM

Re: Physical therapy/Sciatic nerve
 
David, within the military and law enforcement world, especially with what you do, you know you're always on the go. I've been dealing with this disc issue for almost a year now, tingling and numbness have been down my leg and in my foot since June, and I've done 3 injections w/ little success. The most recent injection has helped a lot more than the others, as I did a L5 nerve root block injection. I know it's Navy medicine, but I swear the military is getting a little better at doing things as everything went smooth for me (nerve racking for sure). I'm in PT right now, one who does mobilizations and manipulations after warming up with a swim or bike, and good stretching. No issues with the manipulations. Some days at work I do sometimes feel like my disc is about to explode out of my back sometimes. I have been swimming a lot lately for exercise, and it's been helping, along with the one on one stretching and core exercises. My leg/foot does feel a little weak from time to time. I've been contemplating getting back in to McKenzie to help out my process, but I finally gave in this month and went on light duty. I met with the ortho today for a follow up and I told him I want to truly exhaust everything before surgery. Of course I get the jokes in my office, but what's more important, thin skin or your back? I may be on light duty for the next 6 months but I plan on getting my back strong again. Good luck man.

David M Welton 11-07-2012 10:39 PM

Re: Physical therapy/Sciatic nerve
 
I went back to the doc on Monday and asked for my mri. I was told no because I told them I did not want to have surgery. The doc told me he was 100% sure I had a Herniated Disk and it should heal within a year... What do you guys think of this? I thought it was very odd...

Lyle Gordon 03-01-2013 03:38 AM

Re: Physical therapy/Sciatic nerve
 
It sounds like you're getting the run around. I had the same issue in the army. I messed my back up pretty bad when I was deployed and the Doc literaly said, "You're just broken now." Turned out after seeking treatment outside the military I had two compressed discs and sciatic nerve damage. I brought this to my PA and was told they could do nothing for me because I went to a civilian doctor. Long story short, after I got out I had to duke it out with the VA but I finally got them to start me on treatment. If they're anything like the army or the VA you'll have to fight it out. From what it sounds like you need an MRI but they don't want to fork over the money. Keep on them about it and eventually they'll cave in.

BMH 03-01-2013 06:27 AM

Re: Physical therapy/Sciatic nerve
 
MRI's aren't the end all be all and they cost more than they are worth to a knowledgeable professional in many cases. They often confirm more than they illuminate. If there are still problems at this point, it sure seems like it would be high time for one now.

My wife ran into this issue with her worker's comp as well. The fact is, the abuse that does occur ruins it for individuals who aren't abusing. And referencing the VA, Brian if you are reading this are you referencing the incentive of the VA to put people on disability and not reduce disability levels?

Brian Strump 03-01-2013 06:20 PM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Bill M. Hesse;1143981]MRI's aren't the end all be all and they cost more than they are worth to a knowledgeable professional in many cases. They often confirm more than they illuminate. If there are still problems at this point, it sure seems like it would be high time for one now.

My wife ran into this issue with her worker's comp as well. The fact is, the abuse that does occur ruins it for individuals who aren't abusing. And referencing the VA, Brian if you are reading this are you referencing the incentive of the VA to put people on disability and not reduce disability levels?[/QUOTE]

Was this a question to me? If so, Bill, could you show me where I said that, or what you're referring to? I'm unsure of the question.

BMH 03-02-2013 02:06 AM

Re: Physical therapy/Sciatic nerve
 
No Brian i wasn't implying you said that. I said it because is something that seems to be an issue. I was asking clarification on what you meant about the VA. I wasn't trying to offend or back you into a corner.

Brian Strump 03-02-2013 04:46 AM

Re: Physical therapy/Sciatic nerve
 
It wasn't being sarcastic, and not sure of what you were asking. So I'm not offended...yet :)
I really do not remember what was said about the VA. Clarification on what about the VA? I'm confused.:confused:

I look over this thread, but only saw mention of Worker's Comp.

[QUOTE=Bill M. Hesse;1144357]No Brian i wasn't implying you said that. I said it because is something that seems to be an issue. I was asking clarification on what you meant about the VA. I wasn't trying to offend or back you into a corner.[/QUOTE]

BMH 03-02-2013 06:16 AM

Re: Physical therapy/Sciatic nerve
 
You are not getting an MRI because it's a Workers Comp case....and that is one of the biggest scams in each state. It's almost as bad as the VA hospitals.

That was it. I suppose you meant quality? I am just curious. I hear a lot of bad press but have had no issues myself. I suppose I would like to know what to safe guard against.

Sara Ochsner 03-02-2013 07:31 AM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Brian Strump;1094414]Unless you have some motor deficit, or major sensory issues we wouldn't recommend an MRI until 4-5 treatments.

You are not getting an MRI because it's a Workers Comp case....and that is one of the biggest scams in each state. [B]It's almost as bad as the VA hospitals[/B].[/QUOTE]

Brian, I think this is what Bill is referring to.

Brian Strump 03-02-2013 05:28 PM

Re: Physical therapy/Sciatic nerve
 
[QUOTE=Bill M. Hesse;1144367]You are not getting an MRI because it's a Workers Comp case....and that is one of the biggest scams in each state. It's almost as bad as the VA hospitals.

That was it. I suppose you meant quality? I am just curious. I hear a lot of bad press but have had no issues myself. I suppose I would like to know what to safe guard against.[/QUOTE]

Ahhhh, not sure how I missed that. My only WC experience was in Ohio, where getting MRI's approved was cumbersome paperwork and frustrating. In NC, I do not accept WC cases.

Personally, I've never been treated by the VA. However, I do have patients that were in the military, and go to the VA for particular issues which in some cases you would expect an MRI after "x" number of weeks/months with specific injuries without improvement. Too much red tape.

I was not meaning the VA hospitals are a scam, just that the quality of care it seems they receive may be sub-par. I have no idea why that would be, I'm not sure how that is all set up through the government, who pays them, etc.


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