Managing Sciatica Pain: When to Continue Physical Therapy or Seek Further Care

Sciatica

Hello, doctor.
At the end of June this year, I saw a doctor and had an X-ray, which diagnosed me with sciatica.
After 7 weeks of physical traction therapy, I was pain-free by mid-August, so I stopped going to physical therapy.
However, I’m not sure if it’s because I lifted some heavy objects a couple of days ago and have been sitting on the bed reading and using my phone, but today I suddenly experienced severe pain in the middle of both buttocks, which then radiated down the back of my legs, causing my knees to bend and resulting in cramping-like pain in my calves.
I quickly went to the clinic, and on the way, my legs felt numb, making it difficult to walk.
The clinic doctor said this is a nerve issue and advised me to continue with physical traction therapy.
While lying down during treatment, I felt okay, but I still experienced pain when I got up afterward.
After completing the treatment and returning home, I found it hard to walk, and the two points in my buttocks felt very tight and cramp-like.
I also had difficulty climbing stairs at home, and later, lying on the sofa for about 10 minutes helped alleviate the pain (the physical therapist suggested lying down to wait for relief when in pain).
Should I continue with rehabilitation, or should I go to the hospital and see a specialist? Thank you.

amanda, 40~49 year old female. Ask Date: 2021/09/03

Dr. Chen Bochen reply Orthopedics

Hello, the symptoms you experienced during your last episode are likely due to a herniated disc.
It is advisable to visit the orthopedic or neurosurgery department at the hospital.
Wishing you a smooth recovery.

Reply Date: 2021/09/03

More Info

Managing sciatica pain can be a complex process, especially when symptoms fluctuate or worsen after a period of improvement. Based on your description, it seems you initially responded well to physical therapy, but recent activities, such as lifting heavy objects and prolonged sitting, have exacerbated your symptoms. This is not uncommon in cases of sciatica, where certain movements or positions can irritate the sciatic nerve, leading to pain that radiates down the leg.

When to Continue Physical Therapy
Given that you have already undergone physical therapy and experienced relief, it is reasonable to continue with this treatment modality, especially since your doctor has recommended it. Physical therapy can help strengthen the muscles around the spine, improve flexibility, and alleviate pressure on the sciatic nerve. Here are some considerations for continuing physical therapy:
1. Pain Management: If physical therapy sessions provide temporary relief, it indicates that the treatment is beneficial. However, if the pain persists or worsens after sessions, it may be time to reassess the treatment plan.

2. Therapist Feedback: Communicate openly with your physical therapist about your symptoms. They can adjust your treatment plan based on your feedback and may incorporate different techniques, such as manual therapy, stretching, or strengthening exercises.

3. Home Exercises: In addition to in-clinic therapy, your therapist may provide you with exercises to perform at home. Consistency with these exercises can help maintain progress and prevent future flare-ups.

When to Seek Further Care
If you find that physical therapy is not providing the relief you need, or if your symptoms worsen significantly, it may be time to seek further medical evaluation. Here are some signs that indicate you should consider additional care:
1. Persistent or Worsening Symptoms: If your pain is not improving with physical therapy or if you experience new symptoms, such as numbness, weakness in the legs, or difficulty walking, it is crucial to consult a healthcare provider.

2. Neurological Symptoms: Symptoms like leg weakness, loss of bladder or bowel control, or severe numbness warrant immediate medical attention. These could indicate a more serious underlying condition that requires prompt intervention.

3. Referral to a Specialist: If your primary care physician or physical therapist believes that your condition may require more specialized care, they may refer you to a neurologist or an orthopedic specialist. These specialists can conduct further imaging studies, such as MRI, to assess for any structural issues contributing to your sciatica.

Conclusion
In summary, it is advisable to continue with physical therapy as recommended by your doctor, especially since you have previously experienced relief from it. However, remain vigilant about your symptoms. If you notice that your condition is not improving or is getting worse, do not hesitate to seek further medical evaluation. It is essential to address any underlying issues that may be contributing to your sciatica pain to ensure a comprehensive approach to your recovery. Remember, managing sciatica often requires a combination of treatments, including physical therapy, medication, and lifestyle modifications, to achieve the best outcomes.

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