Tag Archive for: back pain specialist

Back Pain

Think You’ve Got Piriformis Syndrome? It Might Actually Be Sciatica

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Think You’ve Got Piriformis Syndrome? It Might Actually Be Sciatica

A reader of this column recently wrote to me with the following question:

“I’m getting Physical Therapy for lower back pain and sciatica that is said to be from ‘piriformis syndrome’. My PT treatment has consisted of various exercises and some massage. Eight sessions in and no change at all. I’m still having pain when sitting or walking a distance. What now? Do I need an ultrasound or MRI to see if there is any damage or tear to my piriformis? Should I get an injection?”

When I hear something like this, my first thoughts are that either the diagnosis has been missed – or the treatment plan is all wrong – because you absolutely should be seeing some progress and results after 8 sessions of quality physical therapy.

Is it really piriformis syndrome – or is it sciatica?

These two conditions are frequently confused and all too often interchanged. The reality is, piriformis syndrome is far less common than you might think. In fact, research suggests piriformis syndrome is often misdiagnosed and may account for only 6–8% of all cases of sciatica-like symptoms (Boyajian-O’Neill et al., Am Fam Physician, 2008).

What’s the more likely reason for your radiating leg pain? That it’s coming from your lower back, not your piriformis.

Sciatica is a symptom – not a diagnosis

Sciatica refers to pain that radiates down the leg along the sciatic nerve. It can stem from a number of causes, but the most common – by far – is a mechanical problem in the lumbar spine. Things like a bulging disc, joint dysfunction, or even a poorly moving vertebra can irritate or compress a nerve root and cause sciatic pain.

Piriformis syndrome, on the other hand, involves the piriformis muscle compressing the sciatic nerve as it passes through the buttock. This can happen, but true cases are very rare – and diagnosing it correctly requires a process of elimination that most general practitioners and physical therapists don’t have the training to perform correctly.

Why mechanical diagnosis matters

Mechanical diagnosis matters because 80% of all musculoskeletal problems – including sciatica – are due to mechanical causes. And if you don’t take someone through a proper and thorough mechanical exam you will not be able to accurately diagnose the source of your sciatica. This is very likely what happened in this reader’s case.

A mechanical specialist will take you through repeated movements designed to map your symptoms and confirm specific responses to movement. This involves testing how your symptoms respond to specific repeated movements – like bending forward, arching backward, or twisting – and tracking which movements improve or worsen your pain. This is the only way to truly diagnose a mechanical pain issue. MRI’s and X-rays can’t detect mechanical pain problems – which is why they often lead to misleading diagnoses when used too soon.

Without a proper mechanical exam, treatment becomes a guessing game. Massage therapy, stretching, dry needling, and general exercises aimed at loosening your piriformis might feel good temporarily, but they won’t solve the problem if the issue is coming from your spine. Research shows that when mechanical diagnosis and therapy is applied correctly, it’s highly effective at resolving back and leg pain – even in cases that have failed previous treatment (May et al., J Man Manip Ther, 2006).

What to do if PT isn’t working

Let’s say your therapist did perform what they believe to be a thorough mechanical evaluation and still thinks it’s piriformis syndrome. And yet, you’ve gone through 8 sessions and feel no better.

This is a red flag for me.

In my clinic, we expect to see at least some change by session 4 or 5 – even if it’s small. If you’re not seeing meaningful progress by then, it’s time to reassess. That doesn’t necessarily mean it’s time for imaging or surgery. It may simply mean you need a different approach – or a more specialized provider.

A mechanical back pain specialist can help

When it comes to distinguishing between true piriformis syndrome and sciatica caused by a spinal issue, no one is better equipped than a mechanical back pain specialist.

These clinicians are experts at figuring out where your pain is coming from and what movement strategies will actually help you.

They don’t rely on vague diagnoses or cookie-cutter treatments. They use a methodical approach based on how your body responds to specific, repeated movements – and this approach has been shown to be highly effective for resolving back pain and sciatica.

The bottom line?

Piriformis syndrome is real – but very rare. If you’re dealing with leg pain, numbness, or tingling and have been told it’s from your piriformis, there’s a good chance it’s actually sciatica from a mechanical problem in your back. And that’s good news – because it means there’s often a clear and natural solution.

Find someone who specializes in mechanical diagnosis, and you’ll be one step closer to getting answers – and finally getting some relief.

Dr. Carrie Jose, Physical Therapy Specialist, and Mechanical Pain Expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH, and writes for Seacoast Media Group. If local to Portsmouth, NH, and looking for help – request a FREE Discovery Visit with one of her Specialists by CLICKING HERE.

work out

5 Ways Working Out Can Aggravate Your Back

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The research continues to show that the best “treatment” for back pain is exercise. But for some, a work out is what actually aggravates their back. This is a common frustration I hear from clients. They know that strengthening their core and working out is good for their back. But when they do – they suffer. 

Here are five ways your work out is aggravating your back:

1. Misguided Exercise Choice

While the research isn’t wrong about exercising and back pain – not all exercises are appropriate depending on the type and severity of back pain you’re experiencing. For example, walking is considered one of the best activities for back pain sufferers, but for some, it’s excruciating. Strength training and lifting weights should be an essential part of back pain rehabilitation (and prevention). But if it’s done haphazardly, you’re going to have problems and likely aggravate your back. “Exercise” is not what causes problems for most people – it’s exercise choice. And when you make the wrong choice and aggravate your back, you tend to do the worst thing possible – rest and avoid exercise altogether. There is a middle ground when it comes to exercise and back pain. Working with an expert who understands this is essential.

2. Premature Stability Training

Stability training is an important part of back pain recovery – but I often see it introduced too soon. “Mobility before stability” is my mantra. If you don’t have full mobility in your spine, there is a reason, and it must be explored. When your spine doesn’t move well, you risk developing compensatory movement patterns that cause structures in and around your spine to get irritated. You don’t want to stabilize this scenario. You want to restore proper mobility first and then stabilize your spine. I can’t tell you how often I see people making this mistake. When it comes to back pain and working out, mobility-first is a must. If you’ve got a stiff back but have been trying to stabilize it – this could be why your back is getting aggravated when you work out. Stability work has been introduced too soon.

3. Poor Core Activation

Knowing how to properly activate your core is different from having good core strength. You can have the strongest abs in the world – but if you don’t use them when they count – your “6-pack abs” are useless.  Knowing how to properly activate your core is essential when you exercise, but especially when you have back pain. If you don’t activate your core properly when you’re lifting weights, or when performing complicated, coordinated movements such as tennis or golf – you’re setting yourself up for injury. The ability to activate your core properly is developed through motor control training. It’s where we teach your mind how to recognize and activate specific muscles, during specific activities, so that it eventually becomes habitual. If you’re constantly having back pain every time you work-out or exercise, it could be that you lack the ability to activate your core properly – and/or when you need it.

4. Poor (or non-existent) breathing technique

Not breathing properly – or not breathing at all – can significantly impact the effectiveness of your exercise routine and impede your ability to perform an exercise properly. As mentioned previously, knowing how to activate your core is crucial when you exercise, and in order to activate your core properly, you must be able to breathe properly. Your deep core is made up of four parts: your deep abdominals, deep back muscles, pelvic floor musculature, and your diaphragm. Your diaphragm is what controls your breathing. Let’s say you hold your breath when you exercise. This means your diaphragm isn’t expanding or contracting, which impacts the other four muscle groups in your deep core. All four muscle groups must work together in order for your core to be functional and strong. Plus – when your diaphragm – or any other muscle group in your deep core can’t work like it should – you get unnecessary pressure and strain on your back muscles. If you’re constantly aggravating your back every time you work out – make sure you’re breathing properly. Or at the very least, not holding your breath.

5. Improper form

Perhaps the most common reason working out aggravates your back is because you’re not using proper form. There’s a lot of people out there who think posture and form don’t really matter. But they do. When you lift weights, for example, you’re adding load to your spine. It’s essential you have good form and technique when your spine is under load or stress. The tricky thing about form, however, is that you can get away with poor form for a time. It might not hurt the first time you lift with improper form – or the fourth – but by your 100th rep – your back will start talking to you. Same goes for body weight exercises. Just because you aren’t adding load to your spine in the form of an external weight, doesn’t mean you can’t still aggravate it by doing the same movement over and over poorly. If you’re going to exercise – and you want to exercise daily – do it with proper form and posture. Otherwise – if you haven’t aggravated your back yet – it’s only a matter of time.

If you’re always hurting your back when you work out – it’s likely due to one of these five reasons.

Get expert help to figure out which one it might be – because at the end of the day – exercise is good for your back – and you don’t want to avoid it or dismiss it when there could be a perfectly reasonable explanation

Are you local to Portsmouth, NH and looking for help?

Consider speaking with one of my specialists – we will ask you all about what’s been going on with you and see if we would be a good fit to help! CLICK HERE to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request one of her free guides for getting rid of back pain – visit her website www.cjphysicaltherapy.com or call 603-605-0402