Who to see for Sciatica or Piriformis Syndrome?

[Anonymous]

I am 99% sure I have either sciatica or piriformis syndrome. It's a dull, not horribly painful, but inredibly annoying pain in your upper butt/lower back, and the horrible raw twinge-y nerve down the backs of my legs. Legs/feet fall asleep easily. The dull constant pain almost nauseates me. Sitting a lot or on hard chairs exacerbates it. Standing a long time in crappy shoes is not fun.

Who do I see? Chiro? PT? I made an appointment for a PT next week because I am not totally comfortable going to a chiro to evaluate me initially. But I am open to one if that's recommended.

[Anonymous]

Bump

[Anonymous]

PT, definitely

[Anonymous]

OP--you say you have pain in your legs, plural. Sciatica only very rarely affects both legs.

Here are some questions you need to answer: 1. Has the pain been there for three or more months? 2. Do you have it when you wake up and it feels better after a half hour more, improving through the day only to worsen at night? 3. In general, does it improve with movement?

If the answers are yes, you need to see a rheumatologist as it could be an inflammatory arthritis. Assuming your use of the word legs was intentional I would tend towards this route for you but I don't know how your other answer line up.

If the answers are no--particularly if it worsens with movement you should see an orthopedist. Also, if you can identify an obvious mechanical cause (eg a fall) you would see an orthopedist.

I would not go to a PT or chiro without a good diagnosis as what they do could worsen your condition.

[Anonymous]

I had this, went to a PT, and got relief in a week. I think it's worth a try.

[Anonymous]

Anonymous wrote:OP--you say you have pain in your legs, plural. Sciatica only very rarely affects both legs.

Here are some questions you need to answer: 1. Has the pain been there for three or more months? 2. Do you have it when you wake up and it feels better after a half hour more, improving through the day only to worsen at night? 3. In general, does it improve with movement?

If the answers are yes, you need to see a rheumatologist as it could be an inflammatory arthritis. Assuming your use of the word legs was intentional I would tend towards this route for you but I don't know how your other answer line up.

If the answers are no--particularly if it worsens with movement you should see an orthopedist. Also, if you can identify an obvious mechanical cause (eg a fall) you would see an orthopedist.

I would not go to a PT or chiro without a good diagnosis as what they do could worsen your condition.

Not necessarily true, a posteriorly herniated disc could cause these symptoms, so could spondylosis, which both cause pain down the legs. Sciatica is use generally as a term for referred pain from the back, it's not referring to what's causing it

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP--you say you have pain in your legs, plural. Sciatica only very rarely affects both legs.

Here are some questions you need to answer: 1. Has the pain been there for three or more months? 2. Do you have it when you wake up and it feels better after a half hour more, improving through the day only to worsen at night? 3. In general, does it improve with movement?

If the answers are yes, you need to see a rheumatologist as it could be an inflammatory arthritis. Assuming your use of the word legs was intentional I would tend towards this route for you but I don't know how your other answer line up.

If the answers are no--particularly if it worsens with movement you should see an orthopedist. Also, if you can identify an obvious mechanical cause (eg a fall) you would see an orthopedist.

I would not go to a PT or chiro without a good diagnosis as what they do could worsen your condition.

Not necessarily true, a posteriorly herniated disc could cause these symptoms, so could spondylosis, which both cause pain down the legs. Sciatica is use generally as a term for referred pain from the back, it's not referring to what's causing it

In either of those cases OP should see an orthopedist first. My guess is in both of those conditions the pain would worsen with movement, not improve.

[Anonymous]

Have you recently had a child?

I had it post partum because of the relaxin still in my body. I actually think PT made it worse honestly but they did have good tips for how to avoid flare ups (don't cross your legs, don't stand on one foot (ie in the shower while shaving). They did send me to a ortho to rule out other stuff but it was really bad and then just gradually went away once I got better about core strength training and avoiding the stuff I mentioned above.

[Anonymous]

If you go to an ortho with those symptoms they will send you to a PT.
Save your time and money and go to the PT.
Unless you need pain meds

[Anonymous]

I thought most states will let PTs only take patients if the have a doctor's prescription. Does insurance pay for PT if a doctor hasn't prescribed?

[Anonymous]

NP here, will a PT see you without a dr's referral?
For liability reasons, I think they want to make sure there aren't any structural issues that could be exacerbated by therapy.

[Anonymous]

Anonymous wrote:I thought most states will let PTs only take patients if the have a doctor's prescription. Does insurance pay for PT if a doctor hasn't prescribed?

Medicare requires a MD prescription. Most private insurances allow what is called "direct access" to PT, and will pay per your insurance coverage

[Anonymous]

Anonymous wrote:I thought most states will let PTs only take patients if the have a doctor's prescription. Does insurance pay for PT if a doctor hasn't prescribed?

+1

[Anonymous]

Anonymous wrote:NP here, will a PT see you without a dr's referral?
For liability reasons, I think they want to make sure there aren't any structural issues that could be exacerbated by therapy.

The entry to PT is now a Doctorate, so 7 years of schooling total. There is "direct access" to PT, much like chiropractors or podiatrists, for many years now. Unless you have Medicare, you typically do not need a script to see a PT.

[Anonymous]

Anonymous wrote:I thought most states will let PTs only take patients if the have a doctor's prescription. Does insurance pay for PT if a doctor hasn't prescribed?

False. This applies only to Medicare