Physiotherapy?

It’s my understanding that physical therapy and physiotherapy are the same thing, but physical therapy is the term more used in the American English while physiotherapy is used more in the UK and Australia.

It’s kind of like how in the US we use the term “primary care physician” more often whereas in other English-speaking countries. the term “general practitioner” or GP is used.

In my experience, a PT can do a lot without a definite diagnosis and can do an assessment of their own to try to determine how the nerves, muscles, bones, etc. may be contributing to your pain, as their focus is more on function and helping you feel better, but I suppose it depends on the PT. This can be helpful because some diagnoses don’t have definitive proof. Or with imaging, pain level doesn’t necessarily correlate to changes seen on imaging and vice versa.

Have you tried seeing a physiatrist if you wanted more clarification on what’s causing your pain? They’re internists but also specialize in physical medicine and rehabilitation so tend to look at things more holistically. I have chronic pain, and my physiatrist has been extremely helpful and was instrumental in helping me get diagnosed.

no I have not, but will check it out thank you. I'm in the process of getting so many needles in my back, I'm losing track. They are trying to determine what's causing my issues. Unfortunately I have a new issue on my left lumbar, that started from my constant over twisting to my left to overcompensate from my right side issue, so now I have to figure that one out. It's all overwhelming and frustrating.

I have had back issues for over 30 years. A neurosurgeon may be the place to go if you haven’t already. They ordered MRI’s with contrast and then ordered nerve conduction and muscle testing to find out where the blocks are. Then from those tests ordered injections of cortosteroid to see if those brought any relief. Then used that information when doing back surgery to clear debris from the nerve to restore function. I had one surgery on the right and one on the left that brought immediate relief after healing.
I had one surgery 35 years ago the remove bone chips and disc material that was blocking a nerve.
But the prior person that recommended a physiatrist might be a good choice.

When I lived in Canada, they were referred to as physiotherapists. In the US, they're physical therapists. Both practice similar therapy.

Hey Doug,

You mention sciatic pain. Is this shooting or stabbing pain in the buttock or back of the legs? It's usually only on one side.

I ask because I've had sciatica, twice. The first time was due to a bulging lumbar disc and it resolved with time. Icing the lower back helps even though the pain is in your leg. laying on your back with your legs elevated can also help for a time. Sciatic nerve pressure can also be caused by stenosis (narrowing of the spinal canal) or scoliosis (abnormal bend in the spine) or disc/vertebra degeneration from osteoarthritis. Those conditions usually require surgery, but not always.

I would get a spine xray and talk to a good orthopedic surgeon. Personally, once the sciatic nerve is compromised, I don't trust PTs or chiropractors to be able to deal with the problem. Now a PT may ultimately help, but that will be on the recommendation of an orthopedic surgeon and a proper examination.

A good surgeon will try everything to fix your problem before suggesting surgery. I had one surgery for my lumbar spine, a minimally invasive laminotomy where part of the vertebra is removed to make more room for the sciatic nerve. And that was a second opinion because the first surgeon wanted to do a fusion. 10 years later, I'm fine with no fusion.

I know this doesn't answer your question about physiotherapy, which I assume is what a PT does based on a solid knowledge of kinesiology - how the muscles and bones of the body work.

I wish you the best. Sciatica is no fun at all....... Joe

Excellent points. Yes a good PT, or even a trainer with a strong education in kinesiology can be very helpful with function. This is no small point, as so many things people do at the gym have no basis in function - how we move throughout the day, and night I suppose.

And you mention "physiatrist" and I would call that a "doctor of physical medicine", sometimes referred to as sports medicine, although that is misleading. These are MDs with a vast knowledge of how the body works and how to diagnose a problem. In most cases, they will refer you to a specialist, but they are invaluable and go well beyond what a primary care dr can offer.

Hopefully this is all useful in response to Doug's initial question.

Thanks jp. I am going through something similar. For a long time, I have gotten sporadic and painful cramps in both hamstrings, despite a lot of stretching and staying well hydrated. I saw a Dr of physical medicine and she believes the problem is with spinal stenosis and specific movements I make that temporarily squeeze the sciatic nerve and cause the hamstring pain - not cramps at all.

Anyway she ordered an MRI and I am awaiting results. MRIs are the best, although in Doug's case, a Dr might want to start with an Xray.

Thanks Joe- Actually I think I have what's called pseudo sciatica which is leg pain, but more like a hamstring pull type of pain with a lot of muscle spasms. alot of burning as well. I believe this is more from the SI, piriformis, hip area, versus the spine. I have degenerative disc disease in all of my lumbar, but apparently they say it shouldn't be causing my symptoms. I have had most of the shots and tests still with no answers as to the specific cause, just a general idea.

Got it Doug, thanks. Yeah my lumbar spine is an utter disaster area, but I work out every day with focus on maintaining a strong core. According to my surgeon, that's all that is standing between me and fusion surgery.

And it's interesting that you think the hamstring pull, spasm pain is being caused by the piriformis muscle and or hip/gluteus/sacrum. And if you're getting no relief after the epidurals, then yeah, it's likely not the lumbar spine or typical sciatica.

I've got a similar problem. While not chronic, I get what feels like hamstring cramps depending on how Im sitting, how my legs are positioned, or if I'm lying flat on my back and doing certain exercises. My Dr. thinks it may be due to stenosis, or another one of my lumbar problems. To that end, I had an MRI done four days ago and hopefully will know more soon.

Ha your Dr suggested an MRI? That would be very helpful if it is indeed a soft tissue issue in your sacrum or gluteus. An MRI could resolve this. Just a thought. All the best! Joe

I agree. I’m a patient at the Shirley Ryan AbilityLab, which is a research rehabilitation hospital, so I was lucky to be referred to someone fairly quickly. I always struggle to summarize exactly what sets a physiatrist/Physical Medicine & Rehabilitation doctor apart. Where I live they go by “PMR” as their speciality. But that tends to confuse me because my dad has a chronic condition with the same acronym.