By Jennifer Falzone, PT
Since opening our advanced physical therapy practice in November 2022, our team (two people!) has been excited to welcome new patients to APC for all their physical therapy needs. We serve all populations, from pain to orthopedics, neurology to rheumatology, and I have to say that from the moment I started working with APC, I was filled with a sense of the comprehensive, collaborative approach. Be confident that we can all make the right decision for our patients as a collective of pain care professionals working as a team.
Patient experience with advanced pain care
Many patients are starting to realize that things are easier when you go to a clinic that has multiple disciplines, and that’s what working with patients every day is all about. In fact, a pain doctor referred a patient to me who was experiencing multiple different pain points, and because we had a lot of expertise, we were able to help him and refer him to an orthopedic surgeon on our floor. When you work with multiple doctors, it sometimes takes months to get an appointment, but he was seen and treated in just two days. Today, he successfully completes the required surgery in a much shorter time than if he had sought out an outside medical provider.
That’s what makes the difference in Pain Relief Institute of America as a whole, but let’s get back to the work that we’re so proud of in the Department of Advanced Physical Therapy.
Related: Various forms of nerve pain
a day in the life
As of this writing, Advanced Physical Therapy consists of myself and our physical therapist assistant, Jan (Jen + Jan!). While some clinics group physical therapy patients together, we work directly with each other and one-on-one with our patients to provide them and us with adequate time to assess their pain, provide necessary treatment, and follow our Individualized plans to help them recover both during and after our treatment. No patient will receive the same treatment – we insist on focusing all of our attention on personalized, targeted care so we can provide thoughtful programs to help patients get the attention and care they need to recover faster.
What is sciatica? & How We Work with People with Sciatica
Before providing an initial diagnosis, we will first assess how the patient is feeling. Let’s look at the following:
- sports: How well the vertebrae in the spine and other joints are moving and whether they are experiencing anything that limits their typical abilities.
- Muscle mass: How strong their backs are and how limited their normal function is.
- Movement quality: How much effort does it take for them to move, what is particularly difficult for them, what triggers their symptoms, and what makes them better.
The basic clinical manifestation of sciatica is pain starting from the buttocks, moving along the side of the buttocks into the thigh, and then along the side of the knee into the big toe.
One of the main reasons we see patients experiencing sciatica symptoms is because of the muscle in the buttocks, called the piriformis, that connects from the side of the buttocks to the back of the pelvis.
Your sacroiliac joint connects the piriformis muscle to the outside of your hip, helping your hip rotate sideways. The interesting thing about this muscle is that the sciatic nerve runs directly underneath it, which means that if this muscle spasms or tightens, it can compress the sciatic nerve, giving you a sharp, stabbing pain that can cause pain that seems to never end. You knock down.
If we find that muscle is indeed the problem, there are several solutions: stretching, manual therapy, massage techniques, heat, ice, and electrical stimulation. How do we determine this? Our personalized approach looks at everything from whether the patient has had back pain before, what their job is and a range of other important factors.
Sciatica Nerve Stretches, Treatments and Programs
We start with each patient and learn the basics, such as how to maintain proper posture and how to establish a stretching regimen. Let’s start with the triplet and try to Reduce pain, improve mobility, and improve strength:
- Electrical stimulation— This irritation “interrupts the conversation” and the nerves are sending pain signals from the ischial area to the brain. The procedure itself is comfortable and well-tolerated, and is completely non-invasive for our patients; all we need is a few small stickers to place on their painful areas, handing the patient control over to us of patients so they can increase or decrease the intensity according to their needs and then let the stimulation do the rest! We also stay with our patients throughout their treatment to ensure they are comfortable throughout.
- Stretching exercises—— Once we have the pain relief, usually through electrical stimulation, we can move on to some gentle sciatic nerve stretching, which is actually part of the handout we give our patients. It is important for our patients to understand that stretching should produce a slight pulling sensation—it should no way feel pain.
- educate- Once our patients receive the options they need, we will always support their journey through education. We teach them things like “fat wallet syndrome,” which happens when men put a thick wallet in their back pocket and then sit on it, which changes their posture and is almost directly related to sciatic nerve issues related. We also familiarize them with sleeping habits such as sleeping with a pillow between their knees, sleeping on their side, what shoes to wear, getting up every 30 minutes when sitting down to work, and how to massage their back with a massager.
Related: How APC finds a solution for severe chronic pain when all other treatments fail – See Stormey’s Story
Sciatica Recovery Timeline: APC’s Pain Management Goals
For general treatment, we say if you don’t notice improvement within the first two weeks (4-6 sessions), we will re-evaluate and see if we need to order imaging or ask other specialists at our clinic.
We typically track improvements by asking them about their pain levels before and after each treatment. If they come in with a rating of 9 and leave with a rating of 8, even small adjustments can tell us something is working. But if they put in a 6 and you’re now at a 10, we’ll look for new directions until we find one that works.
We are evaluating every visit, every activity, and every treatment technique.
You don’t have to suffer.
If you are located in one of the greater Texas areas, we would be happy to assist you! Join us in celebrating the growth of APC through our new Advanced Physiotherapy discipline. No matter how long you’ve been battling pain, we’re telling you it stops right there. Search here for your nearest APC location!
