T Nation

Do I Need a New Physiotherapist?

About 3 weeks ago I suddenly felt a pain in the region where my ass meets my hamstring. I took a week off running and lifting and it was gone completely so I started again and then the pain came back right away to the point where I had to stop all activity including walking to work and using the stairs.

My doctor didn’t believe it was sciatica after he twisted my leg around and had my bend and he referred me to a physiotherapist. I have been doing very light crossfit workouts omitting anything that uses my hamstrings and the pain is almost completely gone now, but I wanted to talk to the physiotherapist before resuming anything. Yesterday I saw her and she didn’t know what the cause is, gave me some very light stretches and exercises, said no more weights and she wants to see if she can get me running again. The one thing she had me do that reproduced the pain was a back lunge.

(She also said I had ‘excellent hamstring length’ which surprises me because I was under the impression having too flexible hamstrings made you more prone to injury? But I don’t know where I got that from)

What concerns me is I still don’t know what the problem is, what caused and what I did that I should avoid now. Running on ice/snow? Bad shoes? Anything to do with lifting at all?? I am thinking the physiotherapist should be doing a bit more investigating or at least giving me more answers. Her approach seems to be just do some exercises to strengthen and carry on.

My questions are: is this a reasonable approach to dealing with an injury or should I be seeking someone who is going to give me more a of diagnosis? Am I just being too impatient? My doctor thought it was possibly piriformis syndrome. How is that diagnosed?

I am a firm believer in second opinions. If you aren’t satisfied with the physiotherapists opinion, maybe you should see another one or perhaps a different doctor. Just my opinion. I do this all the time with my children’s issues, most of the time the doctors agree, but sometimes they don’t.

Terms like this get used imprecisely - is the person you’re seeing a physiotherapist of a Physical Therapist (PT)? If physiotherapist, leave, as they’re people who were unable to handle the rigors of PT school. It’s like the joke about doctors and dentists, except not a joke.

You might consider seeing a sports oriented PT or a chiropractor who didn’t go to Logan chiropractic. Note that the recommendation against Logan is just personal experience; I’m sure some decent chiros come out of there, but I’ve seen enough ridiculous bullshit from the ones I’ve met to strongly recommend against them. Your mileage may vary. The sports oriented PT would be the preferred choice since they’re typically better trained in more rehabilitative techniques should they be necessary.

I took a look at your deadlift video; it appears (though it is hard to tell) as though you might be making up for a lack of pelvic mobility with lumbar mobility, which could potentially result in the pain you describe, especially since you run a bit. Usually a few weeks of using a reverse hyper machine will clear it right up by strengthening the erectors and stretching the hamstrings, but it might be a good idea to get checked out by a PT or good chiro first to make sure you don’t have any contraindications. Also, not sure if this applies to you, but a great many people don’t do hamstring stretches properly and instead end up stretching the erectors (further compounding problems).

Feel free to contact me by PM if you’d like any recommendation on someone good in your area.

Best,

Dan

She is a PT ( her card says 'Sports physiotherapy BCS (PT). CERT. SPORTS MED. ) from a sports institute and her partner at the institute is the CMO of the 2010 games or something like that and she comes recommended. I’m thinking I’ll go back in a week and see what she says but I hope I’m not wasting my time.

I have corrected my deadlift since that video (hopefully!) but I don’t rule out bad form as cause. I don’t think hamstring flexibility is a problem–I can lay my hands flat on the floor with my palms at my toes while keeping my legs straight.

Is there any harm in deep tissue massage or working with a tennis/lacrosse ball? Foam roller doesn’t seem to do anything but I’m also worried about aggravating things.

Thanks for your comments!

[quote]buffalokilla wrote:
Terms like this get used imprecisely - is the person you’re seeing a physiotherapist of a Physical Therapist (PT)? If physiotherapist, leave, as they’re people who were unable to handle the rigors of PT school. It’s like the joke about doctors and dentists, except not a joke.

You might consider seeing a sports oriented PT or a chiropractor who didn’t go to Logan chiropractic. Note that the recommendation against Logan is just personal experience; I’m sure some decent chiros come out of there, but I’ve seen enough ridiculous bullshit from the ones I’ve met to strongly recommend against them. Your mileage may vary. The sports oriented PT would be the preferred choice since they’re typically better trained in more rehabilitative techniques should they be necessary.

I took a look at your deadlift video; it appears (though it is hard to tell) as though you might be making up for a lack of pelvic mobility with lumbar mobility, which could potentially result in the pain you describe, especially since you run a bit. Usually a few weeks of using a reverse hyper machine will clear it right up by strengthening the erectors and stretching the hamstrings, but it might be a good idea to get checked out by a PT or good chiro first to make sure you don’t have any contraindications. Also, not sure if this applies to you, but a great many people don’t do hamstring stretches properly and instead end up stretching the erectors (further compounding problems).

Feel free to contact me by PM if you’d like any recommendation on someone good in your area.

Best,

Dan [/quote]

[quote]debraD wrote:
She is a PT ( her card says 'Sports physiotherapy BCS (PT). CERT. SPORTS MED. ) from a sports institute and her partner at the institute is the CMO of the 2010 games or something like that and she comes recommended. I’m thinking I’ll go back in a week and see what she says but I hope I’m not wasting my time.
[/quote]

Okay, so she might be pretty good then. Maybe. :slight_smile:

If you’re having pain with that level of flexibility, it does sound like it may be piriformis syndrome. Deep tissue massage/ball rolling of the glute and maybe IT band would likely be beneficial.

If you’re that flexible and having problems at the hip, I’d wager the root cause isn’t at the hip extensors but lower down, or perhaps at the hip flexors. What sort of stretches do you do for them? It’d be worthwhile to have your feet assessed (if you haven’t already) and/or your running form analyzed as well, as structural problems at the foot often manifest at the hip.

If it’s available, a 3-D gait analysis can help you/the PT tease out these sorts of issues fairly easily. A 3 condition test with barefoot walking, shod walking, and jogging (with shoes) would illuminate the cause pretty quickly.

Have a good one,

Dan

I think I said the same thing on the last thread you posted. It probably is piriformis syndrome.

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you.

[quote]PRCalDude wrote:

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you. [/quote]

I second the book recommendation. The Trigger Point Therapy Workbook by Clair Davies is a fantastic resource for guidance in dealing with many types of muscular pain.

The illustrations really help in understanding the musculature involved, what’s happening with referred pain and how to safely perform trigger point self-treatment.

However, I recently “did something” to my hip that I just couldn’t touch with foam and ball rolling. The referred pain in my knee, calf and achilles tendon was excruciating.

My massage therapist (university trained as a sports physical therapist in Romania) was able to get deep into the piriformis and hip rotators and begin to work out the trigger points. The result was immediate relief.

I continue to work on the trigger points at home, but will also go back for further professional treatment with the massage therapist, and possibly ART and acupuncture at the chiropractor.

Re physical therapist vs physiotherapist, in Canada the terms are interchangeable. Your PT would be licenced to practice by the College of Physical Therapists of BC.

John

Thanks buffalokilla. See that’s what makes me skeptical about her–she doesn’t seem to be doing any analysis or investigating and instead is slapping on a cookie cutter ‘strengthening’ routine that doesn’t help me find the source of the problem and seems to be so effortless that I find myself doubting its effectiveness. But what the hell do I know? :slight_smile:

[quote]PRCalDude wrote:
My doctor thought it was possibly piriformis syndrome. How is that diagnosed?

I think I said the same thing on the last thread you posted. It probably is piriformis syndrome.

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you. [/quote]

Thank you very much for the recommendation! I remember that you said that, and have kept that in mind. I have been trying with a ball but I don’t feel like I know what I’m doing. The book will certainly help and seems to have many good reviews. I just ordered it.

I am leaning towards not going back to the PT but I’m still torn. I saw one years ago about a neck issue and I had the same impression and was inneffective but I do tend to be overly skeptical at times and I am trying to keep an open mind. But I’m not very good at that!

Thanks also for the recommendation. I may still book with the chiro near here (who is also an ART practitioner) but I might wait on that.

[quote]cakewalk wrote:
PRCalDude wrote:

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you.

I second the book recommendation. The Trigger Point Therapy Workbook by Clair Davies is a fantastic resource for guidance in dealing with many types of muscular pain.

The illustrations really help in understanding the musculature involved, what’s happening with referred pain and how to safely perform trigger point self-treatment.

However, I recently “did something” to my hip that I just couldn’t touch with foam and ball rolling. The referred pain in my knee, calf and achilles tendon was excruciating.

My massage therapist (university trained as a sports physical therapist in Romania) was able to get deep into the piriformis and hip rotators and begin to work out the trigger points. The result was immediate relief.

I continue to work on the trigger points at home, but will also go back for further professional treatment with the massage therapist, and possibly ART and acupuncture at the chiropractor.

Re physical therapist vs physiotherapist, in Canada the terms are interchangeable. Your PT would be licenced to practice by the College of Physical Therapists of BC.

John[/quote]

[quote]debraD wrote:
Thanks also for the recommendation. I may still book with the chiro near here (who is also an ART practitioner) but I might wait on that.
[/quote]

ART would be a great idea for immediate short-term relief. ART is much like chiropractic adjustments for muscles; they fix the symptom, but not the habits that cause them.

Thinking more about what you mentioned with the PT, it’s very possible that the skill and knowledge are there but the time needed to apply them to your case are not. If all that’s in the plans is strengthening sessions, I’d skip them and instead take a look at Mike Robertson’s and Eric Cressey’s older corrective exercise articles for a better source of rehabilitative movements.

Good to know, thanks for mentioning that John.

Have a good one,

Dan

[quote]debraD wrote:
Thanks buffalokilla. See that’s what makes me skeptical about her–she doesn’t seem to be doing any analysis or investigating and instead is slapping on a cookie cutter ‘strengthening’ routine that doesn’t help me find the source of the problem and seems to be so effortless that I find myself doubting its effectiveness.
[/quote]

I vote for a second opinion. When I hurt my shoulder in high school, I got my physicians opinion and saw a specialiast, and both of them didn’t look too far into the situation and just suggested surgery straight away. I searched around for a highly regarded shoulder specialist, and he gave me my options of surgery, no surgery, etc. I opted out of surgery, and he gave me a “you can do this, don’t do this” type of guideline which I stick to about 80% of the time, and I’ve been alright for years.

[quote]
But what the hell do I know? :slight_smile: [/quote]

We’re not supposed to know this stuff! That’s why they went to school for seven years. It’s the same reason people come to you to do [whatever you do] lol.

[quote]debraD wrote:
PRCalDude wrote:
My doctor thought it was possibly piriformis syndrome. How is that diagnosed?

I think I said the same thing on the last thread you posted. It probably is piriformis syndrome.

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you.

Thank you very much for the recommendation! I remember that you said that, and have kept that in mind. I have been trying with a ball but I don’t feel like I know what I’m doing. The book will certainly help and seems to have many good reviews. I just ordered it.

I am leaning towards not going back to the PT but I’m still torn. I saw one years ago about a neck issue and I had the same impression and was inneffective but I do tend to be overly skeptical at times and I am trying to keep an open mind. But I’m not very good at that![/quote]

I think the fact that you had a neck issue a year ago and now you’re having this problem means you ought to try a mind-body approach.

A lot of PTs will think you’re having symptoms caused by some emotional issue and not tell you about it - they’ll just end your course of treatment as quickly as they can.

More than likely, if you get rid of this problem in your piriformis through trigger point therapy, the pain will just show up in another part of your body.

[quote]rrjc5488 wrote:
debraD wrote:
But what the hell do I know? :slight_smile:

We’re not supposed to know this stuff! That’s why they went to school for seven years. It’s the same reason people come to you to do [whatever you do] lol.[/quote]

That’s why I feel like an ass when I question everything they do. But I cannot help myself!

The book came today and I’ve only had a chance to just flip through it but it looks like the kind of thing I was looking for. Thanks again. I’ll see if I get anywhere with this. I’m hoping!

[quote]PRCalDude wrote:
debraD wrote:
PRCalDude wrote:
My doctor thought it was possibly piriformis syndrome. How is that diagnosed?

I think I said the same thing on the last thread you posted. It probably is piriformis syndrome.

I say you should get this book:
http://www.triggerpointbook.com/sciatica.htm

and blow off any more physical therapy. If you’re already an active person, physical therapy doesn’t do much for you.

Thank you very much for the recommendation! I remember that you said that, and have kept that in mind. I have been trying with a ball but I don’t feel like I know what I’m doing. The book will certainly help and seems to have many good reviews. I just ordered it.

I am leaning towards not going back to the PT but I’m still torn. I saw one years ago about a neck issue and I had the same impression and was inneffective but I do tend to be overly skeptical at times and I am trying to keep an open mind. But I’m not very good at that!

I think the fact that you had a neck issue a year ago and now you’re having this problem means you ought to try a mind-body approach.

A lot of PTs will think you’re having symptoms caused by some emotional issue and not tell you about it - they’ll just end your course of treatment as quickly as they can.

More than likely, if you get rid of this problem in your piriformis through trigger point therapy, the pain will just show up in another part of your body. [/quote]