Steroid injections as part of phys therapy.

[false_aesthetic]

Hey,

The pain in my legs has gone away some with PT but it has seemed to hit a plateau--PT thinks the source of my pain is periformis + hamstrings are choking my sciatic nerve. PT suggested that we try a steroid injection to help things heal up while we work on strengthening the surrounding muscle structure (apparently there's a lot more Suzanne Somers in my future).

I've only known a few people who have done this and its all been used to help deal with pain from playing musical instruments. No one has ever said, "That was awesome." Pain during/after the injection, didn't do much, etc.

I recognize that the DR would be injecting into a different part of the body and for a different reason.

I guess my question is (for people who have been through this) "After 4 weeks of PT are we jumping the gun?"

(Yes, I have a call in to my Dr and I've also asked my PT to talk to him so that all 3 of us are on the same page. )



By the by. PT says, "I think we're gonna need to give you steroid injections...but I promise you, you're not gonna win the tour." I appreciated his humor.

[ned]

*standard Internet disclaimer, blah, blah, blah*
I'd think you'd see some positive changes in 4 weeks of PT. If the best treatment is dependent on exercises that are too painful to perform then perhaps the injection is worth perusing. If the injection is because you've not made progress with the PT then that's a whole different story. There have certainly been times when I've sent a patient for steroid injections--there is a time and place for such treatment. I will say that I haven't sent anyone for injections since I've been able to send patients to my wife for acupuncture. Personally I'd go down that road way before getting steroids.

PM me if you want to discuss the details of your case.

[SeanEasley]

that or see if 'dry needling' is a technique that is offered by anyone near you. Similar needles as used in accupuncture, but different goal. A PT who works here with me at the naval academy is using it with good results. It is considered invasive but nothing is injected--the attempt is to break up trigger points.

I am surprised they want to put steroids near your nerve?? Something not to take lightly IMO. Short course oral steroid is often prescribed for a 'hot nerve' and it doesn't have the same level of risk.... IMHO of course

[teleguy57]

that or see if 'dry needling' is a technique that is offered by anyone near you.

+1 on dry needling; my PT is one of the few in the area trained in the technique and it worked for me.

also +1 on accupuncture, although I had the two done for different purposes so I can't do a good side-by-side comparison of effectiveness for the same issue.

Oh, and I did have an epidural steroidal injection near a nerve. The pressure my bulging disc between c6-c7 put on it caused inflammation that didn't respond to other treatments. It worked in breaking the compression/inflammation/more compression cycle that kept me off the bike for almost six months.

[Elefantino]

Same thing for me, only weirdly post-surgery. A real pain in the ass. Tried steroid injex; bupkis. Went the acupuncture route, bingo.

YMMV.

Hope you get it fixed.

[false_aesthetic]

Went to the Dr and talked to him for about an hour about options other than cortisone injections. Ended up going for the injection simply because it is "affordable" (It seems that even platelet replacement therapy is cheaper than going to get massage.)

The injection was nothing but HOOOODEEEHOOOO I was in some special kind've pain 2 days later. Ended up telling my students, "If it looks like I'm doing the pee-pee dance its cuz my leg hurts and moving distracts me."

Friday I was back to the PT. Things felt way worse last night (nothin Advil PM can't take care of) but I'm 85% better today. Something still feels amiss but I'm in less pain today than I have been in weeks. Hopefully the trend continues.

Still not allowed to ride the bike though. PT says maybe Monday.

[EFHeath]

I'm in the musician contingent you mentioned. Cortisone has a pretty bad reputation for not working long term. Whether that's because lots of musicians are prejudiced against modern medicine and experience a sort of anti-placebo effect, or the fact that many musicians are economically unable to take time off to rest injuries, or if cortisone itself just doesn't help, I can't say.

I was discussing acupuncture the other day with some of my Chinese colleagues. I have never tried it, but I'm having a problem with my shoulder, and was making a mental list of my options. To my surprise several of them dismissed it, saying it just treats the symptoms, not the root cause. "Just stops the nerve", was how he put it. I lean to the same view myself, but since most people in Hong Kong are very open to Chinese traditional healing, it was interesting that my colleagues didn't have a very positive view of acupuncture.

As to Piriformis, I've had that go away with a few weeks of rest and light stretching, but I've had friends with Sciatica who suffered for very extended periods of time, and some who seem to have a recurring problem with it. So four weeks doesn't seem like an outrageously long time for treatment to work.