Sciatic nerve pain - start with Primary Care MD or Chiropractor?

I was diagnosed(by my urologist - long story) about 12-years ago with a bad disc in my lower back. It didn't really cause much pain/problems - I couldn't bend enough to touch my right toe, and I had to limit any weight I lifted to about 150 lbs. I've been pretty good about not overdoing it during these 12-years.

However, a little over a week ago I started getting pain through my left butt cheek & leg. It doesn't hurt when I'm on my MTB (leaning forward over the bars) or when I walk, but sitting(depending on position) - and particularly sleeping - are are causing problems.

I've never used a chiropractor, and the few I've known personally I would not have used, but I know there are good ones out there. Our insurance will allow chiropractic treatments without a referral, so I'm curious if this sounds like something I should go straight to one for, or contact a primary-care doctor first?

FYI - if I do go to a chiropractor(regardless of referral or not) I'm looking at ~$200 out-of-pocket for my first visit, and $30 each afterwards. Also, I don't yet have a primary care doctor since our move, so I'm basically starting from scratch either way.

So...call the chiropractor first, or go to a primary-care MD?

Only one of those is a doctor. I'd start there.

If you want a back massage go to one of the places truckers frequent. The services are better and about the same money.

I certainly would recommend that you go to the chiropractor first. He may be able to fix you and do it in a completely non-invasive way.

MD first. Ask for a recommendation for a chiropractor while you're at the MD.

The thing with chiropractors is that it is hard to separate the quack from the legitimate healthcare pro. The legitimate guy will tell you "Yeah, sorry, you need to see an MD".

Huckleberry wrote: Only one of those is a doctor. I'd start there. If you want a back massage go to one of the places truckers frequent. The services are better and about the same money.

Eh? I would strongly recommend that the OP consult with a Doctor of Chiropractic, or "D.C." Look it up, it's a real thing. Still a doctor, just less likely to cut you up and prescribe expensive drugs with crazy side effects.

Physical therapy did wonders for my Parrs defect, slipped disc, & bulging disc.

m4ff3w wrote: Physical therapy did wonders for my Parrs defect, slipped disc, & bulging disc.

That's very good to hear! When I first talked to my primary care doc after the original diagnosis it sounded like surgery was the most likely option, and I wanted to avoid that since it didn't affect me much at that point.

Did you go through your primary care to get the PT setup?

I'll just leave this here. It may come as a surprise to some.

http://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors

"A study by researchers at Johns Hopkins Medicine says medical errors should rank as the third leading cause of death in the United States"

1988RedT2 wrote:

Huckleberry wrote: Only one of those is a doctor. I'd start there. If you want a back massage go to one of the places truckers frequent. The services are better and about the same money.

Eh? I would strongly recommend that the OP consult with a Doctor of Chiropractic, or "D.C." Look it up, it's a real thing. Still a doctor, just less likely to cut you up and prescribe expensive drugs with crazy side effects.

DC is a real thing like Doctorate of English is a real thing but it's not an actual doctorate of medicine. The reason they don't prescribe medication is because they are not trained in pharmacology and they are not allowed to write prescriptions. An RN has more medical training than a DC. It's a guy who might be helpful for a very narrow window of problems - like physical therapy. You go there because your doctor says you should.

Cracking your knuckles feels good but it does not actually change anything. If you have cancer when you crack them, you still have cancer after you crack them.

A couple weeks ago mine was killing me. I don't know what caused it to start hurting other than I was super tight. I started stretching twice a day, targeting mainly the hip flexors and hamstrings and have seen a markable improvement in pain. Basically, I feel much less like an old man. Google stretches for sciatica and see if you can do any of them without hurting your back.

Huckleberry wrote:

1988RedT2 wrote:

Huckleberry wrote: Only one of those is a doctor. I'd start there. If you want a back massage go to one of the places truckers frequent. The services are better and about the same money.

Eh? I would strongly recommend that the OP consult with a Doctor of Chiropractic, or "D.C." Look it up, it's a real thing. Still a doctor, just less likely to cut you up and prescribe expensive drugs with crazy side effects.

DC is a real thing like Doctorate of English is a real thing but it's not an actual doctorate of medicine. The reason they don't prescribe medication is because they are not trained in pharmacology and they are not allowed to write prescriptions. An RN has more medical training than a DC. It's a guy who might be helpful for a very narrow window of problems - like physical therapy. You go there because your doctor says you should. Cracking your knuckles feels good but it does not actually change anything. If you have cancer when you crack them, you still have cancer after you crack them.

I'm not even sure that all the DC schools require a bachelors to go there.

My mother is a PT and has seen several patients who went to a chiropractor and wound up paralyzed for their efforts.

MD first for workup and referral to PT if necessary. Avoid back crackers like the berkeleying plague if you enjoy walking upright under your own steam. (just my opinion, take it for what it's worth)

I've had mixed results with Chiros and won't be going back unless there is reccy from an MD. The last one I had was phenomenal. http://sodohp.com/ I hurt my back and he put me on an exercise rehab program that got be into shape quick. Yes.. It seemed weird to do front squats and front rack lunges to get the back in shape, but man did it help...

Watching this thread with interest.

I've had some occasional lower back issues for some time now, probably going back to high school as I think of it now (currently 26), that seem to have gotten worse the past few years. Not surprising, as I'm much less active and in poorer shape now that I've got a grown up job and whatnot, but I'm thinking it might be time to consult a doctor, as I'm sure this won't get better with age.

Pain generally starts in the lumbar spine, usually initiated by extended periods of standing or if I'm sitting in an awkward position for a while (underneath a car for example), then my lower back muscles, hamstrings, hip flexors, glutes, ect all get tight as hell and it kills me for a few days. Might be some sciatic nerve issues at play as well, although it's kinda hard to sort out what might be nerve pain and what just hurts because of muscle tightness.

Huckleberry wrote: DC is a real thing like Doctorate of English is a real thing but it's not an actual doctorate of medicine. The reason they don't prescribe medication is because they are not trained in pharmacology and they are not allowed to write prescriptions. An RN has more medical training than a DC. It's a guy who might be helpful for a very narrow window of problems - like physical therapy. You go there because your doctor says you should.

D.C.'s are trained in pharmacology. Their school is 9 trimesters. Medical school is 8 semesters. Overall, they graduate about 3 months before a MD does if both start at the same time. The last year of MD training is very "light" so I would say overall FROM PERSONAL OBSERVATIONS OF BOTH that the schools are very similar in duration and teaching. They use many of the same textbooks. Typical RN school is about 4 semesters. An RN does not have more medical training than a DC. Significantly less.

DC practice is limited to muscular skeletal problems, BY LAW in most states.

mtn wrote: I'm not even sure that all the DC schools require a bachelors to go there.

MD schools don't necessarily either. FYI.

Use science to heal you -- see a doctor.

BTDT with both upper and lower back problems. A doctor that specializes in these sort of problems would most likely order an MRI to see if there is a problem, and where specifically that problem is. There are all sorts of therapies available to you before the cutting happens. Most likely a localized cortisone injection and some regimen of PT will do the trick for you. Your symptoms sound a lot like mine....and science has worked for me.

Nick (picaso) Comstock wrote: A couple weeks ago mine was killing me. I don't know what caused it to start hurting other than I was super tight. I started stretching twice a day, targeting mainly the hip flexors and hamstrings and have seen a markable improvement in pain. Basically, I feel much less like an old man. Google stretches for sciatica and see if you can do any of them without hurting your back.

This guy. I have issues and it goes away for years but if I have pain I do my excersize. I went to my MD then to a specialist. Specialist had me do stretches before surgery. Stretches worked.

orphancars wrote: Use science to heal you -- see a doctor. BTDT with both upper and lower back problems. A doctor that specializes in these sort of problems would most likely order an MRI to see if there is a problem, and where specifically that problem is. There are all sorts of therapies available to you before the cutting happens. Most likely a localized cortisone injection and some regimen of PT will do the trick for you. Your symptoms sound a lot like mine....and science has worked for me.

A doctor that specializes in these sort of problems would find your problem without an MRI. He or she would order an MRI if he or she was planning on cutting you open and pulling stuff out of you or adding more metal to you. A quack that couldn't diagnose his or her way out of a wet paper bag would send you for an MRI to see if the radiologist could find something wrong. Oh, and BTW, you MRI 100 people walking around without problems and you will find 10 "ZOMG, LOOK AT THAT! IT NEEDS A WHACK!!" cases that should not be touched.

+1 for an mri.

Popped disks don't show on x-rays.

When I blew mine, we started with x-rays. At each step the new expert would look at the xray and find something other than a disk issue. About a 9 months later, some one got smart and sent me for an mri and it was clear as day what the issue was.

Shots worked for a limited time, each shot lasting a bit longer until the combo of the shot, the right stretch to open the bad joint, and some shrinkage, a good thing in this case, of the blow out got the disk off the nerve enough for me to function normally with little pain. It does act up frome time to time, usually after a couple 60 hour weeks at my desk with few breaks.

Dr. Hess wrote:

orphancars wrote: Use science to heal you -- see a doctor.

A doctor that specializes in these sort of problems would find your problem without an MRI. He or she would order an MRI if he or she was planning on cutting you open and pulling stuff out of you or adding more metal to you.

Totally hasn't been my experience. Been seeing the same team of doctors for several years and never been cut open, nothing removed, metal free. The initial MRI pointed out where the cortisone needed to be placed. I occasionally need to go in every 12-15 months if the inflammation gets so bad that normal OTC NSAIDS aren't cutting it.

Better living through science, not quackery.

I will agree with you -- would run away from a doc that relied on a radiologist who did nothing but look at films all day. My doc orders the MRI then reads it herself.

mtn wrote: MD first. Ask for a recommendation for a chiropractor while you're at the MD. The thing with chiropractors is that it is hard to separate the quack from the legitimate healthcare pro. The legitimate guy will tell you "Yeah, sorry, you need to see an MD".

+1 for this.

"Legit chiropractors" usually call themselves something else like physical therapists. If you hear something about "subluxations," run.

In reply to orphancars:

They are sticking something in you, OC. A radiological study would be indicated for that.

Man, there are some serious bad suggestions in this thread. Your island may be different than THE UNITED STATES OF AMERICA, Gameboy, but up here physical therapists and chiropractors are two different things.

Wife has been dealing with these issues for over 10 years off and on. See your physician first. Sciatica is typically treated with a mild steroid to get the nerve to stop swlling (which is what is causing the issue) and a mild muscle relaxer to get the muscle tissue to relax around htat area. Once you do that, then there are a series of stretches you can do to prevent recurrences. Sadly, the wife stops doing hte stretches and then a few months later has a relapse. Rinse, repeat.

A chiropractor is not going to help this issue as it is not a back alignment issue as much as it is a nerve/muscle issue in the glutes/upper thigh. Also, water therapy (pool stretching) helps trememdously relieve the discomfort and helps with mobility.

MD -> MRI -> PT, then if it's not all better-> EMG