Back Pain & Sciatica: Do I Need an Injection?

Back Pain & Sciatica: Do I Need an Injection?

January 21, 2020

Chino Hills, CA – When it comes to eliminating back pain and sciatic pain (“Sciatica”), having an injection is usually one of the first things that comes to mind. At the clinic, we see patients on a regular basis who’ve had any number of injections before coming to see one of our physical therapists for treatment. In fact, in the last week alone, we’ve had 3 patients with sciatica who’ve already started injections and are now going to start physical therapy (in that order).

Let me tell you about one of them briefly before I make my point for the day. Nancy is a 65 year old woman who came into the clinic with complaints of sciatic pain starting in her right buttocks and radiating down the back of her thigh and into her calf. She’s had this pain for several months, but it recently worsened when she went up and down her stairs several times while doing several loads of laundry. A few weeks back, Nancy’s doctor sent her to a pain clinic, and she’s had one injection into her buttocks so far (they injected her piriformis – a hip muscle). And while the injection felt good for a couple of days, her pain is back to its normal level, and she still can’t go up and down stairs, squat down or bend forward without significant pain.

After taking a look at Nancy, her PT had very good news for her: her back looked great, and all her pain was indeed coming from that small muscle in her buttocks (the piriformis), which in turn was putting pressure directly on her sciatic nerve, resulting in her buttocks and leg pain. So now that we know what’s causing her pain, we know exactly what to do with it, right? We just need to make that little muscle happy so it won’t aggravate her nerve. Simple!

But wait a minute…

If it was that easy, the injection would’ve done the trick for Nancy. But it didn’t. So what does Nancy really need to do in order to eliminate her pain and get back to her usual activities?

This is where I make my point!

And here it is: Eliminating back pain, with or without sciatica, is a 5-step process.


5 Steps to Eliminating Back Pain & Sciatica


  1. Figure out the “Root Cause” of the problem
  2. Pain Relief
  3. Restore Flexibility and Strength
  4. Return to Normal Activities
  5. Maintain your Progress, and Prevent Re Injury


    In Nancy’s case, starting with an injection was a mistake, as an injection will never get her past step 1. What I didn’t tell you about Nancy is that she has significant weakness in the muscles surrounding her hips and pelvis. This weakness is the true ROOT CAUSE of her pain. The irritated piriformis muscle really isn’t the problem. The fact that this muscle is weak and is easily aggravated by activities like squats and climbing stairs is the underlying problem. What we’re about to do for Nancy is take her through our 5-step process. Now that her therapist determined the ROOT CAUSE of her problem (Step 1), we can start eliminating the pain and tightness in her piriformis muscle, using hands-on techniques, stretches and other tools (Step 2). Next, they’ll start showing her how to strengthen her hip, leg and core muscles. (Step 3). We then want to make sure she is able to do the things she was unable to do like bending and using the stairs (Step 4). And finally, her therapists will make sure to continue to progress her, monitor her symptoms, and her progress, giving Nancy the confidence that she won’t hurt herself again.

    If we let Nancy stop her therapy sessions before completing each of these 5 steps, we’ve done her a huge disservice. If we let Nancy believe that pain relief is enough to solve her problems and let her go on her way after she feels better, I can 100% guarantee you that her pain will be back. It may take a couple weeks, but it will certainly come back. I know that was a roundabout way to make any kind of point,… 

    …So Let Me Just Summarize Things For You


    Point 1: having an injection is not a good first option for any kind of pain relief.

    Point 2: you must find the true ROOT CAUSE of your pain before trying to eliminate it.

    Point 3: pain relief is not enough. It’s merely a start.


    True relief and healing come when you can pinpoint the cause of your pain, treat it with the 5-step approach I mentioned above, and ultimately return to the activities that you enjoy.

    I hope that was helpful. We will continue our discussion about ways to eliminate lower back pain and sciatica next week.

    Have questions for me? I’m happy to answer any questions about back pain by phone at (909) 907-0805 or by email at

    You can also TEXT me at (909) 907-0805

    Until next time!

    Healthy Regards,

    Dr. Carlo Sayo, DPT, OCS


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