When back pain or sciatica flares up, an injection is often one of the first things people consider. At the clinic, we regularly see patients who've already tried one or more injections before coming in for physical therapy — usually in that order, rather than the reverse.
A closer look at how this usually plays out
Consider a patient in her sixties who came in with sciatic pain running from her buttock down the back of her thigh and into her calf. It had built up over several months and worsened after a stretch of housework that involved a lot of stairs. Her doctor referred her to a pain clinic, where she received an injection into her piriformis, a small hip muscle. The injection helped for a couple of days, but her pain returned to its usual level, and she still couldn't manage stairs, squat, or bend forward without significant discomfort.
When she came in for an evaluation, it was clear her pain truly was coming from that piriformis muscle, which was putting pressure directly on her sciatic nerve. So why didn't the injection solve it?
The 5 steps to eliminating back pain and sciatica
Because eliminating back pain, with or without sciatica, is rarely a single step. It's a process: finding the root cause of the problem, relieving pain, restoring flexibility and strength, returning to normal activities, and then maintaining that progress to prevent re-injury.
An injection, at best, addresses the pain-relief step. In this patient's case, the real root cause was significant weakness in the muscles around her hips and pelvis — not the piriformis itself. That muscle was simply the one getting aggravated by activities like squatting and climbing stairs. Working through the full process meant treating the irritated muscle with hands-on techniques and stretching, then building strength in the hips, legs, and core, returning to the activities she'd been avoiding, and monitoring her progress so the pain didn't creep back.
Why skipping steps leads to the pain coming back
Stopping therapy once the pain eases, without working through the rest of the process, tends to be a disservice. Pain relief on its own isn't the same as resolving the problem — it may take a few weeks, but without addressing the root cause, the pain typically returns.
When to see a physical therapist
If you're dealing with back pain or sciatica and considering an injection, it's worth having a physical therapist evaluate the true source of your pain first. Our therapists at Empower Physical Therapy & Wellness work through each of these steps with patients in Chino Hills, Chino, and Pomona to find lasting relief, not just short-term relief.
