Our back and spine expert Q&A this month is with Dr. Brian Wolfe, orthopedic certified specialist through the American Physical Therapy Association (APTA) with Evolution Physical Therapy
He specializes in sports medicine, orthopedic physical therapy, rehabilitation of CrossFit athletes, post-operative rehabilitation, and return-to-work programs. He also believes it is important to listen to his patient's goals which allows him to understand what has helped or hurt them in the past and fix their problems quickly.
He’s a graduate of Ithaca College who holds a master’s and doctor of Physical Therapy.
Dr. Wolfe talked to SpineNation about sciatica and back pain.
We hear a lot about physical therapists in the back and spine world. Some people may see a physical therapist similarly to a personal trainer. What is a physical therapist and what does the scope of the job cover?
A physical therapist is different from a personal trainer in the way we treat patients who have an injury or pathology versus working towards athletic performance. While this can be in many different physical settings, in the spine world physical therapists are pivotal in treating musculoskeletal and neurological issues such as muscle strains, sacroiliac dysfunctions, discogenic pathologies, and more.
Let’s talk sciatica. What is it?
is the irritation of the sciatic nerve which will often times be caused by either a degenerative pathology of the spine such as stenosis or a repetitive injury such as a disc bulge. Sciatica is a symptom of a greater pathology. Sciatica typically causes a burning, tingling or numbness sensation down the back of a person’s leg and/or muscular weakness in the lower extremities as well.
How do people typically get sciatica?
Typically, the most common way people get sciatica is a gradual onset from prolonged sitting at home, driving or at work, however, it can come on from a traumatic onset like running, jumping or twisting.
How long does sciatica typically last?
It depends on treatment, but a typical case can be resolved with physical therapy in about 2-6 weeks. If left untreated, sciatica may never fully resolve.
Is sciatica recurring once you get it, or is it usually a one and done ailment if properly treated?
Typically, sciatica is caused by certain postural faults. If treated properly by a physical therapist certain exercises should resolve sciatic and prevent the injury from recurring.
Does sciatica worsen and affect other parts of the body if left untreated?
Sciatica will usually worsen if left untreated or “bouts of Sciatica” will become more frequent or higher in pain intensity. It can affect leg and low back function long term if left untreated.
What are some ways you treat sciatica patients?
Typically, postural correction and extension-based exercises are a great place to start for treatment of Sciatica, however exercises and positions can vary. It’s important to see a physical therapist to get specific exercises for the cause of their sciatica
What are some things people can do at home to help with sciatica pain?
Regular exercise and taking time to focus on increasing flexibility and mobility is a great way to prevent sciatica. Also using a standing desk to minimize prolonged sitting can help.
What are common mistakes people with sciatica do that could cause their pain to worsen?
The most common mistake people make when treating sciatica themselves is bending forward to “stretch out” their back. This often leads to increased tension being placed on the sciatic nerve and can cause greater irritation.
How can people avoid sciatica?
Regular exercise and taking time to focus on increasing flexibility and mobility is a great way to prevent sciatica.
For our summer athletes, like runners or cyclists, how can they stay sciatica free while they train?
Cross training in between running
and cycling is crucial to prevent sciatica. Switching up the type of exercise they are performing and taking the time to focus on flexibility after training session is also incredibly helpful.
When should a person consult with a physical therapist regarding sciatica?
The faster someone consults a physical therapist if they suspect they are having Sciatica symptoms the better. Often times if caught and treated quickly Sciatica can be resolved in a matter of days to weeks.
Tell me one sciatica pain patient success story (if you have one)
We treat patients all the time who have sciatica. Two weeks ago, we had a track and field athlete who was battling a bout of sciatica following a session of sprinting and hurdle training. Within the first two visits he was able to return to training regularly without symptoms by simply adding a pre and post workout routine to address his mobility issues causing his Sciatica.
What do you enjoy most about treating patients?
I love helping athletes achieve their goals. My personal passion is working with aging athletes who want to continue to push the limits of their training and sport without risking injury or long-term musculoskeletal problems. I love helping people stay active without needing surgery, injections or long-term medication use.
Updated: June 5, 2021