For three years I have had severe gnawing pain in my buttock with sciatic nerve pain. It is worst sitting or lying down and I can’t sleep for long because the pain wakes me. I have tried an osteopath, alternative therapies and had a scan, but nothing has worked. I’m 53 and otherwise very healthy. Any suggestions?
It is likely that exercise will be able to help clear up the pain and prevent a recurrence, but not at this stage. As you have realised, you need treatment first. I hear many stories of long-term pain that doesn’t seem to respond to treatment, so here’s a few pointers that I hope will improve your chances of success.
If there is no suggestion of a more serious underlying cause, I firmly believe you should be able to sort out the pain with the help of a physiotherapist, osteopath or chiropractor. Each of these professions has a slightly different approach, and it is a personal decision which to go for. However, as with fitness trainers, no two osteopaths or physios are going to be the same – and some are simply better and more skilled than others.
Rather than do the rounds of alternative therapies – many of which have a poor evidence base for what they do – I suggest you seek out another osteopath or a sports physiotherapist, preferably one who specialises in the back and pelvis, and try again. This is expensive and frustrating, but if it can banish your pain it will be worth it.
Your therapist should be able to give you some kind of diagnosis by the end of your first visit, but with chronic pain the therapist often has to be a detective, trying out one theory and moving on to the next one if that doesn’t work. Stick with it for about four sessions before judging whether the therapist is right for you. You should certainly expect to feel some relief from your pain within that time, but it may take rather longer to banish the pain altogether.
One reason for this is that pain is a very tricky and individual thing. Two people with identical injuries can experience extremely different levels of pain. Once pain is really “wound up”, it may stay that way, even though the damage is small, or healing, or even completely better. Your therapist can help you start to “unwind” it. They should also try to work out what caused the original problem, so that you can prevent a recurrence.
Once things start to improve, look for a “clinical Pilates” instructor and get some highly specialised individual exercise tuition to help correct the way your pelvis and low back are working. Over time (it may take a few months), your pain should gradually fade away.
Meanwhile, you might get some pain relief by lying on your back, knees bent and lower legs and feet resting up on a chair in front of you. Also try a similar position in bed, propping your lower legs up on lots of pillows and sleeping on your back.