<s>[INST] I am now having severe right buttocks pain, which has gotten worse after two cortisone shots, physical therapy for 11 sessions and an xray was taken in the begginning. Do you think my next step will be an MRI to determine what the pain is coming from? [/INST] Hi, thank-you for providing the brief history. As the history suggest that this is more of a lumbar spine disc degenerative disease. As due to nerve root impingement in the lumbar spine the sciatic notch in the gluteal region will have a severe pain and needs a thorough clinical examination and an MRI to understand the pathology of the lumbar spine. Infact with 11 sessions of physical therapy the pain can not come down and may need more sessions as well. Taking therapeutic ultrasound therapy and TENS therapy should help control the pain symptomatically and exercises will play an important role in stabilizing the spine and also improving the muscle strength to hold the spine without leading to nerve root impingement. In my clinical practice most patients need more than 15 sessions of physical therapy, and they respond well. Regards Jay In Chat Doctor.  </s>