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Ask an expert - muscles and bones

323 questions

We have been asked about the treatment of sciatica many times, and a recent answer was:

As you can read from our factsheet

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sciatica.html

there has been a significant amount of research into the treatment of sciatica with acupuncture, and the results have been increasingly positive. The threshold for being able to make a definite claim is based on a research process for which very little acupuncture treatment except non-traditional formula work will work, but there have been dozens of Chinese studies aimed at finding what works better which seem to show that sciatica responds well to treatment. Certainly this 'expert's' experience is that sciatica seems to respond well to treatment in most cases.

There is no doubt that formula treatment will work to an extent, and there are many medical acupuncturists and 'cookbook' practitioners who will use the same 'sciatica' patients on every patient. The real strength of traditional acupuncture, though, is that it addresses the problem of why sciatica occurs in this particular patient, or more properly why the system does not put right and recover from the injuries which normally cause it. Twenty different people may have the same named condition but be treated in twenty entirely different ways. What this does is not just put the problem right but try to make sure that it does not recur.

There are no special treatments for sciatica, and no specialists, so any well-trained traditional acupuncturist should be able to help you. The best advice, though, since there are one or two cases which would not make us feel so optimistic, is to pop in to see a BAcC member local to you for a chat and to get a short face to face assessment of what is going on. This will not only give you more precise information but also give you a chance to meet a practitioner and see where they work before committing to treatment.

We are surprised that seeing an osteopath has made no difference, but the one strength of acupuncture is that it mainly deals with function, not structure. If an osteopath puts a lower spine back into shape but the surrounding musculature still retains levels of poor function, then it will revert quite quickly. Encouraging better function in the local tissue can of its own accord spring the spine back into shape, as well as balancing up the whole system which in and of itself can achieve good results. Many people come to acupuncture treatment for back and hip problems.

Of course, if the problem is pseudo-sciatica, the most likely cause of which is piriformis syndrome, then this is all the more likely to be the case. The effect of the spasm in this muscle can put pressure on the sciatic nerve which generates exactly the same symptoms as one would get from compression of the nerve root. Acupuncture treatment can be effective in helping to address this as well.

In summary you may well find that acupuncture can help your wife. The real question is how much help and how sustainable the outcomes are. We have great faith in treatment always doing something, but there are times when the effects are short lived and non-incremental, so it is very important to try to establish good measurable outcomes and also to review progress every five sessions or so to ensure that you don't build up an unintentional treatment habit where the weeks can slip by unnoticed.

A great deal depends on whether the damage to the nerve had become permanent before the operation successfully dealt with the disc herniation. It is unlikely that the continuing numbness is a consequence of the operation itself unless it was already impinged and then further damaged by the surgery. If this is the case then the evidence for nerve regeneration through acupuncture is not at all convincing and related mainly to experiments on animals. From a conventional medicine point of view unless there is an obvious site of inflammation, or the operation itself has left scar tissue which is impinging the nerve it is probable that this may be permanent.

However, from a Chinese medicine perspective it may just be possible that what you are experiencing as numbness may derive from changes in the flow of energy caused by first the herniation and then the operation itself. We are not in the business of giving people unrealistic expectations but we have come across situations, especially post-operatively, where changes in the flow of energy, called 'qi' in Chinese medicine, can manifest as a loss of sensation. Reinstating this flow can sometimes start to restore some of the sensitivity of the tissues.

This would be a bit of a long shot, but may nonetheless be worth trying. The best advice we can give, and which applies particularly in your case, is to visit a local BAcC member for an informal assessment of what may be possible based on physical sight of the problem. Most members offer some time without charge to prospective patients to check whether acupuncture is the best option, and if they find that there is a strong correlation between your areas of numbness and acupuncture channels it may convince them that treatment would be worth trying. 

It is always rather difficult to provide the kinds of answer people might like for questions like this. From a Chinese medicine perspective metacarpal bursitis is the kind of problem which we all tend to feel confident that we can do something about, even if we cannot make the problem go away. With its central themes of removing blockage and stagnation moving stuck energy in the form of fluid filled sacs should be highly responsive to treatment.

However, just as there can be any one of a dozen reasons from a western medical viewpoint which someone might have as the underlying cause of the problem, so in Chinese medicine the symptoms might well arise from many different causes. It will depend a great deal on whether this is a purely local problem, brought on by accident or over-use, or whether it is the tip of a much larger iceberg. In this latter case clearing the symptom will only be effective to the extent that the conditions which created it are gone.

Although there is a fair bit of research into osteoarthritis as one of the predominant causes of bursitis there isn't a great deal specifically about the hands, and osteoarthritis is only one possible cause of the problem. The best and only advice we can give is that you visit a BAcC member local to you for an informal assessment of what may be possible. There is no substitute for a face to face look at a problem, one which also allows you a chance to explain in more detail how the problem has arisen, the precise nature of the pain it gives you and the what you have discovered for yourself makes it easier or worse. Most members are happy to give up a small amount of time without charge to prospective patients to make sure that everyone is very clear before committing to treatment what the propects for change are.  


Generally speaking most of us feel fairly confident that we can do something. The only question really is how much that something is and how sustainable the outcomes are.


We think that the first thing you might want to do is to see your GP to rule out any other underlying conditions for which this might be a presenting symptom. The fact that you are unable to lie or sit comfortably suggests something quite a deal more problematic than a simple muscle strain, and there are a number of health issues, like niggling gall bladder problems, which can generate referred pain in the shoulder area. On the surface these feel like muscular pains but actually aren't, so you need someone with an expert medical eye to have a good look first to exclude anything which needs conventional treatment. This is unlikely, but it is probably what we would recommend if you came to treatment.

If it is a simple muscle spasm then it is quite possible that acupuncture might well be able to relieve the pain and also reduce or remove the cause. All versions of acupuncture, both traditional and medical, have ways of understanding this kind of symptom and clearly defined protocols for dealing with the problem. Obviously we believe that traditional acupuncture offers slightly more, because in our experience a symptom is usually the outward manifestation of a more deep rooted imbalance. While in many cases treating the symptom will clear it for good there are often times where not looking at the overall picture will just offer temporary relief, and when the symptom returns the patient will conclude that the acupuncture hasn't worked, which is a shame.

Generally speaking, though, traditional acupuncture is premised on the good flow of energy, called 'qi' by the Chinese' and treatment is aimed at adjusting the flow and balance of energy to ensure good function. There are some occasions, though, where other interventions, like chiropractic and osteopathy, can deal with structural problems very directly, if these are the cause of the problem, and we often work alongside colleagues in both traditions to ensure that structure and function are treated together.

Without more detail, though, there isn't much more that we can say. The best advice we can give is that you visit a local BAcC member so that they can actually see the problem and talk in a little more depth about how it started and what works in relieving your discomfort. This will give you a far better idea of what may be possible. Most members are only too happy to give up a little time without charge to prospective patients so that they can offer a more balanced view of whether acupuncture treatment might help.

 

There is certainly some good-ish evidence for the treatment of cervical spondylosis with acupuncture. As our factsheet shows

 

 

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

 

there are several good quality trials which suggest that acupuncture can reduce the neck pain with which it is associated. We have searched the databases for any further and more recent research, but while two studies are in development there is nothing else to report.

 

 

We always tread with caution when advising on the use of acupuncture, though. From a western medicine point of view this is a 'wear and tear' problem for the treatment of which the best that can be achieved is a reduction in the deterioration, getting worse slower, and some reduction in the pain caused by the inflammation. If the pain and discomfort is a recent phenomenon it suggest that the inflammation caused by the problem is not yet too severe, and that there may be some hope of significant reduction.

 

 

From a Chinese medicine perspective pain arises from blockage and stagnation in the flow of energy, and the use of needles is intended to restore normal flow and balance. Physical problems, changes in structure, can have an impact on the flows of energy, especially in the neck, and while acupuncture is never going to correct the changes in physical structure, it can often restore flow and remove pain.We see this quite often with lower back pain associated with crumbling of the lumbar spine, or shall we say attributed to the damage seen on X-ray. We have seen many cases where the X-ray remains unchanged but the pain has reduced.

 

 

As far as cost and frequency of treatment is concerned, that is almost impossible to say. In Greater London the cost of a first session is often in the £50-£70 range with follow up sessions perhaps £40-£60, where in the rest of the UK prices are likely to be £10 lower. There are a number of community based multi-bed clinics where treatment is offered in a group setting at much lower rates, and most members are prepared to discount treatment for those with financial issues. NHS treatment free at point of delivery has become a great deal more difficult to find, and it is a matter of luck whether you have a doctor near you who may be able to offer a number of sessions within GP practice.

 

 

Frequency of treatment is usually more predictable. Unless someone has acute pain treatment tends to be weekly, but with chronic conditions with an underlying physical change of structure you will find that most practitioners will review progress after four or five sessions to see what has happened. At this stage it is worth establishing clearly whether there has been a change and how sustainable any change has been. If the effect has been small and short-lived it may be worth exploring other treatment options.

 

 

The best advice is to contact a local BAcC member and see if they are happy to give up a little time without charge to have a face to face chat and look at the problem. Most do, and this will give you a very clear idea of what may be possible in your specific case. 

 


 

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