Ask an expert - muscles and bones - sciatica

11 questions

Q:  I have bad sciatica had 3 visits to a chiropractor and started to feel a bit better  yesterday.  I was given acupuncture in the bottom of my spine.  The needles caused me a lot of pain when inserted and since then I am in so much pain feeling  like raw nerves -  is this normal ?

A:  We would hesitate to use the word 'normal' in circumstances like this but it can happen.

 There are two possibilities. First is that the treatment has caused an exacerbation of the original problem. This can happen with treatments for back, neck and sciatica types of pain, and if this is the case then the feeling will subside within 48 hours, or by the time you read this reply. Many health professionals like us, osteopaths and chiropractors do warn people that this can happen, and take it as a good sign that the treatment has 'engaged'. 

 The reaction is not usually that severe, however, normally the existing problem plus a bit more, so we suspect that the problem may well have been caused by the treatment. Chiropractors are not within the mainstream of acupuncture practice within the UK, and many learn small amounts of acupuncture for treating specific problems within their scope of practice. This can mean that there use of needles is slightly more hard-hitting than, say, a traditional acupuncturist who is trying to move energy. Trying to get a neuro-physiological effect can sometimes mean using thicker needles and deeper insertions, and with that the risk of a bruise or a slight nerve impingement increases considerably. This does not usually mean permanent damage; even when people do suffer treatment injuries very few indeed cause more than a short lived problem. It does mean, though, that there can be a very different kind of post treatment pain, often sharp and severe.

 The best thing to do is to discuss the problem with the person who gave you the treatment to see if they can provide any illumination about where they were needling, how deeply and with how much manipulation, to get a sense of what damage might have been caused and how quickly it will resolve. If it carries on for a week then it would be advisable to arrange a GP appointment for the doctor to have a look at what is going on, and possibly prescribe some pain relief.

 The chances are that the reaction is the former. We certainly hope so, and this will mean that it has resolved by the time you read this. If it hasn't, then it would warrant further investigation

A:  As you can read from our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1138-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.



A:  This is always a difficult question to answer.  The great Canadian physician William Osler once said' tell me not what kind of disease a patient has but what kind of patient has a disease.', and the traditional Chinese medicine system rests on a similar kind of premise. Not only would the presenting cause make a difference but also the overall constitution of the person. Sciatica from a jar in a sporting contest in a teenager will heal differently from that caused by a fall in a seventy year old.

What we tend to say to patients is that there should be some positive changes within three to four sessions, and our job then is to assess how much change and how sustainable it is. If there is a day or so of reduced pain which then returns, and this happens three or four times, then it may be an indicator that the treatment isn't really doing anything more than provide short-term pain relief. If the effects are slowly incremental, getting a bit greater and enduring with each session, then it is a matter of careful management to ensure that the changes justify the expense of treatment. Many of us also work closely with local osteopaths and chiropractors, and we often cross-refer to ensure that if there is a physical misalignment that this is addressed alongside what we do to speed the process up.

Our factsheet on sciatica

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

is very encouraging about the effects of treatment, and underpins our own sense that even where progress is slightly slower, i.e. more than four or five sessions, there is a good chance that it will ultimately have a positive outcome. The only common sense measure is to keep treatment under rolling review to avoid running up a large bill without realising.

Q: I am having physiotherapy for what I understand so far is a right sacro iliac joint problem vs right L3. L4 nerve compression. My physio has suggested a course of acupuncture may help the stinging and sharp nerve pain that I am experiencing in my right leg from knee to calf. Particularly bad at night. Is this good information and how do I find an appropriate accupuncturist near me? 

A: We think that the physiotherapist's assessment of the value of a course of acupuncture treatment is probably well-founded. 

From what you describe your symptoms are very similar to what many people would call sciatica. We have produced a factsheet on this

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

which makes some very encouraging remarks about the growing body of research supporting the use of acupuncture treatment. When we conduct patient surveys online, we find that sciatica is high on the list of conditions for which people have sought a practitioner.

A great deal depends on the exact presentation of the symptoms and how significant the weakness of the sacro-iliac joint is. If there is still considerable work to do to stabilise this by building up the muscles, then it may be a case of two steps forwards, one step backwards in terms of controlling the pain. Once the joint has become more stable then treatment tends to be more effective at settling the discomfort for longer periods of time.

The best assessment of problems like these, however, is done face to face. Normally we advise people to seek out a member and see if they will offer a few minutes without charge to see whether acupuncture would or could help. A referral from a physio, though, is pretty much always based on a good assessment of what will help, and physios tend now to be very knowledgeable about acupuncture treatment even if they do not administer it themselves.Ca

The best way to find a practitioner near you is to use the 'find a practitioner'search facility on our home page www.acupuncture.org.uk. This is postcode based and much more sensitive than an area search in finding the nearest BAcC members to you. 

Q:  I had a crushed disc (L5)diagnosed in 2005 which was treated at the time with traction. For the last 4 years or so I have suffered sciatica in my right leg (down the back of the thigh from the hip and down the side of my right calf into my ankle. I recently had acupuncture to try to improve this and it seems to have worked, the pain has gone. Unfortunately,  the same weekend that the pain went my foot dropped  I am now struggling to walk. I'm awaiting an MRI scan and my consultant doesn't believe the acupuncture cured the sciatica but my question is could what worked on the sciatic pain have caused the drop foot?

A:In our view it is extremely unlikely that there is a direct causal relationship between the acupuncture treatment and the dropped foot. 'Dropped foot' is normally caused by some form of nerve impingement, and if someone has needled directly into or adjacent to a nerve you would have been in no doubt that this had happened.
 
The only thing that we can surmise is that after the disc had become crushed there had been a significant tightening of muscles in the area to guard the disturbance, and that this may have exacerbated the nerve impingement causing the sciatica or even been its direct cause. Acupuncture is well-known for its properties of relaxing tension in muscles, both in eastern and western versions, and it is just possible that the relaxation of the muscles which have caused the sciatica has in turn allowed a second impingement to happen, causing the dropped foot.
 
This is all speculation, however, and the MRI you will have will probably show what is going on. We're not sure what kind of consultant you are seeing, but if he or she is a neurologist they should be able to pinpoint exactly where the impingement lies which is causing the dropped foot.
 
Further treatment with acupuncture may, in fact, be able to help with the problem you now have; it is not unknown for the treatment of one problem to uncover a secondary problem, and so on. However, a great deal will depend on the source of the problem and whether it is actual physical damage to the discs and/or vertebrae which is causing the problem. If not, then from a Chinese medicine perspective any weakness of movement in a limb is usually regarded as a blockage in the flow of energy, or 'qi' as it is called, and treatment would be aimed at restoring this flow and removing the symptom.
 
This is something which your practitioner will be only too happy to discuss with you, to see if you can be relieved of both problems.  

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