Ask an expert - muscles and bones - sciatica

12 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.

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. 

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