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Ask an expert - muscles and bones - sciatica

15 questions

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.  

Q:  My husband has had sciatica on and off over the past 2 years.  He has had a lot if private physiotherapy and  is under the GP for the pain.  He is taking  all sorts of strong painkillers.  He had to go to A&E due to the amount  of pain he was in. He has had an MRI scan and is waiting for the results but over the last 3 days he has been in agony. He  seems to be taking lots of different painkillers without any effect on the pain. He is running out of options would acupuncture be of any help to him?

A:Our first advice would always be to see what the scan reveals before committing to treatment. Acupuncture treatment may be able to help relieve some of the pain he is in - this was, after all, one of the main effects of treatment which came to notice in the West and into which a great deal of encouraging research has been done - but if the scan reveals something more substantial either damaged or out of alignment this may well need sorting out by conventional means. Acupuncture may well be useful for pain relief while he awaits the next option, but may not be able to sort out the underlying problem.

However, we are quite used to being the treatment of last resort, and it is not uncommon for us to have patients who come to us with pains which defy explanation by all of the sophisticated testing now available. One of our first tasks is often to describe the basics of Chinese medicine to explain how pain can arise as a blockage in the energy of the body, called 'qi' by the Chinese, and how we set about resolving blockages. This can sometimes mean treating in the area where the pain is, but is almost invariably accompanied by treatment to help the body re-establish proper energetic flow and balance. This can sometimes mean needles a long way from the site of the pain, which can confuse patients, but from a Chinese medicine perspective most local symptoms, however extreme, are often an indicator that the body's ability to sort its own problems out is not functioning as well as it might, and treating the root as well as the branch is often necessary.

Sciatica is, in fact, one of the named conditions for which considerable research has been done, and although our factsheet is cautious in summarising the results of studies

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

it is one of the more frequent conditions for which people seek help from BAcC members, and anecdotally one which tends to respond well. It is certainly a condition which this expert approaches with some confidence. One of the great strengths of Chinese medicine is that it takes particular care to understand exactly how the problem manifests, and this means that each treatment is often unique to the individual, even though there are a few frequently used points for all cases. We tend to find that the term sciatica is used rather loosely in conventional medicine for a wide range of problems even in orthodox treatment, and we believe that the differentiation which we do as a matter of course can often pinpoint what is going on in a way which enables us to deal with the exact manifestation.

As always, our advice is to visit a BAcC member local to you for advice. Because the term sciatica is used as a catch-all for a number of problems, it is always best to see someone face to face who can give you a much more precise assessment of whether treatment may be beneficial. Most members are more than happy to give up 20 minutes without charge to ensure that if someone books in it is with a clear idea of the possible outcome and time scale for treatment.

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