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Ask an expert - muscles and bones - sciatica

15 questions

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 having 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 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?

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


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.

Q: After having a hip replacement and then mri scans in my  hip and then the pelvic area,  it was diagnosed by exclusion of other possibilities that I had piriformis syndrome and i  have tried physiotherapy.  As  yet I have no relief from nerve pain in my buttocks going down my leg to my foot. I tried 2 sessions of acupuncture with a chinese acupuncturist in Dukinfield, who targeted the source of the pain,  but I have not seen any improvement. The pain is brought on by playing golf with the rotation of the hips and impacting on the left side of my buttocks.  It is a sharp pain that travels down the outside of my leg to my foot.  Can you recommend how this might be treated.  I might add that this has now been going on for some 10 years

AThis is one of thise questions where sight of the problem is pretty well essential. Everything in the lower back area which causes pain to travel down the leg tends to get lumped under the general heading of 'sciatica' and there are two classic presentations, one down the posterior surface of the leg and one down the lateral margin, which are the standard presentations in both conventional and eastern medicine. In the West they determine which of the vertebral discs and nerve impingement are causing the problem, while in eastern medicine it is further understood as a pathology in one of the channels of energy. This is why your Chinese practitioner can deliver such a clear statement, and as our factsheet shows


there is a certain amount of confidence which one can take from the research available.

If the definition of piriformis syndrome is conclusive there are fewer studies of the use of acupuncture treatment for this, although many articles such as this one


from our equivalent US organisation which offer fairly standard treatment options.

Ten years, however, is a long time, and suggests that there may be something structural which is misaligned, since in the words used in NLP, 'if you always do what you always did, you always get what you always got.' Golf is a particularly asymmetric exercise, with the swing putting an enormous amount of strain on the body both at the point of acceleration but more crucially at the point of deceleration where the follow through sees the muscles being pulled quite hard and a form of rotation carrying on. There is certainly one school of Japanese acupuncture thought which sees this rotation on a par with a seat-belt injury where a person is thrown forward in a car accident. The belt is diagonal, so the torso twists around it. There are treatments specifically designed to re-align the central axis of the body.

Our first suggestion, though, might be to see what an osteopath makes of your overall structure. It could be that the hip replacement has caused the pelvis to be very slightly out of alignment, and this, even at very small amounts, would be sufficient to cause discomfort if the body is stressed under rotational forces.

As we said, though, ten years is a long time. Although acupuncture can sometimes work very quickly with longstanding blockages, ones which spring from misalignment can take longer because the body learns to regard the misaligned form as 'natural' and it can take a while to straighten up again. There may well be degrees of pain relief on the way, but it may take a while to maintain pain-free intervals. The experience of Alexander Technique teachers is that the body gets used to 'poor use' and it can take a while to encourage it back to normal position and function.

Q: Is face lift acupunture- safe and effective  Also is  acupunture for sciatica effective?

A:  In the hands of a properly trained and qualified practitioner acupuncture remains a very safe practice. There are very few reports of adverse events, and most are minor and transient, resolving within a matter of hours.

'Face lift acupuncture', also known as cosmetic acupuncture and facial acupuncture has been somewhat problematic for the BAcC. A substantial number of members practise this form of acupuncture, and most use it within the context of an overall understanding of the system in Chinese medicine terms. However, an increasing number of people are learning about the technique in isolation from the main body of acupuncture training, and using it in a very pragmatic way. This may mean is is not effective, and may also increase the risk to patients - BAcC members are trained to avoid making mistakes and to know what to do if things go wrong. Someone undertaking a very short training in just the techniques may not have this grounding, and when you are talking about someone's appearance, this is not an area to be working untutored.

Whether it is effective is an entirely different matter. There is no research of which we are aware which would provide incontrovertible evidence of success, and there are always going to be people whose 'before' and 'after' photos are going to look stunning. Everything works for some people, but rarely does something work for all people. The best advice we can give if you decide to have cosmetic acupuncture is to visit someone who is trained properly in acupuncture as a whole, not just someone who may or may not be a healthcare professional who has had a brief training.

As far as sciatica is concerned we can speak with greater confidence. As our facsheet shows


there is an increasing body of evidence which suggests that acupuncture treatment may be beneficial in the treatment of sciatica. This is not conclusive to the extent that we can make advertising claims about it, but along with back problems it was one of the most common reasons for people to seek treatment in an online survey some years ago.

The best advice we can give is to visit a BAcC member local to you and seek face to face advice. Some manifestations of sciatica may need the help of an osteopath to make structure corrections, and some cases are caused by physical deterioration in the lower spine which no amount of acupuncture treatment can reverse. It is important to establish whether it is treatable and also what has been tried already to ease the problem. On that basis a practitioner can give you a good idea of how well you may respond and how many sessions it may take.

Q:  I have my leg in plaster would I still be able to have acupuncture for my sciatica?

A:  The answer is 'yes.'
The strength of Chinese medicine is its flexibility in situations like yours. If the practitioner needs to move energy in the area where the sciatica manifests it is possible to do so either by using local points or what are called 'distal' points, points which often lie at the end of a channel or meridian which flows through/under the plastered area and which can have an effect on the area even when far away. This can often be confusing for patients when they have treatment for headaches and have needles stuck in their feet, or finding that a first aid point for haemorrhoids lies on the very top of the head, but when we show them our charts and diagrams they can see that it makes perfect sense.
In cases where a limb is in plaster it is very common to needle the opposite limb in the points where the plastered limb would have been needled. The channels of the body are bilateral, and the received wisdom is that there is a resonance between the two channels such that needling one will affect the other. For people in plaster this is the most common approach to treating a 'concealed' problem.
The only question we would want to resolve before treating someone for sciatica where they were in plaster was how much the injury was contributing to the condition. It may well be that the plaster is a major factor, in which case one might have to be slightly more cautious about making estimations about prognosis.
The evidence for the use of acupuncture in the treatment of sciatica is good, although not yet conclusive, as our factsheet shows

Q:  My mum is experiencing severe sciatic pain at the moment and has tried a range of pain medications, most latterly morphine, and this is not relieving the pain at all. It has been going on for a period of 3 weeks now and it is limiting her ability to mobilise. She is incredibly low as a result. Although she is reluctant to consider acupuncture I'd really appreciate it if you could direct me to some resources which she may find encouraging/provide advice?

A:  We have a fact sheet on our website which provides some, but not very helpful, background - it is probably too technical and not accessible enough for someone who is simply trying to weigh up the benefits of treatment. The sheet
also refers to other factsheets on back pain and arthritis, both of which can be found on the home page of the website under the button for research and sub-section factsheets.
There are a number of 'lighter' articles on the internet, largely from the US and from Australia, an example of which is
but what is of concern to us is that the pain has become so intense that your mother requires morphine. The majority of cases we see tend to be caused by disc problems or accidents, but the great majority, while extremely uncomfortable, do tend to be bearable in some positions. The need for morphine suggests something altogether more acute, and this would tend to make us think that acupuncture treatment may not be as effective if there is a direct physical cause involving, say, the complete collapse of a disc.
Acupuncture can certainly be used for general pain relief, and in fact this is one of the more heavily researched areas of treatment, especially because the neurotransmitter chemicals involved in pain are well understood and easily measured. Again we have a factsheet
which talks about this. The only question with pain relief treatment is how much relief someone can get and how sustainable the relief is. This can often become a question of finances, unfortunately; if treatment buys two days of relief, it can become an expensive process to maintain the reduction in pain.
However, the first thing is to establish whether acupuncture could be of benefit, and that is best done by seeking the advice of a BAcC member local to you who can assess your mother's case far better face to face than we can here. The second point to make clear is that acupuncture will do no harm; it is a very safe treatment with a very low incidence of adverse effects. The treatment itself is unexceptional, and for someone who is dealing with pain at the level of your mother's current experience the needles will be almost imperceptible.
In cases like this we often suggest to a prospective patient that a course of four or five treatments would be enough to assess how well a person is responding and whether further treatment is worthwhile. However, as before, we would be concerned about someone in such pain as to require morphine, and we would see how much more investigation was possible within conventinal medicine and work with the patient to ensure that they receive all the help which is possible.     

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