Sciatica is a common presentation in my clinic. It usually occurs as a result of spinal nerve root impingement in the lumbar region. The most common causes are bulging or herniation of the intervertebral disc or discs at the vertebral joints L4/ L5 and or L5/S1.
It is interesting to note that the majority of presentations are a result of a posterior bulge, which can lead to central canal stenosis, lateral canal stenosis and/or foraminal stenosis. It should be noted that lateral bulges also present, however these appear to be less common and effect mainly the lateral and foraminal aspects.
The spinal nerve(s) are impinged or compressed within these areas of stenosis to varying degrees, which results in varying presentations within the sensory and, less commonly, motor spheres. Pain, numbness, tingling and temperature sensations are the most common sensory symptoms, whilst drop foot is the most common motor issue. Of course, many patients may have reduced mobility due to pain or numbness as well.
Some other common causes include arthritic changes, especially at the exiting foramen; spondylolisthesis, usually anteriorly; and impingement due to tightness in the piriformis muscle.
Traditional Chinese Medicine (TCM) looks at sciatica in a few different ways. The main meridians affected are the Urinary Bladder and Gall Bladder. Usually this can be interpreted as a blockage or stagnation of energy and blood along the meridian. It is important to note that symptoms often don’t occur along the entire length of the meridian and may centre at other pivotal acupuncture points. This idea corresponds to the relevant spinal nerve dermatomes as well, the symptoms can occur anywhere along the nerve pathway and may migrate from time to time.
A full TCM diagnosis is required to determine the underlying pattern of disharmony which is leading to the deficiency or excess pattern in the lumbar region. Some common patterns include kidney yin, yang, jing and/or qi deficiency, liver qi stagnation or cold invading the lumbar region. Of course, there a multitude of possibilities, however the point is that the underlying pattern must be addressed otherwise the symptomatic treatment may be just a stop gap until the next episode occurs.
I like to treat sciatica using a mechanically based method which is underpinned by resolution of the base pattern of disharmony. As discussed above, the most common cause of sciatica is a bulging disc impinging a spinal nerve root. When there is pathology of this sort the musculature of the lower back will tighten up to protect the joint from further damage. This includes not just the superficial erector spinae muscle groups, but also the deeper muscles such as the multifidus and interspinales. The key to good treatment results is to firstly release the deep muscle groups.
The best way to do this is to needle the relevant hua tuo jia ji points. In acute cases, and in many chronic cases, the patient may experience a strong twitch response and a dull heavy aching sensation. Sometimes this is all that is required, for the first treatment, to begin the process of loosening up the lumbar region to open deep anatomical space so that the disc can begin to migrate away from the nerve. Releasing the psoas muscle can also be beneficial.
Often, I will insert a shallow needle lateral and superior to the main needle and run high frequency electric current between the two needles. This should induce a buzzing or vibrational sensation, which is painless. This appears to further enhance the migration of the disc away from the nerve root and reduce local inflammation.
As discussed above, the use of the appropriate acupuncture points along the meridians and within the diagnostic framework is critical to long term resolution. Strengthening the abdominal and pelvic floor muscles helps to buttress the spine and take pressure off affected joints, weight loss is also usually helpful.
Treatment protocols vary from patient to patient. However, the best results are often achieved with 2 treatments per week for the first two weeks, and then weekly after that.
Momentum is key to a good outcome!
Safe Sciatica Solutions – YouTube
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