Sciatica or Sciatic Nerve Inflammation
Sciatica is the most common disorder seen in the acupuncture clinic. It is a form of nerve inflammation and getting rid of inflammation is what acupuncture does best.
Sciatica is not a conventional medical diagnosis. It has several possible causes and these may lead to different treatments, so we use the term sciatica to describe a set of symptoms. These may include back pain but there may be only hip, leg pain or even foot pain. Sometimes there is minimal pain and the patient mostly suffers from numbness or tingling, we call paresthesia. There may be leg weakness or coldness. The presentation is quite a bit variable and usually manifests on one side only.
There may be aching, stabbing or burning pains. There may be spasms, shooting pain or the leg may give out causing a fall.
drawing by Justin Bean
Some of the more common causes of sciatica include the idea of the nerve getting pinched. Nerves hate to be placed under pressure, they react, often sending the message to “get off”. Pressure can cause the nerve to become inflamed and inflamed nerves make us miserable. A nerve cell is supposed to carry the signal, be it hot or cold or pain or whatever. When the inflammation causes the nerve to malfunction, the pain is off the scale.
The pressure may come near the spine where the nerves that feed the legs emanate. It may occur in the hip joint or near the muscle known as piriformis. In most cases, the inflammatory process itself, encourages increased pressure, by causing the tissues to swell.
drawing by Justin Bean
Many different therapies have been used over the years. Everything from simple postural adjustments to reconstructive spinal surgery may be considered. One stubborn case was traced to the patient carrying a large wallet in their back pocket. Sitting on it, especially while driving, caused pressure on the nerve and initiated the syndrome. Transferring the wallet to a front pocket solved the problem.
drawing by Justin Bean
For my patients, sitting posture often has a profound effect on the course of their condition. We sit in the car, on the couch, in front of the computer, when we eat, or read, or watch or go out. Sitting is a very un-natural state. It is potentially very injurious. Large scale studies find sitting to increase mortality, meaning it causes people to die before their time. Problems with metabolism, circulation, digestion and immunity among other systems, exacerbated by sitting, increased the risk of what researchers called all cause mortality.
But sitting is really hard on the back. Tremendous strain is placed on the low back and hips especially when slouching.
Maintaining a lumbar curve while seated often improves the outcome. In some cases it was all that was needed. If the condition was caused by improper seated posture, I would first try correcting it.
drawing by Justin Bean
Here we see two different postures. On the left is how we all sit. The right looks better. It is very difficult if not impossible to train yourself to sit up straight. You just cannot remember with the sort of consistency required. As soon as you move your attention to what you are doing, like driving, the low back flattens out and the whole back looks like a big “C”.
I suggest a lumbar support. Not the kind intended for that purpose, another sort. This could be a conventional couch cushion. The idea is to select a support that is big enough and firm enough to prevent your lower back from flattening out and looking like a “C” (on the left). We want the support to help our back take on the shape of an “S” (on the right).
drawing by Justin Bean
More invasive treatments include spinal manipulation or massage, hot or cold packs, stretching or strengthening exercises, ointments and liniments as well as injections of various types and in various locations and of course surgery
drawing by Justin Bean
Depending on several factors, the symptoms of sciatica may vary. Even in the same patient, there may be dramatic variation from one moment to the next. This is common when nerves get inflamed. Any treatment strategy that does not include a differential diagnosis, the attempt to figure out why the nerve is inflamed, should be carefully considered.
Nerve inflammation hurts so bad it can make the patient desperate for relief. They may be willing to take any risk for the chance for quick relief, it is our responsibility as practitioners to try the most effective and most conservative modalities first.
For this purpose, acupuncture is unrivaled. It is without risk, highly effective and not difficult to endure, as it is painless. It is also accessible to all, whether or not they have medical insurance. It doesn’t always work, but when it does, the relief comes quickly and often results in a permanent solution.
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