Sciatica: What is it & How Do I Treat it?

Common Misconceptions can delay or prevent treatment of the problem

Almost everyday someone asks me if acupuncture can help their sciatica because they haven't been able to find anything that works. And the answer is of course it can help. Here is a great meta analysis for you science geeks. TLDR? Don't worry I got you:
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• "Following a comprehensive search of eight electronic databases, 12 studies (1842 participants) were included in the review. Analysis of outcomes revealed that acupuncture is more effective than medication for individuals with sciatica for effectiveness (RR 1.21; 95% CI: 1.16–1.25), pain intensity (MD −1.25; 95% CI: −1.63 to −0.86), and pain threshold (MD: 1.08; 95% CI: 0.98–1.17). The pooled results of this meta-analysis indicate that acupuncture is clinically effective, reduces pain intensity, and increases pain threshold in patients with sciatica compared with medication. "

Okay now that we know acupuncture can help sciatica, let's get to the key part of this post - ​the basic misunderstanding of sciatica:

• Sciatica is not a diagnosis it's a syndrome

Okay, but what's that mean? A diagnosis is the reason a thing is happening, and a syndrome is just a description of the pain. E.g. Kidney stones are the diagnosis behind urinary pain. This may just seem like semantics but it's important that you know the mechanism causing your pain or you might not be getting the appropriate treatment. 

Sciatic pain can be caused by a number of things, but is most often caused by a disc issue in the low back - which could be caused by a degenerative problem, a herniation, pregnancy, and even spondylolisthesis. Imaging such as x-rays and MRIs can help us learn if there really is a disc issue. But honestly lost of people have disc problems who never even have any symptoms.  So even when people have sciatic pain are diagnosed with a disc issue, that might not still be the root cause. Often times sciatic pain is caused by something caused Piriformis Syndrome and has nothing to do with the low back. Here, take a look at the sciatic nerve:

As you can see it travels all the way down the back of the leg after it comes out from the lumbar spine, and goes right underneath the piriformis muscle. So when the muscle is very tight it can also compress the sciatic nerve, causing the exact same symptoms as lumbar based sciatic pain. If you have a piriformis problem but no one ever treats it, then you're not going to get lasting results. Of course some distal treatments on the channel can relieve some pain, but that tight piriformis is still there and it's going to start impinging on the sciatic nerve again. Thus, proper diagnosis is very important for effective treatment. 

Luckily there are a number of physical assessments that a provider can do to determine if the issue is back related, piriformis related, or in some cases even both. So here's the rub, you're going to have to advocate for yourself. If your provider hears your symptoms and diagnoses you with "sciatica" but never does any physical assessment (or even simple palpation), then you may need to go see someone else who has a better understanding of the complexities involved with sciatic pain.

​Finally, when you and your provider figure out what is causing the sciatic, then the treatment approach can be determined and your protocol can start. With low back and spinal/disc related sciatic pain, working on the low back with acupuncture needles can decrease pain by stimulating blood flow and relaxing the muscles which puts less strain on the spine and discs. Acupuncturists also use a variety of distal techniques meaning they can treat the pain in the channel from different areas of the body, so don't be surprised if they put needles all over the body.  For piriformis related sciatic pain, the focus will of course be on the piriformis and releasing this muscle's tightness to let up the pressure from its exerting on the sciatic nerve.  One easy way to get yourself feeling better is to use a foam roller to go across the piriformis and glutes. 

If you're struggling with sciatic pain, contact Red Raven Acupuncture and come in for an assessment and see if you would be a good candidate for this approach. 

​Stay healthy, friends!
​~The Red Raven