Sciatica — What a Pain in the Butt! Can Acupuncture Help?
By Nicole Rasor, Doctoral Candidate of Acupuncture and Chinese Medicine
Chances are you or someone you know has been diagnosed with sciatica or sciatic nerve pain. That’s because according to the Harvard Medical School, as many as 40% of people will suffer it during their life (Harvard Health Publishing, 2016). As an acupuncturist, there isn’t a day that goes by where I don’t treat this condition. Patients come to me and other acupuncturists for help, because most often they were sent by a friend who was successfully treated for their sciatic pain. Some are referred by their physician because of the existing scientific evidence and unsatisfactory results from conventional treatments. A 2015 analysis of 122 studies suggest that acupuncture can be considered in the treatment of sciatica (Lewis et al., 2015).
What is sciatica?
It is not your regular back pain, rather it is pain of the sciatic nerve. This pain is caused by the root or the fibers of the nerve getting pinched or irritated. The pain can appear anywhere along the nerve such as low back, buttocks, upper or lower leg or foot. The sciatic nerve is actually made up of five nerves. It is formed on the right and left hand side of the lower spine. The five nerves come together in the buttocks and become one large nerve, the sciatic nerve. This nerve then travels down the back of each leg, branching out to provide motor and sensory functions to specific regions of the leg and foot.
What does the pain feel like?
Because it can be so complex, almost everyone with sciatica experiences the pain in a unique way. The pain can be anywhere along the sciatic nerve path. The quality of the pain can range from achy to tingling, throbbing, burning and stabbing. The intensity can be a nuisance to so debilitating that it is hard to walk or stand. However, if at any point you have bowel or bladder incontinence, or progressive leg weakness, it could be a sign of a more serious spinal issue. This is a medical emergency and should be seen by an orthopedic physician immediately.
What is the cause of the sciatic nerve pain?
In about 90% of cases sciatica is caused by a herniated disc with nerve root compression (Koes, Van Tulder, & Peul 2007). A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior (Mayo Clinic “Sciatica – Symptoms and causes,” 2018). Other causes for radiating pain in the hip, buttocks and lower extremities include lumbar facet joint issues, sacroiliac joint pain as well as Piriformis syndrome. According to Matt Callison, a leading educator of sports medicine acupuncture, “There is “true sciatica” where the sciatic nerve is directly affected from nerve compression, likely from a herniated disc and, there is “sciatica-like sensations” that can stem from other sources that need a proper assessment.” “While disc degeneration is part of the natural process of aging, it does not necessary lead to low back pain.” 5% of patients diagnosed with low back, buttock or leg pain actually have Piriformis syndrome (Papadopoulos & Khan, 2004). It is a condition where the Piriformis muscle, which is deep in the buttock, compresses the sciatic nerve.
Who is susceptible to sciatica?
Most patients who I treat for sciatic nerve pain are athletes or active individuals who practice sports that require trunk rotation such as golf, baseball and track and field. Others are people with occupations that require frequent sitting and leaning forward. According to Matt Callison, “Although certain postures and motions predispose the lumbar disc to injury, an active lifestyle is better than a sedentary one.” This was also confirmed in a 2014 study where it was shown that by far the greatest change in disc height is after prolonged sitting without intermittent breaks (Billy, Lemieux, & Chow, 2014).
How is sciatica diagnosed?
Radiological examinations can confirm a disc issue. However, as mentioned above, having a disc issue does not necessarily mean that is the cause of the pain. An orthopedic assessment can help the practitioner determine the source of the pain. However, if I personally find inconclusive results, or have a suspicion of more than one source, I will treat multiple locations.
What are your treatment options?
By the time most patients seek help from an acupuncturist, they have had one or more of the following treatments: medications, such as anti-inflammatory or muscle relaxants; physical therapy; steroid injections; chiropractic and in severe cases surgery. In a 2015 study Lewis concluded “The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered” (Lewis et al., 2015). Acupuncture can be utilized alone or in conjunction with all of these therapies. You don’t need to do one or the other. In fact the synergistic effect of more than one modality may do the trick. The authors of a systematic review concluded that acupuncture may enhance the effects of medications in low back pain relief (Qin, Liu, Wu, Zhai, & Liu, 2015). In my private practice I have found that the positive effects of steroid injections are prolonged with the addition of acupuncture. Also, combining acupuncture with chiropractic adjustments or physical therapy or massage can speed up recovery. I have a group of practitioners of various modalities around town who appreciate and encourage the co-managing of patients.
How does acupuncture treat sciatica?
An acupuncturist uses solid, stainless steel, one-time use, disposable, sterile needles. The average diameter of an acupuncture needle is about 10 times smaller than the average diameter of an injection needle and only about two times larger than the average diameter of the human hair but thinner than a cat’s whisker. A practitioner will choose one or more of the Huatuojiaji points of the low back. These points are located on both sides of the spine and are the motor points of the multifidus. The multifidus muscles help to take pressure off the vertebral discs. Other locations include deep needling (still a lot less painful than your massage therapist’s elbow) in the buttock at acupuncture points such as GB30 (located on the buttock 2/3 lateral between the hip and the tailbone) and the Piriformis muscle (located deep in the buttock (behind the gluteus maximus). A 2016 randomized trial of 60 sciatica patients concluded that acupuncture stimulation of the sciatic nerve trunk is effective in relieving sciatica (Qiu, 2016). A 2015 study on rats administered deep electroacupuncture stimulation at GB30 improved the pathological changes and functions of the injured sciatic nerve (Dai et al., 2015). “One mechanism of acupuncture and electrical acupuncture stimulation could be that, in addition to its influence on the pain inhibitory system, it participates in causing transient change in sciatic nerve blood flow, including circulation to the cauda equine and nerve root” (Inoue et al., 2008, p.1). The cauda equine are called this because they resemble a horse’s tail. Just above the cauda equina, the spinal cord ends and it continues on as this collection of spinal nerves through the vertebral canal.
In addition, your acupuncturist will also use points on the legs and other parts of the body specific to your presentation and other signs, symptoms and conditions. Acupuncture as part of Chinese Medicine always treats the whole body. This means that an acupuncture treatment will include treating your sciatic nerve pain but also other problems that may arise such as digestive issues, insomnia, hormonal, endocrine, neurological or emotional issues. Whatever the problems may be, the goal is to get your body and mind optimally functioning. A balanced body will help with the healing of the sciatic nerve.
How many acupuncture treatments will it take to be pain free?
You should start feeling periods of relief between 6 to 10 treatments administered 2 times a week. The longer you have had the problem, the longer it will take to heal. A fresh injury responds much quicker than chronic pain. One reason is that with acute pain, the brain is still actively involved in the healing process. With chronic pain, we need to get the brain reengaged. Additionally, the damage to the sciatic nerve may be more extensive if it has been compressed or irritated for a long time. However, after you experience pain relief, treatment frequency will be spread out according to the length of pain relief. For example, if you had pain relief for 7 days, the next treatment should be scheduled 7 days later. If you are still pain free after 7 days, your next treatment may be scheduled 10 days out, etc. Depending on the cause of the problem such as degenerative disc disease and your activity type and level, maintenance treatments may be required to remain pain free as you pursue an active lifestyle.
Nicole Rasor is the owner of ACTIVE Life Acupuncture, LLC in Oro Valley, Arizona. She has been in private practice for 11 years. Nicole is a Doctoral Candidate of Acupuncture and Chinese Medicine at Pacific College of Oriental Medicine. She is nationally certified in Acupuncture and Chinese Herbology and licensed in Arizona. Nicole was born and raised in Austria. She competed in the 1984 Olympic Games as a springboard and tower diver for Austria, became a US citizen in 1999 and competed in archery for the US being named as a member of the USA Archery National Team in 2011 and 2012. For inquiries and appointments, please call 520-548-1838 or visit our website at www.ACTIVELifeAcu.com
References
Billy, G. G., Lemieux, S. K., & Chow, M. X. (2014). Changes in Lumbar Disk Morphology Associated With Prolonged Sitting Assessed by Magnetic Resonance Imaging. PM&R, 6(9), 790-795. doi:10.1016/j.pmrj.2014.02.014
Dai, L., Han, Y., Ma, T., Liu, Y., Ren, L., Bai, Z., & Li, Y. (2015). Effects of Deep Electroacupuncture Stimulation at “Huantiao” (GB 30) on Expression of Apoptosis-Related Factors in Rats with Acute Sciatic Nerve Injury. Evidence-Based Complementary and Alternative Medicine, 2015, 1-8. doi:10.1155/2015/157897
Harvard Health Publishing. (2016, February 24). Sciatica: Of all the nerve – Harvard Health. Retrieved from https://www.health.harvard.edu/pain/sciatica-of-all-the-nerve
Inoue, M., Kitakoji, H., Yano, T., Ishizaki, N., Itoi, M., & Katsumi, Y. (2008). Acupuncture Treatment for Low Back Pain and Lower Limb Symptoms—The Relation between Acupuncture or Electroacupuncture Stimulation and Sciatic Nerve Blood Flow. Evidence-Based Complementary and Alternative Medicine, 5(2), 133-143. doi:10.1093/ecam/nem050
Koes, B. W., Van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313-1317. doi:10.1136/bmj.39223.428495.be
Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., … Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal, 15(6), 1461-1477. doi:10.1016/j.spinee.2013.08.049
Mayo Clinic. Sciatica – Symptoms and causes. (2018, May 30). Retrieved from https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
Papadopoulos, E. C., & Khan, S. N. (2004). Piriformis syndrome and low back pain: a new classification and review of the literature. Orthopedic Clinics of North America, 35(1), 65-71. doi:10.1016/s0030-5898(03)00105-6
Qin, Z., Liu, X., Wu, J., Zhai, Y., & Liu, Z. (2015). Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2015, 1-13. doi:10.1155/2015/425108
Qiu, L. (2016). A Randomized Controlled Clinical Trial of Treatment of Lumbar Disc Herniation-induced Sciatica by Acupuncture Stimulation of Sciatic Nerve Trunk.
Client Spotlight – Linda Sheehan
1. What was the reason you decided to go to a trainer?
There were actually a few reasons. Mainly, to be able to increase my strength, flexibility, and balance while being careful not to injure or re-injure myself. I don’t have enough understanding of physiology and exercise to know how to do that on my own. Part of the reason for the strength training is to help reverse and prevent additional bone loss. I had also been in an accident about 3 years ago and had not returned to a regular workout program since then other than yoga, and my favorite yoga teacher stopped teaching about a year and a half ago.
2. Did you consider or participate in any other form of treatment for your reason before seeking a trainer?
My physician had me start a regimen of nutritional supplementation, but that alone was not enough to reverse the bone loss. I had done physical therapy after my accident, which was very helpful, until the insurance limit was reached and I had to stop. I also did several sessions of acupuncture, which was also quite helpful.
3. How did you hear about BodyBasics?
It was recommended to me by my Naturopath, Katie Rose. I very much respected and trusted her recommendation. (Glad I did!)
4. Did you evaluate other gyms or trainers before deciding on coming to us? If yes, what were other places missing that BodyBasics was able to provide?
Not really, as the recommendation was quite specific. I had been to other gyms before, including LA Fitness and Planet Fitness, but neither had trainers with the level of knowledge that I’ve found at Body Basics.
5. Ultimately, why did you choose BodyBasics over other options?
I think I’ve answered that in the previous two questions. What I can say is that I’ve chosen to continue at Body Basics for several reasons. One, is the quality of instruction I’ve received, then the willingness of the trainers to listen to me when I have concerns, and their ability to work with any physical limitations that I have and still help me to progress. I really appreciate the collegial approach to training here. I’ve worked with a few of the trainers and have learned valuable things from each one. I always feel welcome here, and not out of place.
6. What goals did you have when you started at BodyBasics?
I’ve already mentioned the immediate goal of doing strength/weight training to help reverse and prevent additional bone loss, but also to start an intentional path to not just maintaining but improving my health and fitness as I age. I recently watched an older relative gradually stop moving and deteriorate over the last decade of her life, and I have promised myself to do what I need to in order not to let that ever happen to me. When I visualize what I want to get out of my training, I picture myself ultimately moving like a dancer, with strength and grace, having complete control and balance, but looking effortless and graceful.
7. How long have you been training at BodyBasics and what specifically have you achieved over that interval?
It’s been about 9 months. I’ve noticed that my balance has improved, my core is stronger, and I find myself noticing my postural alignment on and off throughout the day, and self-correcting for better and healthier movement.
8. What current goals are you pursuing with your trainers at BodyBasics?
Continuing with core strengthening and working up to more weight -bearing movements, all within the overall fitness and balance context that we’ve been doing all along.
Welcome New and Returning Clients
The greatest compliment we can receive is a referral from one of our clients or allied health network!
Pat McMorrow ~ driving by and walking in
Pat and Rod Iverson ~ daughter found us by doing a Google search
Chris Brady ~ found us by doing a Google search
Bill Thephasdin ~ referred by Dr. Martinez at TMC One
Barbara Bailey ~ found us by doing a Google search
Artie Mabbett ~ referred by Dr. Martinez at TMC One
Michelle Marshall ~ referred by Dr. Mike Lee at ProActive Physical Therapy
Jan Lamb ~ found us by doing a Google search
Debbie Greene ~ referred by Dr. Martinez at TMC One
Terry Gardner ~ found us by doing a Google search
“Shout Outs”
Shout outs are about us voicing victories we witness you all having at BodyBasics. We’ll keep it to our top 5 each month.
Burke Krueger ~ for squatting deeper and with more weight now than he was prior to his total knee replacement!
Pat Schumann ~ for her ongoing commitment to keeping the 6 p.m. Monday, Wednesday, Friday Fitness Fusion class alive!
Terry Gardner ~ for already showing such commitment to get the most out of her sessions, so much so that she recently went and bought her own trap bar for home practice!
Gregg Sinner ~ for improving his hip hinge so much that he can now reach down to his pool to sample the water without hurting his knees! Talk about application outside of the studio!
Dee Fletcher ~ for her proactive approach to healing from her ankle fracture! Because of her personal initiative to follow through on her therapy exercises she’s already back to deadlifting 120+ pounds just 10 weeks later!
Recipe – Chickpea Salad Sandwiches
Sharing a vegetarian option today. My chickpea salad recipe is a great way to use those canned chickpeas in the pantry! Enjoy this one, it is a great meal prep option.
INGREDIENTS:
1 (15oz) can of garbanzo/chickpeas beans, drained and rinsed
2 tablespoons plain Greek yogurt
1 medium avocado
1/2 lemon juiced
2 tablespoons green onion chopped
1/4 teaspoon ground turmeric
1/4 teaspoon salt
Pinch black pepper
INSTRUCTIONS:
Mash drained and rinsed chickpeas in a medium bowl.
Add yogurt, avocado, lemon juice and mash again until mixed well.
Add your remaining ingredients and mix/mash until all combined.
Taste and add more seasoning if you wish.
Serve in a sandwich or over greens and enjoy!
Keeps in an airtight container, in the refrigerator for 3-5 days
Ashley is a Tucson native, and the owner of Ashley Munro Nutrition, LLC, were she offers virtual nutrition counseling and meal planning support. She is a trained chef, and certified Intuitive Eating counselor. Through delicious cooked meals and recipes, Ashley shares her passion for food freedom, cooking, and family on her blog. Outside of work, Ashley enjoys running and ice cream dates with her 4 year old.
Basic Moves by BodyBasics – Products for Your Workouts Away from BodyBasics
It’s that time of year again where we say so long for now to our winter visitors. Take the time this month to meet with your coach and determine which of these products would be good for you to have before you leave for the summer! Give us 2 weeks notice for order and delivery.
Community Events
3rd annual “Torture the Trainer” Event! Raffle tickets are available now!
Join us Saturday, April 27th, from 1:30 – 3:30 for our 3rd annual Torture the Trainer event. Purchase raffle tickets for $20 a piece beginning April 3rd at the front desk and start devising! All money raised for this event will be donated to this year’s chosen charity, the Humane Society of Southern Arizona. Last year we were able to raise $1500 for Tu Nidito. Let’s see if we can match or beat that total for the Humane Society! Make any checks payable directly to Humane Society of Southern Arizona.
1st Place “Best Gym” in Northwest Tucson Thanks to All of You!
When the best of lists were revealed by the Northwest Explorer, we found out we were NUMBER ONE! Thank you to all of you who continue to show us tremendous support through your loyalty and willingness to always go to bat for us. We APPRECIATE you all so much! Stay tuned for our newest addition to the wall. We’re going to have to do some rearranging!
Team BodyBasics
Chris, Kris, Kristian, Amanda, Dustin, Chelsea, Xavier and Aaron
