Pioneering neurologist Vladimir Janda once said that "he who treats the site of pain, is usually lost." Janda made this statement at a time when scientists were just beginning to recognize the potential for dysfunctional muscles to cause referred pain, which is pain manifesting in an area distal or proximal to the source of the problem. In the case of sciatica pain, the distribution of discomfort (from back or upper buttock to the lower leg and even toes) can be so long that it encourages the practitioner to determine the source rather than just the location of the pain.
Yet there is much confusion about sciatica pain among patients. And even more disturbing is the confusion among some medical professionals about the various possible sources for sciatica or "sciatic like" pain (pseudo-sciatica). There is a common thread underlying both types of pain; improper muscle function strains the body's structures, including its discs , nerves, as well as its tendons and ligaments, leading to pain conditions like sciatica or "sciatica like" pain in the case of the first two structures listed.
Nevertheless, much of the medical establishment and even alternative medicine practitioners remain obsessed with treating the body's structure, rather than restoring proper muscle function. This often leads to expensive and sometimes unnecessary surgery, or repeated visits to the chiropractor or acupuncturist without a fundamental change in the underlying condition that is the context in which pain develops. This blog entry provides a brief distinction between true sciatica and false or pseudo-sciatica, and to briefly discuss how advanced acupuncture techniques like motor/trigger point therapy, along with traditional acupuncture techniques can effectively treat the location of the sciatic or pseudo-sciatic pain and the underlying factors fostering the pain, by restoring proper muscle function.
True sciatica pain is caused by nerve root compression by a herniated or bulging disc, typically at the level of L5-S1. Psuedo-Sciatica can have a similar pain distribution as real sciatica, but the direct cause is compression of the sciatic nerve by a muscle. Most medical professionals are familiar with the sciatic like pain that can result from the piriformus muscle compressing the sciatic nerve, but other muscles can compress the sciatic nerve, if too tight, including Gluteus Minimus, Gluteus Medius, Hamstrings and Peroneals.
To remove the sciatica pain and heal the underlying disorder fostering the pain, I first conduct a thorough case review, in which I conduct an orthopedic exam to pinpoint the specific muscles implicated in the pain. It is also important to conduct tests that help determine whether the pain is due to true sciatica (as with the Straight Leg Raising Test) or pseudo-sciatica. Furthermore, in the exam, I use manual muscle testing to determine which muscles are weakened from chronic overuse and contraction. I palpate each muscle that could contribute to the pain and see if there is a pain referral pattern that matches the patient's description of the pain's path. With this information, I choose which muscles I wish to target as the source of the referred pain along with targeting the muscles in which the pain is located.
I distally needle vessels that nourish the particular muscle or muscles at issue. In addition, at the patient's second or third treatment, I will needle into motor and trigger points in muscles implicated in the orthopedic exam. The distal needling provides rapid pain relief along with healing of the source of the pain. The motor/trigger point needling resets the muscle or muscles that are chronically tight and putting strain on the body's structures. Several of these motor/trigger point sessions may be necessary to fully resolve the problem. This advanced technique helps to restore the muscle's function and improves its range of motion as well.
It also restores the healthy balance between a muscle and its antagonist muscles. There is a relationship of reciprocal inhibition between each muscle and its set of antagonist muscles. The antagonist muscles of the chronically tight agonist muscle being treated benefit due to a restoration of the proper balance that becomes distorted whenever the agonist is in a chronically contracted state. A return to proper function, enhanced range of motion, and balanced reciprocal inhibition allows for both long term as well as immediate relief.
Because true sciatica arises from a direct nerve root compression caused by a bulging or herniated disc, pain relief from an acupuncture treatment may not last as long as it would when treating a pseudo-sciatic condition. However, needling motor points in tight muscles that have been excessively straining the spine, takes pressure off the spine, assisting the healing of the nerve root compression. Distal needling into joints that are homologous with the spine can also help heal the bulging or herniated disc. With regular treatments that incorporate both distal needling and motor/trigger point therapy, even patients with true sciatica typically experience lasting relief. This approach appeals to patients because it is not only effective in relieving and resolving the pain, but because it helps them avoid costly surgery and countless trips to the office for treatment. In brief, the combination of the traditional distal needling with the advanced motor/trigger point technique reduces the number of visits that are necessary to resolve the problem.
Regardless of the condition, I also provide stretching recommendations for self care/healing. Patients who participate in their healing feel empowered to take other steps that foster greater wellness. If appropriate, and especially if the patient has other health issues that indirectly affect the pain, such as being overweight, a customized herbal formula and program and nutritional guidance are important components of the overall Pain Relief Solution (PSS).
For a free, Freedom From Sciatica Pain consultation to resolve your sciatica or other type of pain, call today!
Return of Function Acupuncture at MindBody Wellness Atlanta