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What is sciatica? What is not sciatica? The term sciatica gets thrown around by patients all the time whenever they are experiencing back pain. In all honesty, sciatica is an archaic word in the medical world and not truly a definitive diagnosis. The term is typically used to define low back pain that is felt down into the legs. The true term for this symptom is radiculopathy. This is when a nerve root is compressed, commonly by an intervertebral disc (IVD) that has been compressed and pressing on the nerve route, aka DH (disc herniation). Each nerve exiting from the nerve root of the lumbar vertebra controls particular areas of the lower body (see below video on myotomes). To treat this kind of back pain, you want to identify where the compression is happening.
The sciatic nerve is a large nerve (16-20 mm in diameter) that originates from the spinal nerve roots of L4, L5, S1, S2, and S3. The sciatic nerve becomes two nerves bundled together, the tibial and peroneal nerve. The sciatic nerve travels through the pelvis, down to the knee, and then the two nerves branch out, the tibial to the posterior lower leg and the peroneal to the lateral part of the leg.
The sciatic nerve can be affected by HD as well as spinal stenosis (narrowing of the spinal canal that compresses the nerves), pregnancy (increased pressure on the nerve), and tightness in the piriformis muscles, piriformis syndrome. Piriformis syndrome is also known as “pocket wallet syndrome” since having a wallet in the back pocket sits on the piriformis and causes entrapment of the sciatic nerve. I hope after reading this, if you keep a wallet in your back pocket you stop doing that. Stretching and not sitting for long periods of time can help treat and prevent piriformis syndrome.
One presentation of low back pain I see in my clinic that gets blamed on the sciatic nerve is when the pain ONLY goes to the back of the knee. This is NOT nerve related. Radiculopathy will result in pain/numbness/tingling that travels down the entire leg. If you feel the pain that stops at the back of the knee, this could be due to a trigger point in the gluteus minimums muscle. Dr. Janet Travell termed this muscle pseudo-sciatica. 1
Written by Dr. Samantha Hodges, DAOM, L.Ac. July 8. 2020
What can you do about your back pain? Acupuncturists with additional training in neurological and orthopedic examinations and techniques can examine you to see if there are neurological symptoms presenting that can suggest a DH or if there is more of a muscular-skeletal presentation. When I am treating a patient that comes in with ‘sciatica’ as the chief complaint, I always examine the nerve roots of L1-S3 and well as the muscles from the waist down, postural alignment, and gait. If there are significant signs of neurological defects, I always recommend seeing an Orthopedist for further imaging and examination. Acupuncture has been shown to be effective in reducing pain and symptoms associated with DH and musculoskeletal issues resulting in low back pain. 2 In addition to relieving back pain symptoms, acupuncture is can help reduce stress, aid in digestion, improve sleep, increase immunity, and overall well-being.
There are several things that you can do on your own. First, is to work on your posture. I highly recommend 8-Steps to a pain-Free Back by Ester Gokhale. Think of it this way, if you walk funny all the time, don’t you think your hip and knees will start to hurt? The same goes for your back. If you are constantly putting the spine (just one long series of multiple joints known as facet joints) in a compromised position, it will start to have wear and tear on the spine. This can have a huge impact on your quality of life when poor posture starts to deteriorate the spine.
In addition to posture, stay strong and active! Having good muscularization will help to support the spine and aid in maintaining the correct posture. Exercise and diet work to maintain a healthy weight which will help treat and prevent back pain.
Eating a healthy anti-inflammatory diet can help both with managing pain and boosting mood and energy. An anti-inflammatory diet consists of fruits and vegetables, healthy grains, good fats, and lean proteins while avoiding food additives, alcohol, sugar, trans fats, and excessive animal meat.
Studies have shown the curcumin, found in the spice turmeric, alleviates lumbar radiculopathy by having an exceptional anti-inflammatory profile. If you have a DH or any inflammatory condition, I recommend CurcuWIN500. Studies have shown that this particular formulation best improves the bioavailability of the curcumin. Be careful not to waste your money on supplements that do not have a formulation to enhance bioavailability. You may be taking in turmeric but to have a therapeutic dose, you need a formulation that makes the curcumin bioavailable. 3
Lastly, manage your stress. Pain is not completely due to structural damage. High-stress levels are correlated significantly with spikes in back pain. Dr. John Sarno has written extensively on this subject. His book, Healing Back Pain: The Mind-Body Connection, discusses TMS (tension myoneural syndrome). Dr. Sarno gave the name TMS to psychogenic musculoskeletal and nerve symptoms, most notably back pain. He claims that anxiety and repressed anger trigger muscle spasms.4
There are many factors that influence how one feels pain. Dr. Greg Lehman writes about the biopsychosocial model. In this model, pain is viewed as a dynamic interaction among and within the biological, psychological, and social factors unique to each individual.5
Not only have treated many patients with radiculopathy and various types of low back pain, but I also had a four-year journey healing from DH at L4/L5 and L5/S1 with bilateral radiculopathy. I had to take three of those four years off from doing my passion, trail running. I have done all the things that I recommend here in this blog post. I can certainly speak to the correlation of stress with my degree of symptoms. There is a lot that can be done to help alleviate your back pain, whatever the etiology. It will take an effort on your part to make the necessary lifestyle changes and do the work. The bright side is this, you can come out of your condition better than you were going into it. Any and all health concerns are an opportunity for self-reflection and correction to begin living your best life. Be well and stay active!
References:
1.Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual: The Lower Extremities . Vol 2. Baltimore, MD: Williams & Wilkins; 1999.
2. Tang S, Mo Z, Zhang R. Acupuncture for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Acupuncture in Medicine. 2018;36(2):62-70. doi:10.1136/acupmed-2016-011332
3.Jamwal R. Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers. Journal of Integrative Medicine. 2018;16(6):367-374. doi:10.1016/j.joim.2018.07.001
4.Sarno JE. Healing Back Pain: the Mind-Body Connection. New York, NY: Wellness Central; 2010.
5. Robert J. Gatchel PD. The Biopsychosocial Approach. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach. Accessed July 15, 2020.
Samantha is by far the most amazing acupuncturist I’ve ever been to! She has solved every injury I’ve had, including completely getting rid of old ones. Being a professional aerialist is tough on the body, but Samantha keeps me going strong and functioning optimally. She is also a high level athlete herself, and her embodied knowledge is such a plus. Her treatment process is extremely unique, and her knowledge spans wide to where she can tailor fit the ideal treatment from different angles. She’s the perfect combination of efficient and methodical, where she will get a lot done in the session but also takes time to check in and take time where necessary. I always look forward to our sessions. She’s also an absolute gem of a human being! I couldn’t recommend her enough!!
Samantha has been my go-to therapist to help recover and prepare for all of my races. She’s the kind of therapist that understands an athlete’s need to push themselves, and most important, she can tell where the line is when that athlete should pull back. What I like most about Samantha’s treatments is that she takes the time to understand long-term goals and can readily identify the hurdles. She supports my ambitions with a deliberate and holistic approach: acupuncture with mindfulness about how nutrition and stress (physical and mental) can play a part in achieving my personal best. I highly recommend!-