What is Sciatica?

Sciatica typically defines as pain occurring in a nerve that runs from the lower back down the leg, often triggered by pressure. However Sciatica describes a symptom not a condition. Pain affects the back, hip, and outer side of the leg, commonly caused by compression of a spinal nerve root in the lower back, often owing to degeneration of an intervertebral disc. Symptoms include;

• Hot pain in the buttock
• Aching in the buttock, back of the thigh (hamstring) and calf
• Pain in the ankle and foot
• Pins and needles
• Increased pain when lifting, straining or coughing
• Loss of power to the muscles of the leg and foot

What causes Sciatica?

Sciatica isn’t an actually condition, it’s actually a symptom caused by irritation or compression that impacts the sciatic nerve. The sciatic nerve begins in the L4 to S3, and exits the lumbar spine and sacrum, then runs through the buttocks down the leg.

Let’s talk about how this nerve becomes irritated or compressed;

Lumbar vertebrae are vulnerable to injury. This area of the spine that takes the most punishment from movement and activity is the lower back, or lumbar region. This consists of five relatively large vertebrae. The discs cushioning these vertebrae are particularly susceptible to degeneration caused by ageing. The cushioning discs become progressively thinner and harder, which stresses this portion of the back and may result in a variety of lower back pain disorders, including sciatica.

Some examples of these structural and neurological disorders  that could cause Sciatica pain are;

• Herniated Discs – A herniated disc can place pressure on the exiting nerve root and localised inflammation, causing nerve compression.
• Osteophytes – Due to degenerative changes the surface of the bones can be become rough and develop bone spurs which can irritate surrounding structures leading to inflammation, or in other cases directly compress nerve structures.
• Spinal Stenosis – A narrowing of the openings for the spinal cord can occur with age and spinal degernation. This spinal narrowing  results in nerve compression.
• Spondylolithesis – The alignment of the vertebra is affected in this condition leading to pressure being placed on the nerve structures
• Trauma – Accident and injury can also lead to significant localised damage resulting in sciatica

How does Acupuncture & Chinese Medicine help Sciatica?

Acupuncture assists sciatica by;

• Pain modulation; Insertion of Acupuncture needles stimulate sensory nerves triggering the release your body’s own pain modulating systems including endorphins (natural pain killers), serotonin, dopamine and affect the gate control mechanism.
• Reduces inflammation; In sciatica there is inflammation around the nerve root. Acupuncture down regulates the pro-inflammatory cytokines such as: Substance P and Pro-inflammatory cytokines.
• Improves local blood flow; Helping to clear inflammatory metabolites and reduce swelling around the nerve. When there is less swelling and inflammation there may be less compression and therefore less pain.
• Relaxes muscles and releases compression; Tightened muscles further impact the sciatic nerve, and restrict exercise / movements necessary for recovery. Think of it like hitting a “reset button” for the muscle, the needles cause the muscle fibres to release causing reduce tightness, stiffness and increased ability to move
• Improve nerve function; Acupuncture enhances microcirculation the nerves which may support nerve repair and conduction. The use of Electro-Acupuncture can also provide targeted stimulation along the nerve pathway to enhance this effect.

Research

There is moderate evidence supporting the effectiveness of acupuncture in treating sciatica, and it is considered safe and well tolerated. Some recent examples of research into Acupuncture treatment of Sciatica includes;

1. Lewis et. al. (2015) reviewed 122 studies, 90 of which were randomised control or quasi randomised control studies (RCT). This Systematic review looked at a number of interventions including acupuncture such as surgery, nonopioid medications, spinal manipulation etc. ​The findings supported the use of acupuncture. It was also reported that acupuncture was 2nd out of all of the interventions for its global effect and reduction of pain intensity.​
2. Qin et. al. (2015) reviewed 11 RCT’s,  10 which were comparing acupuncture to medication and 1 was comparing acupuncture to a sham control. This review found acupuncture maybe more effective than anti-inflammatories such as ibuprofen, meloxica​m, and diclofenac in reducing leg and lower back pain. It also reported that acupuncture may enhance the effect of medications. The authors identified that because of the lack of high quality, rigorous RCTS”s in the review that the evidence was limited and further well designed and Larger RCT’s were required to confirm these findings.
3. Ji et. al. (2015) included 12 studies in their systematic review. Similar to the previous study they found acupuncture to be a safe and well tolerated intervention and effective for the treatment of sciatic pain. They also reported being unable to draw definite conclusions due to the lack of quality studies.