I get questions on a regular basis asking if I treat
sciatica. And then, I get further questions asking what I do for sciatica. The
first question is easy. Yes, I treat sciatica. The second question is more
difficult because, sciatica is not a very precise term and can involve many
different but related syndromes. Strictly speaking, these involve irritation of
the sciatic nerve, but there are many conditions such as muscle referrals that
can be classified as ‘pseudo-sciatica’.
The Mayo Clinic defines sciatica thus: “Sciatica refers to pain that radiates along
the path of the sciatic nerve — which branches from your lower back through
your hips and buttocks and down each leg. Typically, sciatica affects only one
side of your body.”
The second common cause involves an entrapment of the
sciatic nerve by one of the muscles involved in turning the leg out. This
muscle is called the piriformis and the condition is called piriformis
syndrome. This would involve deep pain in the buttock region and pain radiation
down the back of the thigh. This pain is often worse when sitting, climbing
stairs, or running; usually there is reduced range of motion in the hip joint. Some
authorities consider this syndrome to be common, while others perceive it as uncommon;
this depends on how the syndrome is defined. In most people, the sciatic nerve
sits below the piriformis, but in about 10% of the population, it actually
penetrates through the piriformis muscle. These people would be predisposed to
piriformis syndrome. In the Sports Medicine Acupuncture Certification Program in New York, we dissected a specimen that had just this situation. It was unknown to use if this individual had pain of this sort, but it was a much stronger likelihood.
While many physicians see piriformis syndrome as occurring only in this population, others (myself included) feel that a tight and contracted piriformis can also contribute, regardless of the position. I treat this condition with acupuncture to release the piriformis and balance the pelvis, and might also involve deep tissue massage, stretching and corrective exercises.
Sciatic nerve exiting below the piriformis muscle. On some people, it actually penetrates through the muscle, predisposing them to symptoms. |
While many physicians see piriformis syndrome as occurring only in this population, others (myself included) feel that a tight and contracted piriformis can also contribute, regardless of the position. I treat this condition with acupuncture to release the piriformis and balance the pelvis, and might also involve deep tissue massage, stretching and corrective exercises.
While these are the main conditions that put pressure on the
sciatic nerve, there are many other syndromes that can mimic the pain of
sciatica and can cause an incorrect diagnosis. In particular, hypersensitive
painful spots called trigger points (TrPs) in the muscles on the side of the
pelvis can radiate pain down the leg and mimic sciatica. In particular the
gluteus minimus muscle which is deep in the outside of the hip region is a common
culprit. Sacroiliac dysfunction and spinal arthritis (referred to as facet syndrome) are also pain
syndromes that can refer into the buttocks and legs. Greater trochanteric
bursitis can also radiate into the leg and be confused with sciatica. All of
these conditions require proper assessment. In my practice, I take the time
necessary to perform orthopedic evaluation and use other tools such as
palpation to determine what is causing the symptoms experienced by the patient.
I look at how the posture might be contributing to the condition. I assess
range of motion, what muscles are strong and supporting the structure and which
are inhibited and failing to provide support. And I use Traditional Chinese
Medical diagnosis to assess imbalances in the channel system. All of these findings
then are used to develop a unique treatment plan to relieve the pain of
sciatica.
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