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Acupuncture for Sciatica

This following information is from College of Integrated Chinese Medicine conditions notes and is being used as placeholder text as this page is being developed October - November 2021

Lumbar spondylosis and sciatica

Sciatica is the term given to describe a pain has its origin in the lumbar and sacral spinal nerves. This pain is referred down one or both legs. The symptoms include pain and/or tingling which radiates down the buttock, back of one leg to the foot. There may be patchy numbness of the skin in the region affected by the pain, and weakness of some of the muscles of the lower leg. The pain is typically provoked by movements which affect the low back, particularly bending forward. Sciatica is often, but not always associated with low back pain.
Sciatica results from damage to one or more of the lumbar or sacral spinal nerves which emerge from the very base of the spinal cord. You might remember that the spinal cord actually terminates at the level of L1/L2 vertebrae. These spinal nerves leave the base of the cord at this level, and then travel downwards within the spinal canal to their points of exit at the sacral and lumbar intervertebral spaces.
The lumbar and sacral spinal nerves can be damaged by anything which compresses them, either as they descend through the spinal canal, or as they emerge through the intervertebral spaces. The most common cause of compression of the spinal nerves is the protrusion ("prolapse") of an intervertebral disc, either between the L5/S1 vertebrae, or between the S1/S2 vertebrae. (for more detail about disc prolapse see Section 4.2 of this Stage of the course). These prolapsed discs will tend to compress the L5 and S1 nerve roots respectively.
You might wish to turn to Figure 20.27 on page 1218 of Kumar (5th edition) to see a picture of how a prolapsed disc can compress the spinal nerve roots. This diagram shows how the bulging of the posterior part of an intervertebral disc can affect either the spinal nerves (b) or the cord itself (a), depending upon the site of the bulge. The bulging which is slightly to one side (b) is by far a more common situation.

The other common cause of compression of the spinal nerves is osteoarthritis of the vertebrae (see Lesson 4.2f in this stage of the course). The arthritic changes to the vertebral bones can lead to narrowing of the intervertebral spaces as well as the spinal canal itself.

The term spondylosis is used to describe the degenerative processes which lead to both disc prolapse as well as arthritic deformity of the vertebrae. Therefore, lumbar spondylosis is the medical term applied to these degenerative causes of sciatica and low back pain.
Sciatica may also occur simply as a result of tension in the muscles and ligaments which support the vertebrae. Tension causes the vertebrae to be squeezed close together and cramps the spaces through which the spinal nerves should exit. This form of sciatica is typically less severe and tends to appear and disappear with according to factors such as overwork, tiredness, moods and the weather.
Rarely a tumour of the spinal canal, or one that is situated close to the lumbo-sacral spinal column, may cause sciatica. In this case the sciatica is slowly progressive. Progressive sciatic pain should therefore be taken as a warning feature of serious disease.
The arthritic changes of lumbar spondylosis may be diagnosed by an X-ray of the spine, although it is known that there is a poor correlation between the changes seen on an X-ray and severity of symptoms. The most informative investigation is the MRI scan which will usually show the site of the compression of the spinal nerve, and whether or not a disc prolapse is present.
The treatment of sciatica and low back pain will be described in more detail in Lesson 4.2e of this Stage of the course.
In Chinese medicine the pain and numbness of sciatica is due to Damp-Cold (or rarely Damp-Heat) in the Gallbladder and Bladder channels. An underlying deficiency of the Kidneys is very often the reason why sciatica has developed.

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