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| Musculoskeletal 2:acupuncture and sciatica |
Q: I have pain from lumbar area down to the bottom of my leg , I do not know what is wrong with me?Is acupuncture help?
A: It is sciatica. Sciatica is pain, tingling, or numbness produced by an irritation of the nerve roots that lead to the sciatic nerve. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. Branches of the sciatic nerve extend through the buttocks and down the back of each leg to the ankle and foot.
Spinal Nerve Root Pain (Radiculopathy) can arise when nerves become pinched or trapped within the bony spinal canal or vertebral column:-
C4 to T1 nerves in the neck cause Brachialgia in the shoulder and arm.
L1 to S1 nerves in the low back cause Sciatica in the buttock and leg.
T2 to T12 nerves in the thoracic spine (mid / upper back) cause referred pain in the chest and abdomen.
What causes sciatica?
The most common causes of sciatica is a bulging or ruptured disc (herniated disc) in the spine pressing against the nerve roots that lead to the sciatic nerve. But sciatica also can be a symptom of other conditions that affect the spine, such as narrowing of the spinal canal (spinal stenosis), bone spurs (small, bony growths that form along joints) caused by arthritis, or nerve root compression (pinched nerve) caused by injury. In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy. You can find exact cause chart as follows:
The causes of the irritation are:-
Within the spine
Annular Tear (small disc tear)
Disc Prolapse (herniation)
Spinal Stenosis (narrowing of the internal diameter of the spinal canal)
Foraminal Stenosis (narrowing of the spinal nerve exit holes)
Spondylolisthesis (spinal slip most often seen in the lumbar spine)
Epidural Adhesions (following spinal surgery, and infections like epidural abscesses and discitis)
Syringomyelia (fluid filled cavity in the spinal cord most commonly found in the neck)
Spinal Tumours (rarely Primary tumours of the spine, more commonly secondary cancer spread to the spine)
Outside the spine
Piriformis Syndrome (Sciatic nerve compression caused by piriformis muscle spasm in the buttock)
Thoracic Outlet Syndrome (Cervical nerve compression by a cervical rib / scalene muscle spasm in the neck)
Medial superior cluneal nerve entrapment in its fibro-osseous canal medial to the iliac crest.
Superior gluteal nerve injury caused by a fall or damage after hip surgery causes pain and tingling in the buttock and outer hip.
Pelvic tumours (Bladder / Rectum / Cervix / Uterus / Ovary)
Retroperitoneal tumour (rare)
Iliopsoas muscle abscess / tumour (rare)
Non-Nerve Root Pain
Local Pain
Somatic pain arising from joints, muscles, tendons, bones, ligaments in the arm and leg which can be mis-diagnosed as sciatica or brachialgia.
Referred Pain from structures other than discs/nerves.
Spinal Paravertebral Muscles, Facet Joints, Spinal Ligaments, Shoulder and Hip Muscles, Sacroiliac Joint.
The pain is often associated with a vague deep ache in the limb, sometimes mild tingling, but rarely numbness or weakness. It occurs because the affected structure shares the same nerve supply as the part of the limb.
Treatment
Look at the table below and the menu above for appropriate treatment links for different types of nerve root pain in the pain clinic. Try Analgesia Flow Chart for analgesia advice.
Pain Diagnosis Treatments Links:
Nerve Root Pain
Acute Sciatica or Brachialgia: Exercises, Manipulation, Epidural Injections, Nerve Root Blocks, Surgery
Chronic Sciatica or Brachialgia: :Exercises, Manipulation, Epidural Injections, Nerve Root Blocks, Surgery, IDET, Epiduroscopy, Spinal Cord Stimulation
Spinal Stenosis :Exercises, Manipulation, Epidural Injections, Surgery
Foraminal Stenosis: Exercises, Manipulation, Epidural Injections, Nerve Root Blocks, Surgery
Spondylolisthesis: Exercises, Epidural Injections, Prolotherapy, Nerve Root Blocks, Facet Joint Injections, Surgery
Piriformis Syndrome: Acupuncture, TENS, Exercises, Trigger Point Injections
Failed Back Surgery :Acupuncture, TENS, Exercises, Manipulation, Facet Joint Injections, Prolotherapy, Epidural Injections, Nerve Root Blocks, Epiduroscopy, IDET, Spinal Cord Stimulation, Intrathecal Morphine Pump
Non-Nerve Root Pain:
Spinal Muscle Spasm :Acupuncture, TENS, Exercises, Manipulation, Trigger Point Injections, Facet Joint Injections
Facet Joint Syndrome: Acupuncture, TENS, Exercises, Manipulation, Facet Joint Injections
Spinal Ligaments: Acupuncture, TENS, Exercises, Prolotherapy
Shoulder and Hip Muscles :Acupuncture, TENS, Exercises, Trigger Point Injections
Sacroiliac Joint :Acupuncture, TENS, Prolotherapy, SIJ Injections ;
I suggest you to make an accurate diagnosis first and then consult some therapists, you need to be very careful to choose surgery because it is high of risk and it is the last choice.Before it, you need to try many conservative therapy first. Chiropractor often do the manipulation for the patient, the physiotherapist often do the TENS and other physical therapy, Registered Acupuncturist often do the Acupuncture,acupressure and herb.So there are many method .Some cases need to combine several therapist together.
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Posted by ChenYang on 2009-03-08 20:23:44 | Rating: | Views: 19
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