Sciatica Should Be Differentiated from Piriformis Syndrome
By Winston Lee L. Ac, Ph.D., KMD
Sciatica, often called ‘sciatica,’ is not a name for a disease. It’s just the name of a symptom that refers to pain that runs from the buttocks to the legs. Just as common symptoms such as gastritis, gastric ulcer, acid reflux, and stomach cancer can be simply called ‘abdominal pain,’ sciatica refers to the apparent symptom rather than the cause of any symptom.
Sciatica is the name of a symptom, and the sciatic nerve is fairly large, the size of a thumb that passes inside the hip bone. These nerves branch from the spine in the lower back, pass through the hip bones, and run to the thighs, behind the knees, and into the calves. Therefore, when this nerve is compressed or pinched by something in the lower back or buttocks, pain occurs in the buttocks, thighs, and calves through which this nerve passes.
The causes of this include herniated disc, degenerative disc, spinal stenosis, spondylolisthesis, and piriformis syndrome. These can be problems with the disc, the cartilage between the vertebrae, the vertebrae themselves, or the piriformis muscle in the pelvis compressing the nerves. To accurately determine which of these causes is the cause, it is not possible to know simply the location of the pain, and an accurate diagnosis can be made when an X-ray or MRI is taken.
Therefore, to treat sciatica properly, an appropriate diagnosis must be made first. After taking the risk of disc surgery by pointing out the disc as the most important cause with only the symptoms, sciatica continued to repeat, and after getting the second opinion with a more cautious examination, they received reports that it was eventually revealed to be piriformis syndrome – not a disc-related disease but just a muscle problem. Meanwhile, when a doctor only looks at sciatica symptoms and continues to only treat for the symptoms, the nerve damage worsens, leading to paralysis of the legs. In case of severe paralysis in the legs, even though intensive treatment is performed later after seeing the paralysis, some sequelae may remain for a lifetime because the initial treatment is delayed in the beginning.
In my personal experience, if sciatica does not have any other reasons, such as discs, and it is only due to the piriformis muscle problem, if the acupuncture treatment is done correctly, the pain can be improved by more than 40% the next day or after two sessions of treatments. Therefore, when a patient complains of sciatica, it is the priority to take a precise physical examination whether the cause is the piriformis muscle or not.
Suppose it is a problem with the piriformis muscle alone. In that case, you can confidently start performing the acupuncture immediately and tell the patient that if you receive acupuncture treatment twice a week, you can almost get better within two weeks. However, if it is determined that it is caused by a disc herniation or stenosis rather than a muscular problem after the first treatment, an X-ray or MRI examination must be recommended seriously, and then appropriate treatment method and prognosis must be determined after seeing the results of the diagnostic image.
Sciatica can be treated with eastern medicine treatment for 95% of pain cases, except for rare cases of less than 5% of sciatica because the nerves are compressed so much that the strength in the legs is gradually lost or there is difficulty in urinating.
First of all, herbal medicine prescription is essential to reduce the inflammatory reaction caused by abnormal contact between the sciatic nerve and the disc, bone, or muscle. This herbal medicine not only reduces the pain caused by inflammation but also helps the regeneration of the sciatic nerve, ligaments, and disc itself, so it is a great help in recovering from after-effects. In addition, there is pain due to muscle tension, and for this purpose, acupuncture treatment should be performed together, and chiropractic treatment to correct the misalignment of the pelvis and spine should be performed at the same time.
