Acupuncture for Sciatica

Jonathan Clogstoun-Willmott

November 8, 2024

Key Learning Points

Sciatica and Back pain often occur together, as do their treatments with acupuncture
Three main acupuncture channels are involved
Pain often comes with both Qi and Blood stagnation
Acupuncture is usually a good way of treating sciatica but there may be other underlying conditions

Why use acupuncture for sciatica?

Well, first, what is sciatica?

Sciatica is a painful nerve pain along the path of your sciatic nerve which runs from your low back sacral area down to your feet. In practice many pains down your leg from you bum are all called sciatica although not all go along your sciatic nerve.

Very often, sciatica comes with low backache but not always, and people often get back pain without sciatica.

Backpain is very common and one in two of us will get it sooner or later. Chinese medicine, especially acupuncture, works well, often very well.

The Path of the Sciatic Nerve

Sciatic and other nerves — Paths of nerves spreading out from the spine

The sciatic nerve originates in the lumbosacral plexus, emerging from the spine between the fourth lumbar vertebra (L4) and the third sacral vertebra (S3). It then travels down through the buttocks and thigh, branching into the tibial and common peroneal nerves at the knee, which extend to the foot.

Possible causes of sciatica include:

It often comes from pressure from one of your spinal discs when it slips out of place. (These discs are made of ligamentous-like tissue. They separate and cushion your vertebrae.) Usually this happens when lifting something too heavy or awkward for your ability. Or, a sudden wrench from an unexpected direction.
It may also be because one of your lower back vertebrae has got dislodged and is pressing on the nerve
Pain when your piriformis muscle in your bum is damaged, again pressing on the sciatic nerve.
Problems with or in your spinal vertebrae from narrowing (stenosis) of the spinal canal, the canal which carries all the nerves, including the sciatic nerve, to your legs and feet
Tumours which press on the nerve

Discs, pads, nerves: maybe sciatica! — Spinal discs can slip out of position, pressing on the nerves.

Sciatica pain

Sciatica pain can range from mild to severe. The following are typical descriptions:

Pain itself can be aching or burning or ‘electric’-nerve type, for example
Numbness with or without tingling is frequent
Tenderness along the path of the nerve
Lack of sensation along the nerve’s pathway
The pain often changes according to your movement or posture
Weakness in back or leg

How Acupuncture for Sciatica helps

You may wonder how acupuncture can help with these seemingly overwhelmingly physical causes, for example where a vertebra or spinal disc is pressing on the nerve.

And you are right. Acupuncture cannot help in EVERY case, but then, few treatments can guarantee success in every case.

Nevertheless, acupuncture repeatedly helps many people with sciatica. Either it appears to ‘cure’ it completely so that the pain no longer occurs, or it greatly improves the pain, making life much more manageable – with no need for powerful painkillers!

Painkillers instead of acupuncture for sciatica?

Some may wonder why painkillers are best avoided when they offer such a convenient solution.

Well … listen to people who take them! Depending on the medication you take, they can upset your digestion and reduce your energy and mental acuity, make you less certain of your movements, and mess with your sleep.

Some of the more powerful painkillers produce strange mental effects and dreams.

The effects are often unpleasant and anyway, they don’t always stop the pain!

white medication pills for sciatica — Painkillers don’t always stop the pain!

Imbalance

Quite often your acupuncturist notices an imbalance between the two sides of your body, leading to a pulling on one side that dislodges a disc or vertebra. If that imbalance can be corrected the disc or vertebra often slips back into place, and the pain goes.

Acupuncture to correct or repair the piriformis helps when that is the cause.

What if the spinal canal is too narrow – stenosis? There are treatments to help the spine and its spinal nerve canal work better.

What if you’ve wrenched your back? Perhaps your dog suddenly bounded off, forgetting you were on the other end of the lead. If this had a twisting pulling ‘wrench’ it could have weakened an already susceptible condition if you aren’t as fit as you’d like!

Why does acupuncture for sciatica work?

Assuming you’re not someone who refutes the very idea that anything described as acupuncture can exist – in other words I don’t have to go into the whole background and the increasing amount of research, including on fascia, supporting it – let’s look at the theory.

Running down your back are three well-known acupuncture channels and another less known. All embrace the area of the sciatica nerve:

Bladder main and muscle channels
Kidney main and muscle channels: also the Kidney ‘divergent’ channel
Governor channel
Chong mai channel. This channel is one of the so-called ‘extra-ordinary’ channels which were, it is thought, laid down in the original blueprint for the body before the more well-known channels came into existence. For what Chong Mai does read more here.

Of course, it’s probably along one of those already listed, but not always. There’s another nerve involved in your thigh and the acupuncture channels for that may need treatment too.

On the lateral side of your thigh runs your ‘Gallbladder’ channel.

On its medial surface is your ‘Liver’ channel

At the front there are two channels, your Stomach and Spleen channels.

Any of these could be affected too, especially if the pain runs down the front or side of your thigh.

From an acupuncture point of view, sciatica occurs usually when one of the above channels is ‘disturbed’ or ‘blocked’ and unable to let healthy Qi flow along it.

Acupuncture theory believes everything is a form of energy

To explain, the idea in Chinese medicine is that everything is a form of Qi – life energy – which for health should flow smoothly along the channels. When Qi stops flowing smoothly, you get pain or weakness.

Importantly the opposite also applies: if someone is in pain and you can get the Qi moving again, the pain or weakness disappears.

The net of acupuncture channels covers both outside and inside of your body. Internal problems (such as depression, heart problems, indigestion and respiratory problems) can all be looked at from the point of view of the channel system, so are treatable with acupuncture. That doesn’t mean acupuncture, (ie with acupuncture needles) is all, ie is the only treatment, that is necessary!

Treating the sacral area for Bladder damp heat, somrtimes a cause of sciatica — Acupuncture into sacral area

That’s because the 3000 and more years of Chinese medicine has evolved many solutions to disease based on lifestyle, environment, weather, emotions and diet: this is the rich culture that comes with Chinese medicine.

In treating backache and sciatica, once it’s been diagnosed with Chinese medicine, there are often suggestions for DIY actions. Indeed, these can be so important that if you ignore them your treatment won’t work so well or for so long.

Obvious DIY for sciatica

Some are obvious and you have probably worked them out for yourself! For example, often pain feels better from the application of warmth, say a warm bath, or a warm bean bag. What this tells your acupuncturist is that your problem is partly due to ‘Cold’. About ‘Cold’ Chinese medicine knows a good deal! (Read more about Cold here!)

If you ignore the question of warmth, and with bad backache still insist on sitting in a freezing bath, then Chinese medicine would say you are storing up trouble ahead for yourself, even if at the time the freezing water numbs the pain.

Here, if the originating cause of your backache/sciatica was from exposure to cold (such as from a cold draft of air), freezing the area will probably push the problem deeper.

That probably leads to poor blood circulation through the area, which leads to something called Blood Stasis. Look up Blood Stasis here – you’ll get an idea of its long-term consequences.

Why is this ‘Blood’ important? Because healthy blood circulation carries away injured tissue and brings nutritional blood to mend the damage. Freeze yourself, and your blood ‘gels’ and slows down. You notice this when your hands get frozen in cold weather and they become stiff and sore.

In Chinese medicine, the main causes of Sciatica include:

Cold invasion (usually it’s a form called Wind-Cold) which can come from contact with cold or damp surfaces or wind or weather. Even the wrong foods can make you more susceptible to Cold invasion!
What Chinese medicine calls Kidney deficiency – more common as we age as our supply of jing-essence depletes
Something called Damp-Heat. This is less common in cold northern countries but does occur even here.

Hot wet weather leads to humidity — Damp Heat conditions

Blood stasis – a frequent cause. You can get Blood stasis from Qi Stagnation which is rather like stress. Read our page on Qi stagnation. The more stressed you are the more likely you’ll get Qi stagnation which often leads on to Blood stasis. Another cause of Blood stasis is from wounds or accidents that create an internal contusion or bruise.
Something called Phlegm. This is a big subject (I’ve even written a book about it): endlessly fascinating! It includes exactly what you think it does, but also lumps and bumps, so this includes tumours, whether or not benign.

So, what about acupuncture for sciatica?

Your acupuncturist will look out for one of those syndromes listed above, because he’ll need to treat them, or tell you what to do about them.

But he’s an acupuncturist so he’ll also be using the acupuncture channels. The first thing he’ll want to know, and test, is on which channels you are getting pain or discomfort.

… a bit more on those syndromes …

Why do you get sciatica from the point of view of Chinese medicine?

Kidney qi deficiency, which could come from chronic disease or age: this makes you more susceptible to many kinds of illness, including sciatica, because your Kidney energy ‘rules’ your low back, the area in which the sciatic nerve starts so if your Kidney energy weakens so does your back.
Heavy exertion, especially from lifting heavy loads, puts undue stress on your back and Kidney area: this includes sudden wrenches which your skeleton is unable to handle. Such heavy exertion drains your Kidney yang energy, occurring more where there is pre-existing Kidney qi deficiency.

pregnant - and heavy lifting, sometimes causing backach and sciatica — Pregnancy can lead to sciatica

Another form of heavy lifting, for women, is pregnancy and childbirth: again this is more likely with pre-existing Kidney deficiency. However, if the woman takes care of her health during pregnancy, with adequate rest and nutrition, her body can take advantage of the fact that her genes are programmed to create and nourish the foetus, and some of this energy ‘drive’ can improve her general health and Kidney action.
What Chinese medicine calls ‘invasion’ by Cold, often with Damp. These external ‘evils’ thicken your Blood, make your sinews rigid and retard the movement of Qi and Blood through the channels making you stiff, slow and weary. This syndrome was perhaps more frequent in the past where they lacked warm homes and were exposed at work to cold, wet conditions – think of the paddy fields. This kind of ‘invasion’ can cause severe pain and stiffness, both acute and chronic. However, it happens in the West too for example, as happened to me, when I got soaked by a sudden summer rainstorm and couldn’t dry off properly after it, so remained damp and cold for some hours. (The next day I could hardly move!)

Help Qi to move with Acupuncture for Sciatica

These causes disrupt the movement of your Qi along your acupuncture channels. The job of the acupuncturist is to get that Qi moving again!

He or she can do this many ways. Some treat via acupuncture points along the affected channels, and this is often very effective, but some acupuncture systems use points on the opposite side of the body from the affected side: also very effective – I’ve often used it!

Also, there are good ways to treat the pain caused by Blood stasis by releasing a few drops of blood, if you know what you are doing and where to do it.

If Cold or Damp forms part of the diagnosis, there are many acupuncture points for these, often with moxibustion.

Often, acupuncturists use both points on or near the lumbosacral area plus points further along the channel(s) concerned.

If stress forms part of the picture, or if there was wrenching which twisted the body, we may use points on other channels to get things back into balance.

How we know what to do – how do we form a diagnosis?

woman listening — Listen not just to what is said but to how it is said

Listening to what you say
Looking at where it hurts
Examining the channel pathways affected
Asking questions about the pain, what makes it better or worse and how it started
Palpating – touching and pressing – over where it hurts and associated places
Taking your pulse the Chinese way. Learning how to take your pulse takes time and lots of experience.
Looking at your tongue can also give useful information about how your body works
Palpating your Abdomen may be important too

Acupuncture channels

From this we diagnose which acupuncture channels are affected and what internal or external events or habits may be contributing to your sciatica.

Then from our knowledge of the acupuncture channels and the theory of Chinese medicine we can decide what treatment to do, and in what order. Probably we’ll also have an idea of how many treatments you will need.

Depending on how interested you are, we will explain our thinking, and if you would like treatment we’ll arrange a time to start, or time allowing, start immediately.

We may make suggestions for diet or movement exercises – for example.

So if you thought everyone with sciatica got the same treatment, you were wrong! Everyone gets treatment individualised to his or her particular needs.

The following describes a treatment that did not use the usual acupuncture channels!

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A Unique Treatment Approach for Sciatica

The treatment was tailored specifically for one particular patient, although I have since had other fairly similar patients.

It is not that different for others where the underlying problem is not along the channels on the back and buttocks. It differs from the traditional acupuncture points commonly recommended in well-regarded texts like The Practice of Chinese Medicine. Instead, I based the treatment entirely on my diagnosis, informed by the patient’s unique background and symptoms.

The patient, a woman in her sixties, experienced severe pain down the back of her left leg following a sudden, forceful twist to her right shoulder. The pain was incapacitating, radiating from her left buttock to her knee and down her lower leg along the shinbone. Even light touch along the affected areas caused significant discomfort. She walked with difficulty and had been taking a combination of medications, including Co-codamol (a painkiller), Naproxen (an anti-inflammatory), Amitriptyline (an antidepressant), Aspirin and Atorvastatin for stroke prevention, and Tamoxifen as a cancer preventative.

Medical History

Her medical history was important: many years before she came to see me she’d had a stroke, and some years later she had a mastectomy followed by chemotherapy and radiotherapy.

This history was key to understanding her current state. The pain along the front of her knee and shin aligned with the Stomach acupuncture channel, which also runs through the chest area where her mastectomy occurred.

I diagnosed a weakness in her Stomach channel.

Stomach Channel Points — Stomach Channel – Copyright Acupuncture Points

This channel does not pass along the sciatica nerve pathway, because it runs down the front of the body. But it has a “divergent” pathway which connects with the Heart. This, combined with her history of circulatory issues (stroke), indicated an underlying deficiency that made her left side more vulnerable to further injury.

(One may add that Cancer often occurs where there has been a big emotional shock. Big shocks affect the Heart in Chinese medicine.)

To explain this, I used an analogy: imagine a major road eroded by a storm, blocking traffic and allowing debris to accumulate. Similarly, the weakened Stomach channel had become “blocked,” accumulating tension and susceptibility to strain over time.

Treatment Plan

The treatment aimed to “clear the path” along the Stomach channel, release tension in her ligaments, and strengthen the channel overall. This approach included:

Techniques to clear and open the Stomach channel – mainly I used Japanese acupuncture for this.
Acupuncture to release tension in ligaments: several points can do this.
Strengthening techniques for the Stomach channel. There are many ways using acupuncture to do this.

I also did some minor bloodletting to alleviate signs of Blood Stasis in her sacral region, which I hoped would also benefit her heart and circulation given the Stomach channel’s divergent branch to the Heart.

Results and Follow-Up of Acupuncture for Sciatica treatment

At her second appointment, three days later, she reported a dramatic improvement. The knee and leg pain were gone, she no longer required painkillers, and only an occasional twinge in her buttock remained. She even brought her partner, hoping I could treat him too.

Could an orthodox approach from the textbook have worked? Possibly. But in this case, the tailored treatment addressed the underlying imbalance, allowing the two sides of her body to realign, relieving pressure on the sciatic nerve. By re-establishing the proper flow within her Stomach channel, her body had the support to heal itself.

Follow-up Treatments?

You could say that the sciatica was the latest ‘display’ of the imbalance following her stroke and mastectomy.

She will probably need occasional follow-up treatments to maintain balance and strengthen the Stomach channel, perhaps every few months. (That’s because surgery, chemotherapy and radiotherapy in the area will have been drying and heating, destroying the original structure, making it more yin deficient. Acupuncture can help alleviate this.)

However, my experience of this kind of cause is that the patient often doesn’t return for treatment until the sciatica re-asserts itself.