Sciatica

Sciatica is a symptom of a problem with the sciatic nerve, a large nerve that runs from the lower back down the back of each leg. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg and the sole of your foot. When you have sciatica, you have pain, weakness, numbness or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body.

Sciatica may be due to a ruptured intervertebral disk, narrowing of the spinal canal that puts pressure on the nerve called spinal stenosis, or an injury such as a pelvic fracture. In many cases no cause can be found.  Treatment, if needed, depends on the cause of the problem. It may include exercises, medicines and surgery.

Understanding sciatica and degenerative lumbar pathology

The term sciatica has long become a catch-all phrase in medicine to refer to any pathology of lumbar pain that produces radiating symptoms to the lower extremities (also see the article Piriformis Syndrome on this website). Often, the actual pathology, when explored, involves myofascial pain patterns and nerve irritation of nerves other than the sciatic proper. Proper treatment involves attention to all the structures that could be causing symptoms of “sciatica”, aggravating the sciatic nerve itself, or contributing to the sciatic pathology. The sciatic nerve arises from the sacral plexus, or tailbone, just below the lumbar vertebrae, and is part of a broad collection of nerve fibers commonly called the cauda equina, or horse tail, because the number of nerve fibers is thick like a horse's tail, and includes all of the nerve fibers emerging from the lumbar. Tissue problems of the lumbar, such as bulging or herniated discs, or inflammatory tissue and scarring, can affect various parts of these nerve roots, or the cauda equina itself. Often there is an underlying degenerative disc or joint condition, with an acute injury leading to sudden pain and paresthesia radiating to the buttocks and thigh. Disc herniation will often cause constant pressure to sustain nerve related symptoms, while a degenerated bulging disc will cause pressure, or impingement, on the nerve depending on the position of the lumbar. Degenerative or acute inflammatory conditions may cause nerve related symptoms by irritating the nerve with inflammatory chemicals, or by decreasing the lumbar stability, which may lead to mechanical pressure on the nerve.

These impingement and inflammatory problems may affect the sciatic nerve portion directly, or indirectly. Identifying correctly the exact area of nerve irritation of the nerve bundle is not easy. An X-ray will only show the bony material, and is insufficient to diagnose soft tissue, such as intervertebral disc, joint capsule, ligament, tendon and muscle. Often, the MRI images show some disc bulging or broad-based degeneration, as well as inflammatory scarring, called hypertrophy, usually of the facet joints, which are the vertebral joinings which are close to the roots of the nerves at the foramina, or spaces that the nerve root emerges from. The question of whether these findings of disc bulge or inflamed scar tissue are causing your pain is difficult to answer. Many patients studied with disc bulging or joint degeneration experience little of no pain. The pain could be caused from myofascial tissue farther away from the spine, or the myofascial contractures could be causing nerve irritation further along the nerve pathway. Chronic inflammation of the muscle and connective tissue could also be causing pain and nerve irritation from buildup of inflammatory mediators along the path of the nerve. MRI studies give valuable information, but do not answer these questions of pathology definatively. This is the reason that medical experts now recommend months of conservative care before considering imaging and surgery.

The sciatic nerve emerges from the broad bundle of nerves at the sacrum and goes through a notch on the pelvic girdle near the sacroiliac joint, and then takes either of three paths through the deep muscles of the buttock. The typical path of the sciatic goes through the piriformis muscle, which is the hip adductor, whose chief job is to stabilize the leg in the hip. This muscle is frequently contracted chronically, and often the leg is rotated laterally resulting in outtoe, or lateral pointing of the foot when standing. In these cases, hip flexion is also limited, and sometimes bending forward or rising from a seat is painful. Another typical path of the sciatic nerve through the buttock is under or over the piriformis, and here too, contracture or weakness can cause sciatic irriation with position or movement. The third type of path in one where the thick sciatic nerve takes two paths, with half of the nerve through the piriformis, and half around it. Often, myofascial release of the gluteal muscles and piriformis provides much improvement of the sciatic irritation. Clearing of the muscle tissues of accumulated inflammatory mediators also improves the condition.

As the sciatic nerve continues out of the buttock region, is travels deep along the biceps femoris, or lateral hamstring. Here too, hamstring problems can cause irrittion of the sciatic nerve. The hamstring need not be contracted in total to cause problems. Imbalance of the stresses of the medial and lateral muscles and tendons of the hamstring can cause significant irritation with common activities. Often, the muscles are strained, and the patient has not learned the proper way to stretch the hamstrings. Irritation of the head of the hamstring muscles at the tendons attaching to the pelvis can also cause a sciatic-like pain pattern, or irritate the sciatic nerve itself. This pathology can result from prolonged sitting with poor posture, or from a strain of the muscles with physical exercise or sports.

Just below and behind the knee, the sciatic nerve branches to two distinct pathways, one lateral on the calf, and one posterior, which are called the peroneal and tibial nerves, although on a percentage of patients, the branching occurs above the knee. Here too, myofascial pathology can irritate the nerve lower on the leg and cause pain symptoms above, contributing to chronic hip and back pain. A thorough musculoskeletal assessment will look for possible myofascial contributors as well as the typical problems at the spine.

To fully address the subject of sciatica, a comprehensive and holistic approach to physiotherapy should be utilized. The allopathic M.D. has the job of assessing the possibility of a serious tissue problem at one point of the sciatic path. If this one area shows severe injury, surgery may be warranted. The allopathic approach is not adequate to address the broad number of problems that can accumulate and cause sciatica. Here, the Complementary Medicine physician enters the picture to provide the patient with an expanded perspective and address the whole array of tissue problems. Choose this physician wisely. Only a small percentage of the Complementary physicians have developed the specialties and skills to address this problem in the most comprehensive and informed manner. As in standard medicine, the patient that chooses the correct specialist achieves the best results.

“Sciatica” is a term that has long been used in standard medicine to describe almost any pain syndrome with symptoms that radiate, spread, shoot, or refer to the pelvic, buttock, hip and thigh, especially if nerve related symptoms, called paresthesia and dysesthesia are present. Most often, these syndromes are not a direct pathology of the sciatic nerve, although sciatic irritation is often involved secondary to another tissue problem. Common symptoms of nerve irritation include sensations of numbness and tingling, dulled sensation, heaviness, and indistinct pain, which are called paresthesia, and burning or hot sensations, pin and needle sharp sensations, sudden stabbing or gripping pain (paroxysm), or electric pain, called dysesthesia. While standard orthopedics looks for an injury to the nerve root at the lumbar spine, which may need surgical repair, as well as inflammatory tissue lesions at the facet joints of the vertebrae, many patients are frustrated to find that MRI imaging reveals no obvious tissue causes, such as a herniated, bulging or shrunken disc (stenosis), or enlarged hardened tissues around the nerve at the facet joint (hypertrophy). This leaves many patients frustrated and confused concerning the nature of their often worsening symptoms. Many men experience a low back and pelvic pain syndrome associated with acute or chronic prostatitis, often with nerve irritation and pain radiating down the leg, and standard assessment and treatment is frustrating.

In addition, many women have complex pathologies with chronic vulvodynia, interstitial cystitis, pelvic endometriosis, and subserosal uterine fibroids that are not addressed adequately in standard medicine, and are part of a pelvic pain syndrome. These syndromes often produce embarrassing symptoms of urinary incontinence, pain with contact to the vulva or vestibular region, episodic sharp or burning pain to the vagina, or large growths in the lower abdomen. A 2003 survey of nearly 4000 women published in the Journal of the American Medical Women’s Association (Harlow BL Stewart EG: Spring, 2003; 58) found that 15.6 percent of these women reported episodes of chronic vulvar pain or vulvodynia in their lives, with a large majority either not seeking care or frustrated by multiple physicians failing to diagnose the condition. The age of the survey was from 18-64, and while such health problems are more prevalent in perimenopause, incidence in young women is not uncommon. While the pathology is still poorly understood, a number of explanations are being explored, often part of a multifactorial etiology. Chronic fungal infections, such as Candida, may lead to hypersensitivity, viral infections of a low grade, such as HPV, low-grade bacterial infections, chronic inflammatory disorders, accumulation of oxalate crystals, and allergic disorders are all implicated, as well as central causes, and history of abuse. Vulvodynia, or painful sensitivity to touch, was most prevalent in the survey, while burning sensations and sharp pain episodes were experienced by about 15 percent of respondents in this survey. The complexity of the causative and contributing factors point to a need for a holistic assessment and treatment protocol, and often a set of potential causative factors need to be treated that are diverse in scope. By addressing these syndromes with a thorough treatment protocol, key contributors to the pathology are less likely to be overlooked, and success more assured.

Pelvic Pain Syndromes often go undiagnosed or simply called “sciatica”. Often, the key symptoms are not an acute and alarming low back and pelvic pain, but instead a nagging, chronic pain syndrome with a number of associated symptoms that present a confusing scenario. The wide variance in presentations of pelvic pain syndromes and piriformis syndromes require a more holistic and individualized assessment and treatment protocol. The Complementary Medicine Physician, especially the knowledgeable Licensed Acupuncturist and herbalist with a specialization in myofascial syndromes and soft tissue pathologies, is an ideal member of an integrated team to properly assess, diagnose and treat these complex pelvic pain syndrome.

Piriformis Syndrome is one of the complex regional pain syndromes that explain many patient's often debilitating conditions. In studies cited in Drs. Janet Travell and David Simon's text, Myofascial Pain and Dysfunction, a broad review of patients with these low back and lower body symptoms revealed that more patients were diagnosed with piriformis syndrome than with nerve root irritation caused by disc protrusion in clinics specializing in low back pain and trained to diagnose myofascial pain syndromes. The ratio of women to men with the diagnosis of piriformis syndrome was 6 to 1, and in some studies, this female subset with generalized “sciatica” showed that over 40 percent could be diagnosed with piriformis syndrome. The reason that this is not well known in the United States is that most clinics are not looking at a differential diagnosis that includes piriformis syndrome and other such soft tissue regional myofascial pathologies. Most clinics are looking for a diagnosis that supports a surgical approach. While the orthopedic specialists usually have little to offer for such pain syndromes, and neurologists often have difficulties with standard diagnosistic clarification, and quickly resort to prescription pain medication and anti-depressants and anti-seizure medications disguised as muscle relaxants, and neural pain relievers, there is help and cure for these syndromes from medical practice that treats the regional syndrome holistically, and uses a variety of treatment modalities to simultaneously correct the various contributors to the dysfunction.

Standard medicine has tried unsuccessfully in the past to promote an allopathic approach to soft tissue injuries, suggesting that a limited treatment protocol of surgical repair when needed, pain medication and corticosteroid therapy is enough. Recent additions to the protocol, such as platelet-rich plasma injections, are proving ineffective, and long-term benefit from corticosteroid injections has not been shown in clinical trials, while risks from overuse of synthetic steroids is now well documented. All of these allopathic approaches have their benefits, but as more and more medical doctors are now admitting, this limited approach cannot replace a thorough holistic approach to aiding soft tissue repair with an integrated multidisclipinary and comprehensive conservative treatment strategy. Limiting rehabilitative care has been partly the fault of the insurance companies as well. But by refusing to pay for adequate therapy with rehabilitation, and failing to utilize herbal and nutrient chemistry to promote better tissue healing, many soft tissue injuries have turned into painful chronic problems, and the eventual cost of chronic health care to insurers has not been healthy financially. Patients are now becoming educated to the need for a treatment protocol that insures the best long-term outcome, and are increasingly turning to Complementary and Integrative Medicine to achieve this goal.

Each specialty in medicine has its focus, and each provides the injured patient with a set of skills and knowledge. Medical doctors are increasingly specialized in the United States, and the surgical skills are greatly appreciated when needed. Often, though, the medical doctor offers little more than surgery, immobilization, and pain medication, and their education does not extend into areas of manual physiotherapies, or herbal and nutrient medicine. The terms Integrative Medicine and Complementary Medicine are used to describe physicians such as Licensed Acupuncturists that add these skills and knowledge to the overall treatment protocol. Physical Therapists and Chiropractors, as well as Osteopaths also offer a unique set of skills and knowledge to aid tissue healing and rehabilitation, and integrate well with the TCM physician, or Licensed Acupuncturist. Too often, the advice from the primary physician is to immobilize the injured body part for too long and avoid other therapy. These other specialties generally realize that prolonged immobility and pain medication alone is not the most scientific approach to tissue healing. When looking at the physiology of tissue healing, we see many therapeutic steps that can be taken to help our injuries heal quickly and optimally. In Piriformis Syndrome the need for a thorough holistic approach is especially important.

Understanding Piriformis Syndrome

The piriformis muscle is one of the prime stabilizers of the pelvis and lumbar region, and is especially important in low back and lower body pathologies because the broad sciatic nerve may go through, under or over the muscle, increasing the possibility that a sciatic nerve impingement or irritation could be related to a contracted or dysfunctional piriformis muscle. Other important regional nerves also run along or through the piriformis muscle, and could be the primary cause of symptoms, or a secondary contributor. Nerve impingement and irritation not only causes symptoms of paresthesia and dysesthesia, but also leads to decreased muscle function and weakness from poor neural firing. Weak function of prime stabilizers of the pelvis and lumbar result in increased strain on other stabilizing muscles, as well as joint tissues. The sacroiliac joint is especially impacted in piriformis syndrome, and lumbar and lumbosacral joint tissues may also be affected, leading to degeneration of joint and disc tissues over time. This is why the pathology is called a syndrome, which is a term that implies that a number of tissue problems and possibly disease mechanisms are involved. An allopathic approach tries to narrow the diagnostic and treatment focus to one particular tissue or disease mechanism. The holistic approach analyzes the problem from a broader perspective and offers treatments that deal with the whole array of contributing health problems and injuries, and is thus perfectly suited to treat a syndrome.

The piriformis muscle is located between the sacrum and the hip, and is the prime lateral rotator of the hip, as well as one of the most important stabilizers of the pelvis and low back. This broad muscle is located deep to the main gluteal, or buttock, muscle. Its origin is across the underside of the sacrum, the greater sciatic foramen of the pelvis, and the pelvic surface of the sacrotuberous ligament, which is a broad ligament that holds the sacrum to the lower pelvic bone. This ligament is directly continuous with the biceps tendon origin on the lower pelvic bone in 50% of the population, and thus piriformis syndrome is often associated with, or confused with, tendinosis of the biceps attachment. Innervation of the piriformis comes from the fifth lumbar to second sacral nerve roots, which are part of the sciatic complex, and so problems with the piriformis may contribute to decreased neural firing of the muscle, perpetuating the problem. The piriformis may also become either swollen or widened with held contracture, and since it fills the greater sciatic notch of the pelvic girdle, this chronic contracture may compress the broad sciatic nerve complex here as well. We see that chronic problems with piriformis dysfunction could thus irritate the nerve at three locations, the lumbosacral nerve roots, the greater sciatic notch of the pelvis, and the pathway of the sciatic nerve through or around the muscle. Other nerves can also be irritated by the chronic piriformis contracture, and innervation to the gluteal and coccyx muscles may also be affected, as well as the nerves that go through the broad sacral nerve plexus, such as the pudendal nerve, which innervates the bladder and rectal sphincters, the external genitalia, and has an autonomic component. Thus, some patients may experience symptoms of increased or urgent urination, urinary escape with coughing, pain associated with bowel movements, and even pain episodes with sexual intercourse.

The piriformis muscle attaches to the greater trochanter of the femur at the hip, and chronic contracture and/or weakness can also create hip pain and dysfunction, as well as postural problems that may lead to low back strain, knee strain, or even improper postural mechanics of the feet and ankles. The most typical sign of piriformis contracture is out-toeing, or the assuming of a lateral angle to the foot when standing or walking. This occurs because the piriformis is the primary lateral rotator of the hip, and the leg is held in a lateral rotation. We can see from this description that the chronic piriformis strain may create many potential problems, and present a very confusing array of symptoms, both to the patient and to the physician. Like all myofascial pain syndromes, this one could eventually lead to increased autonomic stress, which may manifest as insomnia, anxiety, constipation, abnormal sweating patterns, increased sinus congestion, poor temperature regulation, neurogenic bladder pathology, etc. Since the piriformis can directly impact the pudendal nerve, which has a strong autonomic component, there is increased potential for these types of autonomic dysfunctions. In addition, since this syndrome primarily affects women, and is most likely to occur in the perimenopausal to postmenopausal time frame, when hormonal deficiencies decrease the efficiency of normal tissue maintenance, there may be an impact on menopausal symptoms, which are themselves autonomic in origin.

The sacroiliac joint is often involved in Piriformis Syndrome. The SI joint problems can cause piriformis syndrome or be caused by piriformis syndrome. This joint is not a typical joint, and the movement is very limited. It's main joint function is to lock and unlock to provide a complex stabilization when we turn and move. Problems with the SI joint occur typically when the joint fails to lock and unlock with movement of the body. When this occurs, much strain is added to the lumbar and pelvic joints and muscle stabilizers. The SI joint is directly attached to and involved in a number of muscular tendons and ligaments. Five important ligaments attach to the SI joint, and a number of muscles, including the gluteus maximums and minimus, as well as the piriformis, are directly involved in SI movement and stability. The joint has greater movement in a woman's body, precluding the sacroiliac involvement in female piriformis syndrome. As stated, the sacroiliac joint does move very little, up to 5.8 millimeters, or about 1/4 inch, in women. This joint is important, though, because it moves in three directions, and is very integral to low back and pelvic stabilization during movements, with its locking and unlocking function. When the muscle quits unlocking, it causes quite a bit of strain on surrounding tissues, and can cause direct pain. This can also lead to hardened and hypertrophied tissue around the joint, leading to limited mobility. Another type of sacroiliac dysfunction is called upslip, or upward displacement of the innominate bone in relation to the sacrum. This type of SI dysfunction typically causes low back and groin pain, or pain located in the upper buttocks as well as the inguinal area and upper anterior thigh.

To summarize, Piriformis Syndrome may involve sciatic irritation or impingmenent, local pain deep to the buttock, strain of surrounding muscles, sacroiliac dysfunction, lumbosacral degeneration, nerve irritation or compression at multiple sites, irritation of the femoris biceps tendon origin and the ligament sling, and strain injury involving the hip, knee or foot. The symptoms are typically varied and confusing, involving increased pain with prolonged pressure on the piriformis when sitting or driving, often with dysesthesias, such as burning pain, or pins and needles sensation, as well as referred pain in various myofascial patterns, and possibly pain referred to the groin. A variety of autonomic symptoms can also eventually manifest, especially increased menopausal or perimenopausal symptoms, urinary problems, and potentially discomfort in sexual intercourse. Syndromes are complex and varied in presentation, so an individual patient may experience just some, or one, of these symptoms, or many of them.

Effective Treatment Protocol in Piriformis Syndrome

As you can see from the complex description of this syndrome, there may be many simultaneous components to the pathology. Poor succes with therapy usually can be attributed to not addressing all of the components involved. Misdiagnosis is the greatest problem, but too much focus in treatment on specific aspects of the overally tissue pathology is also common in medicine. The successful physician, and patient, will work simultaneously on all of the aspects of the pathology in order to achieve results that are not hampered by aggravating factors that are not addressed in the treatment protocol. This means that a holistic approach should be utilized, with myofascial release, joint mobilization, improved tissue healing and circulation, and correction of postural mechanics, as well as targeted stretch and exercise. The piriformis, gluteal muscles, TFL, and low back stabilizers, the quadratus lumborum and iliopsoas, should all be restored with myofascial release and soft tissue mobilization. The sacroiliac joint should be unlocked and restored with mobilization. The lumbosacral joints should be mobilized. The nerve conduction should be stimulated, and mechanical pressure on the nerves should be released. One may need to treat the biceps femoris (hamstring) tendon. When only one aspect of this whole treatment strategy is utilized, there will be limited success.

Tissue healing may be hampered by problems with the general health, and could also perpetuate the Piriformis Syndrome. Since piriformis syndrome is typically seen in women, and especially in women of perimenopausal to postmenopausal states, or with other hormonal and metabolic imbalances, analysis of and addressing hormonal balance may be important. Tissue repair and maintenance is an ongoing issue in the body, and hormones are integral to regulation of this process. When hormonal deficiency and imbalance occurs, there is a greater chance of calcified tissues, poor inflammatory response, and degeneration of joint tissues. Even the prescence of a strong premenstrual imbalance could be a sign that progesterone deficiency in the second half of the menstrual cycle is contributing to poor tissue maintenance. Adrenal insufficiency and sublclinical hypothyroid and hyperparathyroid imbalances may also play a significant role in poor tissue maintenance and play a part in the array of degenerative tissues often seen in piriformis syndrome.

A wide variety of approaches with herbal and nutrient medicine may be important in the overall treatment protocol. Herbal formulas that stimulate improved tissue healing, decreas spasm, promote improved blood and nerve circulation, and stimulate better immune and adrenal health may be very helpful in the long run. Hormonal balance may be aided with bioidentical hormones, as well as a variety of herbal and nutrient medicines. Topical herbal salves, lotions and plaster, as well as herb infused oils, may also deliver effective tissue repair aids directly to the local tissues, as well as the blood circulation. Much study has been conducted to elucidate the role of various nutrient supplements on tissue healing. While oral glucosamine and chondroitin have been proven to have only mild benefit due to the problem of digestive breakdown and poor delivery to the tight joint tissues, there are a number of nutrients that are proven to stimulate improved tissue healing, especially amino acids, and essential fatty acids. In addition, a variety of nutrient medicines may contribute to a healthier nervous function, as well as improved hormonal and metabolic health. Much of this science is complex and difficult to understand, as many nutrient medicines work indirectly on the various systems of the body to achieve goals. Utilizing a professional with knowledge of these therapies affords the patient a great chance of success.

Pelvic Pain Syndromes

Pelvic pain syndromes are multifactorial syndromes of chronic pain that affect both men and women and are often associated with urinary problems related both to interstitial cystitis and chronic non-bacterial prostatitis. Symptoms often wax and wane, and may be experienced in the pelvis, low back, hip and groin. There is much overlap between Piriformis Syndrome and Pelvic Pain Syndrome, and the chronicity and complexity of Pelvic Pain Syndrome, with its variations, often produces a misdiagnosis. Patients experiencing an array of symptoms and a chronic pain lasting for more than 3 months in the pelvic area, low back and/or hip should suspect that this syndrome is affecting them. In men, pain after ejaculation is a hallmark symptom, and this complaint is both embarrassing and routinely dismissed as a psychological problem. In women, difficulty holding the urine, frequent urination, and stress incontinence are hallmark signs, but many patients without these more dramatic symptoms suffer from Pelvic Pain Syndrome. Researchers at Stanford University Medical School have produced a high selling book entitled Headache in the Pelvis, which is now in its sixth edition, and has helped many patients better understand this confusing syndrome of pain and dysfunction.

In 2006, the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, a prestigious medical school, reviewed all clinical data on prostatitis in the United States and determined that 90-95% of cases of chronic prostatitis actually involve Pelvic Pain Syndrome (PMID: 16409145). This was then classified as non-bacterial prostatitis. The diagnosis and treatment with standard medicine for this condition is unclear and offers little chance of success, often treating with such problematic pharmaceuticals as alpha receptor blockers (alpha adrenergic receptor antagonists). These drugs are prescribed for a variety of conditions, including hypertension of autonomic origin, autoimmune diseases, autonomic vascular diseases such as Renaud’s phenomenon, and some anxiety disorders. A number of herbs contain chemicals that are alpha receptor blockers as well. For example, once popular herb, Yohimbine, is a selective alpha receptor blocker. Standard medical guidelines suggest that these drugs should only be used for benign prostatic hyperplasia with moderate to severe symptoms, though, and the side effects tend to create noncompliance in a large percentage of patients. In other words, standard medicine has little to offer the patient with Pelvic Pain Syndrome causing prostate problems. On the other hand, Complementary Medicine and the knowledgeable Licensed Acupuncturist has an array of therapeutic tools to treat this problem thoroughly, systematically and holistically.

The finding that Pelvic Pain Syndrome accounts for almost all of the cases of male benign prostate hyperplasia or chronic prostatitis has led to the impression for many patients that Pelvic Pain Syndrome is a male disorder and does not exist outside of the prostatitis. This is patently untrue, and in fact, as researchers at Stanford University Medical School have indicated, perhaps a majority of women with unclear diagnoses of stress incontinence, chronic interstitial cystitis, and chronic pain syndromes of the pelvic area and low back may attribute their condition to Pelvic Pain Syndrome. For aging women especially, Pelvic Pain Syndrome is now considered one of the most common gynecological complaints, and points to the need to take a holistic approach in medicine. Pelvic Pain Syndrome as a gynecological pathology involves the nervous system, both central and peripheral, chronic inflammation, hormonal dysregulation, and musculoskeletal problems, and is associated with gastrointestinal disorders such as irritable bowel syndrome (IBS) and interstitial cystitis (chronic inflammation of the bladder, usually associated with low-grade bacterial infections).

What exactly is Pelvic Pain Syndrome, you may ask. As with all pathologies that are called a syndrome rather than a disease or specific injury, Pelvic Pain Syndrome is defined by a wide variety of parameters, making the definition unclear. At the heart of the Pelvic Pain Syndrome, though, is a myofascial syndrome of strain and dysfunction of the deep pelvic muscles. Of course, a number of these muscles are not easily treated, as they are located on the inner side of the pelvic bones. A number of techniques of neuromuscular reeducation can be utilized to directly release these problematic muscles and restore function, and should be the focus of therapy for the muscles not easily reached by the deep tissue therapist skilled in myofascial release. Chronic myofascial syndromes often create autonomic nervous system stress that leads to dysfunction, and this creates a variety of symptoms in Pelvic Pain Syndrome. Local tissue problems, such as uterine fibroids and polyps, endometriosis, interstitial cystitis, intestinal inflammation and functional disorders, such as irritable bowel syndrome, diverticulitis, and prostate hypertrophy and chronic inflammation all may contribute to the deep pelvic myositis, or myofascial inflammation.

Women with Pelvic Pain Syndromes involving localized or generalized vulvodynia (heightened pain sensitivity to touch or pressure) may be experiencing changes in either the central or peripheral nervous system. Persistent low-grade inflammatory damage to tissues, or low-grade infections, often associated with interstitial cystitis (inflammation or the bladder membrane), may lead to hypersensitivity, or even excess growth, or peripheral sensory nerves. The symptoms may occur only with sexual intercourse, with insertion of tampons, with cycling, or when wearing tight clothing or irritating synthetic fabrics. Deeper pain may be felt as well, typically referred to as vulvovestibulodynia, and may involve interstitial cystitis, uterine fibroids, pelvic endometriosis (tissues of the uterine lining expressing outside of the uterus), or irritable bowel syndrome. Even syndromes without any of these more common underlying conditions, and only a pelvic pain myofascial syndrome, may occur. A proper assessment often requires patience and persistence. Treatment may need to address a number of these underlying problems at once. Studies have shown that hypersensitivity disorders, similar to allergic reactions, may involve increased mast cell populations in the tissues, and subsequent overexpression of certain inflammatory cytokines that stimulate and sensitize nerve endings. Fibromyalgia and some autoimmune disorders are also associated with a small percentage of cases. The key to proper evaluation and treatment is time spent by both the patient and physician, working together, to increase understanding of the pathology and potential of a multifactorial cause.

Pelvic Pain Syndromes require patience, persistence and a holistic and thorough approach to treatment. Patient knowledge and understanding is critical, as the bulk of the therapeutic work needs to be accomplished by the patient. A comprehensive treatment strategy, utilizing acupuncture, physiotherapy, herbal and nutrient medicine, combined with patient instruction in therapeutic techniques, postural corrections, and ways to improve underlying health provides the proactive patient with the tools to correct this difficult health problem. The key areas of neuronal pathways at the sympathetic portions of the spinal nerves need to be addressed in therapy as well. The sympathetic innervation of the pelvic organs originates in the thoracolumbar area and the parasympathetic portions follow vagal nerve distribution at the sacral nerve roots. Sensory innervation is shared among the pelvic organ tissues, making the sensation of pain and other symptoms vague and confusing. In the brain, symptoms stimulate portions of the brain closely associated with the limbic system, and a strong interaction between emotional memory and motivational states linked to anxiety and depression has been noted, with a gate-control theory developed to explain this confusing ineraction between the emotional and psychological states of the patient and their symptoms. Treatment of the Pelvic Pain Syndromes must therefore be individualized, address the healthy function of the brain, spine, pelvic organs, and pelvic musculature. Associated problems must also be addressed, and restoration of the hormonal balance, gastrointestinal health, and optimum immune function may also be needed to fully treat Pelvic Pain Syndrome. Complementary Medicine and the skilled Licensed Acupuncturist and herbalist can deliver such a broad and holistic approach.

Understanding Injury to Better Understand Healing needs

The precipitating cause of piriformis and pelvic pain syndromes is often a chronic or acute tissue injury. When these injuries are not treated properly, and become a chronic nagging health problem, syndromes such as piriformis and pelvic pain syndromes may be created, especially when other contributing health factors, such as intestinal inflammation and dysfunction, uterine fibroids and endometrial lesions, chronic bladder inflammation or dysfunction, or prostate problems exist. Understanding myofascial injury and treating it properly, whether it is an acute injury or a chronic strain, is very important to the resolution of piriformis and pelvic pain syndromes.

Each patient that suffers injury to muscle, tendon and joint tissues experiences a unique injury that must be rehabilitated according to the individual needs of the patient. That person's body will do the work of repair, which is an amazing physiological process, and even patient's with severe injury will experience a regrowth of tissue that is often stronger than the original tissue. During this repair process we must provide the optimum conditions for the body if we are to expect optimum outcomes. The person that should be in charge of this responsibility is the patient themself, and this requires gaining knowledge and choosing the right team of therapists. Various physicians and therapists provide skill and expertise to help the patient, but only the patient is there every day and every hour to insure that the right conditions are being provided for their body to heal properly. Understanding of the healing process, and the time frame of tissue healing, helps guide the patient to take a logical and individually tailored step-by-step therapeutic schedule. Eating the right foods and taking the right herbal and nutrient chemicals that can optimize the cellular environment to achieve the best healing results is also important. Patients with chronic health problems that could impede tissue healing need to understand the special needs that must be addressed. By taking the time to better understand tissue repair, you can feel more confident in the process, and avoid the disability of chronic pain and dyfunction. How your body heals is not out of your control, but you must understand that your own body does the work, not some outside force.

Soft tissue injuries basically are comprised of what we call strain and sprain in most cases. In acute injury, strain refers to injury of a muscle or tendon in which the fibers of these tissues tear as a result of overstretch, or overload. In repetitive and postural stress injuries, or subacute injuries, strain is defined as pathological tissue reaction to prolonged stress, usually sustained overload from repetitive use, or maintaining postural positions that strain. In overuse injury that does not happen suddenly, with a strong trauma, which is called subacute, excessive cumulative loading leads to microtrauma, and often a chronic inflammatory response, as collagen is deformed under consistent low level overloading. The deformed collagen and inflammatory response leads to unwanted scar tissue and adhesion, which must be broken up and rehealed. The least elastic part of the muscle is the tendon, and the most frequent site of injury in muscle strain is the myotendonal junction. This part of the strain injury is called an enthesopathy, and must be treated by decreasing contractile tension with myofascial release, gently breaking up tissue lesions with active release technique, and increasing nutrient delivery to the tendon tissue with mobilization.

In most acute injuries with a chronic underlying tissue injury, we rarely see tendon inflammation, which accompanies acute rupture or tear, but instead see a degenerative tendon condition that is exacerbated by the acute injury. This is called a tendinosis. Chronic inflammatory problems with the joint capsule itself are common, though, and this is called arthritis. The patient must understand that arthritis is a symptom, not a disease, although over 50 types of arthritic disease are classified, usually utilizing the term arthritis in the name, such as Rheumatoid arthritis. As we approach the subject of sensible treatment protocol for acute injury with underlying tissue problems, we must usually treat degenerated tendons and chronically inflamed joints. Although the term partial tendon tear is often used to describe tendon injuries viewed with MRI, many experts feel that this term has been routinely used to justify arthroscopic surgeries, and the the partial tendon tear is in actuality more rarely seen than degenerative tedoninosis. In recent years, studies showing poor long-term results in many cases of arthroscopic repair if the underlying degenerative tendinosis and arthritis is not addressed with proper conservative care, has greatly reduced the number of these surgeries. To correct underlying tendinosis and chronic arthritis, mechanical tension on these tissues must be reduced, tissue perfusion restored, stabilization of the joint must be accomplished, and proper joint mechanics must be taught to the patient.

Sprain refers to injury to the ligament and joint capsule that is caused by stretch beyond their normal capacity, also involving tissue tears and other pathological reactions, such as the pulling of the tissues off of the bone attachment, and eventual degeneration of the cartilage and meniscus. Often, chronic tissue injury underlies the acute strain and sprain injury, with calcified and degenerative arthritic tissues more susceptible to injury. If the past injuries were not treated with a thorough protocol, the possiblity of future reinjury is greatly increased. By taking a holistic and individualized approach to therapy, both the acute and chronic underlying tissue problems can be addressed to maximize successful outcomes. If the tissue tears are partial, or composed of many small tears in the tissues, surgical repair is usually unnecessary. This does not mean that the patient should do nothing to promote healing of these partial tissue tears and microtears, as well as other degenerative tissue problems that can lead to prolonged pain and dysfunction. Proper conservative care is needed. Decreased range of motion, weakness, and positional pain may all result from incomplete repair of strain and sprain injuries.

By first defining your injury as acute, subacute, or acute with chronic underlying conditions, you can better understand the individualized needs of your body in tissue healing, and choose the right therapeutic routine to promote quick and healthy healing. If you promote the best healing in the individual case, you might be surprised to find that in many ways your body heals with new tissue that in some ways is stronger and healthier than what you had before. You might also develop new skills in maintaining tissue health that will stick with you and benefit you in the future. Time and money spent in proper healing from injury is an investment in your future health.

Standard treatment of tissue strains and sprains has involved rest, ice, compression and elevation (denoted by the acronym RICE). Proper use of ice and compression can reduce excess swelling and pain within the first 24 hours, and rest and elevation may aid circulation and drainage. Application of this acute therapeutic protocol in chronic tissue injury, such as piriformis syndrome, though, may actually create problems. These therapies should be applied judiciously, as normal swelling and inflammation protect the injured tissues, and excessive icing and compression may reduce circulation and impede the natural processes of tissue healing. Excessive rest and elevation of the injured area may also decrease circulation and impede natural tissue repair. Within 1-3 days, in most injuries, mobilization is very important, and mild exercise to regain strength and prevent muscle wasting is very important to long term outcomes. To treat soft tissue injury with too simplistic of an application of RICE, and to avoid other therapies and therapeutic activities that could speed healing and prevent complications, is not an intelligent approach. More elaborate infomation on tissue healing in acute injury or onset of injury is found in a different article on this website.

The array of therapies available from the experienced Licensed Acupuncturist

The physiotherapies of Traditional Chinese Medicine, called TuiNa, address many of the needs of the tissues during the healing phases. Soft tissue mobilization stimulates new growth, gently breaks up adhesions, and increases circulation. One problem often encountered as injuries heal are contractures or shortening of the various tissues, especially the tendons. If the shortened tendon and muscle is left in an immobilized and shortened position, the outcome may be poor for regaining full range of motion. In the joint, ligament and capsule may regrow in a position that also restricts movement and range of motion. Gentle soft tissue mobilization will prevent this undesirable outcome. Active release techniques will gently break up the adhesions and tissue lesions near the joint. Myofascial release will reduce spasms and contracture, taking the pressure off of tendons, myotendinous junctions, and joint tissues that are difficult to heal. Neuromuscular reeducation will help the patient focus on the restoration of proper joint mechanics and postural stress, as well as targeted stretch and excercise that can be continued at home. Often, the continued use of improper body mechanics, with overuse of the crutch or cane, will cause more long-term problems than the injury itself, as improper body mechanics put unnatural stress on the healing tissues, itself a cause of strain and sprain.

Both acupuncture and herbal medicine offer great advantage to the overall protocol. Acupuncture may stimulate both local circulation and healing, as well as address better systemic health, and also treat underlying health problems that may impede the healing from injury. Studies have proven that electroacupuncture treatment speeds cellular growth and accelerates repair in tendon, ligament, and joint capsule tissues. Acupuncture also stimulates healthy pain relieving neurotransmitters, endorphins, dynorphins, and enkephalins, providing sustained pain relief to allow greater ease with therapeutic protocols. Both topical herbs and oral consumption have proven benefits in tissue repair. Herbal formulas address many aspects of tissue healing, and may be combined with various food nutrients, such as antioxidants, proteolytic enzymes, amino acids etc. Professional herbal companies continue to utilize the latest research to provide better formulas and higher quality products. Since this industry is not properly regulated, it is best to depend upon professional products from a Licensed Herbalist and Acupuncturist to achieve the most assured results.

Chronic pain and restriction of mobility after an acute injury

If your injury has healed, and you are left with underlying chronic joint pathology that has worsened, this is the time to focus your energies on restoring healthy tissue where chronically degenerated tissue has ensued.

"Modern medicine is turning to less invasive and more holistic protocols such as prolotherapy, laser surgery and other minimally invasive surgical techniques combined with a comprehensive package of support therapy to promote healthy restoration of the arthritic joint. This is where the use of Complementary Medicine comes into play."

Prolotherapy is an example of the new attitude taken by the medical community to degenerative joint conditions. In this therapy, also called sclerotherapy, sugar or nutrient solutions are injected repeatedly into the deteriorated or degenerative ligaments, joint capsule soft tissues and tendon attachments to stimulate regrowth of the fascia, or connective tissue. Prolotherapy produces an inflammatory response in these soft tissues to stimulate regrowth, but as the Mayo Clinic reports on their website, prolotherapy alone is not proven to be beneficial. It must be combined with an array of Complementary therapies to achieve success. Utilizing acupuncture, topical herbal medicines, and nutrient medicines, all of which have shown clinical proof of benefit to arthritic joint conditions, along with direct soft tissue physiotherapies, such as TuiNa and myofascial release, the ultimate success with prolotherapy is greatly enhanced.

Prolotherapy produces an inflammatory response in the joint tissues to promote healthy growth. While anti-inflammatory medicines such as ibuprofen and naprosen may relieve pain temporarily, the inhibition of inflammatory processes may result in long term degeneration rather than healthy tissue restoration. Corticosteroid injections will also cause joint degeneration if repeated too often, and a new clinical trial comparing long-term outcomes of PRP and corticosteroid injection showed that corticosteroids provided no improvement in long-term outcomes of pain and disability (see NY Times article cited below). Corticosteroids come with considerable health risk when a patient is taking multiple products with synthetic steroids chronically, and synthetic steroids are now found in many prescription and over-the-counter products. The real benefit of corticosteroid injection is a short-term relief of pain that provides a window of opportunity for the patient to utilize an array of conservative treatments to achieve better tissue healing. Complementary and Integrative Medicine provides this array of treatments, combining phyisotherapies with acupuncture, herbal medicine, topical herbs, nutrient medicine, and patient instruction to ahcieve maximum results. Complementary Medicine also utilizes the inflammatory mechanism to do what it is supposed to do, not just create pain, but to repair the tissue. Herbal and nutrient medicine may optimize the inflammatory response to promote the natural tissue healing mechanisms built into the body. For this to work a comprehensive and holistic approach must be taken that insures that your immune response and inflammatory tissue repair works optimally.

One type of injection that has been utilized more frequently in recent years for degenerative joints, especially for osteoarthritic knee joints, is hyaluronic acid. A multicenter placebo-controlled trial of the effects of this therapy in France was completed in 2008, and the results indicated that a single injection of hyaluronic acid produced no better results than placebo (see additional information). Hyaluronic acid is a substance found in normal joint fluid and tissue, and is a major component of synovial fluid, which lubricates and protects the white tissues of the joints, which have no direct significant blood supply, and thus depend upon movement to push fluids in and out of these tissues. The white tissues are the cartilage, meniscus, ligaments and tendons, and these are the tissues that degenerate in the joint. One reason that they degenerate so severely in osteoarthritis is because the bone covering, or periosteum, which does have abundant blood and lymphatic vessels, is absent where cartilage covers the bone at the joint. Instead we normally have layers of cartilage where bone meets bone, and these layers are supplied with nutrients from two directions, the vascularized muscles, and the vascularized bone. When degeneration occurs in the bone and cartilage, spurs or osteophytes, and changes in the bone underlying the cartilage, occur, where this outer bone is converted into a dense smooth ivory-like substance (eburnation), preventing the lower layers of cartilage from getting the necessary blood supply from the richly vascularized bone and also preventing the normal conversion of cartilage into new healthy bone. This basement layer of your cartilage is composed of a type of cartilage cell that creates hyaline and type II collagen. This layer of cartilage near the bone is normally oxygen-rich, from the bone blood supply, and a lack of oxygen accounts for poor hyaline formation. Injection of hyaluronic acid alone will not correct this problem, and only restoration of these cartilage cells that produce hyaline will achieve proper lubrication and decrease of pain. A step-by-step therapeutic approach is necessary to regain the healthy metabolism of lubricating hyaline and formation of new collagen. A combination of passive joint mobilization, stimulation with acupuncture and electrical stimulation, increased blood flow, healthier immune reaction, antioxidant clearing, and tissue nourishment with type II collagen, and perhaps hyaluronic acid included in the comprehensive treatment protocol, is the logical course to increase the success of this therapy.

More advanced study of the physiology of this cartilage near the bone has indicated that activated Vitamin D3 hormone, or 24,25-(OH2) D3, is essential to regulation of the healthy calcification of this layer of cartilage. When calcification slows, the cartilage near the bone becomes hypertrophied, or swollen, preventing both circulation to the tissue, as well as inhibiting the growth mechanism of the more surface layers of cartilage. Restoration of this D3 hormone mechanism involves more than just taking Vitamin D. Hormone balance is essential to the Vitamin D3 metabolism. Restoration of healthy hormone balance may thus be needed in certain patients with degenerative cartilage. In the healthy individual, most of our Vitamin D3 cholecalciferol prohormone is generated in our skin with frequent exposure to sunlight for short periods at midday. This cholecalciferol is then transformed, via a number of enzymatic steps, tightly controlled by endocrine feedback regulation, into the activated hormone D3 forms that we need. This occurs mainly in the kidneys. To restore potential D3 deficencies that may be greatly contributing to your degenerative cartilage and joint conditions, a thorough holistic approach is recommended, and professional guidance may be necessary. The book entitled Cartilage, by Brian Keith Hall and Stuart A. Newman thoroughly outlines these findings, and states: ”What distinguishes chondrocytes (cartilage cells) of the growth plate from other chondrocytes would appear to be their ability to respond to environmental regulation by Vitamin D metabolites in a manner not shared by other chondrocytes.“ What this means is that for patients with chronic degenerative cartilage, no matter what the cause, surgical correction and supply with nutrients such as glucosamine and chondroitin will not achieve ultimate goals of restoration without a healthier hormonal support. This type of increased hormonal health can only be achieved with a holistic approach.

A second type of joint degeneration occurs with repetitive wear and tear to the upper layer of cartilage, and this is called chondromalacia, or commonly ’runner's knee‘. In this degenerative condition, the upper layers of cartilage, usually under the patella, degenerate due to poor regrowth when patellar motion wears away the surface of the underlying cartilage. Uneven muscle tension and/or joint subluxation may be the cause of this abnormal abrasion of the patella against the cartilage. Most cases occur in young athletic individuals, especially women, whose wider pelvic structure may create more lateral force on the patella. Masking of the pain with non-steroidal anti-inflammatories and steroid injections may actually contribute to the degeneration because these allow the athlete to continue with harmful activities instead of resting and affecting repair. Using conservative therapies early in the syndrome may be the best advice one could get. After the chondromalacia has become chronic, there are few standard treatment options. Surgical correction has produced very few good outcomes, and often the patient is told that they may have to endure chronic pain until a full knee replacement is justified later in life. The patient wants to hear a more optimistic treatment plan than this. Since our body's tissues constantly regenerate, there is never a reason to believe that with proper treatment protocol, that restoration of healthy cartilage surface cannot by achieved. It only takes work, time, and the care of a knowledgeable Complementary Med physician who combines the various treatment strategies in a logical manner.

Trust and Confidence: the need for the patient to take a realistic and objective assessment of the health care industry and influence on government when deciding the course of treatment

There is a history of enormous monetary intervention by the health care industry in both influencing government, and influencing the health care provider and public with treatment recommendations and data. The current health care debate has revealed that the health care industry accounts for over 15% of the entire economy, and could potentially account for up to 30% in the future. Of course, with this amount of profit as a motive, common business sense requires the industry to try to control how this enormous sum of money is spent. Lobbying and political contribution by the health, insurance and pharmaceutical industry accounts for over half the direct campaign donation to congress in 2008, and anaylysts report that a similar figure might be applied to lobbying money spent. Advertising budgets have soared, and the finance committee in the U.S. Senate, leg by Republican Charles Grassley, has uncovered massive amounts of money spent on fraudulent ghost-written scientific studies and payments to researchers and those who control university health research.

As published studies of efficacy in knee surgery emerged, there was a large decrease in the number of surgeries to repair degenerative knee joints. New devices, promising a more natural and “biologic’ approach to surgery, have emerged. In 2009, the FDA admitted that its own former commissioner unduly influenced the fast-track approval of such a device, a biologic meniscus patch, because of intense pressure from three Congressman and one Senator, all whom received significant campaign donations from the company manufacturing this device. The FDA agency director overrode the advice of its science advisors to approve and endorse this surgical device. The story can be read by clicking on the site in additional information at the end of this article.

Both the patient and the surgeon must not be unduly swayed by data and recommendations pushed by the industry, but must make a decision based on the realistic, safest and best course of therapy by analyzing objectively what could realistically work. Hopefully, this article helps the patient and their doctor decide to look into, and try conservative therapies. The course of therapy presented in Complementary Medicine is not simpler, and requires a proactive approach by the patient, but may produce the best long-term outcome for many patients.

Joint degeneration of the Lumbar vertebrae

A similar profile of degenerative joint conditions and unnecessary surgeries has been shown in large studies of lumbar spine pathologies. The New York Times article quotes Dr. Michael Modic, chairman of the Neurological Institute at the Cleveland Clinic, who scanned hundreds of study participants with MRI and concluded that as many as 60 percent of healthy adults with no back pain have degenerative conditions in their spines, and that between 20 and 25 percent that receive MRI studies of the lumbar have herniated or bulging discs. Dr. Modic states that one-third of these herniated or bulging discs disappear in six weeks when repeat MRI studies were performed, and about two-thirds disappear in six months. His study found no definitive correlation between worsening disc bulging, resolving disc bulging, and symptoms. He recommended that a person with low back and leg pain should be treated conservatively for at least eight weeks before considering surgery, and that MRI scans should be used as a presurgical tool, and not as a definitive diagnosis suggesting surgical correction.

Unfortunately, we live in a culture that wants a quick fix, and patients usually look at their situation as a choice between one type of therapeutic agent or regimen versus another. This will result in failure in the majority of cases. The successful approach utilizes a variety of agents and therapies to accomplish all 3 of the above goals, namely pain relief, elimination of the causes and contributors to tissue degeneration, and restoration of healthy tissues. By trying to choose a simplistic treatment approach, rather than a comprehensive treatment protocol, the patient is usually prolonging their suffering and at best will only slow the degenerative process. Surgery may be necessary, and may clean up some of the problems with unhealthy tissues, but without a comprehensive treatment plan, degenerative conditions will recur and continue to cause pain down the road.

In many patients, the same vascular pathology that worries them about risk of future cardiovascular problems also contributes to the spinal degenerative condition. In the medical text, Myelopathy, Radiculopathy, and Peripheral Entrapment Syndromes by David Durrant, and Jerome True, the authors state: “Many of the patients that develop degenerative stenosis fall into the same age group at risk for acquiring cardiac and peripheral vascular disease. Some of these individuals may also have a coagulation disorder from disease or from therapeutic intervention (blood thinners). Clinicians who identify cardiac, vertebral, and/or aortic diesase should pay attention to the possibility of a history suggestive of an undiagnosed intermittent myelopathic (spinal cord) presentation.” The arteries run alongside the nerve roots, spinal cord, and supply the needed nutrients to maintain the vertebral discs and lamina. Attention to vascular health should be part of the therapeutic protocol for degenerative lumbar conditions.

Much scientific research is devoted to understanding the underlying health problems leading to secondary osteoarthritis, or degenerative joint disease. The National Institutes of Health estimates that 18.2% of the U.S. population will have some form of arthritis or rheumatic condition by 2020. Osteoarthritis is the most common form of arthritis, affecting 12.1% of U.S. adults in 1998, and was the second most common diagnosis in the population. It is estimated that 80% of the aging population will experience secondary osteoarthritis. Research reveals that this slowly developing degenerative condition is likely related to a syndrome of anabolic dominance leading to an eventual catabolic excess. Anabolism is the metabolic construction of complex molecules in our tissue which is balanced with catabolism, the breaking down of complex molecules in the tissues to resupply energy and the building blocks of larger molecules. This process is stimulated and regulated mainly by hormones and the endocrine feedback system. In TCM terminology, this would be referred to as a balance of Yin and Yang, with anabolism being a yang process balanced by the bioavailability of catabolic yin nutrients and energy. When this balance is dysfunctional, a gradual disease process occurs leading eventually to Osteoarthritis.

The anabolic hormones include insulin and insulin-like growth factors, testosterone, estradiol, and growth hormone. When we have problems with hormonal balance and insulin resistance, or relative excess of estrogen from progesterone deficiency, we may develop anabolic dominance. Excess adrenal stress that is chronic may not only stimulate high blood pressure, but excess androgens and testosterone. Testosterone may aromatize to estradiol in our tissues, or to dehydroepiandosterone, and stimulate breast tumors, prostate hypertrophy, and other tissue abnormalities. In a similar way, these hormones play a significant role in tissue repair and maintenance, and imbalances may lead to degenerative arthritic conditions. Insulin resistance and anabolic dominance may lead to metabolic syndrome and inability to lose weight from the midsection, high cholesterol and poor cardiovascular maintenance. Such syndromes of imbalance lead to poor inflammatory regulation and tissue remodeling, and eventually degenerative joint disease is discovered, often too late to fully correct. The smart patient will seek help to prevent these problems be utilizing preventative medicine and TCM. The knowledgeable TCM physician can test for your hormonal profile, look at the circadian rhythms of cortisol imbalance, and gradually correct the Yin and Yang of hormonal imbalances that lead to degenerative disease. TCM may thus be a valuable Complementary Medicine in prevention of osteoarthritis as well as a comprehensive treatment strategy.

Achieving pain relief with medication does not mean that the degenerative condition is resolved, and when the patient focuses only on pain relief as a measure of success, this success is usually temporary. Dependence on pain relieving medication can be very harmful to the health and create other serious problems, such as stomach and gastrointestinal problems, and cardiovascular inflammation. A whole treatment protocol, directed by a competent physician, utilizing physiotherapy, patient instruction, acupuncture, herbal prescription, dietary supplements and changes, and correction of postural mechanics is effective, especially when the physician, who is a Licensed Acupuncturist, identifies contributing health problems and addresses these as well. The ultimate benefits of this comprehensive approach are many, and the patient will emerge with not only pain relief, but lasting tissue health, a healthier daily routine, and decreased risk of serious health problems related to aging.

Popular supplements and herbs are frequently advertised with exaggerated claims and give the patients false hope. Prescription of herbal formulas and nutriceuticals by a Complementary Physician with a Medical License and education in herbal medicine, and utilizing professional products, will be much more effective. Along with the proper herbal formulas, acupuncture and physiotherapy, there are a variety of specific herbs and supplements of use. These products are usually helpful but are not a cure by themselves, and quality varies considerably between products due to the lack of regulation by the FDA. Professional products insure quality control, and these are available only to the Licensed herbalist. Here are the facts on some of the popular therapeutic aids available to the public:

Oral Glucosamine supplement: studies show that oral glucosamine had no effect of increasing glycosaminoglycan content when the cartilage was normal, but had some mild beneficial effect if the cartilage was in a rebuilding phase. Rebuilding cartilage has a much increased demand for glucosamine. Studies show that rates of collagen repair in the cartilage & meniscus were not affected by the amounts of oral glucosamine or injected glucosamine. These studies point to the fact that the patient must improve the body’s response to tissue repair in order to utilize the glucosamine supplement, and then this supplement will be effective. Thus, oral glucosamine, or glucosamine delivered locally to the tissue, in the form of topical agents or injections, will benefit only as part of a program that improves the overall tissue repair response. In patients that have no rebuilding of cartilage or meniscus, the glucosamine supplement is a waste of money. When the patient utilizes a complete conservative care treatment plan with passive soft tissue mobilization, gentle breaking up of tissue adhesions, and various stimulation techniques, the cartilage goes into a rebuilding phase, and the glucosamine is utilized fully (refer to PubMed PMID: 12355498)

Cartilage extracts with Matrix Proteins: sharks cartilage and bovine cartilage extracts have been available for some years. In many cases of degenerative joint problems, these have been ineffective. Studies that looked at patients with autoimmune cartilage diseases such as Rheumatoid Arthritis and Polymyalgia Rheumatica showed that these supplements could be useful to modify the course of the disease. The studies showed little effect in cases where the degeneration or joint inflammation was induced by medication side effect. The effectiveness of the cartilage protein extracts was linked to the immune stimulation of proteoglycan synthesis, and thus, concurrent use of immune stimulants or modifiers that enhanced interleukin or other cytotoxic immune response could greatly improve the effect. Once again, alone, these supplements may not benefit, but integrated logically into a treatment plan, they may have dramatic results for the right patients.

Collagen extracts and antioxidants: when the joint is receiving physiotherapy, with gentle breaking of chronic adhesions and improved circulation, there is a great need for large amounts of collagen in joint tissue repair. Studies show that the tissues may need up to 80 times the normal supply of collagen. Along with this nutrient material, antioxidants are required to help with clearing of dead tissues and debris. I use Health Concerns Collagenex to supply usable collagen type 2 (glucosamine, chondroitin etc.) derived from compatible tissue extracts from the chicken. Perhaps the most beneficial joint tissue antioxidant is derived from the whole pomegranate fruit, rind and seed, which is proven to be a potent tissue antioxidant, and is available from Health Concerns as well as Pomagranex. I also utilize a topical herbal cream that delivers glucosamine and chrondroitin with the carriers MSM and emu oil, so that these nutrients can get to the tissues directly. When used within the course of physiotherapy, this combination can benefit greatly. A study at Harvard University School of Medicine by Dr. David Trentham found significant improvement in rheumatoid arthritis patients with the use of low dose collagen type 2 extract derived from chicken tissue for 3 months, with the effects attributed to both increased collagen supply and an inflammatory modulating effect on cytokines. Further research at Harvard found that a patented coating on the supplement helped to deliver more bioidentical collagen type 2 to the affected joints. Further studies proved that this healthy collagen also benefited degenerated joints in cases of osteoarthritis. Since a purified type II collagen extract is needed, many collagen supplements on the market are insoluble and insufficient, and may be broken down by the body before reaching the affected joint. A professional and proven product such as Health Concerns Collagenex 2 is recommended, and concurrent phyiotherapy and acupuncture stimulation while taking these supplements insures that the circulation to the affected joint tissues is optimum for the delivery of this important nutrient supplement and antioxidant.

Maca and Cat's Claw: studies have shown significant benefit for cartilage repair with the use of these herbs. Of course, cartilage cells, or chondrocytes, will not regrow until manually stimulated. Studies have also shown that chondrocytes will regrow when the tissue is stimulated with gentle cross-fiber massage, or if this is not possible, with passive joint mobilization techniques and electrical stimulation. Studies showed enhanced mRNA (insulin like growth factor or IGF) expression and production in human chondrocytes when joint mobilization was utilized, and certain herbal chemicals have shown efficacy in promoting insulin like growth factor as well. For example, the Chinese herb Scutellaria barbata (Ban zhi lian) has been shown to beneficially modulate IGF expression via a number of herbal chemical constituents, including baicalin, berberine, resveratrol, luteolin, and apigenin. Such beneficial chemicals have now become well known and promoted as individual nutrient medicines, but are what makes up the balanced array of chemistry in this herb. Various Chinese herbs that are commonly used provide regulation and promotion of healthy growth and maintenance of joint tissues.

Gotu Kola: this herb has also demonstrated significant benefit in regrowth of joint tissues and cartilage. Chemicals act on collagen formation, anti-inflammatory activity, and antioxidant clearing. Amino acids and triterpenoids in Gotu Kola are considered to be essential to tissue healing. If there is a problem with varicosities or veinous insufficiency, combine this with Butcher's broom and Stone Root (Formula V).

Amino acids: certain amino acids are essential for repair of soft tissue such as ligament and tendons. L-Arginine, L-Lysine, L-Leusine and L-isoleucine are all effective, and should be combined with Vitamin B6 (P5P) to increase utilization. The olympic swimmer Dara Torres claimed that an amino acid formula was extremely helpful in healing her tissues and helping her get to another Olympic tournament at age 41.

Manganese or Manganese SOD: manganese deficiency has been shown to be a significant factor in many cases of degenerative cartilage. Manganese deficiency results in the poor utilization of chondroitin, glucosamine and other mucopolysaccharides in the normal repair and maintenance of cartilage. Manganese SOD (super oxide dismutase) is a combination of a potent antioxidant with manganese, and thus may aid cartilage repair even more. This supplement is hard to find, but essential mineral supplements contain manganese and will help the body to create this potent antioxidant chemical.

Proteolytic enzymes: Serratiopeptidase and Seaprose-S are two researched enzymes that help clear the rebuilding tissues and are proven to aid in both cartilage repair and decrease in chronic joint pain with a long course of use. Nattokinase is also a potent proteolytic enzyme proven potentially useful to clear fibrins and promote healthy tissue regeneration.

Pomegranate extract with seed oil and polyphenol antioxidants enhanced by fermentation: a study by the Case Western Reserve University School of Medicine, published in the September 2005 issue of the Journal of Nutrition, demonstates that a properly prepared concentrated extract of pomegranate exherts significant antioxidant and anti-inflammatory properties, such as the inhibition of interleukin 1b, which plays a key role in cartilage degeneration in osteoarthritis. Utilizing a professional extract is important to insure quality and effectiveness.

Boron and Vitamin D3: boron along with activated vitamin D3 hormone may increase cartilage formation. Boron helps regulate calcium metabolism and helps activate estrogen and vitamin D3, as well, preventing tissue calcification and aiding tissue repair. Food sources of boron include dates, raisins, prunes, almonds, hazelnuts and honey. Like many individuals, you may be deficient in activated vitamin D3, which is a hormone activated by exposure to sunlight on circulating D3. A simple blood stick test is available to determine D3 deficiency. Daily exposure to sunlight on the face and arms for 10 minutes insures activation, and so a midday walk in the sun is helpful. Exposure through glass in the car or office is not effective. You might take a cholecalciferol D3 supplement as well as chelated boron supplement combined with amino acids to aid utilization. Current study on boron supplementation is insufficient to definitively confirm that boron supplementation will treat arthritic conditons. Vitamin D3 is not really a vitamin, but rather a prohormone. D3 cholecalciferol is created daily in your body by exposure to sunlight, health cholesterol metabolism, and minimally from food sources. This cholecalciferol goes to the kidney to produce hormone D3. Two types of D3 hormone are known to science, and recent research has found that one isomer is integral to cartilage remodeling, regulating the basement membrane of the cartilage near the bone, and may be responsible for successful cartilage remodeling and repair. Since D3 hormone is tightly regulated in your body, not only supplementation with cholecalciferol and increased midday sun exposure is recommended, but also treatment to correct hormonal imbalances and improve the functions of the kidney and liver metabolism. Studies show that a high percentage of the population is deficient in D3. Utilize a holistic medical regimen to best advantage when taking these supplements.

Information Resources

The Cleveland Clinic, one of the most respected hospitals in the United States, gives a good standard description of “sciatica”, which most often involves no direct sciatic nerve pathology, but a secondary irriation of the sciatic nerve, sometimes episodically, as in piriformis syndrome:http://my.clevelandclinic.org/disorders/sciatica/hic_what_is_sciatica.aspx An August 1, 2011 article in the New York Times Personal Health section describes how a prominent medical doctor in New York, Dr. Loren Fishman, a physiatrist at New York Presbyterian and Columbia hospital, utilizes trigger point needling and adapted yoga stretches and exercises to effectively cure patients in his practice. The article describes how the standard medical community frowns on this practice of treaing without drugs, surgery or standard physical therapy when possible, but how effective this has been for his patients: http://www.nytimes.com/2011/08/02/health/02brody.html A report by the Justus-Leibig University Polyclinic for Urology in Giessen, Germany, pointed out that the diagnosis of Benign Prostate Hyperplasia is a mulitfactorial pathology with a number of classifications, including non-bacterial prostatitis (commonly now called Pelvic Pain Syndrome), and that the patient population should be aware that standard medicine has little to offer therapeutically: http://www.ncbi.nlm.nih.gov/pubmed/19568373 The Feinberg School of Medicine at Northwestern University in Chicago, Illinois, in 2006, did a thorough review of the clinical data on benign prostatic hypertrophy in the United States, and found that 90-95% of cases appeared to fit the description of non-bacterial chronic prostatitis, now referred to by many as Pelvic Pain Syndrome:http://www.ncbi.nlm.nih.gov/pubmed/16409145 The prestigious Johns Hopkins University School of Medicine wrote in 2002 that Chronic Pelvic Pain Syndromes were not being addressed diagnostically or in treatment for a majority of patients due to the lack of objective tests and lack of knowledge of the clinical characteristics by health providers. The treatment recommendations, though, are limited to symptomatic pain management in standard medicine. :http://www.ncbi.nlm.nih.gov/pubmed/12474033 Underlying health problems should be addressed to facilitate better tissue healing and pain reduction. This National Institute of Health study outlines how deficient estrogen syndromes increases pain perception and decreases tissue healing in women:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808228/ A NY Times Health article on recent evidence supporting conservative care with meniscus tears points to the growing realization that Complementary Medicine should be integrated into rehabilitation injured and degenerating tissue disorders.http://www.nytimes.com/2008/12/09/health/09scan.html?partner=rss In 2006, pharmaceutical research in Japan found that a common Chinese herb used to treat tissue injury, Boswellia, or frankincense, contained 17 chemicals with marked anti-inflammatory activity: http://www.ncbi.nlm.nih.gov/pubmed/16621377 In 2009, research at the National University of Singapore measured the in vitro and in vivo collagen-induced anti-platelet and anticoagulant effects of Panax notoginseng in animal studies, and found that the effects were greater than aspirin. These are just two of the many beneficial effects of the various chemicals in this herb:http://www.sciencedirect.com/science Harvard Medical University conducted a double-blind placebo human trial of collagen type 2 extract derived from chicken tissues and found a significant benefit in tissue healing in patients with rheumatoid arthritis: http://www.chickencartilage.com/harvardstudy/ Environmental Health Perspectives gives a peer-reviewed in depth analysis of the benefits of boron supplement at http://www.ehponline.org/members/1994/Suppl-7/newnham-full.html Serratiopeptidase is clearly explained athttp://www.purebodysolutions.com/Merchant2/graphics/00000001/PDF/serratiopeptidase.pdf Hyaluronic acid injections are not the same as prolotherapy; a large randomized trial in France was completed in 2008 and showed no benefits:http://www3.interscience.wiley.com/journal/122220639/abstract?CRETRY=1&SRETRY=0 A 2009 article in the New York Times outlines current research that shows that platelet-rich plasma injections found in rigorous study to provide no better healing than saline injections, and that steroid injections provide temporary benefit, but do not change long-term outcomes of pain and disability. : http://www.nytimes.com/2010/01/13/health/13tendon.html?ref=health A 2001 study by the Univerisidad Nacional in Lima, Peru, demonstrate that Cat's Claw, or other species of Uncaria, had proven beneficial effects on human study participants with osteoarthritis of the knee, both reducing pain and with antioxidant and anti-inflammatory mechanisms, especially the inhibition of TNFalpha:http://www.ncbi.nlm.nih.gov/pubmed/11603848 A 2009 NY Times article reveals manipulation of FDA approval of new biologic surgical devices: http://www.nytimes.com/2009/09/25/health/policy/25knee.html Medicare guidelines for treatment of bone fracture are described, and the evidence for use of pulsed electrical stimulation is presented: http://lobby.la.psu.edu/

 

 


Liddell Laboratories Back Pain Sciatica
Liddell Laboratories Back Pain Sciatica

With our fast acting homeopathic oral spray for back pain and sciatica, these limiting discomforts are quickly and easily eliminated. Why continue to suffer when you can get fast relief without side effects, with our all natural spray?

Liddell Homeopathic Back Pain/Sciatica 1 Oz

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MagniLife Sciatica Pain Relief Cream: For the Lower Back, Buttocks, and Legs
MagniLife Sciatica Pain Relief Cream: For the Lower Back, Buttocks, and Legs

Natural, botanical cream helps relieve persistent, shooting pains associated with the sciatic nerve in the lower back, buttocks, and legs.

MagniLife Sciatica Pain Relief Cream: For the Lower Back, Buttocks, and Legs

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