(Pseudo)sciatica
The majority of spinal disorders however can be treated with biopuncture in a safe and economic way by giving injections in muscles, tendons, joints and ligaments; such injections are advantageous in both acute and chronic pain syndromes. Of course, it is important to always make a diagnosis in an orthodox way, before deciding on a treatment with natural medicine. Both clinical examination and history taking can bring crucial information. It is obvious that biopuncture is not the appropriate treatment for many diseases, like tumors, certain inflammatory processes, important degenerative processes, or serious intervertebral disc disease.
Especially the use of injections in myofascial trigger points and painful ligaments is a very interesting option in general practice. There is no adequate explanation as to why some people more than others are prone to activate trigger points in their spinal muscles or are prone to develop painful spots in their ligaments, where in some people these cause acute pain, and in others recurrent or even chronic pain. Certainly there is no definite evidence that specific structural disorders of the spine make any significant contribution to this. Several authors (Baldry, Simons, Travell) suggest the importance of perpetuating factors such as chronic overloading of muscles and tendons by sudden overload (e.g. lifting objects whilst in an awkward position such as with the back twisted and flexed), repetitive abuse (e.g. at work, during athletic activities), and psychological factors (psychological problems at the workplace or at home).
Sciatica is usually assumed to be caused by compression of a nerve by a herniated lumbar disc (radiculopathy). Other neurogenic sciaticas include nerve root compression by spinal tumors or spinal stenosis. Pseudosciatica however is a more appropriate name than sciatica when a patient with pain in the lower limb does not show abnormal sensory or motor neurological findings. In these cases, it is suggested that the pain is not neurological pain: one should look for myofascial pain, pain caused by ligamentous lesions, pain caused by bursitis, etcetera. The most common reasons for pseudosciatica are myofascial trigger points (MTPs) in the gluteus minimus muscle, gluteus medius muscle and gluteus maximus muscle, myofascial trigger points (MTPs) in the piriformis muscle, referred pain from lumbar facet joints (zygapophysial joints) and referred pain from bands or ligaments in the lumbar, sacral or hip region.
Case
A housewife (56) had low back pain, radiating down the right leg. She had been suffering from this pain for three months. CT-scan revealed a discus hernia on L4-L5, touching the nerve root. Although she had a lot of pain, and periods of numbness in the right leg, she refused a low back operation. She took painkillers in order to be able to do her work at home. I asked her if the pain was continuous, or not. She admitted that there were several hours a day that were pain free. The latter indicated that there was not yet constant pressure of the hernia on the nerve root. She added that she had no pain at night either.
On clinical examination, I found paravertebral myogeloses on the dorsal level and a tense musculature on the lumbar level. I could not identify any trigger points on the lumbar or gluteus level. There were no abnormal sensory or motor neurological findings.
I proposed intramuscular injections on the lumbar level, both on the left and right side. I explained that these injections would decrease the external pressure of these muscles on the intervertebral space. In fact, it is not that surprising to notice that we can treat discus related sciatica through influencing the muscular tension. Similar effects may indeed be noticed when people are told to watch their back muscles in some way or another (rest, exercise, relaxation, stretching, back school). It is true that many patients heal completely from sciatica without a surgical intervention on the discus hernia, especially when no serious (motor) nerve damage is involved.
Still, she remarked that these injections would not take away the hernia itself. How could biopuncture possibly help her then? I explained to her that those moments of the day that she had mentioned to be without pain in the right leg were very significant for the diagnosis. I asked, “When you are without pain, you still have your hernia, don't you?” So, there must be another influence on the pain, which I believe could be the muscular tension (M-factor). And I explained that decreasing these continuous muscular spasms on the low back level could eventually lead to less pressure of the hernia on the nerve root. And as such, result in less pain in the right leg. If we were lucky, this approach could even result in a withdrawing of the hernia (a phenomenon which also appears spontaneously without any treatment), and as a result a complete disappearance of the nerve irritation.
So, we started by giving those intramuscular injections, twice a week. I gave her Spascupreel mixed with lidocaine at a depth of about 3 to 4 cm . During each session, about six injections were given, each about 1 ml of the above named cocktail. After about two sessions, she mentioned that the pain was ‘moving.' I explained to her that this was a normal phenomenon, showing that her body was responding on the biopuncture treatment. After about seven sessions, she mentioned a complete disappearance of the pain and numbness in the leg. I gave her another ten sessions, which resulted in about a 90% cure. Later on, I also gave her a few paravertebral injections with Zeel and lidocaine in the myogeloses on the dorsal level. She agreed that the latter gave an extra relief regarding the suppleness of her back. She agreed that now she felt as if her back showed a lot more flexibility than ever before. After these 20 sessions, I also sent her to a physiotherapist for back school and a training program.
Case:
A man (37) had suffered from pain in the left crista iliaca, left groin and inner thigh for about three years. All radiological examinations (X-rays, ultrasonography, MRI) were negative and blood samples and EMG were normal too. NSAIDs and valium did not produce any significant results.
On going back over the history, the patient remembered a rotational strain in the low back during a golf swing, and he supposed that this particular movement was the beginning of his pain, three years earlier. In fact, any rotational strain on the back (golf, tennis) worsened his pain. So rotational musculature should be given extra attention.
On clinical examination, however, no sensitive structures could be found in the musculature of the back, lower abdomen or hip region. But two very sensitive spots were discovered on the left iliolumbar ligament. Although I could not evoke the pain in his back and leg by pressing on these painful spots, I supposed that the pain in his low back, groin and inner side of the thigh was referred pain from this strained iliolumbar ligament .
I gave him weekly injections of a mixture of lidocaine 0.5%, Traumeel and Zeel (2 ml of each) in the left iliolumbar ligament (fig. 42): the injections were given exactly in the sensitive spots that I had found during clinical examination. Nine sessions were necessary to remove the pain completely.
Case:
A 39-year-old woman showed severe sciatic pain in the left leg for two years. She told me that she had had this problem regularly, and that further investigations (X-Rays, CT scan, blood analyses) were normal, except for a discus hernia (L5-S1) on the left side. The pain was worse after bending over for some time and premenstrually. Lying down on a sofa made the pain disappear after two minutes. Paracetamol (4x1g/D) didn't help her. Stronger pain killers made her feel dizzy. Each time her family physician gave her i.m. (intramuscular) injections in the right gluteus muscle with nonsteroidal anti-inflammatory drugs (NSAIDs), and she usually recovered after about a week. Later however, the NSAIDS stopped being effective and she wanted to try another approach.
I gave her injections with a mixture of Traumeel and Discus compositum in the lumbar paravertebral muscles (both left and right). Four sessions of intramuscular injections (in the low back, not in the right gluteus muscle) twice a week were enough to alleviate the pain for about 40%, without the use of conventional painkillers or NSAIDs. I then started to inject Zeel in the hip region (around the left trochanter major). I combined these injections with the lumbar injections - again twice a week - which gave some further improvement (she told me the pain had now improved by about 60%). Finally I also added injections with Hormeel in the pain zones of the lower leg. Injecting these areas (both s.c. as well as i.m.) finally gave about 90% improvement.
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