When sciatica pain gets the better of you and nothing you do seems to help, here is a medical treatment you can try to get relief from my Checklist Part 2 on corrective actions and treatments.
Have Trigger Point injections when appropriate (see a physiatrist usually, also medical pain specialists, neurologists and anethesiologists) Dry needling is a good option that doesn’t use an anesthetic.
To determine if you have Trigger Points, go to this previous post “Treat Trigger Points,” that shows those that cause sciatica symptoms. Manual treatment with a Trigger Point therapy like Neuromuscular Therapy usually helps. My NMT center is near Boston.
A Physiatrist is an MD, a Doctor of Physical Medicine (like a Physical Therapist with an MD). They are the ones in the rehabilitation centers that treat neuromuscular disease, chronic illness and conditions needing rehab. Physiatrists usually know about Trigger Points because it has most likely been taught in their specialty courses. Remember that Trigger Point information on sciatica pain has only been around since 1991! Other doctors who have learned about this source of pain are those who specialize in Pain Management, and sometimes anesthesiologists and neurologists. Some forward thinking PCPs have enough information to guide you to the right specialist.
Trigger Point injections are used when non-invasive treatment hasn’t helped enough. Drs. Travell and Simons in their medical text Myofascial Pain and Dysfunction: The Trigger Point Manual recommend using an “ice and stretch” treatment protocol first. When a Trigger Point is found in a taut band eliciting a “local twitch response.” the skin is cooled with ice in the direction of the muscle fibers of the taut band to turn off the nerve response. The muscle is then passively stretched.
The injection procedure involves inserting a needle in an area where TrPs are located and searching until one is found, indicated by a “jump sign.” (The muscle jumps when contacted by the needle.) A combination of a local anesthetic and saline are then injected, the anesthetic to stop the muscle from firing and the saline to flush the tissue of pain-causing elements. When this works it can stop the pain temporarily or permanently depending on several factors.
Dry needling is done by doctors but also by nurses and acupuncturists. The procedure involves inserting a needle repeatedly into a Trigger Point to break it up and is usually effective when a specific TrP is targeted. Both TrP injections and dry needling are uncomfortable, as would be expected.
The next post is about other procedures.