There are like a thousand ways to treat lumbar pain and sciatic pain. If you've been practicing a while I know you've had to learn a few because this has got to be one of the main reasons people seek acupuncture.
The protocols below work well for lumbar pain, back strain and sprain, sciatic nerve pain, and piriformis syndrome.
Start with cupping
For back pain I always start with cupping when I can. Pain by definition in Chinese medicine is the inability for Qi and Blood to flow for whatever reason. Cupping opens the channels affected and allows for Qi and Blood flow and often immediate pain relief. You can do sliding cupping, flash cupping, or static cupping. Cup the affected area and also the Back Shu of the Kidneys and Bladder.
Cupping + hand needles
This is my favorite method, actually. I find it very effective because it uses the energy of the needles in the hands and then directs the energy to the lower back with the cupping. Sometimes this is all it takes to alleviate back pain and/or sciatic pain. Obviously, if you're treating in a community clinic or other group setting, you can't do this whole treatment. I've got an alternative for you after the steps below.
Lie the patient face down on a treatment table. Have the patient loosen or remove their pants so you can get to the affected area when you apply the cups.
Needle San Cha A02 and A04 with a 1 cun or 1.5 cun needle on the affected side. Thread both of these needles proximally on the hand, aiming toward the Yao Tong Yue extra points (located at the base of the junctions of the 4th and 5th metacarpal and the 2nd and 3rd metacarpal).
Apply static cups to the affected area of the low back, sacral area and/or Gb 30 area. Be sure you put a couple of cups on the Bl 23 points, the Back Shu points of the Kidneys.
If you are in a setting in which a patient can't drop their pants like a community clinic, the alternative to this is to use another method to bring energy to the lower back. I've used these same Master Tung points on the hand while the patient is standing, then I have them walk around for about 10 minutes. This brings Qi to the lower back. Have them also do gentle stretches. You may have to guide them through this. Keep them moving for 10 minutes if you can. The back should start to feel better after just a few minutes. This generally encourages them to keep going.
Option two - needles only
Needle Xia San Huang on the same side as the pain
Add one or more sets of the following needles based on what channel is affected. Needle these points on the affected side as well. Bladder channel = Bl 40, Bl 63, Bl 54 Gallbladder channel = Gb 34, Gb 36, Gb 39 **Stomach channel = St 34, St 36, St 44
**Stomach channel? Yep. One branch of the sciatic nerve bundle goes to the anterior thigh. Patients that have anterior thigh pain or groin pain along with point reactivity upon palpation around Gb 30 or the Huan Zhong extra point will react positively to these points.
Piriformis Syndrome. Because this protocol functions as a targeting system that addresses the whole lumbar and sciatic region, it also works for piriformis syndrome, which can express with pain on the front of the thigh. Piriformis Syndrome is basically the signs and symptoms of sciatic area pain but without any lumbar involvement. The piriformis muscle is one of the muscles deep in the gluteal region covered by the gluteus maximus. It connects the sacral area to the top of the greater trochanter of the hip. When it gets tight it can squeeze the sciatic nerve bundle causing pain on any of the sciatic branches.
Option Three - Three needles
I use this set when the pain isn't the chief complaint. If you are treating other complaints, you can add these needles and do either cupping or massage at the affected area to guide the Qi.
Needle UB 40, the command point for the back, on the affected side
Add cupping, acupressure at Gb 30 or Huan zhong extra point, or massage in the affected area
"Homework"
I will often use ear seeds or ear tacks at the appropriate auricular points - hip joint points, lumbar, lumbago, lumbar vertebrae, sciatic nerve (sometimes called ischium), and/or relax muscle points. I generally choose no more than three points and coach the patients well about when and how to remove them.
I generally don't do this for geriatric patients because they forget they are there. Seeds especially can embed if left in too long. If the patient is trained well and have a good track record of removing the seeds or tacks reliably or if I know they are coming back in a couple of days I will put them in.
