Sciatica Naturopathic Protocol

Sciatica Naturopathic Protocol

This Sciatica Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan and should not be substituted for medical advice, diagnosis or treatment. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Sciatica Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

HealthMasters Naturopath Kevin Tresize ND

 

Overview:

1. Definition

2. Aetiology / Risk factors

3. Signs and Symptoms

4. Treatment Recommendations

5. Supportive Lifestyle Programs

6. Diet and Lifestyle

7. Pathology Tests

8. Pharmaceutical Treatments

9. Footnotes



1. Definition

Sciatica is pain in the leg as a consequence of irritation or inflammation of the sciatic nerve.  The sciatic nerve is formed by nerve roots that exit the spinal column at lowest lumbar vertebral bodies (L4 and L5) and the sacrum (S1, S2 and S3).

The sciatic nerve is the largest nerve of the body. It supplies sensation to the posterior thigh and buttock, calf and foot, and motor power to the hip, knee, lower leg and foot (refer to Figure 1).

When this nerve is compressed, inflamed, or irritated anywhere along its length, pain may result. True sciatica is caused by compression or irritation of the nerve roots as they exit the spinal column, usually by a herniated disc, and most commonly at L5 or S1.

 

Sciatica Naturopathic Protocol Figure 1 at HealthMasters Sciatica

Figure One: Causes of sciatica



2. Aetiology and Risk Factors

Major causative factors and risk factors that can contribute to the incidence of sciatica include:

  • Sciatica is generally caused by the compression of a lumbar spine nerve root, and, far less commonly, by compression of the sciatic nerve itself.
  • Spinal disc herniation
  • Spondylolisthesis
  • Degenerated discs
  • Spinal canal stenosis
  • Sciatica may also be experienced in late pregnancy, resulting from the uterus pressing on the sciatic nerve, muscular tension and/or vertebral compression consequent to carrying the extra weight of the foetus, and the postural changes inherent to pregnancy.
  • "Pseudo-sciatica", which causes symptoms similar to spinal nerve root compression, is caused by the compression of peripheral sections of the nerve, usually from soft tissue tension in the piriformis or related muscles.
  • Another source of sciatic symptoms is active trigger points of the lower back and the gluteus muscles.


3. Signs and Symptoms

Symptoms and signs vary depending on the exact site of the pathology. The most common symptom of sciatica is neuralgic pain in the back of the thigh, calf and foot.  Pain may also extend into the hip, and there may be numbness, tingling and weakness with difficulty in moving or controlling the leg. Knee and ankle jerks may be reduced. Typically, the symptoms are only felt on one side of the body.



4. Treatment Recommendations

4.1 Core Treatment

4.1.1 Reduce inflammation

High Potency Anti-inflammatory Herbs - 1 tablet every 2 hours (up to 6 tablets daily

Specialised Pro-Resolving Mediators[*] - 1 capsule twice daily

4.1.2 Manage neuralgic pain

Highly Bioavailable Palmitoylethanolamide (PEA), with Saffron and Thiamine for Nerve Pain - 1 capsule twice daily

Highly Bioavailable PEA and Magnesium for Neuromuscular Support and Pain - 1 scoop twice daily

OR (if tablet preferred)

High Bioavailability Magnesium (Meta Mag) with active B6 - 3 tablets daily

4.1.3 Relieve pain sensitivity and promote restorative sleep

Gamma-Aminobutyric Acid (GABA) - 500mg daily

If contributing to insomnia:

California Poppy and Passionflower for Sleep - 2 tablets 1-2 hours before bed

4.1.4 Support neural regeneration, nerve conduction and mitochondrial function

Lipids and Tocotrienols for Healthy Cell Membranes and Cognition - 5 mL twice daily

4.1.5 Achieve and maintain a healthy body composition with an anti-inflammatory diet

Wellness and Healthy Ageing Program

 

4.2 Treatment Options

4.2.1 If overweight or obese

Shake It Professional Weight Management

4.2.2 Chronic pain ongoing discomfort

Highly Bioavailable Palmitoylethanolamide (PEA), with Saffron and Thiamine for Nerve Pain - 1 capsule twice daily

BCM-95 Turmeric and Devil’s Claw to Treat Chronic Inflammation - Acute: 3 capsules twice daily, Maintenance: take 1 capsule morning and 2 capsules at night with food.

Specialised Pro-Resolving Mediators[*] - 1 capsule twice daily

Highly Bioavailable Palmitoylethanolamide (PEA), with Saffron and Thiamine for Nerve Pain - 1 scoop twice daily

4.2.3 If joint degradation, support joints, cartilage and connective tissue 

Gelatin Complete Joint and Bone Formula - 1-2 scoops daily

 

4.3 Alphabetical Reference of Nutritional Support

Formula Catch Phrase Key Benefits
BCM-95 Turmeric and Devil’s Claw to Treat Chronic Inflammation A combination of herbs to provide powerful synergistic anti-inflammatory and analgesic effects by inhibiting RAGE, COX-2 expression, TNF-α and NFkB. This herbal combination is safe for long-term use.
Gamma-Aminobutyric Acid (GABA) Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the CNS, acting to down regulate pain signals in the brain.
Gelatin Complete Joint and Bone Formula This blend of glucosamine, MSM and gelatin plus nutritional co-factors, is clinically trialled to help reduce pain and inflammation to protect against joint degeneration and maintain healthy tissues.
High Bioavailability Magnesium (Meta Mag) with active B6 Magnesium, zinc, active B6 and chromium promote musculoskeletal health, reduce pains, cramps inflammation and regulate blood sugar levels to manage headaches, fatigue and cramping.
Highly Bioavailable Palmitoylethanolamide (PEA), with Saffron and Thiamine for Nerve Pain Highly bioavailable PEA in combination with saffron and vitamin B1 providing anti-inflammatory and endocannabinoid-like actions to reduce chronic pain. PEA is a bioactive lipid that enhances cannabinoid receptor activity within the nervous system and immune cells, benefiting persistent pain and neurodegenerative conditions. Saffron has been observed to reduce pain receptor sensitivity by blocking transient receptor potential ankyrin 1 (TRPA1).
High Potency Anti-inflammatory Herbs  Herbs, including bioavailable BCM-95 turmeric and BosPure boswellia, with willow bark, ginger and quercetin blended to rapidly reduce acute pain and inflammation.
Lipids and Tocotrienols for Healthy Cell Membranes and Cognition Vitamin D, tocotrienols, omega 3 EFAs and phospholipids effectively protect and replace damaged lipids and support cellular and mitochondrial structure, function and numbers.
Highly Bioavailable Palmitoylethanolamide (PEA), with Saffron and Thiamine for Nerve Pain A combination of palmitoylethanolamide (PEA) and magnesium for acute or chronic pain management. PEA is an endocannabinoid-like lipid mediator that influences both nerve and immune cells to elicit anti-inflammatory and analgesic actions. Magnesium has been shown to block glutamate via inhibition of the NMDA receptor, thereby reducing excitatory neurotransmission.
Specialised Pro-Resolving Mediators SPMs are lipid mediators that promote resolution, reduce pain, encourage clearance of pathogens and mitigate pathological inflammation, without immunosuppression. SPMs regulate macrophage polarisation; triggering the switch from M1 (proinflammatory) to the M2 (anti-inflammatory) phenotype, therefore promoting resolution.


5. Supportive Lifestyle Programs

Shake It Professional Weight Management Program A carbohydrate-controlled diet which incorporates good levels of dietary protein, appropriate levels of healthy fats and moderate exercise to support ketosis, insulin sensitivity and fat loss, especially for those who are overweight or obese. This strategy has specific benefits for chronic pain management and mitochondrial function (energy production).


6. Diet and Lifestyle

Dietary and lifestyle guidelines that may assist in the management of sciatica include

  • Manual bodywork such as remedial massage, osteopathic or chiropractic care.
  • Most cases of sciatica can be effectively treated by physical therapy or massage therapy and appropriate changes in behaviour and environment (for example cushioning, chair and desk height, exercise, stretching).
  • Reactive antigens that might trigger the pain must be minimised through correcting intestinal flora imbalances, eliminating reactive foods/chemicals, and repairing damaged mucosal barriers and defective liver detoxification enzyme systems. An integrated detoxification process involving both bowel repair and liver regeneration is the best way to achieve this.
  • Decrease overall intake of carbohydrates. Eat protein as part of each meal and include moderate amounts of fat. The ideal ratio is approximately 30/30/40 (protein/fat/carbohydrate).
  • Acupuncture may be beneficial in alleviating symptomatic complaints.
  • Mind/body techniques such as meditation, yoga, and tai chi may be beneficial in reducing the effects of stress.
  • Eliminate refined foods, alcohol, caffeine, saturated fats (e.g., animal products), and additives (especially monosodium glutamate and aspartame).
  • Eat a diet high in protein and anti-inflammatory oils (nuts, seeds, and cold-water fish). Include orange, yellow, and dark green vegetables.
  • Regular aerobic and resistance exercise is essential for health maintenance.


7. Pathology Tests

Diagnosis does not require pathology testing.  Often, a straight-leg-raising test is done, in which the person lies face upward and the healthcare professional raises the affected leg to various heights. This test, with specific subtests including the bowstring test, and passive ankle dorsiflexion, may help to differentiate sciatica from other causes of posterior leg pain.

Other tests, such as having the individual rotate the hip joint, assess the hip muscles. Any pain caused by these movements may provide information about involvement of the piriformis muscle; and piriformis weakness is tested with additional leg-strength manoeuvres. 

Further tests may be done depending on the results of the physical examination and initial pain treatment. Such tests might include x-rays, magnetic resonance imaging (MRI) and computed tomography scans (CT scans), and nerve conduction studies.  These tests can reveal problems with the vertebrae, the disk, or the nerve itself.

TEST INTERPRETATION GUIDELINES

Omega-3 Index Test

A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.


8. Pharmaceutical Treatments

Anti-inflammatories: NSAIDs and/or corticosteroids are prescribed for their analgesic and anti-inflammatory effects.  Epidural spinal injections are occasionally given for severe pain.



9. Footnotes

[*] Ensuring patients maintain an omega 3 index above 8% is essential to SPM production. Omega-3 status can be evaluated/monitored using the Omega-3 Index Test (refer to pathology testing section). In the instance of deficiency, consider co-prescribing an omega-3 essential fatty acid supplement.

 

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