Acupressure for Sciatica

MedlinePlus describes sciatica as pain, weakness, numbness or tingling in the leg, caused by injury to or pressure on the sciatic nerve. It is a symptom of another problem: a slipped or herniated disk, spinal stenosis, piriformis syndrome, a pelvic injury or fracture, spondylolisthesis, or a tumor. The pain most often occurs on one side, and it can get worse after standing or sitting, at night, or when you sneeze, cough or laugh.

Often sciatica gets better on its own, but it commonly comes back. Because the cause can be serious, the warning signs below matter more than any point.

The Sciatica page is the reference; this post explains the routine and the evidence behind it. If the pain stays in the back, see Lower Back Pain.

We found no Cochrane review of acupressure or acupuncture for sciatica, so little high-quality research exists to say what pressing these points does. The points below are tradition, labelled as such.

Traditional use: in TCM, points such as BL-40, BL-60 and GB-30 are traditionally used for pain along the back of the leg. Each point's page shows where to find it and when to skip it.

• Main points: BL-40 Middle of the Crook (Wěi zhōng) behind the knee, BL-60 Kunlun Mountains (Kūn lún) at the outer ankle, and GB-30 Jumping Circle (Huán tiào) on the buttock.
• For a tight back of the thigh: BL-36 Support (Chéng fú), at the crease under the buttock.
• Also used: GB-34 Yang Mound Spring (Yáng líng quán) below the outer side of the knee, and BL-54 Order's Limit (Zhì biān) on the buttock.

The Sciatica routine has the order and timings. The idea behind it: the leg points, behind the knee and at the ankle, come first, are pressed lightly, and you can reach them alone. GB-30 on the buttock is the one pressed firmly, often by a helper, but its page says to leave it out during an acute flare and to stop if pain shoots down the leg. Pressing should never send pain down the leg.

1. Lie on the side that does not hurt with the knees slightly bent, or sit with the sore leg stretched out.
2. Press BL-40 for 1 to 2 minutes, lightly, with the knee slightly bent: large blood vessels run behind the knee, so never press deeply.
3. Massage BL-60, pinching gently into the hollow beside the ankle bone, not on the bone.
4. When the leg is not in an acute flare, have someone press GB-30 with a knuckle, firm but controlled.
5. If you like, add GB-34 with moderate pressure. For a tight back of the thigh, add BL-36 with gentle, steady pressure.

Hold each point for 15 to 30 seconds to begin with, and work up to 1 to 2 minutes.

Skip: GB-30 during an acute flare, with a severe hip injury or after hip or buttock surgery; stop if pain shoots down the leg. BL-60 during pregnancy. BL-40 with a bleeding disorder, and press BL-60 only lightly if you have one. GB-34 during an acute leg cramp, or with a severe leg injury. Don't press on broken, irritated or blistered skin, bruises or new scars. If you have a bleeding or clotting disorder or low platelets, press more lightly and for less time, or ask your doctor first.

MedlinePlus suggests:

• ice for the first 48 to 72 hours, then heat;
• cutting back on activity for the first couple of days, then slowly returning to your usual activities. Bed rest is not recommended;
• no heavy lifting or twisting for the first 6 weeks after the pain starts;
• back exercises started early, and exercise again after 2 to 3 weeks, including core strengthening and stretching. Your provider may suggest physical therapy.

To lower the chance of it coming back: avoid sitting or lying for long with pressure on the buttocks, and keep the back and stomach muscles strong.

MedlinePlus says to contact your provider right away for:

• loss of control of urine or stool;
• weakness or numbness in your buttocks, thigh, leg or pelvis;
• pain traveling down the leg below the knee;
• back pain after a severe blow or fall;
• unexplained fever with back pain;
• burning when you urinate, or blood in your urine;
• redness or swelling on the back or spine;
• pain that is worse when you lie down or wakes you at night;
• severe pain, when you cannot get comfortable.

And contact your provider if you are losing weight without trying, if you use steroids or inject drugs, if the pain is different from before and worse, or if it lasts longer than 4 weeks.

Acupressure is not a reason to wait. See also when not to self-treat.