Acupuncture and Lower Back Pain (LBP)

Lower back pain is a very common condition with 7 out of 10 people experiencing it at some point in their life [1]. Usually it is not serious despite being debilitating. A clear aetiology is not present in 85% of Lower Back Pain cases. However 97% may be due to musculoskeletal issues [2] which means that the experienced pain is a symptom of stress or damage to the muscles, ligaments, tendons, intervertebral discs or bones. Sometimes this can cause Sciatica as the sciatic nerve can be pinched, irritated or compressed which spreads the pain down to the buttocks, the legs and even down to the feet.

Overview:

  1. Symptoms
  2. Causes in Western Medicine
  3. Medical Conditions that can cause Lower Back Pain (LBP)
  4. Causes in Traditional Chinese Medicine
  5. Diagnosis in Traditional Chinese Medicine
  6. Treatment in Traditional Chinese Medicine
  7. Prognosis
  8. How does acupuncture help with Back Pain?
  9. Some at home self-help advise
  10. Some Lower Back Exercises and Stretches
  11. When to see the GP?
  1. Symptoms of Lower Back Pain:

The main symptom of lower back pain (lumbago) is experiencing pain in the lumbar region of the back which lies roughly between the bottom of the ribs and the top of the legs. The pain can be an achy feeling or even a sharp one in the lower back area and can range from a sudden, acute pain to a chronic, mild pain.

  1. Causes of Lower Back Pain in Western Medicine:

As mentioned above, most cases of lower back pain are due to musculoskeletal issues known as ‘non-specific’ as there are no serious underlying conditions and are usually caused by sprains, muscle strains, minor injuries or a pinched or irritated nerve. These can be “triggered by bending awkwardly, lifting, carrying, pushing or pulling incorrectly, slouching in chairs, standing or bending down for long periods, twisting, coughing, sneezing, muscle tension, over-stretching, driving in hunched positions, or driving for long periods without taking a break. Sometimes, you may wake up with back pain and have no idea what has caused it.” [1]

  1. Medical conditions that cause back pain

The NHS lists the following conditions that can cause back pain:

  • a slipped (prolapsed) disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body [3]
  • sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet [3]
  • ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that’s usually worse in the morning and improves with movement [3]
  • spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation [3]

How does Traditional Chinese Medicine (TCM) see Lower Back Pain and how can it be treated with acupuncture?

  1. Causes in Traditional Chinese Medicine

In Traditional Chinese Medicine there are 6 different causes that can lead to lower back pain

  1. excessive physical work weakens the back either by putting repeatedly too much strain on the muscles and/or in an energetic sense by weakening the Kidney-Qi which in turn weakens the back muscles
  2. overwork in terms of working long hours without adequate rest over many years can deplete Kidney-Yin (energetically) which in turn cannot nourish the back leading to lower back pain.
  3. invasion of external pathogenic Cold/Wind/Damp due to not adequate clothing or exposure of the lower back to the elements can lead to Wind/Cold/Damp invading the muscles, sinews and channels of the back. This is a very common cause of back-ache. In rare occasions it is caused by Heat invasion which this article is not going to cover.
  4. inadequate exercise
  5. pregnancy & childbirth as it puts a strain on the back muscles and afterwards if the woman did not get adequate rest, nourishment and care after childbirth
  6. excessive sexual activity weakens the Kidney-Qi and therefore weakens the back in an energetic sense. This can only cause chronic lower back pain
  1. Diagnosis in Traditional Chinese Medicine:

The above mentioned causes can lead to the following 3 main Diagnosis in Chinese Medicine:

  1. Stagnation of Qi and Blood due to Trauma (sprain, muscle strain, contusion, etc.):
  1. Sign & Symptoms:
    1. severe, stabbing pain
    2. history of sprains
    3. pain worse with rest & better for light exercise
    4. pain worse standing or sitting
    5. pain unaffected by heat application
  1. Cold/Wind Damp:
  1. Signs & symptoms
    1. pain is weather related and better with heat application
    2. pain worse in morning & better with light exercise
    3. cold predominant: stiffness & contraction of back muscles
    4. damp predominant: possible swelling, numbness & heaviness
    5. pain not alleviated by bedrest
  1. Kidney deficiency
  1. Sign & Symptoms
    1. chronic pain, dull and/or sore ache, comes in bouts
    2. better with rest & worse with exertion
    3. weakness in lumbar area and knees

 

  1. Treatment with Traditional Chinese Medicine

Acupuncture can be extremely effective in treating both acute and chronic lower back ache by inserting very fine needles in certain points on the body. It can stimulate the body’s own painkiller response, supporting the proper flow of energy by removing/dissolving local stagnation, expelling external pathogenic factors and by warming the channels, sinews and muscles.

Depending on the cause in Traditional Chinese Medicine the most common Acupuncture Points are listed below

acute conditions points can be selected from the following:

distal point selection: BL40, Du26, BL10, SI3, Yaotongxue, BL58, BL62, BL59

local points selection: Du3, Du4, Du8, Shiqizhuixia, BL32

chronic conditions points can be selected from the following:

distal point selection: BL40, Du26, BL10, SI3+BL62, Yaotongxue, BL58, BL62+SI3, BL59, BL60, Kid4, Sp3, Du20, Ht7, SI3+BL62 & Ht7 & Sp3

local points selection: BL23, BL26, Shiqizhuixia, BL54, Tunzhong, Yaoyan

point combinations: BL23+Kid3, BL20+Sp3, BL11+GB39,

cupping is frequently used

some herbal formulas that can be used to support the acupuncture treatment:

Damp-Cold invading back channels:

  • Gan Jiang Ling Zhu Tang Variation
  • Cang Bai Er Chen Tang Variation
  • Er Chen Tang Variation

Stagnation of Qi & Blood:

  • Shen Tong Zhu Yu Tang Variation
  • Gu Zhe Cuo Shang San (short-term & only for acute back ache)

Kidney deficiency:

  • Liu Wei Di Huang Tang to nourish The Kidneys and strengthen the lower back
  • Du Huo Ji Sheng Tang nourish Kidney Yang for chronic Obstruction syndrome of lower back & knees
  • Zuo Gui Wan
  • Yao Tong Pian
  • Du Zhong Hu Gu Wan
  • Jian Bu Hu Qian Wan
  • Te Xiao Yao Tong Ling
  1. Prognosis:

Acupuncture is fantastic and extremely effective at relieving acute and chronic back pain, even more so than Chinese Herbal Medicine.

“Acute attacks from sprain or invasion of Damp-Cold can be cleared in a few treatments,… If, however, the acute attack is a recurrence of a chronic problem, the treatment will take much longer: usually about 10-15 sessions.” [4]

  1. How does acupuncture help with the back pain:

The BAcC states that it helps in:

  • providing pain relief – by stimulating nerves located in muscles and other tissues, leading to the release of endorphins & other neurohumoral factors and changes the processing of pain in the brain and spinal cord [5] [6]
  • reducing inflammation – by promoting the release of vascular and immunomodulatory factors [7] [8] [9]
  • improving muscle stiffness and joint mobility – by increasing local microcirculation which aids dispersal of swelling and bruising [10]
  • reducing the use of medication for back complaints [11]
  • providing a more cost-effective treatment over a longer period of time [12] [13]
  • improving the outcome when added to conventional treatments such as rehabilitation exercises [14] [15]
  1. Some at home self-help advise:

try epsom salts bath to relax all the muscles as epsom salts are high in magnesium and muscles need magnesium to function properly

try hot water bottle or heat pads

try slow  and gentle stretches

try gentle exercise specific for backache and increasing core strength

  1. Lower Back Exercise & Stretches: [16]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. When to see the GP:

Sometimes back pain can be a symptom of something more serious and it is advised to seek the GP when one or more of the following occur together with back pain:

a fever, weight loss, inflammation or swelling on the back, constant back pain that doesn’t ease after lying down or resting, pain that travels to the chest or pain high up in your back, pain down the legs and below the knees, a recent trauma or injury to your back, loss of bladder control, inability to pass urine, loss of bowel control, or numbness around the genitals, buttocks or anus. You’re under 20 years old or over 55 years, you have taken steroids for a few months, you are a drug abuser, you have or have had cancer, or you have a low immune system due to chemotherapy or another medical condition (for example, HIV/AIDS). [1]

 

If you suffer from lower back pain or stiffness, come and see our acupuncture and Chinese medicine specialist at the Acuhealth Clinic in Sale, Manchester. To book an appointment, please ring 0161-465 1150 or email info@acuhealth.org.uk

 

References:

1 NHS Choices, ‘Back Pain’, Nursing Times [website], https://www.nursingtimes.net/clinical-archive/pain-management/back-pain-23-03-2009/, (accessed 24 January 2020).

2 Deyo RA, Weinstein JN. Low back pain, N Engl J Med, 2001, vol. 344 (pg. 363 – 70)

3 NHS, ‘Back Pain’, NHS [website], https://www.nhs.uk/conditions/back-pain/causes/,  (accessed 24 January 2020).

4 Maciocia, G., The Practice of chinese Medicine The Treatment of Disease with Acupuncture and Chinese Herbs, London, Churchill Livingstone, 1994.

Ratnagar, S., Trading Encounters: From the Euphrates to the Indus in the Bronze Age, New Delhi, Oxford University Press, 2004.

5 Zhao ZQ.  Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

6 Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

7 Kim HW, Uh DK, Yoon SY, Roh DH et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

8 Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7

9 Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

10  Komori M, Takada K, Tomizawa Y, Nishiyama K, et al. Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg. 2009 Feb;108(2):635-40.

11  Thomas KJ, MacPherson H, Thorpe L, Brazier J et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ. 2006 Sep 23;333(7569):623.

12 Ratcliffe J, Thomas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis, BMJ. 2006 Sep 23;333(7569):626.

13 Witt CM, Jena S, Selim D, Brinkhaus B et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol. 2006 Sep 1;164(5):487-96.

14 Ammendolia C, Furlan AD, Imamura M, Irvin E, van Tulder M. Evidence-informed management of chronic low back pain with needle acupuncture. Spine J. 2008 Jan-Feb;8(1):160-72.

15 Yuan J, Purepong N, Kerr DP, Park J et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008 Nov 1;33(23):E887-900.

16 Axe, C., ‘The Best Lower Back Exercises & Stretches for a Strong, Pain-Free Back’, Dr Axe [website], https://draxe.com/fitness/lower-back-exercises-stretches/, (accessed 24 January 2020).

 

Castello, E. & Lieberman, D., ‘Lower Back Pain’, Evolution, Medicine, and Public Health, Volume 2015, Issue 1, 2015, Pages 2–3, https://academic.oup.com/emph/article/2015/1/2/1795271, (accessed 24 January 2020).

Yin Yang House, ‘Acupuncture for Lower Back Pain’, Yin Yang House [website], https://theory.yinyanghouse.com/treatments/acupuncture_for_low_back_pain, (accessed 24 January 2020).

Yin Yang House, ‘Alternative Natural Options for Back Pain’, Yin Yang House [website], https://theory.yinyanghouse.com/conditions-treated/alternative-natural-options-for-back-pain, (accessed 24 January 2020).

British Acupuncture Council, ‘Back Pain’, British Acupuncture Council [website], https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html, (accessed 24 January 2020).

 

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