Sunday, January 13, 2013

Relieve Low Back Pain with Acupuncture & Integrative Medicine

Low back pain is extremely common, affecting anywhere from 75 to 90 percent of people at some point in their lives. Low back pain is second only to the common cold as a cause of lost days at work and the most common cause of disability. It is one of the most common reasons to seek medical care, including acupuncture. In fact, one of the top reasons that people get acupuncture treatments is for low back pain.

In spite of the large number of pathological conditions that can give rise to low back pain, up to 85 percent of the cases are classified by physicians as 'non-specific'.

Incorporating Chinese medicine and western orthopedic perspectives, here's how I help patients relieve and manage low back pain.

Two Perspectives: East Meets West

Diagnostically, I always seek to understand a pain or injury syndrome from both a Western orthopedic medicine perspective and from a Traditional Chinese Medicine perspective.

Western Orthopedic Assessment:

From a Western orthopedic perspective, I take into account diagnoses the patient may have already received from other medical practitioners and view the patient's x-ray or MRI images. Then, I ask the patient a range of questions about specific location(s) and nature of pain and perform a series of orthopedic exams of the lumbar and pelvic regions in an attempt to isolate causative factors. From a Western perspective, we must consider nerves, muscles, connective tissue and postural imbalances.

Some patients with low back issues experience pain or parathesia (weakness or numbness) sensations that refer into the buttock, hip and/or leg. In some cases, this referred pain is true sciatica, or nerve pain, resulting from nerve impingement originating from the spine. In cases of true sciatica, an understanding of the nerves innervating the legs and the geography of dermatomes can help a practitioner isolate which spinal nerve root is impinged (typically L4, L5 or S1) . On the other hand, sciatica-like sensations often have causes other than spinal nerve root impingement. These include: pathology of the facet joints of the lumbar vertebrae, tearing of the intervertebral disk's annulus fibrosis, sacroiliac joint/ligament pathology, trochanteric bursitis, tension of the piriformis or other muscles. Differential diagnosis is important in determining and treating the cause of pain.

An assessment of bony structure of the pelvis is also important. Anterior, posterior or lateral tilt or rotation of the pelvis can cause wear and tear on the bony structures of the spine and/or the intervertebral disks. Structural imbalances are indicative of imbalances among the muscles which stabilize the legs, the waist and the pelvis. (Typically we find that certain muscles are tight and short, while their paired antagonist is weak.) Muscle imbalances and pelvic disparities are, of course, mutually reinforcing and often exacerbated by our daily habits and activities (too much sitting, poor posture, etc.) The good news is that pelvic disparities can be corrected by acupuncture treatment or therapeutic massage of appropriately-selected muscles, tendons and meridian pathways--as well as by exercise therapies.

Traditional Chinese Medicine Assessment:

When low back pain is examined from an Asian medicine perspective, it is seen as a disruption to the flow of Qi within the area and associated with a specific disharmony and is treated accordingly.

The disruption of Qi that results in low back pain is usually associated with the following three disharmonies:

Weak Kidney Qi
In Traditional Chinese medicine, the lower back is referred to as the “dwelling of the Kidneys”. The majority of chronic low back pain conditions are associated with Kidney deficiency. Pain related to Kidney deficiency is typically dull and erratic. It is usually aggravated by fatigue and improves with rest.

Stagnation of Qi and Blood
When the flow of Qi along the meridians that traverse the lumbar region becomes congested, it is referred to as the stagnation of Qi and blood. This presents with a severe stabbing pain that is worse with rest and better with movement, tender to touch and can be accompanied by stiffness and tightness. Qi and Blood stagnation is more often seen in an acute injury or acute exacerbation of a chronic pain syndrome or imbalance.

Invasion of Cold and Dampness
Cold, damp type pain is generally worse in the morning and when the weather is cold and damp. This type of pain improves with movement and the application of heat. Stiffness and contraction of back muscles that is aggravated by immobility indicates cold predominance. Swelling, numbness and a heavy sensation are indicative of dampness. Cold and dampness are often considered to "set in" after an acute injury as the injury becomes chronic. This includes tissue adhesions that form as a result of inflammation and limit mobility. From a Chinese medicine perspective, it is important to receive prompt treatment for a pain or injury condition, because weakness or cold and dampness are likely to exacerbate lingering, non-healing injuries.


Effective treatment of low back pain also integrates both Western orthopedic and Chinese medicine perspectives. Once a diagnosis of the exact structural and/or energetic cause of pain is established, acupuncture or manual therapy is applied. A variety of points are treated including:
  • points around bony structures like facet joints or the sacro-iliac joint,
  • motor points on affected muscles (the point where the motor nerve enters the muscle),
  • points affecting the motor nerve roots as they exit the spine, and
  • points along the specific meridian channels whose energetic blockage is implicated: these are often above or below the site of pain & injury or on the opposite side of the body.
An excellent acupuncturist also takes a holistic view of a patient's condition, making sure to include acupuncture points or apply herbal therapies which treat constitutional patterns underlying a patient's injury. In the case of low back pain, constitutional factors typically include weakness of the Kidney energy, a propensity to Qi congestion or blood stasis, a weakness of the Spleen energy (as the Spleen is responsible for the production of blood and energy & assuring the health of muscles). Stagnation in any of the merdians traversing the low back and pelvis (bladder, gall bladder, Spleen, Kidney, Liver, Stomach) is also a factor. 

The goal of the acupuncturist, in addition to relieving pain, should be to encourage a homeostasis in the patient's body that promotes strength and suppleness to bones, muscles and connective tissues and prevents further pain or injury.

If you or someone you care about is suffering from low back pain, please call 510-495-5752 or email to learn more about how acupuncture and Chinese medicine can help.