By Shihan Mary Bolz
How many people do you know with back pain? You may even be one of them. Of all the musculoskeletal complaints, backache is the most common. It is estimated that at least 50% of people in Western industrialized countries will suffer from back pain at some time of their life. Several million working days are lost each year because of back pain. Chinese medicine, and in particular acupuncture, gives excellent results in the treatment of this complaint.
Pain in the lower back is generally considered anywhere in the back region below the lower border of the ribcage, including the buttocks. Sometimes the pain will radiate down the back of the thigh or the side of the thigh and even below the knees, down the calves, to the ankles or toes.
What are some of the causes of low back pain?
Poor posture, lack of exercise and overeating can be your back’s worst enemies and is probably a major factor in all back pain. Poor posture strains the lower back and makes it more vulnerable to injury. An increased lumbar curve is a result of weak muscles. If you did not have muscles, your entire spine and skeleton would collapse. Muscles hold you up, enable you to move, and they hold up all of the internal organs as well. Think about it: good muscle tone is major in providing health and comfort for your entire body. Weak and flabby abdominal muscles deprive your back of its greatest support when the muscles of the back have to support the extra weight in front. Being overweight even adds more to the strain.
Some other causes are back sprains, slipped or “ruptured” discs, wear and tear arthritis (osteoarthritis), tension and emotional problems, and other causes. These other causes could be any condition that affects the various back structures or nearby areas and cause backache. Some, like birth defects and scoliosis are relatively rare, but do exist. Others, like male prostate trouble or female problems are more common.
Spondylosis is a general term for degenerative changes in the spine, and is often associated with back pain, it is actually a disease. The symptoms consist of back pain which is worse on movement especially extension and tenderness over the affected joint. The movement of the joints is restricted and the muscles alongside the spine are stiff and under spasm. This is a condition affecting the synovial joints (a joint in which the opposing bony surfaces are covered with a layer of hyaline cartilage or fibrocartilage, the joint cavity contains synovial fluid, allowing some degree of free movement) with their cartilage and ligaments. Oriental medicine would treat the cause by addressing the health and integrity of these structures as well as relieving the pain.
Chronic lower lumbar ligamentous strain is a very general term which applies to an ill-defined group of conditions characterized by persistent and recurrent back pain without a recognizable pathology. It is due to the back muscle failing to protect the ligaments in maintaining posture. The pain is usually better with rest and worse on exercise. From a Chinese medical perspective, as the problem lies within the muscles and ligaments, it is necessary to treat the internal organs and meridians related to the muscles and ligaments which would be the Spleen and the Liver. One can also realize in this case, how important exercise is in keeping the back muscles strong and flexible, because the health of the internal organs is affected.
Spinal osteoarthritis consists of degenerative changes of the vertebrae bodies themselves. These changes cause a narrowing of the disc and hypertrophy (enlargement) of bone at the joint margins which leads to the formation of osteophytes (a boney outgrowth or protuberance). Osteoarthritis of the spine can be very severe without causing any symptoms. In most cases it causes an ache which is worse on exertion and in the morning. There may be a feeling of stiffness when getting up from a sitting position. As this condition consists of degeneration of the vertebral bodies themselves, one would treat the bones and kidneys in Oriental medicine. If x-rays have shown pronounced spinal osteoarthritis, it is important to remember the possibility that such degenerative changes are not related to the pain experienced by the person. Guo Jian-hua, in Jiang Su Zhong Yi (Jiangsu Chinese medicine Journal) #4, 1994, reported that in treating 78 cases with prolapsed intervertebral discs with a combination of acupuncture, massage, heat lamps and acupressure, 56 cases or 72% were cured, 15 cases or 19.2% were markedly improved, five cases or 6% showed fair improvement and only two cases or 2.8% got no result. This is a total amelioration rate of 97.2% If severe spinal osteoarthritis is the cause of the pain in old people, then acupuncture and these other modalities will be less effective, because the older people have less of their own bodies’ healing and recovery power. In this case, proper diet, nutrition and appropriate herbal supplementation prescribed by a knowledgeable practitioner of Oriental medicine can be vital to recovery and/or relief. It is important to get this person’s entire bodily function at its optimum. Then, after he or she is getting stronger and more balanced internally, the acupuncture will have more effect. That is because one way in which acupuncture functions is to implement the healing ability of the body itself. This is a very strong point of acupuncture and Traditional Chinese Medicine: it works on the healing and correcting of the balance of the body, both internally and from a neuromusculoskeletal perspective.
Now, lets talk about a very well-known cause of back pain: prolapsed lumbar disc. This condition is commonly referred to as “slipped disc.” This is the most common cause of nerve-root compression. It is caused by the nucleus pulposis ((the soft fibrocartilage central portion of the intervertebral disc) bursting through the annulus fibrosus (the tough and yet elastic fibrocartilaginous ring constituting the outside of the disc). This is a misleading term as the disc itself does not move: it is only the central nucleus that bursts through the outer ring.
The most common discs to prolapse are those at L-4-5 (lumbar discs) and L-5 S-1 (the last lumbar disc and the first sacral disc). The main clinical manifestations are sudden and severe shooting pain in the back radiating down to either leg (sciatica). In allopathic (Western) medicine, it is believed the radiation of the pain follows the dermatome distribution. Dermatomes are the areas of skin supplied by branches from a single spinal nerve. Neighboring dermatomes may overlap, that is why the pain may be felt in different areas on different occasions. It is interesting to note that the location of pain in sciatica follows the distribution of the acupuncture channels more accurately and not necessarily the dermatomes. But in the case of disc prolapse, it is also useful to take the dermatome distribution into account and use acupuncture points on these related areas as well. If pressure or pinching of the spinal nerves continues, actual nerve damage can occur and cause either numbness or muscle weakness in the leg. Most patients with slipped discs do well with non-surgical treatment, especially if they are being treated with acupuncture. Therapeutic exercise and postural training can help. Wu Shi-qian, in Tian Jin Zhong Yi (Tianjin Chinese Medicine Journal), #4, 1994, reported on 50 cases of lumbar disc protrusion treated with acupuncture. The total amelioration rate in this study was 96%. These studies show that treatment by qualified and experienced acupuncturists can relieve both acute and chronic low back pain. These studies are based on the real-life treatment of real live low back pain of real pain patients of all ages and both sexes. In all these studies, the cure rate was above 60% and the total amelioration rate above 95%.
Sometimes people may benefit from either special injections to dissolve the disc material or surgery, but these are usually not necessary if the person is faithful and persistent with their acupucnture and exercise. In Oriental medicine, the value of herbal therapy, both internal and external should not be overlooked. There are a variety of exceptionally effective external Chinese herbal liniments for use, as well. These are not just analgesic in nature; these liniments can decrease inflammation, move the blood and improve circulation and stimulate the area to heal. Liniments need to be rubbed in for 20-30 minutes so that they get down into the tissues: through the skin layers, to the muscles and even the bones.
Invasion of external cold and dampness should not be overlooked as causes and stagnation of energy, blood and body fluids also occurs. Kidney deficiency is a likely cause of chronic back ache as well, according to Oriental medical theory. Kidney deficiency causes chronic backache. The pain is dull and comes in bouts, better with rest and worse when the person gets overtired. In this case, it is important to strengthen the kidneys, as well as relieve the local pain. Weak kidneys can lead to a background which facilitates the invasions of cold-damp and repeated sprains. Obviously a backache from kidney deficiency is more common in middle-aged or elderly people. However, young people may also suffer from this type. These types of pains will get worse with changes in the weather; such as when it is cold and damp outside.
By far, the most common cause of back pain is the lack of exercise and poorly toned back muscles, along with overweight. But, it can also occur due to excessive exercise, such as jogging or aerobic exercises which can cause back sprain. Those people who have a tendency to back sprain should never lift heavy weights, as this not only can cause an acute sprain, but also weakens the kidney energy. Balanced movement, both in direction, type and quantity is very important. Balance-this is the key! Balance in life-style as well as exercise, eating, drinking, sexual activity, (in Oriental medicine, an overactive sex life weakens the kidneys), work and play. Emotional stress can also be a major factor-so remember-balance in all things! Acupuncture works quite effectively for relieving stress, besides working on the physical problem of back pain. Also remember, you can get better, even when the outlook seems bleak, such as a diagnosis of degenerative changes-they can be improved with proper treatment, managed, healed, and/or prevented from getting worse. Chinese have been treating low back pain with acupuncture and Chinese medicine for more than 2,000 years, and, in the last 50 years, a large body of research has been developed proving that Chinese medicine can be an effective alternative to Western drugs and surgery. Nature is very powerful and we should not limit that power with our prejudices or preconceived ideas. Nothing is permanent and pain and disease doesn’t have to be either.