Low back pain is a very common complaint in the general population, affecting around one-third of the UK adult population each year (NICE 2009).
A definitive diagnosis is often elusive and this can be a source of enormous frustration to those seeking help from acupuncturists and professional healthcare providers. In fact, less than 10% of cases may be attributed to a clear cause, however, it is encouraging that management and treatment of non-specific or somatic pain is still possible even without a precise diagnosis (Brukner and Khan 2012).
Treatment options for persistent non-specific low back pain include acupuncture, manual therapy and exercise therapy, and clear guidelines are provided by The National Institute of Clinical Excellence.
Often the clinical picture is complex and involves treatment of the presenting signs as well as identifying and addressing a number of possible contributing factors. Those at an increased risk of developing low back pain include those involved in heavy physical labour involving twisting and lifting, as well as the other end of the spectrum, those with a relatively sedentary lifestyle (such as prolonged sitting, standing still or driving).
An integrated approach is more effective than one approach (Brukner and Khan 2012) as well as recognising and addressing exacerbating factors.
In our experience at Belfast Community Acupuncture, learning to identify these exacerbating factors is key to long term success. This will be a reflective learning process, in which one learns from ones successes and set-backs, developing awareness and adapting behaviours. We would suggest perhaps through keeping a ‘pain diary’ in which you record your pain levels from 1-10 each day, noting any activities which aggravated or alleviated pain. By learning to recognise triggers, you can gradually learn to take adaptive, corrective action to prevent reoccurrence.
Acupuncture and Low Back Pain
In Traditional Chinese Medicine there is a saying that “when there is free flow of Qi there is no pain, and when there is pain there is no free flow of Qi”.
Let’s say that Qi may be interpreted as a metaphor which describes many different functions, depending on the context, and in the case of back pain, an obstruction to the normal circulation of blood, motor and/or sensory nerves may be caused by bruising, inflammation, scar tissue, a reduction in local circulation, stiff muscles, trigger points or other trauma. This is one way of interpreting “when there is pain there is no free flow of Qi”, at least within the narrow context of low back pain. We may attempt to alleviate these obstructions through therapeutic intervention using acupuncture, moxibustion (heat), Chinese cupping therapy or electro-acupuncture in order to stimulate the free flow of Qi.
However, in Traditional Chinese theory, it is not possible (or at least it is not Traditional Chinese Medicine) to isolate or reduce one factor from the bigger picture. This is a fundamental difference between Chinese Medicine and a solely orthopaedic approach. When a condition becomes chronic we will also look at the overall health picture, with your permission. For example from a Chinese point of view, chronic emotional frustration or anger also obstructs the free flow of Qi. Interestingly this same functional system is said in Chinese theory to ‘govern the sinews’. So we can see that there are two quite different functional causes contributing to a similar diagnostic picture in Chinese theory ie the obstruction of the Qi mechanism. It makes logical sense that by holding onto tension, we contribute to myofascial pain, or inhibit our recovery and it can be helpful to recognize this.
From a medical perspective, acupuncture may help the symptoms of low back pain by providing pain relief (through the release of endorphins altering the perception of pain), increasing local microcirculation to improve tissue healing, reduce inflammation, releasing tension in taut muscles and myofascial trigger points, improve the outcome when added to other conventional treatments in a multi-disciplined approach to treatment (British Acupuncture Council 2013).
At Belfast Community Acupuncture we believe in an integrated approach, using our training in Traditional Chinese Medicine but allowing ourselves to be guided also by the available evidence, our clinical experience and the work of expert modern clinicians such as Whitfield Reaves and Kevin Young. NICE guidelines recommend up to 10 sessions of acupuncture over 12 weeks. We recommend that you attend 3-4 weekly treatments before reviewing your progress. By this stage you should have some confidence that acupuncture is beginning to establish a therapeutic benefit.
Finally, Chinese Medicine has a rich and varied history and there are many approaches to the management and treatment of low back pain. We continue our journey as you continue yours, learning, reflecting and adapting our treatments to provide the very best care within the scope of our practice. We look forward to assisting you in your journey.
Emma Van Loock Lic.Ac
Belfast Community Acupuncture
British Acupuncture Council. (2013). Back Pain. Available: http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html. Last accessed 3rd December 2013.
Brukner and Khan (2012) Clinic Sports Medicine, 4th ed, Australia: McGraw-Hill
NICE (2009). Low back pain: Early management of persistent non-specific low back pain. Available: http://www.nice.org.uk/nicemedia/live/11887/44343/44343.pdf. Last accessed 3rd December 2013.