Treatment of back pain with acupuncture
Effectiveness in treating back pain
“Affecting around 1 in 3 adults in the UK each year, low back pain is a very common According to NICE [National institute for clinical excellence] Lower back pain is a condition with an estimated 2.5 million people seeking help from their GP about their condition” 1. Recent recommendations from the guideline for health professionals include “ offering a course of acupuncture needling, up to a maximum of 10 sessions over a period of up to 12 weeks”2 While it is gratifying to have support from bodies such as NICE acupuncturists and their patients have long been aware of the benefits of acupuncture for back pain, which probably ranks as one of the more common complaints that people come to see us with.
So what can you expect if you come to see an acupuncturist for back pain. To some extent it depends who you go and see, what kind of training they’ve had, what style of acupuncture they practise etc. Part of the problem of trying to research acupuncture for a given condition is that there are a number of different approaches to treatment, and even within a given style practitioners adapt and evolve their own techniques. Thus research protocols that are based on standardized treatments actually tell us little about the efficacy of acupuncture in a realistic clinical setting.
From the perspective of a patient the most obvious differences will be whether they needle the area that hurts or whether they needle somewhere away from the pain, whether you feel the needles strongly or not at all, whether they leave the needles in or not, whether they use other techniques such as massage or cupping or moxa for example, how much importance they put on other aspects of your health/life, whether they rely on just asking you about the problem or whether they use traditional diagnostics such as pulse taking, inspection of the tongue, abdomen palpation etc.
Root and Branch
In traditional acupuncture there is the idea of ‘root’ and ‘branch’. Broadly speaking from a any problem such as a back ache has an aspect that is visible and tangible such as the pain it self and a more hidden aspect or origin out of which it has arisen and or to which it is still connected. In the same way as a tree has an aspect that is above ground and another that is below, the yang aspect is the branch or symptom and the yin aspect is the root which could be seen as the relative functioning of the body as a whole. This greater disharmony could have been what lead to the pain or in the case of a sudden acute trauma it could just be the way the body is responding to the pain; maybe with other muscles groups tightening, referred pain to other joints, affects on posture etc. Any treatment in traditional acupuncture consists of bringing a greater balance within yin and yang aspects of the person, that generally requires attending to the root and branch of the problem.
Often the difference in approach is characterised by the degree to which the acupuncturist focuses on the root or branch and the methods they use to treat one or the other. In this context the sort of ‘acupuncture’ [here on referred to as dry needling] that is done by GPs, physiotherapists, chiropractors etc can be thought of as one approach to treat the branch without consideration for
1 http://www.nice.org.uk/media/7D0/4D/2009031LowBackPainGuidelineRelease.pdf 2 http://www.nice.org.uk/media/7D0/4D/2009031LowBackPainGuidelineRelease.pdf
the root. Unless the pain is acute to the point that one has to control it before doing anything else, most traditionally trained acupuncturists will focus part of the treatment in resolving the symptom and part in resolving the root pattern. A smaller proportion of acupuncturists may focus simply on one or the other. This in turn leads to a broad diagnostic approach that goes beyond the specifics of the back pain and rather looks to see if there are any underlying patterns of disharmony whether in digestion, menstruation, sleep etc and is ascertained by questions as well as through traditional techniques such as palpation of the abdomen and pulse, and inspection of the tongue. These findings are in turn considered with reference to the main symptom eg back pain. Sometimes there is a clear connection, sometimes not. In either case traditional acupuncturists see balancing the big picture as a necessary step in treating any symptom, rather like laying firm foundations before building a house. Root treatment tends to relax the body’s nervous system which in turn helps in the release of spasm and improved postural alignment. Usually this is achieved through 2 or 3 points in the arms or legs which may or may not be left inserted [or in the case of some styles such as Toyohari which I practise, may not even be inserted at all].
Variation in Needling
In treating the main symptom some practitioners will tend to needle the place where you are feeling the pain, where as some will tend to needle away from the area, and of course a lot of us will do both to varying degrees. Alongside location differences exist between number of needles used (from just one or two to twenty or thirty), degree of stimulation (from none to very strong/painful) and also whether they use adjunct therapy like moxibustion, cupping, massage etc.
For me personally though I do often treat the affected directly I prefer to treat away from it as much as possible; the body is connected up in many interesting and mysterious ways that over many centuries have been documented in texts that became the basis for traditional East Asian medicine. [More on this in future article]. Often one has to release blocks in one part of the body which is stopping another part from repairing. Practically it means that stimulating a point on the outside of your wrist can help your lower back to get better! This is useful as sometimes when the back is in spasm trying to insert needles at that location can be quite uncomfortable and in some people can actually aggravate the condition. When this is suspected having a plan B or a selection of distal points can be very handy. So next time someone such as myself starts needling your foot for your headache, don’t assume that you have totally wasted your money on someone who doesn’t know his arse from his elbow, as there is in fact a point below the elbow that work rather well for haemorrhoids!
An extension of the use of distal points is the use of micro systems. You may have come across this idea in Reflexology treatments where the whole body is treated from the feet. This is also the case with ear acupuncture or Korean hand acupuncture, both of which use similar idea of treating the whole body from just a small part. In affect taking the body to be like a hologram. So sometimes one or two points in a specific part of the body can relieve your back pain or shoulder pain.
Another difference between approaches to treatment is the degree of stimulation and depth of insertion. Broadly speaking modern Chinese styles tend to needle more deeply and with more stimulation [including electric stimulation similar to TENS], needles are left in place for 20-30 mins or periodically stimulated. At the other end of the spectrum is shallow and contact needling used by
Japanese acupuncturists which is characterised by mild or no stimulation and without needles left in place [or for much shorter periods]. Both systems work well when practised correctly; personally I use a mix of the two but mostly rely on shallow insertions [often non insertions] and mild or no stimulation. Whatever the approach the final goal is for the nervous system and soft tissue to relax, alleviating spasm and allowing repair and re-alignment to take place.
What to expect from treatment
First a general consultation takes place to try to better understand the background to what may have caused the back pain as well as its nature and location. Then together with information about general health further diagnostic checks are made such as palpating the abdomen and the radial pulse, a few points will be chosen to either needle, or stimulate using heat or pressure, on the arms, legs and abdomen [not necessarily all at the same time]. This helps to relax the body as a whole and correct the big picture imbalances. As the body’s tissues are all interconnected this will begin the process of relaxing the area in pain. Then if you are able to turn over the back is now treated. Usually points are used in the lower legs and often the local area too is needled or treated with moxibustion [heat].
Traditional acupuncture is more than just insertion of needles. Originally acupuncturists used 9 kinds of needle; around half of these were not meant to be inserted, with rounded tips they were used to massage and press muscle tissue and joints. In addition moxibustion [heat from burning a herb] is used to warm the area or to dispel spasm and inflammation. There are many techniques for moxibustion that all revolve around the application of heat over a large or small area, either with a heat lamp or the pure dried herb. Other techniques include cupping and massage to move stuck blood and relax spasm.
Receiving treatment should feel relatively pleasant and relaxing. If it’s causing discomfort then its counter productive and alternative techniques need to be used. After treatment where possible try to relax and have an easy day, try to avoid vigorous exercise and alcohol. How many treatments are needed will depend on how long you have had the problem and you general state of health. Most muscular problems that present with reasonable healthy individuals respond fairly soon, with some noticeable improvement usually in the first two or three treatments. In some cases only one or two treatments are necessary, in more chronic cases it might take longer with the frequency of treatment decreasing as the condition improves. Usually I treat once a week though it sometimes it is better in the beginning to treat twice a week if the condition is severe. Acupuncture and moxibustion [as well as Chinese herbal medicine] often offer good cost effective solutions to back pain, joint pain and many muscular skeletal problems. If you are suffering from anything of this kind and would like to discuss it further please email me at firstname.lastname@example.org or call me on 0781 585 1476.