Back Pain

 

 Back Pain, Lumbago, & Sciatica Traditional Chinese Medicine

From the Chinese Medicine viewpoint, patients who present with back pain, lumbago, low back soreness, cold or hot back, or sciatic pain are usually diagnosed as suffering from a type of bi syndrome which translates to pain syndrome and is caused by blockage to the free movement of Qi & Blood to the affect area.

Where there is stagnation or no free flow of Qi & Blood there is pain. Bi syndromes are often caused by unknown factors; that is, there may be little apparent reason for the occurrence, though a significant injury to the back would be an obvious cause.

From the period of the Neijing (ca. 100 B.C.) to the present, bi syndrome has been said to be induced mainly by the influences of cold, damp, and wind other causes are excessive sexual activity, over working the body (these causes directly affect the Kidney leading to Kidney Vacuity/Deficiency).

Because of the location in the lower body, the kidneys are the root of the Qi, and the tendency of the pain to radiate downwards, the disorder is frequently attributed to a combination of cold and dampness: these are yin factors that have a natural downward course. [1]

Proper treatment of low back pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior, deficiency of qi and blood or kidney essence), characteristics (qi and/or blood stagnations), and locations (upper body, lower body, extremities, or internal organs). 

Optimal treatment integrates use of herbs and or western medicines, acupuncture and Tui-Na (Chinese massage), Tai Chi exercise therapies. All these therapies work together to strengthen the underlying deficiencies, strengthen the body, and facilitate recovery.

TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long- term success. Furthermore, TCM pain management is often associated with few or no side effects. [1]

The causes and mechanisms of lower back pain are categorized into three major categories:

1. Invasion by exterior pathogens: Exterior cold-dampness or damp-heat invading the channels inhibits the circulation of qi and blood in the lower back.

2. Stagnation of Qi and Blood Stasis: Traumatic Injury, Chronic Illnesses

3. Kidney Essence Deficiency: Excessive Sexual Activity, Constitutional Weakness, Chronic Illness Advanced age

Back Pain: A more Western explanation

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a chronic degenerative disorder such as arthritis, osteoporosis, a common cause of back pain is a slipped disc (aka Lumbar radiculopathy or Herniated nucleus pulposus (slipped disk).

Pain from trauma may be caused by a sports injury, improper posture, lifting, work related, or a sudden jolt such as a car accident or other stress on spinal bones, discs, and surrounding tissues. Spinal stenosis may also be a cause (narrowing of the openings the lumbar nerve roots emerge from).

Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.
Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Is there any treatment?

Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.

In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries. Most low back pain can be treated without surgery. Bed rest is recommended for only 1–2 days at most. Individuals should resume activities as soon as possible.

Treatment involves using integrated therapies Acupuncture, Chinese Herbal Medicine, Homeopathic Remedies, Acupuncture (Biopuncture, Mesotherapy, Prolotherapy, and or Neuraltherapy) with homeopathic medicines to reduce pain & inflammation.

Reeducation on how to protect your back through proper lifting, better posture; strengthen and relaxation exercises of the lower back muscles and tendons. Over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation can be used in conjunction with acupuncture.

The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.

What is the prognosis?

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable.

Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture.

Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back. [1]

Check this out to learn how to protect your back, click link below.
How to Prevent Back Pain Interactive Back Class

Sciatica

The sciatic nerve originates in the lower spine and is composed of a combination of several nerves from the lumbosacral region.

The nerve branches from the spine to the left and right buttocks, passes between the piriformis muscle, and then travels down the back of the legs, to the feet.

Sciatic pain usually radiates from the buttock and is felt primarily in the back of the thigh, though it may extend to the foot. Usually, only one side is affected.

Although the pain is felt in the fleshy part of the body, the origin of the pain is a pinching of one or more of the nerves departing the spinal cord in the area of the intervertebral disks.

Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot.

In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body. Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood.

Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

Initially, there may be a temporary prolapse or extrusion of the disk (or disks) that causes the spinal column to squeeze down on the nerves.

In cases of destruction of the disk, the pain will become chronic. Pressure can also be applied on the nerve from damage to the vertebra themselves.

If the pressure is sufficiently severe, the nerve transmissions are interrupted and there can be weakness, loss of feeling, and a resultant wasting of the leg. Sciatic pain may worsen whenever a pressure is applied to the affected area, such as results from coughing, sneezing, or straining during defecation, as well as common physical activities.

Sciatic pain is actually a spinal problem related to some cases of lower back pain, known as lumbosacral pain, and commonly called lumbago.

Lumbago may arise from similar types of disk problems that don’t happen to affect the sciatic nerve, but, instead, remain localized. Lumbosacral pain may also result from muscle and tendon strains in the lower back, whether or not they lead to disk compression or protrusion.

Another pain syndrome, Achilles tendonitis, has a relatively high rate of association with sciatica and lumbago. It is caused by injuries that may occur more often when the lower back is painful, leading to abnormal gait. ITM Online

Piriformis Syndrome:

The piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve.

This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats.

The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.

Approximately 50% of patients with piriformis syndrome have a history of trauma, with either a direct buttock contusion or a hip/lower back torsional injury. The remaining 50% of cases are of spontaneous onset, so the treating physician must have a high index of suspicion for the problem, lest it be overlooked. Rice University Sports Med  emedicine-medscape piriformis syndrome

Causes of Lower Back Pain: Differential Diagnosis [1, 6]

1. Acute muscular or ligament strain or sprain
      a. Weight Lifters Back,  Weekend Warriors Back, Work related injuries
2. Gynecological & Obstetrical
      a. Fibroids
      b. Pregnancy
      c. PMS
      d. Dysmenorrhea
      e. Prolapsed uterus
      f. Endometriosis
3. Degenerative Arthritis of the lumbar spine
4. Herniated Discs
5. Spinal Stenosis
6. Compression fractures or the lumbar spine due to osteoporosis
7. Urinary tract problems
      a. Kidney stones
      b. Urinary tract infections
      c. Prostatitis
      d. Cystitis
      e. Pyelonephritis
      f. Tumors of the kidneys, adrenal glands or bladder
8. Ankylosing spondylitis
      a. Autoimmune disorder affecting lumbar and sacral spine
            i. Pain is worst with rest and better with activity
9. Bone cancer either primary or metastatic
10.  Cancer in nearby organs
      a. Prostate
      b. Colon & rectum
      c. Cervical & uterus
      d. Kidneys
      e. Pancreas
11.  Bone infection (Osteomyelitis)
12.  Scoliosis
13.  Aortic aneurysm 


Tai Chi Exercise

Tai chi developed in China in about the 12th century A.D. Many people practice tai chi for health purposes. In the United States, a 2002 national survey on Americans' use of CAM found that 1.3 percent of the 31,000 survey participants had used tai chi for health reasons in the year before the survey. Tai chi is widely practiced in China (including in its hospitals and clinics) and in other countries with a substantial native-Chinese population. In Asia, many people consider tai chi to be the most beneficial exercise for older people, because it is gentle and can be modified easily if a person has health limitations. In tai chi practice, it is considered important to concentrate; put aside distracting thoughts; and breathe in a deep, relaxed, and focused manner. Practitioners believe that this breathing and meditation have many benefits, such as: Massaging the internal organs. Tai chi is a practice that supports, unblocks, and redirects the flow of qi. Aiding the exchange of gases in the lungs. Helping the digestive system work better. Increasing calmness and awareness. Improving balance. NCCAM-NIH Tai Chi Article

Yoga for Chronic Low-Back Pain

Chronic low-back pain (LBP) is a common reason that people seek medical care. Calling current treatment options "only modestly effective," Karen Sherman, Ph.D., M.P.H., and colleagues of the Group Health Cooperative in Seattle conducted a study of yoga (a mind-body therapy that involves both physical exercise and mental focus) for LBP. They chose the style of yoga called viniyoga, noting that some other styles may be inappropriate for back pain. Yoga was compared with two other treatments: therapeutic exercise classes and reading a self-help book. The three groups had 101 participants in total. Those in the yoga and exercise groups participated in instructor-led classes for 12 weeks and continued to practice on their own for 14 more weeks. At the end of the first 12 weeks, the LBP symptoms of all three groups had improved. Over the last 14 weeks, however, symptoms continued to improve in the yoga group only; symptoms in the other groups worsened. The authors found that viniyoga is a safe and effective treatment for chronic LBP. The study appeared in the December 20, 2005, issue of the Annals of Internal Medicine. CAM at the NIH Volume XIII, Number 1: Spring 2006

[1] Essentials of Chinese Medicine Internal Medicine By Anshen Shi 2003
[2] National Institute of Neurological Disorders and Stroke
[3] CHINESE HERBAL THERAPY FOR SCIATICA AND LUMBAGO by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
[3] Clinical Manual of Oriental Medicine. 2nd Edition by Dr. John Chen PharmD
[4] Sciatica National Library of Medicine
[5]Low Back Pain Fact Sheet National Institute of Neurological Disorders and Stroke
[6] Biomedicine A Textbook for Practitioners of Acupuncture & Oriental Medicine By Bruce H. Robinson, MD 2007
[7] Spinal Stenosis information from The National Institutes of Health
[8] CAM at the NIH Volume XIII, Number 1: Spring 2006
Rice University Sports Med
emedicine-medscape piriformis syndrome
NCCAM-NIH Tai Chi Article
Sciatica  Herniated Disc