Lower back pain is easily the most recurring and frequent problem that I see in clinic. I would say that 2 out of 3 people who I treat have lower back pain, it may not be their overriding concern or what they necessarily want treating for, but they are still suffering from it. I see it in all different age ranges, not just older people who have declining kidneys, but I also see it in much younger people as well. It seems that when people reach the age of being around their thirties that it starts to become more common. I also have some friends who had a lot of lower back problems in their early twenties, with some undergoing surgery to try to fix the issue.
What is the cause? Why is this such a prevalent issue?
I would hypothesise many and varying different reasons; some of which are completely unrelated to the others. Firstly, let’s look at the way we move around today as bipedal mammals. We have a very upright structure that requires very little use of our back, or even requires any bending forward to stretch the muscles and tendons over the hips to help keep them loose. It strikes me that it is probably quite significant that we are one of the very few mammals that walk around as bipedal animals as opposed to quadrupedal animals. If we examined our evolution and how our ancient ancestors would have lived, have we always been bipedal creatures or is this something which has developed relatively recently? If we are truly descended from apes, then it is most likely that we spent the majority of our ancient history as quadrupedal creatures. Making the change to walk on two legs must have had its own evolutionary benefits, or we wouldn’t have made this change, however all the forces of gravity are now bearing down on the body in one linear fashion, constantly pulling it towards the ground from the tip of our head to the soles of our feet.
The force of gravity is not broken or shared in any other direction. Which over time will have a compounded effect and squash the vertebrae and disks together in the spine, this could cause them to change their natural position and cause problems in the back. This is evident in that we are supposed to be a little taller in the mornings than in the evenings, as the spine naturally decompresses overnight. The body should be able to withstand the effects of gravity under normal circumstances, however I believe that most people have an underlying issue or deficiency somewhere in their body caused by their lifestyle choices, whether it is diet, stress, lack of exercise, sedentary lifestyle or another external factor. By walking upright, our back muscles are effectively quite inactive when moving around, compared to if we walked on all fours and our back muscles actually had to contend with gravity in order to keep us upright. If our back muscles were a lot stronger and got used more to get the blood pumping through them during normal movement, then I consider they may get injured a lot less. Though in the same way that spreading the weight of your body across four limbs during movement would massively reduce the impact on the spine and surrounding muscles, it would also undoubtedly put much greater stress on the hips and shoulder joints. We see in animals like dogs that the hips are always the first thing to go. If you also consider how a dog would use its hamstring muscles, which is a big full movement when driving forward compared to how a human uses their hamstring muscle taking comparatively much shorter steps. The human hamstring never really gets stretched naturally to its full potential throughout the day, which leads to a tightening and shortening of the muscles, which can easily contribute towards lower back pain.
From an energetic and acupuncture point of view it would make sense to walk around as a quadrupedal animal, due to the fact that the Ren meridian, which is the sea of yin and reclusive by nature, is protected from external threat when facing the ground. Now that we are upright it is a big open target to anyone who would wish to attack. However it is on our front and we are able to defend against attacks from the front as it is within our visible eyeline. Similarly the Du channel is on our back, the sea of yang and expansive in nature is there to protect us if we are attacked from behind. The Bladder channel which is the yang fu pairing to the Kidney zang, with the kidney being the root and eminence of all yang in the body, the bladder channel is also placed on the back and runs the entire length of the body, flanking the Du channel as it runs down the side of the spine, with the bladder channel continuing down the back of the legs and into the heel before proceeding down the outside of the foot to the little toe.
Life today is very different from life thousands or even hundreds of thousands of years ago when we will have lived in tribal communities. Where our daily activities would include a lot of roaming and hunting or travelling to the nearest water source covering many miles in a day. Before the invention of agriculture humans would constantly be on the move looking for the next food source, similar to how many animals migrate to different regions throughout the year. Now we live a very sedentary lifestyle with a majority of the population sitting at their desks for the best 8 hours of the day, then they go home and sit on a couch for 8 hours and then lie down and sleep for 8 hours. It is not how we were designed or are supposed to live. Many of our bodily functions including digestion rely on walking to pump the blood effectively around our body to keep us healthy and help to flush out the toxins that can build up and reduce stagnation. Living a sedentary lifestyle will cause a build-up of stagnation in the body which will lead to inflammation and disease taking root.
Life needs to be about balance as it is not like we are conserving our yang energy by living this kind of sedentary lifestyle. It is often a very stressful lifestyle that is lived in the west, stressed at work, often over worked, stressed at home with young children to raise, often poor nutrition as there isn’t enough time (or desire) to cook a healthy meal and instead opting for convenience foods which will be of low nutritional value and be high in salt, preservatives and trans fats which will damage our organs. Convenience foods will also often involve microwave cooking which further reduces the nutrient value in the food we are consuming.
The kidneys are often deficient when there is lower back pain and the lifestyle that we lead is detrimental to the kidneys, burning our stores of yang too quickly with stressful high impact lives and not replacing the energy efficiently enough by eating the right nourishing foods. Which in turn will deplete our pre natal jing and further add to the increment of our demise.
Humans also appear to be getting taller as food is plentiful and modern medicine is sufficient enough to ensure that most people are able to survive long enough to be able to breed and pass on their genes to the next generation. Though food is more plentiful, the manner in which we prepare our food is vastly different today compared to even just one hundred years ago. When my Grandmother was growing up, there would be a green grocer on virtually every street. There were no fridges to keep things for a long period of time, so most items were bought fresh daily, where the nutrients will still be fresh and strong compared to days or even weeks old and decaying. International shipping of food items was nowhere near as rampant as it is today, meaning that a lot more food will have been grown in this country and in the correct season it is supposed to grow so that we are getting the right nutritional value at the right time of year. As opposed to food that is grown all year round with the use of hydroponics so that we are not eating the right food in the correct season. This could ultimately disrupt the balance of yin and yang in our bodies, creating a deficiency or excess pattern which, if not rectified, can lead to a weakening of the organs and further disease. We could also consider regular farming methods such as pesticides and herbicides and the damage that these poisons will be doing to our bodies. There is also the after farming product effects of e numbers and stabilisers as well as the amount of microplastics that will also find their way in to the body. All of this toxicity needs to be cleaned by the liver, which will have a damaging effect.
With the liver and kidneys having a common source of origin and a mutually supportive relationship, this will also in turn damage the kidneys. I haven’t even mentioned the amount of refined sugars which are now very common in the western diet. Sugar is stored as an easily available though ultimately false food source, as there is no nutritional value other than the calories it contains. Over-consumption can lead to a variety of health problems, such as being overweight, which can put a lot of strain on the back if you become very overweight. It can also cause problems with the Spleen and eventually lead to diabetes. Some theories suggest that consuming too much sugar affects the kidneys by forcing them to produce more urine to flush out the sugar, which can eventually lead to dryness or yin deficiency. Even though classically, we are taught that sugar causes damp.
What I often find is that the area where the client is feeling the pain is usually not the area where the problem is. Lots of people will have lower back pain which runs across the top of the iliac crest, however when you palpate this area you get very little response from the client, not all clients but a lot of the time. A more common culprit would be an issue in the Erector Spinae muscles in the lower back or middle portion of the back, sometimes it is even on the opposite side to where the pain is being felt, another possible issue, is a lot of tightness and tension being held in the glutes and / or hamstrings which needs to be released. Something I have found to happen quite often is that the client will come in saying they have pain in the lower right side of their back, after a few sessions and, after good progress, later they will say that the pain in their right side has now gone, however the pain has now moved to the left side in near enough the exact same geographical location.
Treatment of lower back pain requires that we look at several different aspects of the clients lifestyle. I have listed several possible causes above regarding the lifestyle of the client which will need addressing. Such as if they are prone for a lot of the day, don’t get any exercise or possibly even do too much exercise, have a bad diet that is contributing to a deficiency in their body or if they are burning the candles at both ends and using up their yang energy too quickly. Whatever the cause I find most back pain usually manifests itself as large knots in the erector spinae muscles. The knot in the muscles can then work to tighten and contract the muscle which can then lead to a shortening of the space between the discs of the spine, which in time can start to squash them, move them out of position or impinge upon the nerve. Usually there will be long knots on one or both sides of the spine. It is also worth looking at the emotions of the client to see if they are holding on to anything from their past and if this is why they are experiencing their back pain and muscle tightness. Often there is large amounts of fluids on top of the knotted area which needs to be cleared away first before you can really get at the issue underneath. I have found many times that the, for example left side, is the worst side in terms of the size of the problem and inflammation, yet when performing something such as gua sha the right side will produce a lot more sha, not because it has more issues, but because it is easier to get at those issues as there is not as much inflammation and fluid covering them. It takes time to clear away the layers of fluid and stagnation which have built up around the issue, fluids which have become stuck and are no longer flowing freely in the manner which they should. This restriction in the free flow of fluids can also effect the meridians in that area, causing blockage and stagnation in the flow of qi and fluids in meridians which can lead to even deeper more internal problems. The bladder channel is one such meridian which runs parallel to the erector spinae muscles and can be influenced by the stagnation in flow of qi and fluids. If you consider the back shu points on the bladder channel and relate it to where the knot is in the muscle then there is always the possibility that it could correlate to their being an issue with the corresponding organ.
The most crippling form of lower back pain is sciatica, where the sciatic nerve is being compressed or irritated. The pain can be debilitating as it vastly restricts the range of motion the client is able to achieve. I have seen people barely able to lift their leg more than an inch or two off the ground. Something simple like putting their socks on is far beyond their abilities. The pain can radiate from the lower back and down the outside of the leg, or even round in to the front of the hip. There is no one defining cause, but if we can see where the pain runs, we can get an idea of where the nerve is being impinged by using a nerve dermatome diagram. We can then trace this back to the corresponding spinal vertebrae and see if there is anything in this area which could be causing any constriction upon the nerve.
If we do find something there is then a good range of techniques which can be used to try to relax the pressure which is being exerted on the nerve. Tuina massage is great for relaxing the muscle, gua sha is exceptionally good at breaking down any stagnation and cupping is brilliant for helping to draw the issue to the subcutaneous layers to allow the body to clear it away. There will be local acupuncture points relative to the issue which can be used to have a beneficial effect on the area. On the back you have the Du meridian, the bladder channel which runs in two lines down the back and huatuojiaji points which can all have a great local effect. There are also many distal acupuncture points on the body which are indicated for back pain or for strengthening the lumbar region. There are points on the hands (SI3, yaotongxue), feet (SP3, KD3, BL60), wrists (SI6), arms (SI7), elbows (LU5), neck (ST9), ribs (GB25, LV13), legs (KD7, ST39 and many BL & GB points). We could also use electro acupuncture for a variety of applications, breaking down knots in the muscles, across the spine if the vertebrae are pulled of line, or on the nerves to close the pain gate on the signals being sent to the brain. We also need to consider which organs are deficient / excess and work to bring them back in to balance.
I personally have found the bladder & gallbladder points very effective at treating lower back pain / sciatica and these two channels run directly through the area where the pain is being experienced. The bladder channel traverses the whole length of the body and so by selecting points on the lower leg can be used to draw the blocked energy down towards the lower end of the channel helping to pull through the blockage which is causing stagnation. The gallbladder channel can play an important part in treating a clients back pain. Gallbladder 30 is specifically indicated as the key point for sciatic pain, where the pain radiates round to the front of the hip and into the groin or down the leg. Often this would correspond with gallbladder 29 when the pain radiates into the front of the hip. It would also correspond with the path of the gallbladder channel when the pain runs down the leg towards gallbladder 31 and gallbladder 32. As tight glutes and potentially hamstrings are another cause of lower back pain, the bladder points bladder 31, 32, 33, 34, 36 & 37 can be beneficial for treating pain in this area.
Summary
Lower back pain is a complicated and diverse issue in the human body. You may see many clients who complain of the exact same issue of lower back pain, but each of them will likely have a different cause as to why they are experiencing it. It is our duty as acupuncturists to ask the right questions and do our due diligence when searching for any issues to make sure that we are finding the cause and not just treating the symptoms which the client describes. The beauty of acupuncture is that no matter what the underlying cause is, there will always be a way in which we can treat it to help the client.
by Adam Stinson MAA RBAF – Acupuncturist and Tuina Practitioner, Formby / Liverpool (Acupuncture Association Member)
