Ask an expert - muscles and bones - back / spine - lower back pain

22 questions

Q:   I have had twp  sessions of acupucture to help me with lower back pain and sciatica. Before the first session my symptoms were not too bad. The following day my sciatica appeared to be more agitated. After the second session my back started to ache. It's been 3 days since my last session and both symptoms are causing me trouble. Is this normal?

A:  We would not go so far as to say that this is 'normal', but it can happen. Acupuncture can cause minor transient adverse events, and it is not unknown for people to have a day, or two at most, after a session where the system is in a state of flux and symptoms can become a little worse. In some cases this can be quite marked, but in all cases this should stop after about 48 hours.
If a problem continues after this, there are a number of possibilities. First, and this has to be expressed with great care in order not to offend a patient, the deterioration or increase in discomfort may have nothing to do with the acupuncture treatment. Many lower back problems have a 'tipping point' after which the symptoms become quite severe, and often what is happening at the time this takes place is unconnected to the change. A more positive therapeutic outcome, and very commonly experienced after osteopathic treatment of lower back problems, is that as the body reasserts its proper form some of the muscles which have been operating in a distorted structure are now forced to accommodate the better structure within which they should function. This is rather like the pain people sometimes experience after sitting in a restricted legroom seat at the theatre and then standing up.
In any event, the important thing is to discuss the problem with your practitioner and get their advice. They will know what treatments they have given and will be able to interpret what is happening to you better than we can at this remove. If they are concerned they may well invite you in for a flying visit just to take a look at the overall picture, and see if any short term adjustment is necessary.
Our expectation, however, is that by the time you read this the paim will have subsided considerably and you will be starting to feel the benefits of the treatment for your lower back.   

Q: I had an epidural when Ihad my son over 2yrs ago.  Since I have  sufferd really bad lower back pain.  Due to the pain I hardly go out and I have  put on a lot of weight. Do you  think acupuncture could help me?


A: This is quite a difficult question to answer. The official NHS sites quote statistics from studies which demonstrate that there are no long term side effects, perhaps only mild and short-term problems, but a quick internet search reveals hundreds of posts from women who have suffered long term debilitating problems.
It is very important to establish as much as possible what the problem is. In the first instance this means going back to your doctor and trying to get an MRI scan of the area to eliminate the possibility that there has been some damage during the epidural or some form of haematoma or tissue change which is causing the problem. This will determine how good the prognosis is.
It is also important to consider the possibility that the back pain may not be a result of the epidural. Pregnancy involves carrying a large weight at a disadvantageous angle, and if there were any minor irregularities or misalignments of the lower spine, these might have been pushed one stage further by the pregnancy and vigorous exertion of birth.
Acupuncture treatment may offer some hope. As our factsheet shows
there is some evidence that acupuncture can help with non-specific back pain, and the NICE guidelines (which determine what treatment doctors can offer) have included ten sessions of acupuncture as one of the cost-effective options to consider.
Back pains arise for all sorts of reasons, however, and even in Chinese medicine there are dozens of ways of categorising what may be happening. Sometimes this will offer a good prognosis, at other times not. The skill of the practitioner lies in seeing what else is going on in the system as a whole and using this knowledge to understand what patterns of imbalance of energy have developed over the years. It is rare for someone to have only one symptom, and there are often changes to the normal systems which people just accept without mentioning, like digestive problems or sleep disorders which just become the 'normal' order of things.
The best advice we can give, apart from following things up with your doctor, is to visit a BAcC member local to you and ask for their opinion in a brief face to face assessment. This can give you a much better idea of what can be done than we can give here.     

A:  In theory acupuncture treatment for your lower back should have no harmful side effects or secondary effects on your other health conditions. The underlying aim of all acupuncture treatment is to restore the natural flow, rhythms and balances of the energy of the body, called 'qi' in Chinese medicine, and as such it is more likely that treatment for your back may have a beneficial effect on any other conditions which you have, especially since from a Chinese medicine perspective the practitioner is treating the person, not simply the symptom.
In fact, this is the one caution we do tend to issue, given that we are not sure whether you are talking about Type 1 or Type 2 diabetes. In the case of the latter there is very often a residual pancreatic function generating some, but not adequate, insulin, and a combination of oral medication and diet ensure that someone is able to maintain their blood sugar at safe levels. There have been one or two cases where the use of acupuncture has stimulated this residual function, and as a consequence has reduced the blood sugar. This has never yet resulted in a serious hypoglycaemic episode, but it remains a theoretical possibility immediately after a treatment, so we tend to caution patients about carrying some glucose or a carton or orange juice in case they feel their levels dropping a little. In the main, however, acupuncture is always seen as encouraging homeostasis, a correction to normal function, rather than an 'overshoot', so this is more a theoretical than real risk.

Q:  I have lower backpain which is supposedly caused by the muscles in my back. I am in pain from I get up in the morning until I go to bed at night. My biggest concern is that my balance is being affected to such an extent I am even going backwards. This is very concerning. I had an MRI scan which thankfully came back clear. Would acupunture help my problem, particularly my balance.


A:  As you can see from our fact sheet

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 the use of acupuncture treatment for chronic low back pain is well-established, and NICE guidelines now recommend a course of ten sessions for people suffering chronic low back pain. The question which an acupuncture practitioner would want to resolve is whether your balance problem relates directly to the back problem or whether it is a separate manifestation of a deeper underlying imbalance. Traditional acupuncture, when it is used properly, treats the person, not simply the condition. While this does not make a great deal of difference in many cases, there are times when a symptom which two people have may be treated entitely differently because in one the symptom is the problem and their health is otherwise good, but in the other the symptom is one of several signs that the system as a whole is not functioning well. This has all sorts of implications for prognosis and for the kind of treatment and secondary advice one might give.
As far as the back pain is concerned, therefore,. we would be fairly confident that a course of acupuncture treatment would be beneficial. If the balance problem is a direct consequence of the back problem itself this should resolve as the back pain improves. If it is a separate issue then we think that a good practitioner should be able to make sense of it within the framework of Chinese medicine, and may well be able to help with reducing its effects. There are a number of conditions such as vertigo and Meniere's disease where the evidence for the benefits of acupuncture treatment, while not yet conclusive, are very encouraging.
Our advice in these situations is always to contact a BAcC member local you and seek a face to face assessment of what they think acupuncture may be able to do for you. 

Not just advisable, we would say, but probably likely to be beneficial
Although acupuncture has now been accepted by NICE as a legitimate treatment on the NHS for chronic low back pain, the fact is that a great many of the strategies which one can use in Chinese medicine for treating chronic low back pain are just as applicable to the treatment of acute back pain. Although it may not be popularly recognised a great many people come to acupuncturists as their first choice for acute back problems, and it is far from everyone who goes straight to an osteopath.
Without delving too much into Chinese medical theory, a great deal of chronic low back pain arises as a consequence of the causes of an acute pain transforming over time into what the Chinese would cause stagnation in the channels on the lower back. Treatment is often aimed at moving or unblocking this stagnation and reestablishing a good flow of energy in the area, because it is often the blockage which is said to cause the pain. Clearly if someone can treat the area before the acute trauma has consolidated into something more fixed, there is more chance of moving the short term problem and reducing the longer term problem. Getting research to validate this would prove difficult - getting dozens of patients in the same area with exactly the same acute problems would prove difficult in the West - but it is standard practice in many outpatient departments in Chinese hospitals to have a course of ten acupuncture treatments daily after an acute episode to ensure that the area is moblised again as quickly as possible.
The vital thing with acute back pain, however, is to ensure that there is no physical damage to the vertebrae or the discs, and no misalignment which if left untreated by conventional medicine could make the situation worse. It would also be vital to rule out any underlying physiological problem; gall bladder problems and kidney problems, for example, can manifest in such a way that the pain feels as though it is in the tissue of the back. It is always best to start with your GP, as we are sure you have, and then perhaps seek the advice of an osteopath if your pains started after a particular movement or injury. We are sure that a BAcC member will guide you carefully through this process if you seek their advice, and most are more than happy to spend a little time without charging giving you a better assessment based on a face to face chat of your options. 

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