Ask an expert - muscles and bones - back / spine

66 questions

Q:  I have had 10 sessions for lower back and hormone treatments. These have helped greatly but how long should I keep going? It is very costly and I would love to keep going although not sure this is possible. Can you stop without any side effects? If I can afford to I will keep going for a while.

A:  We are always sorry to hear of a patient running into financial barriers to continuing treatment from which they are clearly benefiting. However, it is a reality of our situation in the UK that most practitioners are in private practice and have to charge fees which are usually commensurate with other health professionals in related fields. Many of our members are willing to discount fees if someone really is struggling to afford treatment, but this can become a source of friction - if the fee is halved for weekly treatment it can lead to bad feeling if the treatments are spaced out and the practitioner then asks for the full fee. 
How long should you keep going? This is a difficult one to answer. Generally speaking, there should be a point where someone's progress is reviewed, and a decision made about continuing. This is not always a case of 'being better'. We have all had patients who have come to us regularly for years to stay well, and in some cases to avoid a deterioration which will continue as soon as they are not having treatment. If someone can get a week's pain relief from treatment, it is a judgement call for them whether they want to spend their money to buy weekly relief in this way, even if the problem is still there in the background . Most of us, though, if we find that treatment buys temporary relief but nothing more enduring, often explore other treatment options with a patient which may offer a more lasting solution.
There will be no side effects from stopping treatment, but it may be the case that the improvements you have made may begin to fall away a little. This is not always the case; the body has a tendency to health, and once treatment has shown the system the way, it is common for gains to be maintained. Each case is different and unique, however, so it is not possible to generalise.
In all cases, though, good communciation is the key. If you do have a problem carrying on, then discuss this frankly with your practitioner and see what can be worked out. Most of us are not driven by money and can make concessions if we think treatment is making a real difference to someone.   

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. 

Q:   I have received the following letter from my consultant neurosurgeon and wondered if acupuncture could help instead of an operation as suggested in the letter, if so I would be very grateful if you could recommend a top acupuncturist who could do this for me. The letter is as follows:-

 "I have propose that we can consider a lumbar nerve root decompression at the L5 and S1. Unfortunately his nerve root injection was not successful in relieving his pain, but the nerve conduction studies which showed a element of neuropathy in addition to spinal radiculopaty. Hence there is a possibility but no guarantee that an operation to decompress the nerve root in the spine would be helpful in relieving some of the pain he is getting in his feet. In addition to this Mr Thorose is getting quite a lot of pain in his foot which I examined today, it does appear acutely inflamed and tender at his first metatarsophalangeal joint, and I suspect he is suffering an exacerbation of his gout. I understand that he had gastric side effects in the past from taking Colchicine for the gout".

A: We would very rarely advise someone to use acupuncture treatment as an alternative to surgery. If your consultant has expressed a view that this is the best option there is usually, with chronic conditions at least, an underlying assumption that the operation is as much to do with stopping further deterioration as it is to do with reducing the current levels of pain and discomfort.
However, many patients who are facing surgery such as this try a number of complementary treatments, with their consultant's approval, as a precursor to the surgery which has been proposed. The usual reasoning is that it can do no harm, and if a treatment succeeds in reducing the symptoms it may delay or postpose the surgery for a considerable time. All surgery carries a small element of risk, and contrary to popular views, surgeons are not all gung ho about getting the knives out.
That said, traditional acupuncture is based on an entirely different theoretical and conceptual basis from conventional medicine, one premised on the flow of energy, called 'qi', in the body. The simple understanding of pain and inflammation rests on an assumption that there has been some blockage or weakening of the flow in a specific area, and the skill of the practitioner lies in determining whether this is a local blockage or a local example of a much more widespread and underlying pathology.  There is often quite a considerable overlap between the way that western and eastern paradigms trace the patterns of causation, but in the west this rests on neurophysiology and nerve pathways rather than qi and the channels which describe its flow. There can even be overlaps with the acupuncture points used by western and eastern acupuncture.
As far as the gout is concerned, there are very few studies of the use of acupuncture for its treatment, although the same understanding of inflammation and blockage can be applied, and the are many anecdotal accounts of practitioners helping to take the edge off a severe attack.
Sight unseen it is always difficult to offer a more precise view, but it is fair to say that many people in your position approach BAcC members for advice on what to do, and a great deal depends on whether the practitioner can make relatively easy sense of what is happening in Chinese medicine terms. The earliest forms of traditional acupuncture were largely asymptomatic and relied on balancing the whole system, so even where there is no direct correlation of symptoms and understanding there remain possibilities for effective treatment, but even this kind of approach makes use of local treatment to help the process along.
We are confident that a BAcC member local to you can gove you clear and impartial advice about the suitability of treatment, and if they feel this is not the best option, they will certainly be able to suggest alternatives which may be effective.       


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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