Ask an expert - muscles and bones - back / spine

66 questions

Q: I have been diagnosed with Spinal Stenosis which gives me intermittent severe phantom pains in my toes and feet. I have had a steroid injection in my back but this had little effect. I do not want to take the pain relieving medication suggested as it severely affects my life style. Would acupuncture be able to relieve these pains I get which are not actually where they seem to be?


We have been asked about spinal stenosis on a number of occasions, and the most recent answer, albeit three years old, still remains a good one. We said:

Lumbar canal stenosis can manifest in many symptoms dependent on the extent of the stenosis. Our colleagues in America are very upbeat about the potential for success in treating lumbar canal stenosis; if you google 'lumbar stenosis acupuncture' you will see an article on the site which speaks positively of success rates, as well as an 'acupuncture today' listing which also gives good cause for hope. Personally we tend to take a slightly more guarded view of the chances of success, and base our own prognoses on gathering as much information as we can about the condition - how long the person has suffered from it, is it degenerative, does it have peaks and troughs, has it been exacerbated by accident or trauma, and so on - before committing to treatment. Even though we are working with entirely different diagnostic systems, if a condition has some very severe manifestations based on irreversible physical change, the expectations of a 'good' result have to be lowered accordingly, even what might count as a 'good' result. The best advice that we can give is that you discuss this with a practitioner whom you might consider seeing and ask their advice. Many of our colleagues are happy to discuss someone's concerns with them rather than book them straight in, and a significant number are happy to set aside a few minutes to meet someone and offer a more informed view of whether they can help based on a rapid assessment of the actual presentation.

Since we gave this advice there have been a number of studies such as this one which give some cause for optimism, although finding a UK practitioner able to deliver this particular form of treatment may take some doing. The most recent systematic review is much more guarded in its views. However, it is often possible that the symptoms from which people suffer are not directly related to a physical change in the same area. We find that many people are told that arthritic changes in the lower spine are responsible for their chronic low back pain, but we often see the pain reduce or vanish without any accompanying physical change. Acupuncture has, in fact, been accepted within NICE guidelines as an effective treatment for the treatment of chronic low back pain, and the evidence base is certainly more compelling than for many other Western named conditions. We try to keep on top of any changes or developments; occasionally research appears which is of a sufficiently high standard for us  to use it in our marketing materials as a claim for efficacy. The only study we found which was more recent and directly applicable was this one, which was far less enthusiastic than the earlier ones we cited. Aside from that we did unearth a rather strange study about a technique called acupotomy, but given that this is a minor surgical technique we suspect there are few practitioners in the UK who could legally perform it.

The broader question of pain relief is one we didn't address in the earlier answer, and does need to be mentioned. Clearly the visit of Nixon to China in the 1970s and the amazing footage of people having surgery using acupuncture as an anaesthetic kicked off a huge amount of research in the West about the use of acupuncture for pain relief. The general conclusion was that for neurophysiological reasons acupuncture is believed to trigger a pain-relieving chemical, and the main question is not whether it works but how well it works and for how long. If someone can have a treatment which provides a few days of considerable relief, then as long as they can afford to continue regular treatment or target those occasions when it would be beneficial to be pain free, then this may be a viable option.

The only real answer, though, will come from direct inspection of the problem by a practitioner. This will enable them to see what is happening in the context of your overall system, and that in turn offers a much better chance of getting a clearer view of what may be possible, certainly better than  we can generate at this remove.

Q: Can acupuncture help or make it worse for pain related with severe disc degeneration and acute inflammation Modic type 1 to the endplates? I've had my condition for three years, with no pain free moment ,which is common with Modic type 1 inflammation. I tried all types of treatment for the condition and the pain, but nothing helped. I was told this is the case with people with my condition, as it is nothing like any other back condition since the most pain is caused by the bacteria in my spine. Recently I was referred for acupuncture treatment and I had two sessions. After each one I felt much worse including pain in the affected area, aches all over the body and massive headache lasting for a week or so. After the second session I experienced a huge relapse with my back problem, with severe pain not going away for days, even with increased dosage of prescribed painkillers, Tramadol. While it's been scientifically confirmed that there is no proof that acupuncture can help with the type of condition I have I still wanted to try. My concern is that I have been much worse after treatment and it takes a week to go back to my 'normal' days when I can somehow manage the pain, which is not possible after acupuncture. Would you recommend continuing with the treatment in my situation?

A: When someone has a problem such as yours it can be quite difficult even in conventional medicine to predict what might happen with treatment. We have conducted a database search for treatment with acupuncture specifically aimed a Modic Type 1 and there is no evidence of any trials which focus on this specific diagnosis. However, until recently NICE used to recommend acupuncture as a valid treatment for chronic back pain of over six months duration on the back of some very strong evidence, and we strongly suspect that many of the thousands of the patients in these studies had Modic Type 1 problems alongside the chronic degeneration of the lumbar spine and discs which may have been assumed to be the cause. The estimates of between 20% and 40% of patients with chronic low back pain being troubled as you are would seem to make this a reasonable conclusion to draw.

We often warn people with back and neck problems to be aware that the next 48 hours after treatment may be a little rocky. We are not alone in doing this; many osteopaths and chiropractors similarly warn their patients, and many of our patients report feeling worse after manipulation. There are various reasons which we have heard advanced for this phenomenon, and the most compelling is that trying to encourage structural or postural changes associated with good function is bound to bring muscles into play which have been relatively untested for years. From a Chinese medicine point of view there is an equally compelling picture of stagnant energy and its renewed movement. This can often be quite unpleasant, rather akin to having cold hands or feet and warming them in front of a fire to restore circulation. This can often be slightly unpleasant to begin with.

The key thing about these reactions to treatment is that they tend to occur for the first one or two sessions only, after which the body had made its initial changes of direction and is now moving forward in a more predictable fashion. Hence sessions three and four and onwards will often have none of the more challenging outcomes as the first ones. If it carries on being painful, then it is just possible that the patient is too sensitive for the treatment. If so, there are only two options. One is to reduce the impact of the needles by using less needles, inserting them less deeply and manipulating them less. Practitioners can do quite a great deal to 'turn down the volume' so to speak, and some forms of acupuncture treatment, especially Japanese style needling, are barely perceptible.

There is, however, a small minority of patients whose sensitivity to needles is such that treatment is a bit of an ordeal and will continue to be so. This can manifest as you describe it, and unless the overall trend is upwards after the first two or three sessions then it would be wise to sit down with the practitioner and discuss how best to carry on. If it has no impact on the pain, then there would seem little point in carrying on. In our experience, though, most people do begin to enjoy lower levels of discomfort, and the usual question is how much pain relief and how sustainable it is.

Of course, the factor which we haven't mentioned is that the acupuncture treatment and the relapse are entirely coincidental. In practice we have to be careful when we broach this because it sounds like the beginnings of an 'it wasn't me' denial. In reality, though, with over 4 million treatments a year in the UK we are going to see a number of occasions where an increase in symptoms has nothing to to with the treatment, and our main aim then is to find out what is happening rather than getting involved in arguments about whether acupuncture treatment was the cause. We find that getting to the bottom of what is happening usually establishes that very quickly so there is nothing to be gained by delaying further investigation.

We do hope, however, that this is a typical pattern of things getting slightly worse before they get better, and that the next few sessions bring you the relief from pain which you would like to experience.



Q:  Can acupuncture for lower back pain cause imbalance and dizziness . The next day I spent in bed because when I moved I felt I might fall over and and everything was moving especially when I bent down or moved quickly.

A: We are sorry to hear of your problems.

 The first thing we have to be clear about is that acupuncture, whether performed as traditional acupuncture or one of the versions of medical/symptomatic acupuncture, treats the person as much as the condition. To that extent even a symptom elsewhere in the body may have been triggered by treatment aimed at something entirely different. The same applies even if the person thinks they are 'only treating a bad back', and we have registered our concerns over the years about people using formula treatment having unexpected effects on the patient.

 That said, the reaction which you have had is a great deal more severe than we would normally see. We warn patients that they may feel a little odd for 24 to 48 hours, but the 'normal' reactions of this type are relatively minor - a slight headache, additional tiredness for a while, and occasionally a slight return of an earlier symptom as the body reverses the process of disease. To have to spend a day in bed feeling dizzy after a treatment would be highly unusual; we gather statistics on what we call adverse events, and this is not one we come across before. That does not mean that it hasn't happened, only that it hasn't been reported to us. However, we find that patients are usually very keen to tell us when something has happened.

 We think the most likely reason is that you have had the misfortune to have a viral infection which has by chance coincided with your treatment. With over 4 million treatments a year in the UK there are going to be a few cases where something happens after a treatment which has nothing to do with it, and this may well be one. It does sound rather unpleasant, however, and if it has persisted into a second or third day we think you might do well to consult your GP. There are other possibilities, none of which you should worry about but which treatment may be able to help. There are a number of problems associated with the inner ear, for example, which can generate these symptoms, and your GP may well be able to help you deal with this.

 We shall definitely keep a record of what you have reported, though. The fact that we have had very few reports like this in the past does not mean that there isn't a theoretical risk that it could happen, and if we find over time a cluster of cases we would always update our information to the public to make them aware of the potential risk.

 In any event, we do hope that the problem has already resolved, and that it hasn't put you off having further treatment for your back. As you may be aware from our literature back pain is a problem which really does seem to respond well to acupuncture treatment to the extent that it forms one of the recommended treatments in the NICE guidelines for NHS patients.

Q:  I have had two spinal fusions (the second one through the stomach) due to different men running into me and then I fell down a flight of stairs so I have torn thumb ligaments and much back pain and sciatica down the left leg. I had acupuncture about 4 days ago, mainly for the back and sciatica, but, ever since I went, my legs are so painful, especially my right knee and at times it feels like the sciatica shifted to the left side and sometimes down both legs. I have had so much pain on the left for so long that now it hurts a lot! Especially if I walk or stand, then both legs are so painful! I keep thinking it like a positive shift and energy, but, it's new pain and I've been through SO MUCH! Help??

A:  We are very sorry indeed to read of your problems; you have had some very great misfortunes, by the sound of it.

 As far as your current problem is concerned, there is no doubt that when we start treatment for someone with lower back and sciatic nerve problems there is a very strong chance that the symptoms will become worse, and sometimes even transfer to the other side. We routinely warn people that there may be as much as two to four days of disruption after a session, and that they will only start to see progress when this has settled down. We are not alone in doing this; chiropractors and osteopaths do the same.

 Quite often it is the functional nature of the treatment which we do which causes the disruption. Once the musculature of the lower back starts to behave as it should it allows for the physical structure to re-establish itself. This can cause some muscles which have been allowed to work in advantageous conditions to tighten, and tight muscles to relax, both of which can cause pain. The change in physical structure which this creates can also put pressure on surrounding tissues and create different sensations when this settles itself into place.

 The only caution when treatment someone with spinal fusions is that the muscle tension from which they suffer is actually because the muscles are performing a useful job. Allowing these to relax is not only going to cause pain but may even cause new pains. Most practitioners assess carefully whether there is such a risk before treatment begins.


If the symptoms have abated by the time you read this, it will mean that the effects were transient and that you are very likely to begin to experience some improvements. If they are continuing, then you need to discuss with your practitioner what the next best step is. There are all sorts of reasons why a treatment can disrupt a system - too many needles, too much needle manipulation, too many needles close to an inflamed site - and a practitioner has a number of practical possibilities to consider and employ.

 Moving symptoms from one side to another is not unknown with sciatica, though, and does imply that the body is trying to correct its overall structure. This may well be a positive sign.


A:  A great deal depends on the extent of the spinal injuries.

There is a long tradition in all forms of acupuncture for treating spasms and cramps in the muscles. In western acupuncture this can often involve the use of what are called trigger points, but from an eastern perspective these are seen as blockages or stagnation in a muscle and treated accordingly. Not surprisingly the points used in both traditions tend to be the same, but we all believe that the real strength of traditional acupuncture lies not just in rectifying situations like this but in looking at the overall context to see what caused them in the first place. There is almost always some form of systemic problem underlying the appearance of a local problem, and our concern is not just to address a symptom for a short while but to make sure that it doesn't come back, if we are at all able.

Spinal injuries, however, may open up a different series of challenges. Sometimes the spasms are a consequence of the injury itself and sometimes a consequence of the structural changes which occur after an accident. In the case of the former there is a good chance of reducing or removing the problem. In the case of the latter it becomes more of a matter of management. If something has changed shape, in a distortion of the spine, for example, the stress on the musculature is going to be continuous and potentially causing spasms for a very long time, especially if there is any impingement of nerves in the area as a consequence of the structural changes.

That said, each case is unique, and with so little information to go on we can only advise that your best course of action is to visit a local BAcC member for an informal chat about what acupuncture might be able to offer. This means that a practitioner can have a look at what's going on and give you a much more accurate assessment of what might be possible than we can here.

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