Ask an expert - muscles and bones - back / spine

66 questions

Q:  I hurt my coccyx about 6 years ago by falling off a seesaw. I have had a couple of courses of ultrasound. Usually the pain is okay but at present it is really bad especially if I sit on the sofa. Would acupuncture help and how many treatments would I need? 

A:  We are sorry to hear of your injury. In our experience coccyx injuries can be a dreadful bane to anyone's life, making long term sitting for meals, movies or leisure very difficult.

There is very little research on the use of acupuncture treatment for what is called coccydynia. The causes are usually identical, falling off horses or similar where someone goes up in a seated position and comes straight down. In one case we came across someone had been sitting on a ledge and slid forward and down with the same outcome.

We have tried treating this on a number of occasions, once to great effect, but we have to be honest and say that the treatment, the insertion of needles in the area and especially at a very powerful point at the base of the coccyx is not to everyone's taste. However, such is the nature of the pain that most people are happy to forego the small amount of embarrassment that such a treatment causes.

What we would say, however, is that from or experience there are often changes to the structure of the coccyx itself. It was long believed that the rudimentary vertebrae forming the coccyx were all fused, but the modern understanding is that there can be limited movement in the inter-vertebral joints, and if these are pushed out of shape it can cause considerable pain. In osteopathic practice we understand that it is  believed that the coccyx is involved in a great deal of the fine tuning of regulatory systems, so damage to the coccyx can lead to problems with temperature control and similar. The osteopathic and chiropractic treatments can involve equally embarrassing interventions, but if that's the price of being rid of chronic pain, most people are up for it.

The best advice that we can give is for you to visit a BAcC member local to you for a brief chat about the unique features of your own pains. Acupuncture treatment can often achieve some quite remarkable structure changes by getting the muscular functions of an area to improve. In some case like yours there is also a possibility that the inflammation brought on at the time of the injury itself has become the source of the pain, and the needles might be a way of clearing the blockage. We are often able to work away from the affected area if for some reason we cannot get access to it. If the practitioner you see does think that this is a job for a chiropractor or osteopath they will undoubtedly steer you towards someone they can personally recommend.

Q:  I have severe spondylitis-  collapse at my L5 S1. I have no disc there. I'm bone on bone. Am I a candidate for acupuncture to relieve that pain?

A:  You would certainly be a candidate for acupuncture treatment to ease pain, but it would need a very careful professional judgement about whether the relief you managed to achieve was sustainable and sufficient to warrant continued treatment.

Acupuncture treatment has a long history of being used for pain relief since the 1970s when President Nixon's visit to China showed operations being performed without anaesthetic under acupuncture treatment. There was a considerable amount of research into how and why acupuncture worked and a general conclusion that treatment seemed to have a very positive effect on the release of endorphins and enkephalins, the body's own natural painkillers.

Of course, this is all very well if there is a chance that the reduction in pain, and with it often a reduction in inflammation, can give the body a chance to heal. In the case of serious degeneration of the spine, however, there is no chance that this will happen. As such it is a pretty straightforward equation: does the cost of treatment stack up against the amount of pain relief you get. We have known people who felt that the two or three days of relief were worth the cost, especially if they could target occasions when they really did need to have a better patch, but this tends to be a long term continuing expense, and to be frank, not everyone can afford to make that commitment.

The best option is to visit a BAcC member local to you and ask their advice based on a face to face assessment of what is happening. All we can say is that you need to set very clear outcome measures to be able to determine that the treatment is having an effect, and regular review periods if you do go ahead to ensure that the effects are as good as they were when you started. 

Q: My son has kyphosis. He is due to see surgeons regarding  an op on his back, the pain he is in is terrible. He also suffers terrible pain in his ribs.  I am wondering if this is because he "stoops" over. He finds it difficult to work, although he has a part time job. He stays in most of the time because of the pain. Would  acupuncture help him either to get to his appointment or instead of surgery?

A: We are sorry to hear of your son's problems.

It would interesting to know whether the kyphosis was a congenital problem or whether something has happened throughout his life to make the problem develop, and where the main areas of 'bend' are. This would to some extent condition the advice we can offer.

Generally speaking, traditional acupuncture treatment is as much about treating the person as treating individual conditions on the simple but effective premise that a system in balance will maximise function across the body and help the body to repair itself. This is why we successfully treat a great many people with back and neck problems, not through manipulating the physical structure but through encouraging better and more correct function in the muscles which in turn pull the body back into shape. It may well be possible that treatment of this kind might benefit your son. There are also a great many ways of treating specific changes in structure by directly supporting the channels of energy which hold things in place, making good weaknesses which allow the shape to 'slip.'

There is also some hope that acupuncture might be able to address continuing pain. We invariably say that it is not a question of whether acupuncture treatment can treat pain as much as how much relief the treatment can give and how sustainable the relief is. This can sometimes, unfortunately, come down to finances. If treatment can buy a fortnight's relief and someone has deep pockets this might be a viable long term arrangement. Most of us are not so fortunate. After Nixon's visit to China in the 1970s made people in the West aware of the use of acupuncture for pain relief and anaesthesia there was a great deal of research which showed that treatment could have a tremendous effect, which is why some many pain clinics routinely offer acupuncture as a primary option.

We think that the best advice that we can give is to encourage your son to visit a BAcC member local to him for a brief face to face assessment of what might be possible. This will be a great deal more precise than anything we can offer here. He might also usefully consider cranial osteopathy as an alternative. This is a very gentle form of treatment which may be able to offer similar benefits.

Q: . I have been in quite severe pain in my back and also my stomach area due to scoliosis. The pain killers the doctors given me for the last 4 odd years make me drowsy and constipated. Would acupuncture ease my pain and what kind of price am I to expect for treatment. I'm a student single mother so this worrys me. 

A: The use of acupuncture for pain relief has a long and interesting history. After President Nixon visited China in the 1970s and the  world saw acupuncture being used for operations it started a huge amount of research into acupuncture for pain relief. Fortunately the markers for pain relief, the release of the body's own endorphins and enkephalins, are very easily measured, and it was soon established that treatment could stimulate the release of these. Many Pain Clinics now use acupuncture as a standard treatment, and the main question is usually not whether it works but the extent to which it works and how sustainable the results might be.

As you have probably already worked out, the answer can eventually become a financial one - if treatment works for a week, is it possible to keep paying weekly for treatment? For someone with deep pockets and a need to be at work this might be a worthwhile deal, but for someone on a tight budget this could price it out of reach. Many of our members feel quite strongly  that acupuncture treatment should not be a middle class preserve, and following a model set up in the States have opened multibed clinics where treatment is offered in a groups setting with three or four couches in a large room for a very much lower fee. The normal safeguards apply for dignity and privacy, but obviously this is not quite the same as being in a private space. For many people, though, this is a good deal, and a list of these clinics can be found here on the website of a special interest group set up to develop this concept.

There is also every chance that most BAcC members will be prepared to offer a fee reduction in circumstances of need. Obviously we don't openly advertise this because it always leads to people who can well afford treatment starting to bargain us down, but I am not aware of many colleagues who have not treated someone as cheaply as they can because they recognise a case of genuine need. This is far easier for those with their own treatment space - if you are renting on a sessional basis you have to cover the overhead - but asking costs nothing.

The only caveat is that problems like scoliosis are generally not fully fixable, however good the treatment is, and it pays to be realistic about the outcomes. Most people we have seen are mainly concerned with managing the pain rather than looking for dramatic change, but it is always really important to be clear about outcomes when dealing with a chronic and potentially irreversible condition. However, we are confident that if you could reduce your reliance on painkillers you would probably be well pleased; being permanently tired and constipated is not much fun.

That said, sometimes the best and unexpected happens, as here

Q  :I have suffered from Cauda Equine since February last year.They fused my back in June,put gel in my disc's had my coxixs manipulated and injected with steroids.My bowel doesn't work properly My legs are numb and painful. Will acupuncture work for me?

A:  We have to be honest and say that we would find it very difficult to offer a definitive view until we knew more about the circumstances which led to the presentation of cauda equina syndrome.

As you are probably already aware, recovery from the syndrome, even with first rate treatment, can be very slow. If the problem which caused the syndrome to develop has been addressed, like a compression injury or a narrowing of the spinal canal, then it may be possible over time for some of the problems which it causes to be reversed. However, if the syndrome has developed after an accident which has caused traumatic injury the outlook may not be so positive. The only way that you could get a more informed view of what may be possible would be to visit one of our colleagues who practises local to where you live and could ask you in more detail about what has happened. Most members are more than happy to give up a little time without charge to assess whether acupuncture treatment would be worthwhile.

However, we must always stress when we give these opinions that we practise an entirely different form of medicine based on a theory of energy, called 'qi', and its patterns of flow and balance in the system. Chinese medicine has been practised for over 2500 years, and even without the kind of detailed knowledge that we now have from X-rays and MRI scans the Chinese would have tried to make sense of the symptoms of problems like yours within their own frame of reference. This can sometimes mean that a problem which has been written off as untreatable in the West can respond to treatment, but only because a blockage has developed in the energy flow which in turn generates a symptom which is thought of as unlikely to recover. We have to be careful how we say this, though, because people can sometimes run away with the idea that Chinese medicine can offer a result where a problem has been written off as untreatable. Whatever system of medicine one practises, if there has been permanent damage it won't reverse.

We think it might well be worth popping along to a local BAcC member for guidance. Our experience is that when recovery is possible acupuncture treatment appears to encourage a speeding up of the healing process. Certainly our practical experience of treating post-surgery patients is that their consultants are often surprised by how well and how quickly they recover, although it would be difficult to generate research to validate this. It would certainly do no harm, though, and may well be able to help you deal with the emotional and mental consequences of what must have been a very distressing change in your life.

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