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

28 questions

Q: I had a back pain about 2 years,I am still going to a physiotherapits. Before I visited the physiotherspist nobody knew about the problem.  They simply said  it was a mechanical problem in my back.  I want to know  is there any way to sort out or find out what the problem is  through any MRI/CT SCA etc. Is there any treatment for the so called mechanical problem?


A:  It is very difficult for us to comment on this. Our expertise is not sufficient to comment authoritatively on the management of your case. Our understanding, though, is that if there is a mechanical problem some form of X-ray, MRI or CT scan should be able to identify it, although it has been our experience of taking on 'last resort' patients that there is sometimes presumed to be a mechanical problem even though the evidence for the problem is not that clear.
What we do find on occasion is that there are sometimes links between visible problems and the pains which people experience which may not always be directly causal. Many people over the age of 50, for example, have some deterioration of the lower spine through wear and tear which shows up on an X-ray, but not everyone with back pain in this group suffers it because of the wear and tear, although it is often assumed to be the case.
Acupuncture has been shown to be effective for low back pain, as our fact sheet shows, please click here
and you may find that if the treatment route you are currently following does not resolve the problem, you might benefit from seeking the advise of a BAcC member local to you to see if they feel that they could help your problem.
The one observation we would make is that sometimes we treat people who have pains for which they want to know the exact cause is, and after the treatment has resolved the problem neither the practitioner nor the patient is any the wiser of what the specific problem was from a western point of view. This can seem quite odd, but Chinese medicine is based on an entirely different way of looking at the body and its problems, and the overlap with western medicine is not always exact.

A:  I am 8 weeks pregnant and have a lumbar facet sprain causing inflammation in my lower left back. a physio friend (who doesn't know i'm pregnant) suggested acupuncture to help relieve some of the tension and inflammation but my chiropractor suggested acupuncture may not be 100% safe in the first trimester.would it be 100% safe for the type of acupuncture i would require?


Q: Backache and lower back pain, together with nausea and morning sickness, are among the most common reasons for women to seek help from acupuncture treatment in early pregnancy. There are well-established protocols for treating all of these without any risk to the foetus, and all properly qualified practitioners are aware of the acupuncture points which it is best to avoid during the first trimester. Even this may be an over-cautious approach; not only are there no recorded instances of acupuncture causing adverse effects in this way, but it is also unlikely that anyone practising in the UK uses needle techniques with sufficiently strong stimulation to risk any adverse effects.
There is an interesting case study published by a medical colleague which details the treatment of low back pain, and he makes the point in a more formal fashion.
Worth a read, if a little technical. There are also dozens of practitioner websites which discuss the use of acupuncture for low back pain in early pregnancy.
It is always worth discussing with your practitioner, if you decide to go ahead with treatment, any fears or concerns you may have. We are sure that they will set your mind at rest.

Q. I have pain in both hips now although until recently i have suffered with Bursitis in left hip. I have been told by a physiotherapist in local hospital that as i suffer from odoema in leg that i cannot have acupuncture in hip as it will cause the leg to loosr feeling. Is this true. I have had acupuncture in the past for back pain and it has worked.

A. We have to say straight away that we are unaware of any evidence that acupuncture into an oedematous leg can cause loss of feeling, or that needling the hip itself when there is oedema can cause loss of feeling. There are certainly no adverse event reports of which we are aware. The main caution observed for treating a patient with oedema is the possibility of causing cellulitis, and a BAcC member will spend considerable time discussing with any patient suffering from oedema what may be responsible for this. 
One of the great strengths of Chinese medicine is that it treats the person, not just the symptom, and this does mean that a practitioner can treat problems in one part of the body with needles somewhere else. In the case of oedema, as we have mentioned above, there is a great deal which can be done without necessarily needling the affected limb. In your particular case, if the bursitis is seen to have arisen from a wider and more systemic problem involving the fluids of the body, there is much that can be done without going near the affected part. Generally, however, it is best to treat the specific area affected alongside the body as a whole.
If acupuncture has been successful for you before it may well prove to be very helpful now. While we would not wish to create discord between patients and other health professionals, we would recommend that you ask the physio what the evidence is for the potential loss of sensation. We are not infallible and there may be studies or reports of which we are not aware where this risk has been highlighted. In the absence of published reports or guidelines suggesting the contrary, we think that you would be perfectly safe to have acupuncture treatment and hope that it brings you some relief from your discomfort.

As our factsheet here shows low back pain is one of a small number of conditions for which the evidence is good enough such that acupuncture is now a NICE recommendation for people with chronic non-specific back pain of over six months duration. This does not mean it doesn't work on many other things, only that the specific type of evidence accepted in the West is very narrow, and the vast quantity of Chinese research available is often methodologically less than perfect.



However, if your case the pain appears to have a very clear specific cause which may make it not be so amenable to treatment. If the scarring and adhesions are significant and permanent, it is possible that acupuncture may have little or no effect. That said, it is surprising how often a physical manifestation such as degeneration of the lower vertebrae or scar is adjudged without further ado to be the explicit cause of a pain. Most people over the age of 50, for example, are likely to be showing some signs of degeneration of the vertebrae in the lower spine, and that does not necessarily mean that this is the root of every reported back pain.


It would be worthwhile discussing the specifics of your case face to face with a practitioner to get a better idea of whether they feel that treatment may be able to help based on a proper inspection of the nature of the problem. The fact that you have scarring and adhesions suggest a wider pathology than simply back pain, and a practitioner would perhaps be able to make better sense of any patterns by actually looking directly at what's going on.

There is evidence, accepted by NICE, that acupuncture can be used for the treatment of low back pain. Our BAcC factsheet details the studies which have supported this conclusion for non-specific pain.


However, in your case there is a very clear cause, and no accepted evidence of which we are aware of that prolapsed discs can be treated with acupuncture as an alternative to surgery. There are dozens of anecdotal accounts from BAcC practitioners of using acupuncture to encourage the reduction of inflammation and to keep it at bay while the protruding section of disc is dealt with by the body, but this is not sufficient basis for us to make an unqualified recommendation.


A great deal depends on the advice of your neurosurgeon. If the bulge is bad enough to require surgery then it would be unwise to ignore this advice. If, however, he or she believes that there is a possibility that with rest and careful exercise the problem can be managed without surgery, then acupuncture along with some form of gentle manipulation like odteopathy may well be able to accelerate the recovery process. We would also recommend that you discuss alternative options with the neurosurgeon; many are very supportive of complementary therapies which encourage restoration of normal function.

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