Back & Buttocks
Back Pain
Sciatica
Piriformis Syndrome
Hip Pain (muscular or joint)
Back Pain
In May 2009 NICE published a guide about the management of lower back pain. NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. It stands for National Institute for Health and Clinical Excellence.
This study was aimed at patients with lower back pain of more than 6 weeks duration and less than 12 months (termed sub-acute). It targeted the group of ‘non-specific back pain’, i.e. where a definitive diagnosis cannot be found. It did not look at specific back problems such as nerve root compression or inflammatory disorders (ankylosing spondylitis).
Lower back pain of less than six week duration was excluded from the study. I expect the reasons for this are :
Summary
This study acknowledges the importance acupuncture can have in the management and treatment of sub-acute lower back pain. It also highlighted the importance of exercise and the possible use of manual therapies such as physiotherapy or osteopathy. TENS therapy (using electro-stimulation) was not endorsed, not because it wasn’t considered effective, but cause there was insufficient evidence to support this technique. Other therapies were also discounted due to a lack of evidence-based research.
The NHS is looking at other ways of treating lower back pain, outside of its conventional framework. They have prioritised treatment modalities that could have a high impact on patients’ outcomes, in particular pain, disability or psychological distress. In addition, they want more efficient use of NHS resources and to equip patients in their own pain management.
The full NICE guidelines can be found by following this link –
Back Pain – NICE guidelines
Further Information about Back Pain and Acupuncture
I am going to talk mainly about back pain of muscular origin since this encompasses by far the majority of back problems and is an area that acupuncture has an enormous amount to offer.
A lot of back pain is the result of our more sedentary lifestyle, and a lot of back problems can be overcome by regular stretching and strengthening of the muscles. However when we are in pain, it can be a struggle to even get out of bed. Doing everyday activities become difficult, let alone trying to work though an exercise sheet.
Acupuncture helps to restore normal functioning in muscles and eliminate pain. The key to successful treatment is to accurately identify the acutely sensitive areas in the muscles and to treat them accordingly. Treatment often involves a combination of massage and acupuncture.
How does it work?
In one sentence… acupuncture helps to disperse localized stagnation within affected muscles that is causing pain and poor movement.
There are various sensations you get with acupuncture which indicate it is having an effect. These include; localised achy sensation, feeling of heaviness, slight numbness sensation, a nervy sensation, or a twitch in the muscle. These sensations are not painful but they will feel a little odd. The ‘twitch’ you can get in the muscle is a spontaneous release in a group of muscle fibres and is often termed a ‘local trigger point’.
News Articles related to Back Pain and Acupuncture
Acupuncture for Back Pain in Pregnancy
Acupuncture for Back Pain Reduces Overall Costs for Healthcare System
Large trial to evaluate the clinical efficacy of acupuncture for chronic lower back pain
Acupuncture study on back pain
Sciatica
Sciatica is a symptom, not a diagnosis. Normally there is pain in the buttock, which then radiates down the leg. The pain either goes down the back of the leg, or down the side. In Traditional Chinese medicine this relates to the Bladder and Gall Bladder channels. This is not to say that there is a problem with your Bladder or Gall Bladder! Within Traditional Chinese Acupuncture it is possible (and very common) to have a problem in the acupuncture channel but not to have any problem with the related organ.
To treat this condition, acupuncture points are palpated in and around the troublesome areas and various points are needled. Good results are often achieved.
Frequently, sciatica-type pain is caused by muscle spasm impinging on the sciatica nerve. Acupuncture is very effective at reducing muscle spasm and the results can be instantaneous. The diagram below has a muscle marked in red. This is called the ‘piriformis’ and is often involved with sciatica-type pain.
When this muscle is in spasm, it will shorten and so increase in diameter. The sciatica nerve runs behind the piriformis muscle and in front of the pelvic bone, thus there is very little room for the nerve! When the muscle goes into spasm it presses on the nerve and refers pain into the buttock and down the leg. Interestingly, this muscle lies on the Gall Bladder channel!
This illustrates how Traditional Chinese Acupuncture can overlap with Western medicine. In Traditional Chinese Acupuncture we would say that there was a problem with the Gall Bladder channel, in Western medicine they would say that there is a problem with the piriformis muscle, and both are correct.
Piriformis Syndrome
The piriformis is a muscle that lies deep in the buttocks (underneath the gluteal muscles). When this muscle goes into spasm, or becomes overly tight & congested it can irritate the sciatic nerve and cause sciatica. This has become known as ‘piriformis syndrome’.
The problem is usually one-sided, although sometimes both sides are affected. The pain may follow the sciatic nerve, or it may be localized in the buttock region. For more information about this condition, please refer to the section above on sciatica where you will see an illustration of the pirifomis muscle.
Hip Pain (muscular and joint)
Hip pain is something I commonly see in my clinic. The pain may be muscular or related to the hip joint, or a combination of the two. I frequently see people who are waiting for hip operations and want some pain relief before their operation. Hip problems can also cause knee problems.
Treatment is based on palpation… I do some investigatory massage to find the areas of acute pain and treat accordingly.
