Browsing articles tagged with " acute low back pain"

68. An Ancient “New Way” to use Acupuncture to treat Cervical Dystonia

Mar 7, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 8 (1), March, 2017, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878, Tel: (203) 637-7720

Cervical Dystonia




Lisa L. is an 18-year-old female, who had been complaining of neck pain for the past six years.  The patient reports that, six years ago, when she woke up, she suddenly realized that her neck jerked to the left. The jerk happened very often; her neck would jerk two or three times every 5-10 minutes.  The jerk was involuntary and occurred more frequently especially when she was tired or under stress. However, if she had a good night’s rest, felt energized, and focused on something (e.g. her favorite sports), she would not experience the sudden, involuntary neck movements. Only when she sat still, did her neck start to jerk.

Lisa’s neck muscle always feels very tight, and the tightness can be very painful. She has been to many doctors and has tried everything, such as physical therapy and multiple medications, without any improvement. She therefore came to me for evaluation and treatment. Upon physical examination, I noted that the left side of the patient’s sternocleidomastoid muscle had hypertrophied. It felt like a thick rope on the left side of her neck. I also noted that other muscles had undergone hypertrophy: the levator scapular and splenius capitis at the cervicals. Throughout the entire physical examination, there was no jerk or involuntary contraction on the left side of the patient’s neck.

What Lisa is suffering from is called cervical dystonia, which is the most common form of focal dystonia.  Cervical dystonia is characterized by abnormal and spasmodic squeezing of the muscle that leads to muscle contractions in the head and neck area. The movements are involuntary and are sometimes very painful, causing the neck to twist repetitively, resulting in abnormal posture.  Overall, this may affect a single muscle, a group of muscles, such as those in the arms, neck, and legs, or even the entire body.  Patients with dystonia often have normal intelligence and no associated psychiatric disorders.

The causes of cervical dystonia are currently unknown.  There are two types of cervical dystonia:

Primary cervical dystonia: This type of cervical dystonia is not related
to any identifiable, acquired disorders affecting the brain or spinal cord such
as stroke, infection, tumor, or trauma. In some cases, primary cervical dystonia
is genetic, caused by abnormal genes such as dystonia DYT1. However,
because not all carriers of the DYT1 gene develop cervical dystonia, it
is likely that other genes or environmental factors may play a role in the
development of cervical dystonia.

Secondary cervical dystonia: Unlike primary cervical dystonia, secondary
cervical dystonia has obvious causes such as stroke, tumor, infection in the
brain or spinal cord, traumatic brain injury, toxins, birth defect, etc.  There
may be a period of months between the injury and the onset of the dystonia.

Tests and diagnosis:

The first step when diagnosing cervical dystonia is to determine if any of the causes that may lead to secondary dystonia are evident.  The following tests may be used to screen and/or diagnose for secondary cervical dystonia:

1.Toxins and infections screening: blood or urine samples will confirm the presence of toxins and infections.

2.Tumor screening: an MRI will identify and visualize tumors of the brain or spinal
cord.

3.Genetic testing: can be used to identify DYT1, which is critical to the diagnosis
of primary cervical dystonia.

4.Electromyography (EMG) testing: measures electrical activity of muscles.  An EMG can help diagnose muscle or nerve disorders.

Medications:

Many different medications have been used to treat cervical dystonia but most are not effective:

1.Cogentin and Kemadrin are examples of drugs that decrease the level of acetylcholine. These have helped some patients but have sedating side effects.

2.Valium, Ativan, Klonopin, etc., regulate the neurotransmitter GABA.

3.Sinemet, Laridopa, etc. either increase or decrease dopamine levels.

4.Carbamazepine is an anticonvulsant.

Botox injections:

Botox injections can usually stop the muscle spasms by blocking acetylcholine, relieving the symptoms for approximately three months. Very experienced doctors should administer the Botox injections. If Botox is used for more than a one-year period, it will gradually become less effective because the patient’s body will begin producing auto-antibodies against it.

Other treatments:

In some severe cases, surgery may be an option.  Surgery is the last resort and is used to selectively denervate the nerve supplying the muscle.

Another treatment option is deep brain stimulation.  This involves implanting an electrode in the brain connected to a stimulated device in the chest that generates an electrical pulse.  These electrodes will temporarily disable nerve activities by damaging
small areas of the brain.

Chinese medicine:

According to traditional Chinese medicine, cervical dystonia is caused by excessive liver wind. The liver controls the movement of all tendons, muscles and joints in the human body. Excessive liver wind overstimulates the tendons, muscles and joints, constantly activating the muscles. We use the following methods to treat our cervical dystonia patients.

  1. Acupuncture

The principle acupuncture treatment used to treat cervical dystonia reduces the excessive liver wind and thereby decreases the activities of the tendons, muscles and joints. The acupuncture points are along the meridians of the liver and gall bladder, such as the Feng Chi and Tai Chong points.

In addition, because patients with cervical dystonia have abnormal head and neck movements, acupuncture must also be used along the Du meridian, which controls head movement. The Du meridian supplies the entire brain. If the energy of the Du meridian is excessive, the entire head will move abnormally. Therefore, the acupuncture treatment should also include the Da Zhui and Hou Ding points from the Du meridian.  These points will adjust and regulate the Du meridian, the yang, activate the tendon function, and balance the input and output of the energy of the Du meridian.

The acupuncture treatment should also include the Xin Shu, a direct outlet acupuncture point from the heart and the Shen Shu, a connecting point from the kidney. Sheng MenTai Xi and the points listed above are involved in the circuitry of the heart and kidney, and will decrease the fire surrounding these organs, keeping the yin and yang in harmonious balance. Some local points in the neck and head such as Tian ChuangTian RongTian Ding, and Fu Tu, should also be used for their localized calming functions.

This combination of local and distal acupuncture points will greatly decrease the symptoms associated with cervical dystonia.

  1. Moxibustion:

Moxa is a Chinese herb similar to cigarette to warm certain points in the human body. We suggest to use the following device to moxa the neck sternocleidomastoid muscle for 30 minutes. Patients should learn how to use it before you use for yourself.

  1. Guasha (Scrape) :

Following  the length of  sternocleidomastoid muscle, use the Guasha plate to scrape down 30 times then up 30 times, 5 sessions per day.
The patient was treated with acupuncture at the above points for approximately two months, three times a week. After the last treatment, the number of neck contractions had significantly decreased. Now, she only experiences mild neck jerks and contractions, allowing her to perform her daily activities in a normal manner.

Tips for acupuncturists:

  1. Acupuncture cannot treat all forms of cervical dystonia. The milder the disease, the better the treatment results. Physicians should find the cause if the patient is suffering secondary cervical dystonia.
  2. Using heating pads and massages after the acupuncture treatment increases its effectiveness.

Tips for patients:

1.The earlier the treatment, the better the treatment results.

  1. Help yourself with Guasha, Moxa, massage and heating pad.

 

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

25. Acupuncture and Low Back Pain-Spine Compression Fracture-Collapse of the spine bone

Jan 7, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  4 Comments

News Letter, Vol. 3 (1), January, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Low back pain-spine compression fracture

Collapse of the bone in the spine

www.yanduguke.com

Linda S. is a 70 year old female, who complains of low back pain the day after she bent down to pick up her 1 year old granddaughter. She felt sudden onset low back pain; she had no history of low back pain before. She immediately felt entire low back spasm and was unable to bend forward and move her back. She had difficulty sitting and standing, the only position she felt comfortable was lying on the bed. She called her daughter right away; she was put on bed rest, she thought she might have low back sprain, she would get better after rest on the bed overnight. However, at the second day, she still felt the pain was sharp and stabbing, she could not move. Therefore, she was brought to me for evaluation and treatment.

By inquiry of her pain, she reported her pain was constant, and the pain also felt at the right hip, accompanied with stomach ache, slightly shortness of breath. But there were neither pain radiating down to legs nor urinary nor bowel incontinency; she denied any numbness or tingling sensation. The patient had history osteoporosis for 20 years, she was advised to take vitamin D 400 units and calcium 800 mg per day, forgetting many times to take them. Her daily exercise is swim and stationary bike one or two times per week.

I examed her, she had curved back to the right side of spine, i.e. kyphosis by medical term,  her muscles on the right side of back were very spasmodic, however,  the muscles on the left side of the back were looser, she looks like to have a hunchback. I was not able to identify a specific spot of her back pain, only at the vague area of  entire low back. Also her muscle strength was unable to be checked because of pain. She did not have any abnormal sensation at either leg.

The above signs and symptoms indicated that she might have diagnosis of Spinal  Compression Fracture. I immediately ordered CT-scan of her spine, which showed the following,

www.haodf.com

The CT-Scan depicted the wedge shaped vertebra, and confirmed my diagnosis of low back spinal compression fracture.

The Causes of Spine Compression Fracture:

The underline pathophysiology spinal compression fracture is osteoporosis, i.e. the vertebral bones lost their bone substance, the shape of the bones is existed, but the bones can not hold certain weight added to their body. The sponge liked bone at the low back spine can not sustain any acute stress, such as sudden bending forward to tie shoe lace, pick up something from the floor, etc.  The reasons for osteoporosis are as following,

1.      For women, the leading risk factors are menopause, or estrogen deficiency, cigarette smoking, physical inactivity, use of prednisone and poor nutrition. For men, except all the above nonhormonal factors, low testosterone levels also may be associated with osteoporosis.

2.      Renal failure and liver failure, which would make nutritional deficiencies, leading to decreased bone remodeling and increased osteopenia.

3.      Genetics, osteoporosis can be observed in closely related family members.

4.      Malignance, i.e. malignant tumors, might metastasize to the spine, such as myeloma, lymphoma, renal cell, prostate, breast, lung cancers.

5.      Infections: chronic osteomyelitis may result in spinal compression fracture.

The following are the major symptoms of spinal compression fracture:

  • Sudden, severe back pain.
  • Worsening of pain when standing or walking.
  • Loss of height.
  • Deformity of the spine – the curved, “hunchback” shape.
  • Some pain relief when lying down.
  • Difficulty and pain when bending or twisting.
  • Neurologic problems may manifest in many ways:
    • Reduced leg strength (paresis) or complete weakness (paralysis) is an obvious problem.
    • Loss of sensation in the lower extremities and in the perianal area (saddle anesthesia) can be just as important.
    • Urinary retention and urinary and fecal incontinence are very important signs that indicate the need for emergency surgery.

Most patients only had the following slight activities, and then the pain starts:

  • Slipping on a rug or making a misstep.
  • Lifting a suitcase out of the trunk of a car.
  • Lifting a bag of groceries.
  • Getting up from sitting position
  • Bending to the floor to pick something up.
  • Lifting the corner of a mattress when changing bed linens.
  • Getting in or out of car

Signs of Multiple Spinal Compression Fractures

Some patients might have multiple spinal compression fractures without notices. However, by careful examination, you may find the following,

  • Kyphosis (curved back, or hunchback): These fractures often create wedge-shaped vertebral bones, which makes the spine bend forward (Kyphosis). Sometimes, your body might twist the spine to the side leading to Scoliosis.  Eventually, neck and back pain may develop as your body tries to adapt the posture changes of the dynamic train of  entire spine.
  • Height loss: With each fracture of a spinal bone, the spine loses some of its height. Eventually, after several collapsed vertebrae, the person’s shorter stature will be noticeable.
  • Hip pain: The shorter spine brings the rib cage closer to the hip bones. If rib and hip bones are rubbing against each other, there will be discomfort and pain.
  • Breathing problems: If the spine becomes severely compressed, lungs may not function properly and breathing can be seriously affected, such as shortness of breath, sometimes the poor spine position may make people prone to infection, such as pneumonia or bronchitis.
  • Stomach complaints: A shorter spine can compress the stomach, causing a bulging stomach and digestive problems like constipation, poor appetite, acid reflexes, and weight loss.

Treatment of Spinal Compression Fractures

1. The best treatment is prevention. This is best accomplished by treating osteoporosis with exercise, calcium, and medications.

1).        Medications for osteoporosis
Calcium 1000 mg per day should be taken for women before menopause and a 1200 mg per day for women who are postmenopausal.
Vitamin D 800 IU for women before menopause and 1000 IU vitamin D for postmenopausal women.  Men up to age of 50  should increase vitamin D and calcium intake to 800 IU of vitamin D and 1000 mg of calcium per day.

Bisphosphonates, such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast), which slow the rate of bone thinning and can lead to increased bone density. These medicines may be used in men and women.

2).        Regular weight bearing exercise. Increased walking, jogging, tai chi, stair climbing, dancing, and tennis. Muscle strengthening exercises include weight training and other resistive exercise.  Weight bearing exercise programs not only increase bone density but also improve both heart and lung functional ability and muscle strength. You may walk with a one to three pound of sand bag tied on your each calf for 2 to 3 miles a day, it will greatly improve your bone density if you stick to the program longer enough.

3).        For prevention, you should take all preventative procedures such as checking and correcting vision and hearing, evaluating any neurological problems, reviewing any prescription medications for side effects that may affect balance, and providing a check list for improving safety at home.  Wearing undergarments with hip pad protectors may protect an individual from injuring the hip in the event of a fall.  Hip protectors may be considered for patients who have significant risk factors for falling or for patients who have a previously fractured hip.

4).        Avoidance of tobacco use and excessive alcohol intake.  Alcohol and cigarettes inhibit osteoblast cell activities and improve osteoclast cell functioning.  Osteoclast cells usually destroy the bone density and osteoblast cell build up the bone density.

2. Alleviating the pain: Usually, treatment is aimed at alleviating the pain, and preventing injuries in the future, we use physical therapy, acupuncture, medications, etc.

1). Physical Therapy

Recent research has shown many benefits of using Whole-Body Vibration (WBV) to increase strength and decrease bone mineral density losses from astronauts, athletes to those recovering from injury.  Holding a quarter squat position for 30 seconds on a WBV machine set at 50 Hz would be equivalent to performing 1,500 squats without the stress on the joints.  WBV is very effective to increase BMD in post-menopausal women even in comparison to a walking regimen (http://www.biomedcentral.com/1471-2474/7/92/, http://www.ncbi.nlm.nih.gov/pubmed/15040822?dopt=AbstractPlus)

http://www.powerplate.com/resources/htm/research/research-cards/research-health-whole-body-vibration-proves-effective-for-the-elderly.htm

http://search.barnesandnoble.com/Using-Whole-Body-Vibration-in-Physical-Therapy-and-Sport/Alfio-Albasini/e/9780702031731/?itm=1&USRI=whole+body+vibration

Wearing a back brace is a very effective means to prevent unwarranted motions of the spine during early healing.  Be cautious of keeping a patient in a brace for an extended period of time typically over 6-8 weeks to avoid secondary complications of immobilization.  Maintaining a neutral spine is very important and must be taught how to properly perform functional activities such as getting in and out of bed while keeping the spine straight by using a technique called the “log roll” to go from lying on ones back with knees bent to log rolling to their side then pushing with their upper arm to a seated position and finally to standing.

http://www.pvhs.org/documents/Orthopedics/ThorasicSpineSurgery.pdf

In addition to learning how to properly perform activities of daily living such as getting in and out of bed it is very important to work on core stabilizing with exercises such described in the previous newsletter dealing with low back pain with failed back surgery syndrome with link at http://drxuacupuncture.co/2010/12/19/low-back-pain-again-after-back-surgery/

Performing a balance test such as the Berg Balance Test or Tinetti Test will give objective measurement of current balance level and risk of falls.  Preventing the risk of falls is very crucial as fractures are more likely with low bone mineral density levels.

There are many ways to improve balance and progressions to do so.  A basic progression would be standing with feet at shoulder width in front of a counter or couch so that you can use your hands to catch yourself if you experience a loss of balance or better yet, have a spotter.  Once able to hold that shoulder width stance without loss of balance, take a narrow width stance progressing to your feet being right next to each other for 1 min.  Taking a smaller base of support, such as bringing the feet closer, makes the exercise more challenging.  From there you can balance on a single leg taking turns between the left and right foot.  Next you are ready to try the shoulder width stance with your eyes closed working again to the narrow width stance with eyes closed.

http://www.diabetesmonitor.com/diet-and-lifestyle/exercise/national-institute-of-aging-guidelines/chapter4_balance_plantar.htm

Next, assume a stance where one foot is in front of the other such as a walking stride and again work balance with eyes open then narrowing the stance till one foot is directly in front of the other in a heel to toe fashion called tandem stance.  Once able to accomplish tandem stance with eyes open go back to walking stride stance and work to tandem stance with eyes closed.

http://www.exercise-to-a-healthier-life.com/tandem-stands.html

Another way to progress with balance exercises is to go from a flat stable surface such as the ground to an unstable surface such as a balance board or foam pad.  An unstable surface will increase muscle activity in the ankles, knees, hips and core making the exercise more challenging.

http://www.physicalcompany.co.uk/products/product_detail.asp?productId=ABPE

In addition to performing core and balance exercises, it is important to increase the strength in the upper spine and shoulders.  Using a theraband is easy but more importantly effective for increasing muscle strength.  A series of Lat Rows, Lat Pulls, and Shoulder External Rotations are three effective exercises to be performed 3-4 x week for 3 sets of 10, progressing to 2 sets of 15 and finally 1 set of 30 in a row.  Start off with a lighter theraband and work you way up to a higher resistance theraband such as progressing through yellow, red, green, blue to black.

http://www.thera-band.com/store/products.php?ProductID=28Standing Row with Theraband http://www.health24.com/fitness/Exercises/16-1339-1344,33165.asp

Standing Lat Pulls with Theraband    http://www.sbortho.com/educational_resources/strength_exercises.html

External Rotation with Theraband    http://www.health.com/health/library/mdp/0,,zm2387,00.html

2). Acupuncture

Hua Tuo Jia Ji points are sets of specially designed points used to treat spine disease. By palpation, you should feel the tender points around the  spinal process, then insert the needles into the disc about 0.5 inch deep and one up and one lower levels of the spinal process, plus 0.5 inch of the lateral sides of the three levels,  i.e. total 9 needles inserted into the tender points around the spine and adjacent area.

I also selected the following points: Sheng Shu, Qi Hai Shu, Chi Bian, Huan Tiao, Yang Ling Quan, Fei Yang, Ju Liao, Jue Gu, and Cheng Fu.

Table 25-1

Points Meridan/No. Location Function/Indication
1 Hua Tuo Jia Ji ExperiencedPoints Along the spine, use the most painful vertebral spinal as midpoint, then locate the upper and lower spinal process and 0.5 inch on the either side, you may choose two spinal process as the starting points. See Pic 4-1 Specifically treat for local neck and low back pain, and pain along the spine.
2 Sheng Shu UB 23 1.5 inch lateral to midline of spine at the level of the lower border of the spinous process of the second lumbar vertebrta Nocturnal emission, impotence, enuresis, irregular menstruation, leucorrhea, low back pain, weakness of the knee, blurring of vision, dizziness, tinnitus, deafness, edema, asthma, diarrhea
3 Qi Hai Shu UB 24 1.5 inch lateral to midline of spine at the level of the lower border of the spinous process of the third lumbar vertebra Low back pain, irregular menstruation, dysmenorrheal, asthma
4 Zhi Bian UB 54 Lateral to the hiatus of the sacrum, 3 inch lateral to the midline of spine Pain in the lumbosacral region, muscular atrophy, motor impairment of the lower extremities, dysuria, swelling around external genitalia, hemorrhoids, constipation
5 Huan Tiao GB 30 At the junction of the lateral 1/3 between the great trochanter and the hiatus of the sacrum. Pain of h elumbar regiin and the thigh, muscular atrophy of the lower limbs, hemiplegia
6 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion
7 Jue Gu( Xuan Zhong) GB 39 3 inch above the tip of the external malleolus, in the depression between the posterior border of the fibula and the tendons of peronaeus longus and brevis Apoplexy, hemiplegia, pain of the neck, abdominal distension, pain in the hypochondriac region, muscular arophy of the lower limbs, spastic pain fo the leg, beriberi
8 Cheng Fu UB 36 In the middle of the transverse gluteal fold Pain in the lower back and gluteal regioin, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities

3). Pain Medicines

Pain medications. A carefully prescribed “cocktail” of pain medications can relieve bone-on-bone, muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at Temple University School of Medicine in Philadelphia. “If it’s prescribed correctly, you can reduce doses of the individual drugs in the cocktail.”

Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications — acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) — are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.

If the pain is severe, and collapse is becoming problematic, procedures called vertebroplasty or kyphoplasty may be considered. In these procedures an interventional radiologist restores the height of the bone and injects cement into the vertebra to stabilize the fracture and prevent further collapse.

Surgical Treatment for Spinal Compression Fractures

When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:

  • Vertebroplasty

Figure 25.16

From: https://www.healthbase.com

After general anesthesia, or simply under sedation, a special bone needle will be inserted into the soft tissues of the back guided by x-ray, along with a small amount of x-ray dye, which will allow the position of the needle to be seen at all times. Then, a small amount of orthopedic cement, called polymethylmethacrylate (PMMA) will be pushed through the needle into the vertebral body, then the cement will be solid after a few mins. The cement will be filled in the fractured vertebrae, and sustained the body weight over night. Each vertebral body is injected on both the right and left sides, just off the midline of the back.

The cement is sometimes mixed with an antibiotic to reduce the risk of infection, and a powder containing barium or tantalum, which allows it to be seen on the x-ray.

Within a few hours, patients are up and moving around. Most go home the same day.

  • Kyphoplasty

From: www. sarasotaspine.com

Similar to vertebroplasty, Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed. The balloon does not remain in the patient.   It simply creates a cavity for the cement and also helps expand the compressed bone.

The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.

The above procedures provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the “downward spiral” of untreated osteoporosis. In my experience, many patients reported miracle results after the procedures.

  • Spinal fusion surgery

From: http://www.neurosurgery.ufl.edu/

This procedure is used primarily to fuse or immobilize two or more vertebrae and to eliminate the pain caused by abnormal motion of the vertebrae.  Supplementary bone tissue, either from the patient (autograft) or a donor (allograft), is used in conjunction with the body’s natural bone growth (osteoblastic) processes to fuse the vertebrae.

The above procedures may help you a lot with a decrease of pain, and improve  your  spine stability and flexibility. However, the procedures may not solve all your problems. Sometimes, you may feel very much pain after the procedures. Therefore, it is necessary to have acupuncture treatment in order to reduce the pain.

TREATMENT OF LINDA

Linda first underwent physical therapy 2x  per week for 4 weeks in another physical therapy facility, she underwent many trunk forward bending and backward extension exercises, however, she felt more pain on the low back after her physical therapy. I did CT scan again, I found out her low back compression fracture was worse than the first CT scan. I immediately informed her stop doing the forward bending exercise, because this exercise causes the further compression fracture.

She was referred to interventional radiology for veterbroplasty treatment. She felt much better after the surgery. However, after 2 months of the surgery, she complained  of low back pain again. She came to me for treatment again.

I then started her with physical therapy 2x per week for another 4 weeks and in the mean time, acupuncture treatment 2x  per week for 4 weeks, Fosamax also was prescribed for her long term use. After about 6 weeks treatment, her pain is much subsided and she is more flexible.

Tips for the patients:

      1. You must give up the bending forward exercise of low back, and try to avoid bending forward postures, for example, do not pick up heavy object from floor, tight your shoes, etc.
      2. You must check your BMD (Bone Mineral Density) measurements at spine, hip, or forearm by DXA devices.
      3. Please read my news letter article no. 4, which will give you the information about how to take care of osteoporosis, please see the attached link: http://drxuacupuncture.co/2009/04/27/case-discussion-4/.

Tips for the acupuncture practitioners :

1.      Acupuncture could decrease the pain, but it can not change the shape of the compression fractured spinal spine.

2.      Do not advise the patients not go to the surgery, because the surgery might be the necessity for the treatment of long run.

3.      Teach the patients that do not bend their low back forward, which will worse the low back compression fracture. The patient should avoid the bending forward exercise.

4.      The patients should be advised to wear lumbar sacral  brace to protect the low back during acute stage of the low back pain.

5.      Acupuncture is not  the only treatment for spinal compression fracture, an integrated treatment might get better results.

22. Acupuncture and Acute Low Back Pain – Low Back Sprain

Oct 23, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

News Letter, Vol. 2 (10), October, 2010, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Acute Lower Back Sprain


Frank M., a 35-year-old male, experienced sudden-onset lower back pain for two days.  He was moving a large piece of furniture for his girlfriend when he suddenly felt pain in his lower back.  The pain was constant, making it impossible for him to move his back; it was so severe that it caused his entire back to spasm.  The pain occurred from his lower back down to his buttocks, though it did not radiate down his legs, nor did he experience tingling or numbness.  All the above symptoms made it extremely difficult for him to put on his socks and pants.  He did not experience any urinary incontinence or bowel or bladder abnormalities.

Frank’s girlfriend took him to the emergency room, where he was given an MRI that came back negative, showing that he did not have a herniated disc.  He also had an X-ray which did not reveal a fracture.  He was given pain medication and sent home and assigned bed-rest for two days.  Massages and heating pads did not help the pain. After two days, the pain had not abated and Frank could not sleep in his bed (he had to lie on the floor, instead), nor was he able to go to work.  At this point, he came to me for a consultation.

My examination showed that Frank could only move his back forward about 30 degrees and could not bend backwards or extend his back.  When I touched his back, his entire back muscle went into spasm, and his cervical, thoracic and lumber spine areas were slightly twisted.  Using a manual muscle test, I concluded that he had no weakness in either leg. A sensibility test showed intact sensation in bilateral legs. There were no signs of a herniated disc or nerve impingement, no spinal fracture, no pain radiating to the legs, and no numbness or tingling sensations.  Based on my examination, I concluded that Frank had acute lower back sprain.

Lumber muscle strains and sprains are the most common causes of lower back pain and occur when the muscles or fibers are abnormally stretched or torn.  Lumber sprain occurs when the ligaments are torn from their attachments. There are usually no positive MRI and X-Ray findings. Because it is often difficult to differentiate between a sprain and a strain, the diagnosis of these two conditions is often confused.

The most important differentiations for acute lower back pain as opposed to other severe herniated discs or lower back nerve impingements, are that the latter two conditions involve the following:

1.     Loss of control of the bladder or bowels

2.     Numbness and tingling sensation in one or both legs

3.     Progressive lower extremity weakness

4.     Lower back pain radiating down one or both legs

If the acute lower back pain is accompanied by the above four symptoms, it is likely that the patient has a herniated disc or that the lumbar sacral nerves are impinged.  If there is only acute lower back pain without these four symptoms, the patient probably suffers from lower back sprain or strain.

The treatments used for lower back sprain and herniated disc are completely different.  For acute lower back sprain, the following method is utilized:

1.     According to Western Medicine techniques, the patient is usually prescribed bed rest for a few days up to one week. Doctors expect that the patients will feel better after bed rest and will be able to return to work and daily functions. However, this treatment is usually not very successful.

2.     Western medicine also employs anti-inflammatory medications,  such as Naproxen, Advil, etc,  or muscle relaxants, such as Skelexin, Valium, etc.  though usually this treatment, too, is not very successful in alleviating acute lower back pain.

3.     Sometimes the patient is fitted with a brace—a lumboscarcal corset that helps support the back—but there are negative side effects of using this because a corset weakens the muscles and ligaments of the lower back.

Traditional Chinese medicine treats this condition as follows:

We utilize the acupuncture points Zan Zhu UB2, Sheng Shu UB23, Da Chang Shu UB 25, Huang Tiao, GB 30, Wei Zhong UB40, Cheng Shan UB57, Kun Lun UB60, and the Arshi points (the tender points along the lower back).

Points Meridian/No. Location Function/Indication
1 Zan Zhu UB 2 On the medial extremity of the eyebrow, or on the supraorbital notch Headache, blurring and failing of vision, pain in the supraorbital region, lacrimation, redness, swelling and pain of the eye, twitching of eyelids, glaucoma, acute lower back pain
2. Sheng Shu UB 23 1.5 inch lateral to Mingmen (DU 4), at the level of the lower border of the spinous process of the second lumbar vertebra Nocturnal emission, impotence, enuresis, irregular menstruation, leucorrhea, low back pain, weakness of the knee, blurring of vision, dizziness, tinnitus, deafness, edema, asthma, diarrhea
3. Da ChangShu UB 25 1.5 inch lateral to Yao Yang Guan(Du 3), at the level of the lower border of the spinous process of the 4th lumbar vertebra Low back pain, borboryggmus, abdominal distension, diarrhea, constipation, muscular atrophy, pain, numbness and motor impairment of the lower extremities, sciatica
4. Huan Tiao GB 30 At the junction of the lateral 1/3 and medial 2/3 of the distance between the great trochanter and the hiatus of the sacrum (Yaoshu, Du2). When locating the point, put he patient in lateral recumbent position with the thigh flexed. Pain of the lumbar region and thigh, muscular atrophy of the lower limbs, hemiplegia
5. Wei Zhong UB 40 Mid-point of the transverse crease of the popliteal fossa, between the tendons of the biceps femoris and semitendinosius muscles Lower back pain, motor impairment of the hip joint, contracture of the tendons in the popliteal fossa, muscular atrophy, pain, numbness and motor impairment of the lower extremities, hemiplegia, abdominal pain, vomiting, diarrhea, erysipelas
6. Cheng Shan UB57 Directly below the belly of the gastrocnemius muscle, on the line joining Wei Zhong UB40 and the calcaneus tendon, about 8 inches below Wei Zhong UB40 Lower back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi
7. Kun Lun UB 60 In the depression between the external malleolus and calcaneus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and pain of the heel, difficult labor, epilepsy.

Fig 16-1

Pic 16-2

Pic 16 -3

All the above points belong to the urinary bladder meridian except the GB 30.  I usually start treatment by inserting the needles into the Zan Zhu UB2 and ask the patient to stand up.  Then I insert the needles deeply along the Zan Zhu and apply a strong stimulation, either by manipulating the needles by hand or via an electrical stimulation.  The energy of the stimulation should transmit from the needles and travel upwards along the meridian of the bladder to the scalp, forehead, and back of the neck, then down along the upper back and into the lower back and legs. I then ask the patient to gradually move his/her back forward and backward and then to turn around.  Many patients are afraid to do so because they think these movements will exacerbate the pain.  However, the energy flow stimulation should relax the lower back muscles and make movement easier for the patient.

Usually, acute stimulation of the needles for 15 to 20 minutes greatly improves the movement of the lower back and alleviates the pain, making the patient’s range of motion in this area much better.  After the range of motion improves, the patient is asked to lie face down on the table.  I then insert the needle into the local Arshi points (around the spasmodic muscles) and into UB40, UB57 and UB60, and apply a strong electrical stimulation for 30 minutes.  This should stimulate the entire bladder meridian and gradually relax the lower back muscles.

After the acupuncture treatment, Frank immediately felt a decrease in the intensity of the muscle spasms, was able to move his back, and bend forward and backward by 50 degrees to a regular position.  He went home, applied a heating pad to the affected area, and returned the following day for the same treatment, which decreased the pain by almost 100%.  At this point, I prescribed a regimen of exercises and stretches that completely relieved the pain.  This is an effective treatment for both acute lower back strain and sprain.

Tips for Acupuncturists:

1.     You should always encourage your patients to move their backs during the stimulation of the Zan Zhu UB2, even if they are afraid to do so.

2.     The stimulation should be strong (stronger than the pain that the patient feels in the lower back).

3.     If you use a combined treatment of massage, acupuncture, and heating pads, you will have better results.

4.     Points in UB meridian are  the most important points to treat acute low back pain.

Tips for Patients:

1.     If you feel the pain radiating to the legs, experience numbness or a tingling sensation, or weakness in the legs, you may have a herniated lumbar sacral disc instead of acute lower back sprain.

2.     If you experience urinary incontinency, this is an indication that your herniated disc is affecting the nerves controlling your urinary system.

3.     If you have the above symptoms, you must consult a physician and ask for an MRI to make a clear diagnosis.

4.     If you lift heavy objects, please keep your objects close to your body’s center of gravity, the closer, the better.

5.     If you upload something in your car, please put one of your foot on your car’s bump or step, your leg will support your back in this way.

6.     If you have low back pain, but you have to drive for long distance, please use low back brace, which will protect your back, you will feel less pain on the back. However, you only can use the brace for short period, otherwise, your low back muscle will become weak if you use it for a long time.

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