Browsing articles tagged with " Low Back Pain"

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/

46. Acupuncture and Fibromyalgia

Oct 25, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (10), October, 2012, © 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

Fax: (203)637-2693

Fibromyalgia

Helen is a 46 years old female, who complains of pain all over the body for about one year. Her husband lost his job about one year ago and has tried his best to find one.  However, he has had no such luck. Helen started to worry about her family financial situation and very often could not sleep well. She always feels sluggish as sleep is not replenishing her energy. She wake up feeling very stressed out and moody and worrying about everything.  She gradually developed pain all over the body, feeling tenderness at symmetric points, such as neck, upper back, shoulders, elbows, middle back, low back, hip, knee and calf. The pain is getting worse, now even moderate touch could make her feel pain. She was forced to move out of her house because she was unable to pay her mortgage and moved in an apartment recently. This made her symptom worse,  she went to her primary care physician, who checked her blood work, chest x-ray and EKG, all were normal, and  prescribed Ambien and pain medication, such as Oxycodone, she felt temporarily  relief, however, she had constipation, headache, sometimes diarrhea, felt very tired when waking up. Because the symptoms were getting worse, therefore, she came to me for evaluation  and treatment.

Upon examination, she looked very tired and fatigue, spoke with a low tone, she was found to have many tender points along the spine, chest ribs, shoulders, elbows, hips and knees, when she was touched by my fingers.

This patient might have fibromyalgia, a common syndrome, most often occurring in middle age women.  Symptoms are long-term, body-wide aches, pains and tenderness.  Typically symmetric in the joints, muscles, tendons, and other soft tissues, very often with accompanying fatigue, depression, insomnia, and anxiety.

Causes

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  1. Genetics: the mode of inheritance is currently unknown, but it is common to see patients in one family, especially mother and daughter.
  2. Stress: an important precipitating factor, Fibromyalgia is frequently found with stress-related disorders, such as chronic fatigue syndrome, posttraumatic stress syndrome, irritable bowel syndrome, and depression.
  3. Physical or emotional trauma
  4. Poor sleep.

Among the above possible causes, the most important are stress and poor sleep,   stress and poor sleep make a noxious cycle: Stress causes poor sleep, poor sleep enhances stress, both stress and poor sleep make muscles unable to relax, for a long time period, the muscles nerve get chance to relax, then it twists together and forms the tender points and bends, which are symmetric and long term.

Fibromyalgia is most common among women aged 20 to 50.

Symptoms-Pain

Widespread pain, fatigue, and severe pan in response to light pressure, numbness and tingling sensation, muscle spasm and weakness in all 4 extremities, nerve pain, muscle taut band, twitching, chronic sleep disturbances, and irritable bowel syndrome.

Fibromyalgia patients tend to wake up with body aches and stiffness, pain improves during the day and gets worse at night. Some patients have pain all day long. Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can’t get to sleep or stay asleep, and they feel tired and stiffness when they wake up.

Many patients experience impaired concentration, poor memory, inability to multi-task, poor attention span, anxiety and depression.

The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia New Diagnostic Criteria and measurement of symptom severity.

Arthritis Care Res (Hoboken). 2010 May;62(5):600-10.

The new criteria keep the requirements that other causes be ruled out and that symptoms have to have persisted for at least 3 months.  They also includes 2 new methods of assessment, the widespread pain index (WPI) and the symptom severity (SS) scale score.

The WPI lists 19 areas of the body and you say where you’ve had pain in the last week.  You get 1 point for each area, so the score is 0-19.

                                                                         http://www.home-health-care-physical-therapy.com/Fibromyalgia-Tender-Points.html

For the SS scale score, the patient ranks specific symptoms on a scale of 0-3.  These symptoms include:

  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms
  • Somatic (physical) symptoms in general (such as headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss)

The numbers assigned to each are added up, for a total of 0-12.

This next part is really interesting to me.  Instead of looking for a hard score on each, there’s some flexibility built in, which recognizes the fact that fibromyalgia impacts us all differently, and that symptoms can fluctuate.

For a diagnosis you need EITHER:

  1. WPI of at least 7 and SS scale score of at least 5, OR
  2. WPI of 3-6 and SS scale score of at least 9.

Treatment

The goal of treatment is to improve impaired function, help a person mentally and physically cope with the symptoms, and to help relieve pain and other symptoms,

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

Physical Therapy is aimed at treating the disease consequences of fibromyalgia including pain, fatigue, deconditioning, muscle weakness and sleep disturbances among others.

Modalities such as ultrasound and TENS machines will help reduce localized and generalized musculoskeletal pain in fibromyalgia patients.

Massage is great to reduce muscle tension and spasms which prevent efficient muscle motion.  Techniques such a joint mobilizations and deep tissue massage prescribed with other therapeutic interventions such as stretching will help your muscles more effectively.

Physical Therapy consult is very beneficial to address sleeping disturbances affecting about 80% of all patients.  Positioning while sleeping and relaxation techniques prior to sleeping can help correct this serious problem.

Fitness machines such as exercise bikes or elliptical machines will improve important measures of cardiovascular fitness, subjective and objective measures of pain.  Also improving is subjective energy levels, work capacity along with physical and social activities.

Focusing on core stability will reduce overloading of the muscle system by supporting the muscles of your spine.  There is a great impact on conditioning weak muscles for improving postural fatigue and positioning.  With a strong core, your body will have a stable, center point.

There is great evidence based research for Whole Body Vibration use on patients with fibromyalgia.  A 6-week study published in 2008, in The Journal of Alternative and Complementary Medicine, by Alentorn-Geli et al reports that WBV safely reduces pain and fatigue while also improving physical function in patients with fibromyalgia.  Here at Rehab Medicine & Acupuncture Center, we have been using this evidence based device in successfully treating symptoms of fibromyalgia.

Another study looking at the benefits of WBV with fibromyalgia performed by Sanudo et al in 2010 was published in Clinical and Experimental Rheumatology. This study examined women with fibromyalgia performing exercise training 2 times a week along with WBV three days a week compared with an exercise only group over a 6-week period with a focus on strength and quality of life.  Significant improvements in all outcomes measured were found from baseline in both groups though additional health benefits were observed with the supplementary WBV.

The second line of treatment is medications, such as antidepressant or muscle relaxant in order to improve sleep and pain tolerance, Duloxetine (Cymbalta), Pregabalin (Lyrica) and Milnacipran (Savella) are very often prescribed.

However, many other drugs are also used to treat the condition, including:

  • Anti-seizure drugs
  • Other antidepressants
  • Muscle relaxants
  • Pain relievers
  • Sleeping aids

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts
  • Keep a diary of pain and symptoms
  • Recognize what makes your symptoms worse
  • Seek out enjoyable activities
  • Set limits

Acupuncture treatment for Fibromyalgia

Acupuncture points mainly are selected from meridians of Tai Yang and Sao Yang, plus cupping.

UB9 Yuzhen, UB16 Dushu, UB18 Ganshu, UB23 Shenshu, Ren6 Qihai, Du20 Baihui, GB13 Bensheng, GB21Jianjin, GB34 Yanglingquan, LI15 Jianyu, ST 36 Zusanli, Sp8 Diji, Ki8 Jiaoxin, UB59 Fuyang, Arshi, etc.

 

Helen’s Treatment:

Helen underwent our treatment about 3 months. I first helped her improve her sleep. According to Chinese Medicine, the key factor was sleep, if the patient can have better sleep, her noxious cycle will be broken, and along with her improvement of sleep, her muscles was gradually relaxed and her pain was gradually reduced. She also was encouraged to have physical therapy to improve her functional abilities and join the entertainment activities,  she had difficulty playing tennis at beginning, after a few treatments, her performance of tennis was getting better, and after all the treatment for three months,  her pain is almost gone and quality of life is much better.

Tips for patients:

    1. Keep a peaceful mood, and you have to realize that your worrying does not take away your stress, but adds stress to you.
    2. Try to get a good sleep nightly, take hot shower before go to bed and avoid TV in order to have a nice sleep routine.
    3. Massage sleep points 5 mins before you go to bed.
    4. Force yourself  to attend the entertainment activities

Tips for Acupuncturists:

  1. Try to help patients to have good sleep by selecting Baihui, An Mian, etc.
  2. Try to help patients to have stress reduction by selecting Shen Men, Shen Shu, etc.
  3. Encourage patients attend all the activities.
  4. Cupping along UB meridian is very helpful.

 

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.

24. Acupuncture and Low back pain again after back surgery

Dec 19, 2010   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 2 (12), December, 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

 

 

Dear Friends and Patients:

Happy Holidays!

This is the last newsletter for 2010. We are very happy to introduce Dr. Robert Blizzard, who recently joined in our practice. Dr. Blizzard graduated from the University of Connecticut with a Bachelor’s Degree in Exercise Science, and continued on to receive his Doctoral of Physical Therapy at Franklin Pearce University. He is a full time licensed physical therapist in RMAC. We believe his knowledge and experience will help you to fulfill your goal to be completely recovered from your injury. Dr. Blizzard joined us to write this newsletter too.

From now on, we will leave our comment space on under the news letter at our website, www.DrXuAcupuncture.com.  you are welcome to leave  your questions or comments .  We will try our best to answer your questions.

We wish you happy holidays!

Jun Xu, M.D.

Hong Su, C. M. D.

Robert Blizzard III, D.P.T.

Low back pain with failed back surgery syndrome (FBSS)


 

 

From: www.yorkshirehighlanders.co.uk

Peter is a 56-year-old male who complains of low back pain for three years.  The pain started from the low back and radiated down to the right leg, which made it difficult sitting, walking, and standing.  The pain also interferes with his sleep, especially while he changes positions in the bed, and therefore he went to his primary care physician. He was referred to physical therapy for about three months of treatment.  However, the pain was not getting better and still he felt pain is sharp and stabbing, and that radiated down to the right lateral thigh and the lower leg.  The pain was constant.  In the meanwhile, he gradually felt his leg was weak and he had difficulty standing from the sitting and driving position.

Then one day he realized his underwear was wet because he had difficultly controlling his urinary bladder and he had decreased sensation at right lateral lower leg.  Therefore, his primary care physician referred him to a neurosurgeon.  An MRI was done, which showed two large right L4/L5 and L5/S1 herniated disc with impingement of right L5, S1 nerve roots.  He was advised to have surgery, L5/S1discectomy.

However, he was afraid of the surgery, then he consulted another neurosurgeon, who suggested to have laminectomy because the MRI, which showed two levels, L5 and S1, with  severe right foraminal L5-S1 nerve impingement and  degenerative changes between L5 and S1 and S1 and S2, which are the reasons for urinary incontinence.

He was thinking, however, he would like to wait a few more months to see if this would be getting better.  He restarted physical therapy again, and also he had epidural injection at those two levels and his pain seemed  better slightly.  However, he felt the right leg is weaker, he sometimes loses control of his urine.  Therefore, he decided to have surgery.

Laminectomy was performed one year ago.  After the surgery within one month, he had immediate pain relief and also he could control his urine and the bowel movement.  The patient was very happy about the surgery.

However, after six months, he started to feel low back pain again and this time he felt the pain is a gradual onset, dull and achy without any radiating down to the leg and he had no bowel or bladder abnormalities, but he still feels some weakness and mild numbness and tingling sensation on the right lateral leg. He visited his neurosurgeon, who told him this pain sometimes occurred after surgery about 6 months, and if he continued to do the physical therapy, the pain should be getting better.

The patient started to do physical therapy again after six months and he did muscle strengthening and stretching on the low back.  However, one day, he felt the pain suddenly getting worse after waking up and the pain is like stabbing with burning sensation around the L3-L4, L5-S1 middle spine and paraspine, and since then, he has had difficulty bending forward and backward, sitting to standing, and driving.  The patient then revisited his surgeon and he was prescribed Tylenol with Codeine.  After he took this pain medication, he felt better.  However, he started to feel drowsy and he had difficulty driving and concentrating on his work, and gradually he also started craving for this drug.  If he did not take for one day, he felt uncomfortable not only in the low back but the entire body and also he felt depressed and low energy.  Therefore, he came to me for evaluation and treatment.

I performed  physical examination, I saw the scars on the both sides of the L4, L5, and S1 para-spine, by palpation,  there was tenderness around L3-L4 and L5-S1 para-spine.  There was no palpation pain at bilateral sciatic areas.  He can bend his low back forward only about 40 degrees and bend his back backward only about 10 degrees.  He had no problem to walk on tippy toes and heels.  He had no decreased sensation at both legs.  I compared the MRI of presurgery and postsurgery,  There was no impingement of the nerve roots anymore.  Based on all the above information, I thought the patient was suffering with post-lumbosacral laminectomy syndrome, also called “failed back surgery syndrome” (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery.

Before I introduce the Failed Back Surgery Syndrome, I would like to let you understand the basic knowledge of low back surgery;

There are seven types of low back surgery.

1.      Discectomy.

2.      Foraminotomy.

3.      Intradiscal electrothermal therapy.

4.      Nucleoplasty.

5.      Radiofrequency lesioning.

6.      Spinal fusion

7.      Spinal laminectomy, etc.

Discectomy
This is a procedure done to relieve pressure on a nerve root that’s being compressed by a bulging disc or bone spur. In order to relieve this pressure, the surgeon removes a small piece of the lamina (the bony roof of the spinal canal) from above the obstruction.

Figure 24.1

http://indiahealthtour.com/treatments/spine-surgery/endoscopic-micro-discectomy-surgery.html

Foraminotomy
This is type of surgery is undertaken to enlarge the foramen (the bony hole) where a nerve root branches out from the spinal canal. Joints thickened with age, or bulging discs, may cause the foramen to narrow, thereby pressing on the nerve. This pressure can cause pain, numbness or weakness in the extremities. In order to relieve the pressure, the surgeon removes small pieces of bone over the nerve through a small slit, which allows her to cut away the blockage.

Figure 24.2

From: http://www.laser-spine.com/spinehealth/treatments/endoscopic_foraminotomy/

IntraDiscal Electrothermal Therapy (IDET)
IDET is used to treat pain caused by a cracked or bulging spinal disc. This therapy involves inserting a special needle into the disc via a catheter. Once inserted, the needle is heated to a high temperature for approximately twenty minutes, effectively thickening and sealing the disc wall. This procedure reduces inner disc bulge and spinal nerve irritation.

Figure 24.3

From: http://www.advanced-pain-care.com/Intradiscal.htm

Nucleoplasty
Nucleoplasty is used to treat lower back pain resulting from mildly herniated or contained discs. During this procedure, a wand-like instrument is guided by x-ray imaging and inserted through a needle into the disc in order to create a channel. This facilitates the removal of inner disc material. Several channels may be made, depending on the amount of material needing to be removed. After removal, the wand heats and shrinks the tissue of the disc wall in order to seal it.

Figure 24.4

From: http://www.kcpain.com/kcp_help5c.php

Radiofrequency (RF) Lesioning
This procedure is used to interrupt of nerve conduction and the transfer of pain signals. Electrical impulses are used in order to destroy the nerves located in the affected area. A special needle is inserted into the localized nerve tissue, with the guidance of an x-ray. This area is then heated for 90 to 120 seconds, destroying the nerve tissue. This may result in cessation of pain for 6-12 months.

Figure 24.5

From: bnsmedical.com

Spinal fusion
Spinal fusion is a procedure which is done in order to support a weak spine and/or to prevent painful movements. However, spinal fusion requires a long recovery period, and may result in a permanent loss of spinal flexibility. The procedure involves the removal of the spinal disc between two vertebrae, and the subsequent fusion of those vertebrae. Methods of fusion include either bone grafting and/or using metal devices secured by screws.

Figure 24.6


From: http://skillbuilders.patientsites.com/Injuries-Conditions/Lower-Back/Lower-Back-Issues/Lumbar-Spinal-Stenosis/a~51/article.html
Spinal Laminectomy
This procedure is used to relieve pressure on the spinal cord and nerve roots. Also known as spinal decompression, this type of surgery involves the removal of the lamina to increase the size of the spinal canal.

Figure 24.7

http://www.eorthopod.com/content/lumbar-laminectomy

Treatments for Faild Back Surgery Syndrome (FBSS)

In 1992, Turner et al. published a survey of 74 journal articles which reported the results after decompression for spinal stenosis. Good to excellent results were on average reported by 64% of the patients. (Turner, J., et al., Spine 1992; 17:1-8 ) Therefore, there are about 36% of the post back surgical patients, who might suffer some degrees of back pain, usually after 6 months of surgery.  For some patients, the pain might achieve the peak intensity as pre-operation after two-year surgery.

Failed back surgery syndrome (FBSS),  is characterized by intractable diffuse, dull and aching pain or sharp, pricking, and stabbing pain in the back and/or legs accompanied with varying degrees of functional incapacitation.  Recurrent herniated disc and symptomatic hypertrophic scar can produce similar low back symptoms and radiculopathy as before the surgery. Gradually increasing symptoms beginning a year or more after discectomy are considered more likely a result of scar radiculopathy, while a more abrupt onset at any interval after surgery is more likely due to recurrent herniated disc. Multiple factors can contribute to the onset or development of FBS, such as residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning.

The treatments of Failed back surgery syndrome (FBSS),  include physical therapy, acupuncture, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, and intrathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. Here, we will mainly introduce physical therapy, pain medications and acupuncture treatment.

1. Physical therapy:

Spine surgery changes the anatomy of the spine but does nothing to improve activation of deep core stabilizing muscles.  That is one of the benefits of physical therapy for re-training the body to properly activate the deep core muscles that stabilize the spine.  The two deep co-stabilizing muscles of the spine are the Transverse Abdominis (TrA) and Multifidus

Spinal braces are an option to wear especially immediately following surgery to improve recovery. A corset helps to brace the lumbar spine by increasing the pressure in the abdomen, and thus reducing the amount of weight placed through the spine.

Figure 24.8The Transverse Abdominis is often called the “human corset” as it is the only abdominal muscle attaching to the posterior spine and runs transverse around the body.

Figure 24.9

http://www.unm.edu/~lkravitz/Media/transverse.gif http://www.exerciseyourpainaway.co.uk/muscles.htm

Draw-Ins

These exercises can be performed in any position and progressed once the very important concept of TrA activation is achieved. The two starting positions are quadruped and supine.  Stabilizing the spine by activating TrA and Multifidus occurs without rotating the hips, tensing the shoulders or holding ones breath but from slowly drawing-in the deep core muscles of the abdominal wall.

Figure 24.10http://www.strattonpt.com/images/uploads/images.3.jpg

Figure 24.11

http://staceyspt.com/Exercise/LowerBack.htm

Figure 24.12http://www.sportstek.net/pressure_biofeedback.htm

Draw-Ins with Alternating Upper Extremity/Lower Extremity Movement

These movements build upon a solid foundation of spinal stabilization from the previous exercises.  Start off first by performing a Draw-In and holding that contraction while moving the Upper Extremities (UE) only, then work on the Lower Extremities (LE) finally moving on to simultaneous movement of both UE/LE.  Quadruped Alternating UE/LE Movement is also called “Bird-Dog” while “Dead-Bug” is the name of Supine Alternating UE/LE Movement.  It is important to maintain a neutral spine from hips to shoulders and for the core to take in the force when an extremity is lifted and not involve a rotation component to the opposite hand or knee.  This will occur if done improperly or rushed to without developing strength and control through the previous mentioned exercises.  Both the Bird-Dog and Dead-Bug can be progressed from a solid stable surface such as the ground or exercise mat to an unstable surface such as foam dyna-discs or a foam roller to increase the activation of core stabilizing muscles thus making the exercise more challenging and effective.

Figure 24.13 Bird-DogFigure 24.14  Dead-Bughttp://michaelwoodspg.blogspot.com/ http://www.canada.com/health/3390881.bin

Kneeling and Standing Chops/Lifts

Once properly able to stabilize the spine with Alternating UE/LE Movements, progression to more functional activities is deemed ready.  Theses moves involve working through all planes of movement while stabilizing the spine.

A resistance cable is used with the hands at arms length from the body starting over one shoulder and working diagonally across the body to the opposite knee, engaging the TrA and keeping from rounding the back forward.  In a Cable Lift the hands start at the knee and work diagonally up to the opposite shoulder.

Cable Chops

Figure 24.15

http://www.menshealth.com.sg/fitness/best-exercises-your-core

Figure 24.16

http://fms.riaguy.com/articles/fitness/2010-03-15_balanced_body_series.introduction_to_the_chop_and_lift

Cable Lifts from Kneeling and Standing

Figure 24.17

http://eas.com/training/strength/rotational-lift–split-squat-cable http://www.whatsupusana.com/2009/04/pregnancy-and-exercise.html

Soft-Tissue Mobilization

Adhesions and scar tissue development are very common following any surgery.  Development of these adhesions can lead to decreased mobility and compression on nerve roots causing increased stiffness and pain. A few simple techniques to rid adhesions/trigger points/scar tissue and improve recovery along the spine are from using a foam roller or having manual work specific to your individual needs.

Figure 24.18 Figure 24.19

http://www.foamroller.co.uk/ http://www.boulderbodyworks.com/physical-therapy.html

2.   Medications:

A. Acetaminoph: (one brand name: Tylenol) helps many kinds of chronic pain.

B. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Examples include aspirin, ibuprofen (two brand names: Motrin, Advil) and naproxen (one brand name: Aleve). NSAIDs come in both over-the-counter and prescription forms. These medicines can be taken just when you need them, or they can be taken every day. When these medicines are taken regularly, they build up in the blood to levels that fight the pain of inflammation (swelling) and also give general pain relief. Please remember that you always take it with food or milk because the most common side effects are related to the stomach.

C. Narcotics: Narcotics can be addictive. For many people who have severe chronic pain, these drugs are an important part of their therapy. If your doctor prescribes narcotics for your pain, be sure to carefully follow his or her directions. Tell your doctor if you are uncomfortable with the changes that may go along with taking these medicines, such as the inability to concentrate or think clearly. Do not drive or operate heavy machinery when taking these medicines.

When you’re taking narcotics, it’s important to remember that there is a difference between “physical dependence” and “psychological addiction.”

Physical dependence on a medicine means that your body gets used to that medicine and needs it in order to work properly.
Psychological addiction is the desire to use a drug whether or not it’s needed to relieve pain. Narcotic drugs often cause constipation (difficulty having bowel movements). If you are taking a narcotic medicine, it’s important to drink at least 6 to 8 glasses of water every day. Try to eat 2 to 4 servings of fresh fruits and 3 to 5 servings of vegetables every day.

C. Other medicines

Many drugs that are used to treat other illnesses can also treat pain. For example, carbamazepine ( Neurotin )is a seizure medicine that can also treat some kinds of pain. Amitriptyline is an antidepressant that can also help with chronic pain. It can take several weeks before these medicines begin to work well.

 

3. Acupuncture Treatment:

There are three types of Failed back surgery syndrome (FBSS) according to Traditional Chinese Medicine.

Figure 24.20

Figure 24.21

Figure 24.22

Figure 24.23

Figure 24.24

Figure 24.25

Type 1: Coldness and Wetness of FBSS:

Patients feel cold, heavy, and  pain at entire low back, difficulty turning over on the bed or standing up from sitting position, getting worse during the cold weather, stiffness at low back, hip and knee joints.

Acupuncture points: UB 25 Da Chang Shu, GB 30 Huan Tiao, UB 40 Wei Zhong, UB 60 Kun Lun, plus Du 26 Ren Zhong, GB 34 Yang Ling Quan, and UB 58 Fei Yang.

Table 24.1

Points Meridan/No. Location Function/Indication
1. Da ChangShu UB 25 1.5 inch lateral to midline of the body on the back, at the level of the spinous process of the fourth lumbar vertebraFigure 24.20 Low back pain, abdominal distension, diarrhea, constipation, muscular atrophy, pain, numbness and weakness at legs, sciatica
2. Huan Tiao GB30 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.Figure 24.23 Low back  pain, thigh pain, muscular atrophy of the lower limbs, hemiplegia
3 Wei Zhong UB 40 Mid point of the transverse crease of the popliteal fossa, between the tendons of biceps femoris and semitendinosius musclesFigure 24.23 Low back pain, motor impairment of t he hip joint, contracture of the tendons in the popliteal fossa, muscular atrophy, pain, numbness and motor impairment of the lower extremities, hemiplegia, abdominal pain,k vomiting, diarrhea, erysipelas.
4 Kun Lun UB 60 In the depression between the external malleolus and calcaneus tendonFigure 24.23 Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and pain of the heel, difficult labor, epilepsy.
5 Ren Zhong Du 26 A little above the midpoint of the philtrum, near the nostrilsFigure 24.24 Mental disorders, epilepsy, hysteria, infantile convulsion, coma, apoplexy-faint, trismus, deviation of the mouth and eyes, puffiness of the face,  low back pain and stiffness
6 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibulaFigure 24.22 Hemiplegia, weakness, numbness and pain of the lower extremities, swelling and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile convulsion
7 Fei Yang UB 58 7 inch directly above Kun Lun on the posterior border of fibula, about 1 inch inferior and lateral to Cheng Shan (UB 57)Figure 24.23 Headache, blurring of vision, nasal obstruction, epistaxis, back pain, hemorrhoids, leg weakness

Type 2: Kidney Deficiency of FBSS:

Patients’ pain demonstrate weakness,  and pain at nonspecific-pointed area, difficulty standing, feel better while lying on the bed, the pain is dull and achy, cold in four extremities

Acupuncture points: UB 25 Da Chang Shu, GB 30 Huan Tiao, UB 40 Wei Zhong, UB 60 Kun Lun plus St 36 Zu San Li, Sp 6 San Yin Jiao, and Ki 3 Tai Xi. ( Please see tables 24.1, and 24.2)

Table 24.2

Points Meridian/No. Location Function/Indication
1. Zu San Li St 36 On finger-breadth from the anterior crest of the tibia in tibialis anterior muscleFigure 24.22 Gastric pain, vomiting, hiccup, abdominal distension, diarrhea, dysentery, constipation, mastitis, enteritis, knee joint and leg pain, edema, cough, asthma, waste syndrome, poor digestion, hemiplegia, dizziness, insomnia, mania
2. San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibiaFigure 24.22 Abdominal pain, distension, diarrhea, dysmenorrheal, irregular menstruation, uterine bleeding, morbid leucorrhea, prolapse of the  uterus, sterility, delayed labor, night bed wet, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and leg pain, headache, dizziness and vertigo, insomnia
9 Tai Xi Ki 3 In the depression between the medial malleolus and tendo calcaneus, at the level of the tip of the medial malleous.Figure 24.21 Sore throat, toothache, deafness, tinnitus, dizziness, spitting of the blood, asthma, thirst, irregular menstruation, insomnia, nocturnal emission, impotence, frequency of micturition, low back pain.

Type 3: Blood Stagnation of FBSS:

There is sharp, stabbing pain at specific area in the low back and buttock. The pain is very severe, so that nobody could touch the tender area, difficulty bending, sitting and standing, and turning over in the bed.

Acupuncture points: UB 25 Da Chang Shu, GB 30 Huan Tiao, UB 40 Wei Zhong, UB 60 Kun Lun plus Sp 10 Xue Hai, UB 17 Ge Shu, LI 4 He Gu, UB 57 Cheng Shan.

(Please refer to tables 24.1, 24.3)

Table 24.3

Points Meridian/No. Location Function/Indication
1 Xue Hai Sp 10 2 inch above the mediosuperior border of the patella (Knee Cap)Figure 24.21 Irregular menstruation, dysmenorrheal, uterine bleeding, amenorrhea, urticaria, eczema, erysipelas, pain in the medial aspect of the thigh
2 Ge Shu UB 17 1.5 inch lateral to the middle line of the body on the back, at the level of the lower border of the spinous process of the 7ththoracic vertebraFigure 24.20 Vomiting, hiccup,belching,difficulty in swallowing, asthma, cough, spitting of blood, afternoon fever, night sweating, measles
3 He Gu LI 4 On the dorsum of the hand between th e1st and 2nd metacarpal bones, approximately in the middle of the 2ndmetacarpal bone on the radial side.Figure 24.25

 

Headache, pain in the neck, redness swelling and pain of the eye, epistaxis, nasal obstruction , rhinorrhea, toothache, deafness, swelling of the face, sore throat, arotitis, trismus, facial paralysis, febrile dieseases with anhidrosis, hidrosis, abdominal pain, dysentery, constipation, amenorrhea, delayed labour, infantile convulsion, pain, weakness and motor impairment of the upper limbs.
4 Cheng Shan UB57 Directly below the belly of gastrocnemius muscle, on the line joining Wei Zhong UB40 and calcaneus tendon, about 8 inch below Wei Zhong UB40Figure 24.23 Low back pain, spasm of the gastrocnemius, hemorrhoids, constipation, beriberi.
  1. Transcutaneous Electrical Nerve Stimulation (TENS):

TENS is thought to disrupt the   pain transmitting to the brain delivering a different, non-painful sensation to the skin around the pain site. In essence, it modulates the way we process the pain sensations from that area, i.e. it closes the pain gate to the brain. It can also trigger the brain to release endorphins. Endorphins act as natural painkillers, and help promote a feeling of well-being.

Figure 24.26

http://www.sodahead.com

5. Local Nerve Block

An epidural nerve block is the injection of corticosteroid medication into the epidural space of the spinal column. This space is located between the dura (a membrane surrounding the nerve roots) and the interior surface of the spinal canal formed by the vertebrae.

After a local skin anesthetic is applied to numb the injection site, a spinal needle is inserted into the epidural space under fluoroscopic (x-ray) guidance, using a contrast agent to confirm needle placement. Local anesthetic and corticosteroid anti-inflammatory medication are delivered into the epidural space to shrink the swelling around nerve roots, relieving pressure and pain.

Figure 24.27

http://www.treatingpain.com

6. Intrathecal Morphine Pump

Pain pump delivery of narcotic drugs is a rather new option available to persons with cancer and non-cancer pain. It is also called intraspinal (within the spine) or intrathecal (within the spinal canal) delivery. It was first used in 1979 after the discovery of narcotic receptors in the spinal cord. The use of an implant device to deliver medications directly in the area of the spinal cord was first used in 1981 for cancer pain. Since then, the pain pump has been used for chronic non-cancer pain such as failed low back surgery syndrome and spasticity from neurological conditions like multiple sclerosis, spinal cord injury, and cerebral palsy.

Figure 24.28

http://www.eorthopod.com

 

About Peter’s Treatment:

Peter underwent our treatment with both acupuncture and physical therapy. The typical protocol was as following,

  1. Peter was first put in the bed with heating pad on the low back for about 10 to 15 mins, his low back muscles were gradually loosening, then massage was given to further relax his low back muscles.
  2. After massage, acupuncture treatment was given, the most important points were selected based on the above principal. He was given needles with electrical stimulation for 20 to 30 min, his energy flow,  therefore,  is activated and the pain is gradually decreased.
  3. He then was transferred to physical therapy area, started to strengthen his abdominal and low back muscles with the above guidance.
  4. He was given the above treatment for about 20 sessions, he felt greatly improvement after the treatment. He has had more flexibility and much less pain. His pain scale decreased to 2/10 from 10/10. He was pain free for one year, and he sometimes returns to my office for tuning.

Tips for patients who had low back surgery, but still feel a lot of pain on the low back:

  1. MRI of low back spine is necessary to check any new injuries, such as new herniated disc, degenerative changes of other levels, any loosening of the screws, and spinal stenosis.
  2. Be very cautious for the subsequent low back surgery. Sometimes, you may be advised to have the second surgery for your low back. From my personal experience, I did not see many successful cases after the secondary even third low back surgery.
  3. Try to find a physiatrist MD, who also practices acupuncture. Physiatrist MDs are trained in US for Musculoskeleton Medicine. They not only understand your problem but also more specifically treat you with acupuncture. They also could guide your physical therapist for the treatment.
  4. The combination of physical therapy, massage and acupuncture treatments are very important, because these combined treatments could not only relax your muscles but also maximize your abilities to perform core body strengthen.
  5. Different patients like different sequence  of the treatment, it is not absolutely necessary to have massage, acupuncture, then physical therapy, because everybody is different. It depends on your personal preference. The most important is that you have to have the combined treatment to benefit the most.
  6. If you drive a distance for longer than 30 min, it is wise to have the lumbosacral corset, i.e. low back brace on,  the brace will protect your low back and prevent further injuries.

Tips for acupuncturists:

  1. You must clearly understand the patient’s pathological mechanism. Some patients are not allowed to have flexion exercise, some patients not for extension exercise.
  2. Heating pad and massage are very important to induce energy and relax low back muscles.
  3. LI 4 is a very important point to increase the secretion of endorphin and inhibit the up going reticular formation to send the pain signal to the brain.
  4. Electrical stimulation on the back points is a must.

Case Discussions