News Letter, Vol. 2 (10), October, 2010, © Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
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).
|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.|
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.