Introduction To Acupuncture

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.

It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee'). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more, see Common uses of acupuncture.

The availability of acupuncture on the NHS is limited (see box, left). Most acupuncture patients pay for private treatment.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.

There is no scientific evidence for the existence of Qi or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture’s method of action is fully understood.

For more information, see Evidence for acupuncture. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain. Read the NICE 2009 guidelines on l

Exercises for Back Pain

The best way to deal with back pain is to stay active and continue doing regular exercise.

The advice 20 years ago was to rest, but research has shown that inactivity only makes things worse,” says Dries Hettinga of BackCare, a charity that offers support and information to people with back pain.

“When you’re in pain you may want to stay in bed and not move around, but that results in further [loss of mobility] and will only prolong the pain.”

Staying active means continuing with regular day-to-day activities to avoid becoming sedentary. Examples include walking to the shops rather than taking the car, getting off the bus one stop early, gardening and taking the dog for a walk.

If you experience moderate pain, take painkillers that are available over the counter from your pharmacist or supermarket. Your pharmacist or GP can advise you on how to use your medication effectively.

Exercise program

In addition to maintaining an active lifestyle, try to exercise. You can do any activity that gives your body a good workout.

“It’s important to pick an exercise you enjoy,” says Hettinga. “If you do something you enjoy, you’re more likely to stick with it. There’s no quick fix for back pain so you need to work at it.”

Ideally, your choice of activities should involve elements of endurance, strength and flexibility. Examples include walking, running or jogging, cycling, dancing, swimming, hydrotherapy (exercising in water) and aquarobics.

Consider a variety of exercises as part of a weekly exercise programme, which could include yoga, t’ai chi, working out in a gym and sport in general.

Hettinga says exercise programmes are most effective if performed regularly and over prolonged periods of time.

Aim for at least three to five sessions a week (approximately 30 minutes each session). You may want to build this up over a number of weeks.

Hettinga says an individually designed exercise programme gives the best results. A physiotherapist or exercise professional can help you with this.

Manual therapy

Hettinga suggests combining an exercise programme with a course of manual therapy, especially when the pain is persistent. Manual therapy is provided by chiropractors, osteopaths and physiotherapists.

“Evidence suggests manual therapies can be effective. Your back is examined to see if any joints need to be freed up.

"They can do it with a gentle massage, mobilisation or manipulation. It’s especially helpful if your back is stiff and flexibility is an issue," she says.

Manual therapists are also qualified to advise you on the type of exercises that will be most effective at dealing with your type of back pain.

“You should see improvements after a few weeks,” says Hettinga. “If the pain hasn’t disappeared after a few weeks of treatment, seek further medical advice to explore alternatives.

"There is always something that can be done about back pain, but it requires some work and dedication from you.”

A Simple Exercise Program To Reduce Back Pain

The best way to deal with back pain is to stay active and continue doing regular exercise.

The advice 20 years ago was to rest, but research has shown that inactivity only makes things worse,” says Dries Hettinga of BackCare, a charity that offers support and information to people with back pain.

“When you’re in pain you may want to stay in bed and not move around, but that results in further [loss of mobility] and will only prolong the pain.”

Staying active means continuing with regular day-to-day activities to avoid becoming sedentary. Examples include walking to the shops rather than taking the car, getting off the bus one stop early, gardening and taking the dog for a walk.

If you experience moderate pain, take painkillers that are available over the counter from your pharmacist or supermarket. Your pharmacist or GP can advise you on how to use your medication effectively.

Exercise program

In addition to maintaining an active lifestyle, try to exercise. You can do any activity that gives your body a good workout.

“It’s important to pick an exercise you enjoy,” says Hettinga. “If you do something you enjoy, you’re more likely to stick with it. There’s no quick fix for back pain so you need to work at it.”

Ideally, your choice of activities should involve elements of endurance, strength and flexibility. Examples include walking, running or jogging, cycling, dancing, swimming, hydrotherapy (exercising in water) and aquarobics.

Consider a variety of exercises as part of a weekly exercise program, which could include yoga, T’ai chi, working out in a gym and sport in general.

Hettinga says exercise program are most effective if performed regularly and over prolonged periods of time.

Aim for at least three to five sessions a week (approximately 30 minutes each session). You may want to build this up over a number of weeks.

Hettinga says an individually designed exercise program gives the best results. A physiotherapist or exercise professional can help you with this.

Manual therapy

Hettinga suggests combining an exercise program with a course of manual therapy, especially when the pain is persistent. Chiropractors, osteopaths and physiotherapists provide manual therapy.

“Evidence suggests manual therapies can be effective. Your back is examined to see if any joints need to be freed up.

"They can do it with a gentle massage, mobilization or manipulation. It’s especially helpful if your back is stiff and flexibility is an issue," she says.

Manual therapists are also qualified to advise you on the type of exercises that will be most effective at dealing with your type of back pain.

“You should see improvements after a few weeks,” says Hettinga. “If the pain hasn’t disappeared after a few weeks of treatment, seek further medical advice to explore alternatives.

"There is always something that can be done about back pain, but it requires some work and dedication from you.”

Pregnancy & Low Back Pain: They Go Together Like Pickles & Ice Cream

Ask any pregnant woman if her back hurts and the majority of them will scream “YES!!!!!”  Especially those who are further along in their pregnancy.  Pregnancy and low back pain seem to go together like pickles and ice cream.

So, what causes back pain during pregnancy?

It is usually caused by strain on the back muscles.  In mid-pregnancy, an expectant mom’s center of gravity changes.  In response to that, her posture changes.  Most women begin to lean backward in the later months of pregnancy, which makes their back muscles work harder.

Pregnancy hormones may contribute to back pain as well.  A hormone relaxes the ligaments in the strong, weight-bearing joints in the pelvis.  This loosening makes the joints more flexible, but it can cause back pain if the joints become too mobile.

What can a pregnant woman do to prevent back pain during pregnancy?

To help prevent or ease back pain, be aware of how you stand, sit, and move.  Here are some tips that may help:

▪   Wear low-heeled (but not flat) shoes with good arch support

▪   Ask for help when lifting heavy objects

▪   When standing for long periods, place one foot on a stool or box

▪   If your bed is too soft, have someone help you place a board between the mattress and box spring

▪   Do not bend over from the waist to pick things up – squat down, bend your knees, and keep your back straight

▪   Sit in chairs with good back support, or use a small pillow behind the low part of your back

▪   Try to sleep on your side with one or two pillows between your legs for support

▪   Exercise – walking, light weight-lifting, and water aerobics are safe to do for most pregnant women

What can a pregnant woman do to ease back pain?

Apply heat or cold to the painful area or massage it*.  If that doesn’t work, ask your OB/GYN to refer you to a Licensed Physical Therapist who has experience with pregnant women.   An experienced Physical Therapist can help an expectant mother do exercises that can help lessen backache.  Such exercises strengthen and stretch muscles that support the back and legs and promote good posture – keeping the muscles of the back, abdomen, hips, and upper body strong.

When should a pregnant woman contact her healthcare provider about back pain?

If you have severe pain, or if pain persists for more than 2 weeks, you should contact your healthcare provider.

*Massage Therapy should NOT be performed during the first trimester.

Sources:

August 2011: American College of Obstetricians & Gynecologists

Journal of Physical Activity and Health, 2011, 8 309-320.

Pregnancy and Back Pain

PREGNANT WOMAN WITH BACK PAINS: CAN YOU AVOID IT?

Many factors predispose the pregnant woman to back pains.  In fact, we know that 70% of the population will come across back pains in their life.  However, even with the predisposing factors, it is possible to go through a pregnancy with a healthy back.  

Some good and practical advice from your physiotherapist can help prevent this problem.

Many changes disrupt a woman during pregnancy.  

For example, the weight of the stomach shifts the gravity centre of the body towards the front, creating the abdominal muscles to release and  the pelvis to tilt provoking a larger lumbar curve (lower back).  This makes the back rounder at the thorax level as well as the chin point towards the front.



On top of all the biomechanical and postural changes, the pregnant woman’s ligaments release with the secretion of a particular pregnancy hormone called relaxin.  The secretion of this hormone increases during the first two trimesters of the pregnancy only to slowly die down until the end.

The releasing of the ligaments is at its peak during the 7th month.  

Result?

The joints of the pelvis and spine become slightly hypermobile and therefore more vulnerable to trauma and pain.

If the woman is not careful, she could suffer from articular pain towards the 6th month of her pregnancy.  

The pain will be more apparent if she is sitting or standing too long, if she is forcing to lift something while turning or simply walking.  

We will observe a waddle in the walk of the pregnant woman.  We must also mention the fact that women with pre-existing back problems should be twice as careful.



What should you do? 

Prevention



Here are some tips from your physiotherapist:

            

            Avoid staying seated or standing too long;

            Avoid wearing high heels (they increase the lumbar curve);

            Adopt a good posture.


To check or correct the posture, do the following exercise:



Standing, back against the wall, feet 5 to 8 cm from the wall, squeeze your stomach, tighten your buttock, slightly bend the knees, shoulders straight and hold your chin in.  While doing this exercise, the back must stay glued to the wall.

            While you are sitting, put a telephone book under your feet so that your knees are slightly more elevated than your hips.  This position reduces tension in your lower back;

            When picking up a child or object, always bend your knees to lower yourself to the child’s level.  When you are holding the child, hold him in the centre.  This will prevent tensions on the articulations of the back.

            Always work facing to what you are doing.  Avoid creating torsions of your trunk when picking up an object.

            If you must stay standing for a long period of time, avoid putting all the weight on one leg.  Balance the weight to both your legs.  There are now anti-fatigue carpets on the market.  Why not try one!

            When you sleep, if you sleep on your side, place a pillow between your legs, and if you sleep on your back, put a pillow under your knees.  This will remove the tension on the articulations of the lower back area.


These are simple tips you can follow.  They are useful to all but the application of these tips is most important while a pregnancy.  


Unfortunately, a woman is predisposed to articular problems which develop back pain.  It is preferable to consult a physiotherapist for an evaluation.  Solutions to this problem exist but we must first determine the cause of the problem

BACK PAIN HELP!

Back pain (also known "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

What is Back Pain?

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be radiate into the arm and hand), in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.
Back pain is one of humanity's most frequent complaints. In the U.S, acute low back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year.
The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Back Pain Classification

Back pain can be divided anatomically: neck pain, upper back pain, lower back pain or tailbone pain.
By its duration: acute (less than 4 weeks), subacute (4 – 12 weeks), chronic (greater than 12 weeks).
By its cause: MSK, infectious, cancer, etc.

Associated Conditions With Back Pain

Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:
Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs.
Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition.
Back pain that occurs after a trauma, such as a car accident or fall may indicate a bone fracture or other injury.
Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention.
Back pain in individuals with a history of cancer (especially cancers known to spread to the spine like breast, lung and prostate cancer) should be evaluated to rule out metastatic disease of the spine.
Back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months.
A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and degenerative disc disease may not be more prevalent among those in pain than among the general population, and that the mechanisms by which these conditions might cause pain are not known. Other studies suggest that for as many as 85% of cases, no physiological cause can be shown. 
A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.

Underlying Causes & Sources of Back Pain

There are several potential sources and causes of back pain. However, the diagnosis of specific tissues of the spine as the cause of pain presents problems. This is because symptoms arising from different spinal tissues can feel very similar and is difficult to differentiate without the use of invasive diagnostic intervention procedures, such as local anesthetic blocks.
One potential source of back pain is skeletal muscle of the back. Potential causes of pain in muscle tissue include Muscle strains (pulled muscles), muscle spasm, and muscle imbalances. However, imaging studies do not support the notion of muscle tissue damage in many back pain cases, and the neurophysiology of muscle spasm and muscle imbalances are not well understood.
Another potential source of low back pain is the synovial joints of the spine (e.g. zygapophysial joints). These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. However, the cause of zygapophysial joint pain is not fully understood. Capsule tissue damage has been proposed in people with neck pain following whiplash. In people with spinal pain stemming from zygapophysial joints, one theory is that intra-articular tissue such as invaginations of their synovial membranes and fibro-adipose meniscoids (that usually act as a cushion to help the bones move over each other smoothly) may become displaced, pinched or trapped, and consequently give rise to nociception.
There are several common other potential sources and causes of back pain: these include spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis, osteoarthritis (degenerative joint disease) and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.
Radicular pain (sciatica) is distinguished from 'non-specific' back pain, and may be diagnosed without invasive diagnostic tests.
New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI and CT scans. One of the newer investigations looks into the role of the dorsal ramus in patients that have no radiographic abnormalities. See Posterior Rami Syndrome.

Back Pain Treatment

The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual's ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.
Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery.