腰痛 YAO TONG - LOW BACK PAIN

Yao means lower back region, and Tong means pain. In China as well as in the west, lower back pain is just that. It could be therefore that it is not mentioned in Chinese medical literature as a stand-alone illness; and it is only addressed with differential diagnosis on syndromes of Kidney Yin Deficiency, Kidney Yang Deficiency, Wind-Cold-Damp syndrome, Blood Stasis syndrome, and Damp-Heat accumulation in the lower back. Kidney deficiency, Wind-Cold-Damp syndrome and Damp-Heat accumulation are the most routinely encountered in clinical practice. Blood-stasis syndrome is mostly discussed in relation to severe traumatic injury.

Low back pain, with pain to one or both sides or directly on the lumbar vertebrae, is a frequently encountered clinical presentation. Low back pain may result from numerous disorders named by Western medicine, including renal diseases, rheumatism, rheumatoid conditions, injury to the lower back muscles and vertebral or spinal cord disorders.

Etiology and Pathogenesis

LBP can be divided into three etiological categories:

Invasion of external evils: LBP from external evils often involves dampness that is characterized by heaviness and turbidity, and that collects in the lower back. This type may be further subdivided as due to Cold-Dampness or Damp-Heat.

Traumatic injury: Traumatic falls, contusions and sprains injuring the channels and connections of the lumbar region will result in stagnation of Qi and stasis of Blood, causing pain. All three categories of LBP can mutually affect one another.

Internal disruption: LBP from internal disruption usually involves KD deficiency, as the lower back is the home of the KD Zang.

TCM Patterns

Cold-Dampness
Damp-Heat
Blood Stasis
KD Yang Deficiency
KD Yin Deficiency

Cold-Dampness

Symptoms
Cold pain and heaviness of the lower back, difficulty turning the waist, pain alleviated by applications of heat but not diminished by lying quietly and an increase in pain during cold or rainy weather.

Tongue: White slimy coating.
Pulse: Slow, deep.

Treatment Strategy
Dispel cold, disinhibit dampness, warm the channels and free the connections.

Damp-Heat

Symptoms
Low back pain accompanied by a sensation of heat at the location of the pain, increase in pain during hot or rainy weather, dark scanty urine, and in some cases a decrease in pain after exercise.

Tongue: Yellow slimy coating.
Pulse: Soft, rapid.

Treatment Strategy
Clear heat, expel dampness, ease the lower back and relieve pain.

Blood Stasis

Symptoms
Stabbing low back pain of fixed location, aggravation of pain with external pressure, increase in the severity of pain at night, discomfort bending forward and straightening in mild cases and, in severe cases, an inability to twist sideways. Some cases may have histories of traumatic injury to the lumbar region.

Tongue: Dark, purplish, sometimes with stasis macules on the tongue.
Pulse: Rough.

Treatment Strategy
Quicken the blood, dissolve stasis, move Qi and relieve pain.

KD Yang Deficiency

Symptoms
Slow onset with extended duration, aching of lower back diminished by pressing and rubbing, fatigue, weakness of knees, increase in pain after exertion, decrease in pain while lying quietly, frequent, recurrence of symptoms. Kidney yang deficiency also shows physical cold, pale complexion and cold extremities.

Tongue: Pale.
Pulse: Deep, thready.

Treatment Strategy
Supplement KD Yang, relieve pain.

KD Yin Deficiency

Symptoms
Slow onset with extended illness duration, aching of lower back diminished by pressing and rubbing, fatigue, weakness of knees, increase in pain after exertion, decrease in pain while lying quietly, frequent recurrence of symptoms. KD Yin deficiency also shows irritability, insomnia, dry mouth and throat, red cheeks, vexing heat in the five hearts.

Tongue: Red with little coating.
Pulse: Rapid, thready.

Treatment Strategy
Nourish KD Yin, relieve pain.

      GLUTEUS MEDIUS

Regardless of the cause of lower back pain on our patients, it is our experience at FullCircle Acupuncture HealthCentre that a strong gluteus medius is an asset to counter a whole host of causes of lower back pain.

With a steady regimen of workout and strengthening of this muscle bilaterally, 70 to 100% of the patients completely recover from low back pain after a short course of acupuncture treatment.

To keep it that way, the patient must include the workout of the gluteus medius in their exercise routine. The picture shows the machine used to work and strengthen the gluteus medius muscle. The gluteus medius is an abductor muscle, and when working it, the adductor in the inner thigh must be worked as well for balance.

What is the Gluteus Medius Muscle?
The gluteus medius is a fan shaped muscle located on the side of the hip. This location positions the gluteus medius as a key posture muscle, one that plays an important role in the health of the back. The gluteus medius is a hip abductor muscle, as well as an antagonist muscle to the inner thigh, or adductor muscle. Antagonist muscles perform the opposite movement from agonists, and together the agonists and antagonists help produce functional joint motions.

The hallmark contribution of the gluteus medius muscle is side to side pelvic stability. It keeps one from toppling over sideways when walking and standing. The gluteus medius also coordinates with the rest of the hip muscles to keep the pelvis in balance during other types of movements. This is important when doing core stabilization work and it may help prevent injury and manage back pain.

In fact, a critical but often overlooked function of the gluteus medius is to maintain hip alignment when standing on one leg. This means it plays a role in walking, running and some standing balance exercises. As it does so, the gluteus medius contracts isometrically, or without either shortening or lengthening.

The gluteus medius originates on the external surface of the outside of the ilium, aka, hip bone. It traverses downward — narrowing as it goes — to insert on the greater trochanter.

From the side, the gluteus medius muscle appears as a fan shape that starts at the greater trochanter, where it looks like a stem, and widens up and out to cover the side of the hip bone in the area mentioned above.

The gluteus medius is one of several hip muscles — each in their own location and specialized action around the hip joint — that connects the thigh bone and the pelvis. The job of the gluteus medius is to abduct the thigh, relative to the pelvis.

Most therapeutic or corrective exercise programs aimed at relieving low back pain include strengthening and stretching exercises for all the muscles that surround the hip joint, including the gluteus medius. This is because the hip joint is key for body stability and locomotion.

Without hip muscle strength and flexibility, the body posture may not be as supported as it could be, which may lead to unnecessary compression or loading of spinal joints, poor posture and low pain.

Low back pain is a universal human experience. The lower back, which starts below the ribcage, is called the lumbar region. Low back pain (LBP) is the most common musculoskeletal condition affecting the adult population, with a prevalence of up to 84% Chronic LBP (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 12 weeks.^[2][3]

Chronic low back pain is defined as pain that lasts beyond the expected period of healing of 3 months. This definition is very important, as it underlines the concept that CLBP has a well-defined underlying pathological cause and that it is a disease, not a symptom. CLBP represents the leading cause of disability worldwide and is a major welfare and economic problem.^[2]

Given this complexity, the diagnostic evaluation of patients with LBP can be very challenging and requires complex clinical decision-making. Answering the question, “what is the pain generator?” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a diagnosis not based on specific pain generator can lead to therapeutic mistakes.

The complex anatomy of the lumbar spine is a combination of 5 strong vertebrae (L1 – L5), linked by joint capsules, ligaments, tendons, and muscles, with extensive innervation. The spine is designed to be strong, since it has to protect the spinal cord and spinal nerve roots. At the same time, it is highly flexible, providing for mobility in many different planes.

Mostly, LBP is considered to be nonspecific ^[4], and the mistaken idea that the cause of 80 to 90% of LBP cases is unknown has persisted for decades ^[5][6]

Muscle tension and spasm are among the most common reasons for LBP, for example, in patients with fibromyalgia. In other cases, LBP can be attributed to different pain generators, with specific characteristics, such as radicular, facet joint, sacro-iliac, and discogenic pain, as well as spinal stenosis.

SCIATICA

TREATMENTS OFFERED

 

__________________________________________________________________________________________________________________________________________________________________REFERENCES
^[1] Personal classroom notes. 2005-2011
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-Above Article Written by Dr. Osorio, Gloria DAOM, L.Ac., MQP. 2020.