Why Acupuncture Should Be the First Choice for Low Back Pain
TL:DL Majority of low back pain, especially the acutes ones, are due to excessive muscle contraction. Through the use of needles, acupuncture is a uniquely effective modality in reaching and relaxing the deep troubled muscles, either through direct mechanical contacts/manipulation or supplemented with electrical stimulation.
For the longest time, medical community has always attributed low back pain to herniated discs, which essentially means that the cartilaginous discs, that are sandwiched between two bony vertebrae, somehow get squeezed out of their proper snug space and start making uninvited contact with the touchy-feely nerves that are found on both sides of the spinal column. So clinicians used to perform a variety of physical exams such as the straight leg raise (SLR), toe resistance test, etc., to help to determine the location(s) of the disc herniation. Then MRI came along. And it provided the holy grail of what clinicians have been looking for all this time: evidence of disc herniation. Finally, the clinicians can see exactly where a herniation and assign a the cause of the patient’s suffering to a proper culprit. So, what’s the solution? On one hand, there is discectomy, which surgically shaves off the protruding portion of the disc so there is nothing physically irritating the nerve. For people who are avoiding surgery at all cost, they are referred to the physical therapists (PT) for rehabilitation, which consists of manual manipulation of the muscles in the affected area and exercises that help reconfigure the patient’s movement patterns.
So what is there left to discuss?Well, the outcome of the aforementioned approaches is mixed at best. And to be fair, there is no such thing as a 100% solution. Every approach, every modality brings something useful to the table. But whether it is the right tool for the right problem, it’s open for debate. Here are a few questions and facts that challenge their applicability.
First, if disc herniation is the cause then a pointed discectomy should remove the problem. But I have seen my share of patients who are still suffering from back pain after the surgery. And take Steve Kerr’s case, back pain surgery, as a traumatic and invasive procedure to the body, is not the savior as one might think.
Second, as MRI becomes more sophisticated, the MRI laboratory has found high prevalence of disc herniation of varying degree in general population. But not all of them manifest as back pain. So as if the Heisenberg’s Principle of Uncertain is at play here: the more closely you observe the data and the symptom, the more uncertain the postulation of herniated disc causes back pain becomes. People with disc herniation do not experience pain; people with back pain may or may not exhibit pain; people with disc herniation but do not experience the predicted pain pattern and location…
Third, even if disc herniation is the culprit, how exactly is PT helping? Yeah, you can learn to use your body differently so you can minimize certain movements or postures that might provoke the unpleasant sensation. But the pain is still there. And what is the purpose of the manual manipulation? What exactly are they trying to manipulate? Shove the disc back in its proper place? Of course not. Adjust the lumbar vertebrae? How? As you might recall from the spinal model you’ve seen in a doctor’s office or your last biology or anatomy class, the lumbar vertebrae are HUGE! And something with that enormity in such a tight snuggedly fitting configuration is not to be manually adjusted. So what are the PT’s and the chiros trying to achieve with their manual manipulations?
Fourth, disc herniation is essential a degenerative process. Cartilaginous structures are much more prone to wear and tear than their ossified counterpart and as they wear out, they gradually lose their structural integrity and make themselves more vulnerable for shifting out of place. But this is a long and gradual process. It doesn’t happen in a snap of a finger as the onset of most acute back pain.
So after all my insightful but less than helpful comments, am I offering anything tangible? Well, if you have read this far, of course I am going to give you more pieces of my mind. So here’s the punch line. The first line of treatment for low back pain should target the soft tissues, meaning the muscles on the back, and acupuncture is the best modality for this job.
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