Low Back Pain Flashcards
5 Sources of Pain
- Spinal
- Discogenic
- Nerve root
- Multiple lumbar spinal stenosis
- Referred visceral
Def
Also called Lumbago, is a subjective symptom with pain on one or both sides in the area between the 12th rib and the Illiac crest on the back of the body
Spinal Pain
Distribution: Sclerotomal
Nature: Sharp, dull
Aggravating Factors: Motion
Neurological Changes: None
Discogenic Pain
Distribution: Sclerotomal
Nature: Deep, Aching
Aggravating Factors: Increased intradiscal pressure ie. Bending, sitting
Valsalva Maneuver
Neurological Changes: None
Nerve Root Pain
Distribution: Radicular
Nature: Paresthesias, numbness
Aggravating Factors: Root Stretching
Neurological Changes: Present
Multiple Lumbar Spinal Stenosis Pain
Distribution: Radicular Sclerotomal
Nature: Paresthesias, spinal claudication pattern
Aggravating Factors: Lumbar Extension, walking
Neurological Changes: Present
Referred Visceral Pain
Distribution: Dermatomal
Nature: Deep, Aching
Aggravating Factors: Related to affected organ
Neurological Changes: None
Corresponding Western Diseases
Kidney Disease Rheumatism Rheumatoid Disease Lumbar Muscle Strain Diseases of vertebrae and spinal cord
Etiology
Cold Damp Invasion - EPF block lumbar channel, qi/blood Stag.
Qi and Blood Stagnation - Block Lumbar channel
Retention of Damp Heat - Block lumbar channel/kidney/UB
Kidney Deficiency: Lack of nourishment to kidneys and lumbar area
Prolonged combination of excess and Deficency
Lumbar Pain Causes
Organ
Bone
Mm./Tendon
Nerve
4 Patterns
Cold Damp
Damp Heat
Qi and Blood Stagnation
Kidney Def. (Qi,Jing, Yin, Yang)
Lumbar pain with a burning or hot sensation at the affected area which is aggrevated by pressure
Damp Heat
Protracted pain, soreness and weakness at the lumbar region with an empty feeling which is alleviated with pressure and bed rest and aggravated by overwork
Kidney Def
Fixed lumbar pain with rigidity of movement that is aggravated by pressure or movement
Qi and blood Stag
Lumbar pain, soreness, heaviness with a cold feeling thats alleviated by warmth at the affected area, stiffness of mm in the dorsal lumbar region, limitation of movement especially in extension and flexion, aggravated by rainy days, pain radiating downwards to the buttock and lower limbs
Cold DAmp
Cold Damp T and P
T: Normal or purple tongue with white or white slippery coat
P: Deep Tight
Damp Heat T and P
T: Red tongue with yellowish sticky coat
P: Soft, rapid or slippery, wiry, rapid
Qi and Blood Stag T and P
T: Purplish or purple spots with thin white coat
P: Wiry, choppy
Kidney Def T and P
T: Pale or red tongue with thin coating
P: Deep, thin, weak or deep thin, rapid
Cold Damp POT
Eliminate Cold damp
Warm the meridians and circulate the collaterals
Damp Heat POT
Clear Damp heat
Relax the tendons
Relieve pain
Qi and Blood Stag POT
Activate blood circulation to remove blood stasis
Regulate Qi
Relieve the pain
Kidney Def POT
Tonify the kidneys to relieve pain
Cold Damp Points
UB 23/24/25/40
Du 3
Sp 9
Damp Heat Points
UB 23/28/32/40 Du 3 Ren 3/9 Sp 6/9 GB 25
Qi and Blood Stag Points
UB 23/40
Du 3/26
GB 25
Yao tong Xue
Kidney Def Points
UB 23/40
Du 3
Yin & Jing: UB 52, Kid 3
Qi and Yang: Du 4, Kid 3
Edu
Get Acup tx's Exercise to strengthen lumbar mm Warm up and stretch before activity Don't sit or lay in cold/damp areas for too long Avoid excessive sexual activity Avoid overwork Wear a lumbar belt
Tx:
Acute Low back pain:
Palpate around UB 23/52
Use YaoTong (UE 8) - manipulate for 1-2 min, leave needle in and
and get the patient to walk around and rotate side to side
Only do a 30 min local tx, distal points ok for longer
Pain on Extension:
Use SI 3, manipulate to get Qi, walk around and bend with needle in
If severe back pain use Du 26 to open Du meridian
Local Tx:
Du, Kidney, UB merdian - Tonify Kidney/Circulate Qi and Blood
UB 23/25/32/53/54
GB 29/30
Du 3/4
Shixiquihia
Ashi
Jiaji L2-L5
Distal pts:
Sm Int 6
UB 2/40/60/62
GB 34/39
Tx Biao and Ben
Herbal Patch
Plumblossom: For acute pain and use cupping after to suction blood
Electro- One back point, one distal point - 2-4HZ for 15-20min
can use mixed wave for extreme pain
Scalp Acup: Sensory/motor line or leg motor/sensory line
Auricular Acup: To diseased side -lumbar, sciatica, kid, shenmen, sacral
Things to rule out
Kidneys: ask about urine, UTI’s, kidney stones etc.
Bladder
Gyno: Before or after period
Mm/Tendon/Bone/Nerve problem
Diagnosis Differentiation
Sciatica vs. Low Back Pain
Down to foot Stays in low back
Disease Differentiation
- Ext vs. Int
- Def vs. Excess
- Cold vs. Heat
Zhi- Willpower (Kidney)
Yi- Thinking (Spleen)
~Swelling
~ Nature of pain: Dull vs. Stabbing
Pain when angry: Liver Qi Stag
Overthinking/worry: Spleen Qi Def.
Deep aching, needs support: Def.
Quick, severe, can’t move: Blood Stasis
Worse at night: Blood stag
Better with stretching and moving: Stag/Damp
Better laying down: Deficiency
Heavy pain, worse on rainy days: Damp
Better with rest: Liver or Kidney Def (Tendon and Bone)
What meridian is it when you feel as if your back is broken?
Taiyang
What vertebrae is involved with bottom of foot pain?
L4
L5
S1
Protocol For Acute Low Back Pain
- Needle Ashi pts moderately for 20 min then withdraw needle. Then needle Du 26 or Yaotongxue or UB 40 with draining method and ask patient to turn, bend and stretch until pain relieved. If after 3 successive tx it doesn’t work add Sp 6 and LI 4 while subtracting DU 26/UB 40
- First needle SI 3, do draining manipulation and get patient to walk, rotate etc for 10 min. Repeat 3 times in one treatment. If acute pain persists withdraw SI 3 and add UB 40, Du 3/4 and ashi pts. Use draining method and moxa for 20 min. Massage low back around tension and ashi points
* For Acute Central Low Back Pain!* - Use same as #2 method but replace DU 3/4 with UB 23/24
- For Acute Lateral Low Back Pain!*
