1 July, 2020 Physician Klaryce Lim

Lower Back Pain Management

Lower back pain (LBP) has become increasingly prevalent and affects people from all walks of life. It is characterised by pain localised in the region between the lower margins of the 12th rib and the gluteal fold. 

LBP is commonly associated with our lumbar vertebrae or the muscles and nerves surrounding it. The lumbar vertebrae are the larger and heavier segments of our spine. It supports the upper body weight while allowing movements around the area. 

Injuries to any of these anatomical structures can result in pain ranging anywhere from a dull constant ache, to a sudden sharp shooting pain. Some LBP may also be accompanied by numbness or shooting pain that radiates down the legs.

There are many potential causes of LBP and some of the common ones include:

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On top of modern medicine diagnosis, the presenting symptoms of LBP are further classified based on TCM theories. This enables physicians to better recognise the characteristics of the illness and aid in the recovery of our body from a more holistic point of view. 

Diagnosis and treatments are based on the concept that our body is one with nature, and thus any changes in nature will be reflected upon our body as well. External factors refer to the six climatic factors corresponding to seasonal or environmental changes. These factors include wind(风), cold(寒), heat(暑), dampness(湿), dryness(燥) and fire(火). 

When the body’s immunity is low it fails to adapt to these changes, resulting in the imbalance of energies in our body. The climatic factor present then becomes a disease-causing pathogenic factor. The three external factors associated with LBP are “dampness”, “heat” and “cold”, which are derived from our naturally hot and humid weather, as well as the widespread use of air-conditioners. 

Apart from environmental influences, blood stasis and kidney deficiency are two internal factors that can also contribute to LBP. 

Firstly, improper posture or injuries sustained during exercise or weight-bearing activities can impact the flow of Qi in our body. Overtime, Qi stagnation affects blood circulation and leads to blood stasis. The pain experienced is a consequence of the blocked channel. 

Secondly, in TCM the lower region of the back is known as the “mansion of the kidneys” due to its function and anatomical position. Therefore, the wellbeing of our kidney system also has a close relationship to LBP.

Symptoms of kidney deficiency include:

  • Kidney Qi Deficiency: Frequent day and/or night urination, premature ejaculation for guys, increased clear discharge for women, shortness of breath, chronic fatigue, and pale face colour.
  • Kidney Yin Deficiency: Giddiness, ringing in the ear, poor sleep, frequent dreams, night sweat, especially warm hands and feet, dry throat, increased thirst and flushed cheeks.
  • Kidney Yang Deficiency: Chronic fatigue, cold hands and feet, adverse to cold, feeling cold in the back, diarrhoea in the morning, water retention and frequent day and/or night urination.

Summary of LBP Causes and Symptoms from a TCM perspective

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DIY Remedies

  • Acupressure massage

Acupressure is a non-invasive technique utilising acupuncture principles. It involves the stimulation of specific acupoints on our body using external pressure. 

Selection of acupoints is based on the meridian channel that lies on the site of injury (经脉所过,主治所及). Channels that run through the back include the bladder (BL), gallbladder (GB) and governing vessel (DU) meridians. Acupoints along these meridians, as well as on other meridians, can be used to ease LBP.

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Place your thumbs on the highest point at both sides of the hip bone. Draw a line towards the mid-line of the back to locate the acupoint. Massage the acupoint by rubbing it with the side of your palm horizontally for 2-5 minutes.
Place your fingers on the midpoint of the crease at the back of the both kneesMassage the acupoints by using your fingers to apply pressure for 2-5 minutes.
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Lie on the bed facing downwards. Fold both legs backwards, bringing the heels as close to the glutes as possible to locate the acupoint. Massage the acupoints by applying elbow pressure for 2-5 minutes
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Place your thumbs on the highest point at both sides of hip bone to locate the acupoint. Massage the acupoints by using your thumbs to apply pressure for 2-5 minutes.
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Using your thumb on the opposite hand, press hard into the acupoint. You should feel soreness in the area.Whilst still pressing into the acupoint, slowly move your back in different directions for about 1 min (i.e. Bend forward, bend backward, bend side to side etc.) 
Find the midpoint of the inner ankle bone and the achilles tendon. Using your thumb, press hard into the acupoint and rotate in circular motions for 1-2 minutes.
  • Back Pain Exercises
Cat-Cow StretchStart with your hands and knees on the ground. Align your wrists underneath the shoulders and your knees underneath your hips. Inhale and drop your belly towards the ground. Lift your chin and chest up. Look towards the ceiling. Hold for 5-10 seconds.Exhale and draw your belly towards your spine, rounding your back. Drop your head towards the ground. Hold for 5-10 seconds.Repeat for 10-20 times.
Knee to ChestLie on your back with your knees bent and feet flat on the floor.Use your arms to pull one side of the knee towards your chest while keeping the other knee bent and foot flat on the floor. Hold for 10-20 seconds and lower the knee. Repeat step 2 and 3 for the other leg. Repeat 3 times for each leg. 
Trunk RotationLie on your back with your knees bent and feet flat on the floor.Extend your arms to the sides with your palm face-down on the floor.Keep your bent knees together and bring them up to a 90-degree angles.Gently roll both bent knees to one side and hold for 10-20 seconds.Return to the center and repeat step 4 for the other side.Repeat 5 times on each side.
Office Chair StretchSit upright in a chair with feet hips width apart. Place your left hand on the outside of the right leg and twist to the right.Using your right hand to hold the back of the chair for support, hold this stretch for 20 seconds. Repeat for the opposite side.
  • Thermal therapies

Hot or cold thermal therapies can be used for pain relief, according to the type of LBP. Cold therapy involves the application of an ice pack to the site of injury. It is more suitable for acute injuries (<24 hours) where swelling is observed. The cold effect causes blood vessels to constrict, decreasing the delivery of inflammatory substances and therefore reducing pain and swelling in the area. 

On the other hand, heat packs are used in hot therapy for chronic LBP. It brings about the dilation of blood vessels, improving blood circulation to speed up the healing process and relieve muscle tension. The use of heat packs should be cautiously monitored to prevent accidental burns, especially for individuals with a history of diabetes.

  • Healing through diet

Inflammation and pain are two closely related mechanisms. When injuries occur, the body releases chemicals to increase blood flow to the area. This process brings about inflammation which stimulates our nerves, causing us to feel pain. A diet high in anti-inflammatory foods can aid in recovery and pain reduction, while a diet high in refined sugars, carbohydrates and trans-fats can exacerbate inflammation.

Anti-Inflammatory 
FruitsBerries
Grapes
Apples
Oranges
Pomegranates
Lime
Lemon
VegetablesSoybean
Broccoli
Tomatoes
Red bell pepper
Cayenne pepper
Ginger
Carrots
ProteinTofu
Salmon
Tuna
Anchovies
Striped sea bass
CarbohydratesWhole grains
Fatty acidsOlive oil
Grapeseed oil

For LBP caused by kidney deficiencies, food therapy can also help to nourish the kidneys and help alleviate some of the presented symptoms. 

According to TCM theories, the kidneys are represented by the colour black. Therefore, we are able to nourish the kidneys by consuming certain foods that are naturally black in colour.

However, it is important to note that individuals with kidney disease are required to follow a strict diet; hence some of the foods listed may not be suitable.  

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Other types of foods that are also beneficial for the kidneys include:

  1. Kidney Yin Deficiency: Goji Berries, Kombu Seaweed, Nori Seaweed, Black Chicken
  2. Kidney Yang Deficiency: Goji Berries, Gorgon fruit, Walnuts, Cortex Eucommiae (Du Zhong)
  • Lifestyle Changes
  1. Avoid standing or sitting in one position for a prolonged period of time. Take frequent breaks and incorporate simple stretches into your routine.
  2. Do not slouch or bend your back when you are sitting, standing or lying down. A straight spine puts less pressure on individual discs.
  3. Avoid lifting heavy weights above your head.
  4. Lift objects off the ground by bending from the knees and holding the objects close to the body.
  5. Maintain a healthy BMI to reduce weight-related pressure on the spine.
  6. Use a back cushion or sleep on a firm mattress for better back support.

Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.

Reference

  • Andersson J.A.D. Problems of classification of low back pain. Rheumatol Rehabil. 1977;16:34–36. doi: 10.1093/rheumatology/16.1.34. 
  • Lin J.G., Chen K.B., Lee Y.C. (2014) Low Back Pain. In: Lin YC., Hsu EZ. (eds) Acupuncture for Pain Management. Springer, New York, NY
  • D Capell H.A., Daymond T.J., Dick W.C. (1983) Pain in the Neck, Low Back Pain and Degenerative Disc Disease. In: Rheumatic Disease. Treatment in Clinical Medicine. Springer, London
  • Wellington J. (2014), Nonmedical Management of Chronic Low Back Pain. Neuromodulation: Technology at the Neural Interface, 17: 24-30. doi:10.1111/ner.12078
  • Jiang H.L., Ji L.L., Ren X.J., Long X.Q., Tu Y. (2015) Exploration of acupuncture prescriptions for chronic low back pain: a review of ancient and modern literature. Journal of Beijing University of Traditional Chinese Medicine, 38(4): 280-283. doi: 10.3969/j.issn.1006-2157.2015.04.013
  • Sulindro-Ma M., Ivy C.L., Isenhart A.C. (2008) Nutrition and Supplements for Pain Management. In: Audette J.F., Bailey A. (eds) Integrative Pain Medicine. Contemporary Pain Medicine (Integrative Pain Medicine: The Science and Practice of Complementary and Alternative Medicine in Pain Management). Humana Press
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About the Author

Physician Klaryce Lim

Physician Klaryce Lim

Management Trainee

Double Degree (Honours with Distinction): Bachelor of Science in Biomedical Sciences & Bachelor of Medicine (Chinese Medicine), Nanyang Technological University and Beijing University of Chinese Medicine

Physician Klaryce Lim graduated with double degrees in Biomedical Science and Traditional Chinese Medicine from Nanyang Technological University and Beijing University of Chinese Medicine respectively. She was a scholarship recipient of Beijing University of Chinese Medicine Foreign Student Scholarship.

Having been exposed to TCM since a young age, Klaryce has experienced first-hand the healing properties of TCM. As a physician now, she aspires to share her knowledge and hopes that more people can benefit from using TCM. Klaryce strongly believes in treating the body holistically and tailors individualised treatments for all of her patients.

Physician Lim’s expertise: General Wellness, Pain & Injury management, Women’s Health.