Spinal column or spine provides the main support for the body, allowing the body to stand upright, bend, and twist, while protecting the spinal cord from injury. The spine is made of 33 individual bones (vertebrae) stacked one on top of the other. Strong muscles, flexible tendons and ligaments, and sensitive nerves are surrounding the spine. Any of these structures affected by strain, injury, or disease can cause pain.
Spinal nerves and acupuncture
Spinal nerves are mixed nerves carrying motor, sensory and autonomic nerve fibers and conducting signals to innervate whole body. There are 31 pairs of spinal nerves which are on each side of the spinal column. They are divided into four groups by their location: eight pairs of cervical nerves at the neck, twelve pairs of thoracic nerves at the upper back, five pairs of lumbar nerves, five pairs of sacral nerves and one pair of coccygeal nerves. Motor nerves innervate muscles and bring nerve signals to the muscles to perform motion task. Sensory nerves innervate organs, carry different sensory signals to the spinal cord and the brain. Autonomic nerves innervate internal organs such as smooth muscles and glands and a control system for internal organ function such as cardiac vascular system, respiratory system, digestive system, urinary system and reproductive system. If there is a problem with the neck and back, this may irritate autonomic nerves and have related symptoms, such as abnormal urination, infertility, indigestion, diarrhea or constipation etc.
Muscles, tendons and ligaments problems are very common.
There are two main muscle groups that affect the spine are extensors and flexors. The extensor muscles which are attached to the back of the spine enable us to stand up and lift objects. The flexor muscles which are in the front and include the abdominal muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back. The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs. There are two ligaments anterior longitudinal ligament and posterior longitudinal ligaments which located in the front and at the back of vertebras separately and run from the top to the bottom of the spinal column. They prevent excessive movement of the vertebral bones. Between the lamina of each vertebra there are also ligaments attached called ligament flavum. Between adjoining spinous processes of each vertebra thin and membranous Interspinous ligament is attached. They limit the flexion of the spine. Supraspinous ligament lie on the tips of the spinous processes from the seventh cervical vertebra to the sacrum. They continue above seventh cervical vertebra with ligament nuchal. They limit the over flexion of the spine.
How tendon changes with aging
Aging is natural and inevitable. The rate of aging is highly individual and depends on many factors, including genetics, lifestyle, and former disease processes. The degenerative changes can be seen in late thirties. Tendon also has aging changes. There are many cellular and vascular changes within the aging tendon. As a result the aged tendon becomes weaker than it used to be and more likely to tear or get overuse injury, when there is increased stress and strain. With aging process, the density of tendon cells decrease and nucleus becomes bigger, long and thin; cell metabolic activity decreases such as protein and amino acids synthesis. Extracellular changes occur with aging: for example, Elastic fibers and water content decrease which contribute to the tendon stiffness and gliding reduction; collagen content changes little, but the relative amount of collagen, volume density and mechanical stiffness increase due to decrease of water content; collagen synthesis and mechanical properties, solubility decrease. Blood Vessels in tendon change. Tendon blood flow and the number of capillaries per unit of surface area decrease with increasing age. The decreased arterial blood flow and thus decreased nutrition and oxygen transport have been suggested to be the main etiological factors behind the age-related tendon degeneration.
How the spine is related to back pain? There are many structures around spine as mentioned above which can be the source of back pain. For example, nerves around the spine are irritated; muscles are strained; ligaments, bones and joints are injured are worn; disc is slipped etc.
Gravity line and gravity center
The human body encounters gravity constantly in posture and movement. There is gravity line and gravity center of the body. The gravity line is located frontally along a vertical line passing through the middle of the sacrum (lower spine) and perpendicular to the ground, and laterally through a vertical line situated slightly to the rear of the femoral heads. This gravity line must fall within the base of support. The gravity center of the human body is the point where the human body rests under normal conditions without rotating, remaining balanced without active effort to remain upright. This center lies in anterior to the second sacral vertebra and it shifts following the posture and movement to keep the body in balance without falling. When the gravity line falls outside supporting base, compensation is required. Long term compensation can result in overuse the muscles and create inflammation causing pain. Such as low back pain.
Back pain is a common condition which affects more than 1 million people in the UK. Back pain can be caused by many factors. But some of the causes cannot be found.
95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.
In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.
Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?
There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.
With 2.3 million acupuncture treatments carried out each year, traditional acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, traditional acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.
Low back pain with acupuncture treatment
Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.
NHS recommended acupuncture combined with self-care for persistent low back pain.
Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.
Effectiveness and acceptance of acupuncture for low back pain
There was a study involved 18000 patients with chronic pain including low back pain. This study showed that the effect of acupuncture was more than placebo. There was a further evidence provided by research from Germany showing that acupuncture is effective for chronic low back pain and acupuncture was highly accepted and had positive effects in patients with chronic low back pain. This was a randomized controlled trial. There were 143 participants with chronic low back pain. 74 patients were offered acupuncture twice a week, while other 69 patients were not given acupuncture as a control. Acceptance of acupuncture, health-related quality of life and pain/symptoms were assessed. The result of the study showed that acceptance of acupuncture was excellent. 89% of the patients would like to have TCM integrated treatment and 83% would have paid for TCM if necessary. Physical functioning, general health, vitality and emotional role were all better in patients with acupuncture treatment compared with control group. Pain relief in acupuncture group was superior to the control group. For instance, pain with sitting/standing, pain upon carrying loads of 10 kg or more and pricking in hands and feet were significantly reduced. Author’s conclusion was that acupuncture was highly accepted and had positive effects in patients with chronic low back pain. Acupuncture can be an effective, well tolerated therapy with no major side events.
Why acupuncture is effective for low back pain?
There are several mechanisms that explained the effectiveness of acupuncture on pain relief. Acupuncture stimulates nerve endings located in muscles and other tissues leading to production of endorphins and other neurohormonal factors. Acupuncture reduces inflammation by releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling. Also how brain and spinal cord processing pain has been altered. In neuroscience, the default mode network (DMN) is a functional network of brain regions that show increased activation during wakeful rest. In patients with low back pain, this DMNconectivity has changed. Acupuncture has been widely accepted for effective low back pain treatment. How acupuncture affect DMN is not clear. Tang et al studied this subject. They used RsfMRI technique to analyse the connectivity of DMN and recruited 20 patients with low back pain and 10 health subjects for controls. They found that there was less connectivity within the DMN in patients with low back pain than healthy subjects, mainly in the dorsolateral, prefrontal cortex, medial prefrontal cortex, anterior cingulated gyrus and precuneus. After 4 weeks acupuncture treatment, patients brain connectivitys were restored almost to the levels seen in healthy controls. Reductions in clinical pain were correlated with increases in DMN connectivity. It can be seen from this data, modulation of the DMN by acupuncture is related to its therapeutic effects.
Standardization of acupuncture points for low back pain
TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. If you go and see a few different acupuncturists, you would get acupuncture at different points. There are no standardized acupuncture points for any conditions. A study has shown that twenty diagnoses and 65 acupoints were used at least once; and only one point UB23 was used for every patient by most acupuncturists. In China standardization of acupuncture points was encouraged to achieve best outcome of the treatment. There was a study compared the efficacy of standardized acupuncture and individualised acupuncture points. In this study up to 15 sessions of acupuncture treatments were offered. The standardized acupuncture was based on the acupuncture intervention from a large multicenter trial previously performed. 78 patients were in the standard acupuncture group and 72 patients were in the individual acupuncture group. Both acupuncture interventions were applied by the same medical doctor specialized in western general medicine (25 years of clinical practice) and trained in Chinese medicine with 20 years' experience in treating low back pain with acupuncture. The result has shown that the average pain severity after 8 weeks and 26 weeks did not differ significantly between both groups. This study has shown the possibility of standardization of acupuncture treatment for chronic back pain patients.
Which acupuncture points are frequently used in lower back pain?
There are over 400 acupuncture points in human body according to Chinese medicine theory. The selection of appropriate acupuncture points is the first step to obtain therapeutic effects. How acupuncturists select acupuncture points? There are three basic principles to select acupuncture points: the first is local acupoints near the area where symptoms occur; the second is distant acupoints along the meridian and the third is distant acupoints based on symptom differentiation. Lee SH et al analysed acupuncture points from 53 studies using modern techniques to extract most commonly used acupuncture points. There were 33 most frequently used acupoints for lower back pain (LBP). The most frequently used acupoints in the treatment of low-back pain were BL23 (51%), BL25 (43%), BL24 (32%), BL40 (32%), BL60 (32%), GB30 (32%), BL26 (28%), BL32 (28%), and GB34 (21%). All local acupoints for LBP are on the Bladder and the Governing vessel especially at the low back position of these meridians. Most of the distant acupoints are on the Bladder and Gallbladder meridians. The acupoints include seven acupoints (BL23, BL24, BL25, BL26, and BL32 as local points and BL40 and BL60 as distal points) on the bladder meridian and two acupoints (GB30 as a local point and GB34 as a distal point) on the gallbladder meridian.
Mechanisms of acupuncture for low back pain
Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment
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Welcome to my blog
Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief, Fatigue.
Based at Harley Street and Kensington Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 year research and clinical experiences
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Kensington: for appointments at Anamaya center Kensington (Mondays, Tuesdays, Thursdays, Fridays, Saturdays) please call at 02030110355 or email at email@example.com
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2 min walk from High Street Kensington underground stationHarley Street: for appointments at Harley Street (Wednesdays) please call ALO clinic at 02076368845 or email at firstname.lastname@example.orgAddressSuite 3 Harmont House20 Harley Street, London W1G 9PH5 min walk from Oxford Circus underground stationMy background: I became a qualified medical doctor 25 years ago in Western medicine in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Particularly I was trained with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. Furthermore I had training in dermatology and oral and maxilofacial surgery in China. Also I had training in fertility and had research experiences in uterine smooth muscles and blood vessels in China and the UK. I am dedicated to treat patients with acupuncture and am recognised as one of the world leading acupuncture specialists.
I obtained a PhD degree in the University of Leeds in the UK.
I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.
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I have many year clinical experiences. Over the years of practising, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, bladder pain, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, nerve pain, chronic prostatitis, Parkison's disease, MS, acid reflex, IBS etc to achieve best treatment results.My devotion and skills are highly praised by my patients.
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