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Jewel of Ancient Wisdom
How to Relieve Low Back Pain at L5/S1 Instantly upon Needle Insertion with 90% Success Rate
Low back pain (LBP) is among the top 10 diseases and injuries that account for the highest number of disability-adjusted life years (DALYs) worldwide (WHO, 2013). The medical doctors can do nothing with LBP except using pain pills, injections, or asking patient to do exercises themselves. However, for the ancient Chinese doctors millennia ago in China, LBP treatment was just a piece of cake. The effectiveness of acupuncture as a main-stream medicine at the time when Huangdi Neijing came into place (100 BC) was magically instant, highly reliable and consistent.
The Locations of Pain in Low Back
The Global Burden of Disease (GBD) study defines LBP as pain on the posterior aspect of the body from the 12th ribs to the lower gluteal folds ... that lasts for at least one day. This is rather a big area covering almost the entire lower half of the posterior body trunk. The exact location of the pain can happen anywhere in this part of the body. For example, it may be at T12 - L5 spine bone or related muscles such as multifidus, spinalis, longissimus, iliocostalis, or obliques, just to name a few, or at L5/S1, or at sacrum S2 - S5, or at SI joints, or at piriformis on either side or bilateral ..., the possibilities of the location of pain is endless.
LBP Treatment in Huandi Neijing
The most remarkable features of Neijing acupuncture in treatment of LBP are its simplicity and convenience for both patients and physicians. The key features include:
- Never insert the needles in the location of the pain to be treated, instead always do distal needling.
- No need to thrust the needles to force the patient to feel de qi (a sensation of being painfully stabbed).
- Never insert the needles in the same side of pain, instead always opposite (unless patients are found to have abnormal pulse).
- No fixed "accurate" spot for needle insertion, always do it case by case according to palpation and observation.
Where to Put Needles?
For needle healers treating LBP, where do we place the needles? In Huangdi Neijing, the chapter Suwen 41 (刺腰痛) particularly talked about where to put needles to treat a wide variety of LBP (pricking or bleeding). It listed 26 types of LBP differentiated by the location of pain, the location of radiating pain, and the location of other related symptoms (range of motion, abnormal sensation or feeling etc). For each type of LBP, a corresponding ball-park area is provided to put needles, not a "one size fits all" therapy.
Most importantly, most of the ballpark area used for treating LBP are located distally on the leg close or below the knee joints.
Neijing merely provided 26 examples of the types of LBP based on a ballpark area of location. In the real world, you can identify at the least 100 types of LBP based on the more finely defined location of pain. With each type of LBP, there are at least 100 spots on the body which once pricked could induce a relief of pain, more or less, in the low back.
The key issue here is: Which spot will produce the maximum and quickest pain relief reliably and consistenttly for each type of LBP?
LBP Treatment in Today's Acupuncture
Today's most widely practiced acupuncture is TCM acupuncture which was invented in China in 1950s largely based on herb theory. Ask a newly graduated TCM acupuncture student to select acupoints for LBP, I am 99% for sure he or she will choose acupoint BL 40 (a spot at popliteal fossa) and BL 23 or BL 25 (a spot 6 cm lateral to L2 or L5 vertebra joint) without asking back "can you first tell me where the pain is exactly located?"
With this TCM acupuncture formula for LBP, patients have to lie face down with chest pressed against the treatment table, undressed, awkwardly with back/hip exposed. Such a treatment in 99% of cases will fail in producing any instant pain relief. Why? It is because pricking BL 40 will not produce instant effect unless the pain happened to be , luckily, located at iliocostalis at L4-5 level. and a needle inserted at BL 23 will never produce instant effect for low back pain (but interestingly it can produce instant effect at a place far away from low back area, say the elbow, or the knee ...).
"Secret" Trick Is: at Least Don't Rub Salts to The Injury
If you really grasped the jewel of wisdom "hidden" in Neijing, you would be able to understand the following idea: Needling distally from the pain to be treated is the key in obtaining reliable and consistent fast pain relief.
The more distal the better!
The worst is to stab exactly the area of the to-be-treated pain. Remember, the goal of acupuncture is to relieve the pain but not make the pain worse. By pricking the area where the pain is located, actually you are rubbing salts to the injury, although it may produce a meager pain relief effect with 10 - 15 treatments in a few months (this was exactly what happened in a Germany acupuncture trial published in 2007 by Haake, M. et al and in many LBP trials by other researchers worldwide).
How to Relieve the Pain like A Magic, 90% Crack Shot
Here I talk about where to put needles for instant relief of pain at L5/S1 vertebra joints with at least 90% success rate, regardless of chronic or acute or the causes (physical injury, or osteoarthritis, rheumatoid arthritis or spondyloarthritis ...).
There are more than 100 locations on the body that can be needled to produce a remedial effect on the pain located at L5/S1 joints. Among these locations, three of magically and consistently effective non-fixed spots are:
- Knee joint spot: a tender spot when pressed that can be located by palpation in an area at medial side of the knee joint (tibiofemoral joint) (close to TCM meridain acupoint KD10 and LR 8);
- Ankle spot: a tender spot when pressed that can be palpated in an area at medial subtalar joint under the medial malleolus (close to TCM meridian acupoint KD 5 and KD 6);
- Wrist spot: a tender spot when pressed that can be palpated in an area at the ulnar side of the carpus of the hand (close to TCM meridian acupoints SI 4 and SI 5).
Note this is not an exhaustive list of the magic spots for relieving L5-S1 pain. These 3 magic points among others were identified by me thanks to the "secret" wisdom of ancient Chinese doctors in Huangdi Neijing era.
In order to get consistently magic effect, you must first identify the most tender spot at these areas by palpation using your thumb, no precisely fixed-location spots available but case by case. Also your needles must hit the bone and best hit the joint in these areas. And also always let patient lie face up, fully dressed with shorts, or if with pants, roll it up above the knees and get a pillow as the knee support.
After you inserted needles in any one or all of these spots, ask your patient "where is the pain now?" while keep him or her wriggling the waist or put your hand under patient's low back and press and massage the L5-S1 area. Within 5- 10 seconds, 80-95% for sure your patient will wow: Are you a magician?
Attention! Before insert needles, be sure to ask patient "how much pain do you feel right now, on a scale of 1 to 10?" This is for a comparison which will let you know how much your needles worked instantly after the needle insertion.
Five to 10 seconds within the needle insertion, the patient may tell you no pain any more, or much less than before, or 50% better .... Ask patient to rank the pain level again on a scale of 1-10.
For minor or moderate conditions, pricking only the knee joint spot at one side (either right or left) may be enough: pain could melt away completely in 5-10 seconds while patient is wriggling or you are massaging the pain area. If a lower intensity of pain still remains, you can needle the knee spot on both side, or add the ankle spot at one side or both side, or add both ankle and wrist spots. If you are lazy, just simply needle all of the spots on both sides from the very beginning.
Here a note. Usually the instantly relieved pain will come back at a lower intensity in hours or a few days or weeks depending on how severe or chronic the initial condition is. The permanent cure of a moderately-severe LBP by needling usually needs 5-10 treatments at 1-2 sessions per week.
Lastly, remember do not twist or thrust the needles to force your patients to feel de qi. As a health care practitioner: Let's not rub salts to our patients' injury!
Haake, M. et al, German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups, Arch Intern Med, 2007 Sep 24;167(17):1892-8
Phillips FM. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976). 2013;38(7):E409
The Inner Canon of the Yellow Emperor (Huangdi Neijing): Suwen 41 刺腰痛, Suwen 63 缪刺论.
WHO, 2013, Low back pain, https://www.who.int > areas > Ch6_24LBP PDF
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