Physiotherapy in Toronto for Lower Back

If you are curious about the proposed theories behind the use of acupuncture, this article gives an explanation of some theories behind the practice and reviews the current scientific evidence. The study results using acupuncture in the treatment of low back pain are varied and therefore inconclusive. Talk to your physiotherapist at PhysioExcellence to discuss the role of acupuncture in treating your back pain.

Lower back pain, usually affecting both men and women between the ages of 30 and 50 years old, is the most common cause of work-related disability and it comes at a high economic cost with time lost to work, workman's compensation, and medical expenses. Estimates are that lower back pain costs the United States about 25 billion dollars every year and, according to the authors of this article, as much as 100 billion "if overall costs are taken into account." It is estimated that the vast majority of adults, up to 80 percent, will experience at least one episode of back pain at some point in their life. While many of those will only have a one-time event, others will go on to experience chronic, or long-term pain.

Usual or conventional treatment for lower back pain includes physiotherapy, heat therapy, spinal manipulation, medications, and more. Unfortunately, the conventional treatments don't always work and people who are living with pain may try other therapies, such as acupuncture. This approach, which involves inserting very thin needles into specific points in the body, has been used for centuries and is gaining popularity in the western world. The points (the Qi where the needles are inserted are along meridians that allow body energy to flow.

The science behind acupuncture isn't understood but it has been the subject of much study, particularly now that the United States FDA allows for acupuncture needles to be labeled as medical equipment and no longer as experimental devices. So far, however, in studies, acupuncture has only been proven to the medical community as effective in treating nausea and dental pain, although there have been many reports of it being effective in other instances, such as treating addition, headaches, menstrual cramps, lower back pain and others. And, even though acupuncture is gaining in popularity, it is still not a widely accepted practice.

Skeptics of acupuncture cannot understand how a needle placed on one part of the body can affect another part. Because of this, they say that the acupuncture merely has a placebo effect, or causes the person to believe it is working, therefore it does. This theory, however, can be countered with studies of animals. In some studies, animals are given acupuncture and they respond. This would not happen if it was merely a placebo effect.

One hypothesis, belief, is that the needles cause a release of hormones called endorphins, which are responsible for relieving pain. Researchers are coming across several findings that point to this direction. One study, involving rabbits had researchers giving acupuncture to one rabbit, withdrawing cerebral spinal fluid (the fluid that bathes the spine) and transferring the fluid to another rabbit. It turned out that the second rabbit benefitted from the pain relieving properties of the first rabbit's acupuncture. In humans, study subjects who were addicted to opium were given acupuncture to help deal with their withdrawal symptoms. Those who had acupuncture did not have the same level of withdrawal symptoms than did the addicts who received conventional medication to help them.

Another theory involves the the stimulation of the nerves, neurophysiology. A study by Inoue and colleagues, found a connection with the blood flow from an acupuncture site on the sciatic nerve and lower back pain from a slipped disk. The flow increased around the nerve roots which could be why pain decreased. Neurohormonal reactions are another possibility because women seem to respond better to acupuncture than do men. This could be due to the estrogen receptors in the central nervous system.

The neurogate theory says that fibers that are stimulate by acupuncture could prevent pain input into the spinal cord, while the diffuse noxious inhibitory control theory has another approach. This theory says that by providing a noxious (not "nice) stimulation, the body responds by changing the signals it receives from the painful area being treated.

The effectiveness of acupuncture is becoming more apparent in the studies that are being done but some people expressed concern about accountability and fear of being sued. This is highlighted when some studies show only moderate or sometimes no effectiveness. These studies are continuing and more are showing positive results. An analysis of studies, done in 2007, looked at 35 randomized, controlled trials that studied acupuncture for nonspecific or chronic lower back pain in adults, or dry needling for another painful disorder, myofascial pain syndrome, also in the lower back. The results of the analysis showed that "acupuncture, added to other conventional therapies, relieved pain, and improved function better than the conventional therapies alone. However, the effect was small, and acupuncture was not more effective than other conventional and "alternative" treatments."

Yet another review that looked at 33 such trials found that acupuncture was more effective than placebo (sham treatment) in providing short-term pain relief for chronic lower back pain.

In 1997, the National Institutes of Health in the United States issued a statement that acupuncture was a reasonable alternative treatment for lower back pain. However, it's important to understand that acupuncture may not replace other healthcare but work as a complement to specialist visits and physiotherapy. Interestingly though, one study, by Longworth and colleagues, found that patients who had not had any other therapy before trying acupuncture seemed to get better relief. Another study, led by Lundeberg, found that acupuncture for acute symptoms could help reduce these symptoms, avoiding more invasive medical treatments later on.

The authors of this article concluded that there is a lack of good research information on the effectiveness of acupuncture in treating lower back pain. Therefore, for definite answers on if acupuncture is a good approach, more research and more thorough studies need to be done in this area.

Reference: Katrina Lewis, MD, and Salahadin Abdi, M.D., PhD. Acupuncture for Lower Back Pain. In The Clinical Journal of Pain. January 2010. Vol. 26. No. 1. Pp. 60 to 69.

PhysioExcellence provides services for physiotherapy in Toronto.