TuiNa used for Lower Back Pain

What is TuiNa 推拿?

TuiNa, also known as Chinese massage, is one of the therapeutic methods of TCM (traditional Chinese medicine), also named as AnMo (massage 按摩). This kind of therapy uses hands and other parts of our body to stimulate the meridian system and treat or heal some diseases by special methods.

Normally Chinese people are used to have TuiNa to relieve the chronic pain of the muscles and joints, some chronic internal medical diseases and for relaxing and keeping healthy for over thousands years. The effects have also been proved by the modern research.

I. Orthopedic Lower Back Pain (LBP)
A. Pain comes from the muscles:
Strain, acute inflammation (sprain, attacked by cold)/myofibrositis
B. Pain comes from the joints (include ligaments, cartilage and bones):
Sprain (twisted/displaced), arthritis (rheumatoid or osteoarthritis/”Bi” syndrome), lumbar spondylolisthesis
C. Pain comes from the bones:
Osteoporosis, bone tumor
D. Pain comes from the nerves:
Protrusion of lumbar intervertebral disc (PLID), spinal canal stenosis

II. Key Points of TuiNa therapy:
A. Chronic muscle pain:
Strains, myofibrositis and myofascitis
Key symptoms and signs: stiff muscles, lower or no elasticity of the muscles, pressing pain on the surface or inside the muscles, nodes or tight strips may be found.
Pathomechanism: chronic inflammations of muscular fibers and fascia. Blongs to “muscle Bi” or Flaccidity syndrome (Wei). There is stagnations of Qi and Blood or no enough nourishment of the muscles.
Goal of the treatment: restore the elasticity of the muscles.
Key points of the manipulations: gentle manipulations are major; drawing and point pressing could be chosen when necessary in the spasm case. Drawing and point pressing may cause side effects.

B. Acute muscle pain:
Sprain, contusion, acute occurring of the chronic pain
Key symptoms and signs: sharp pain, tender spot, swelling feeling, the pain may radiate to the hip, but no shooting pain on the leg and foot, limited motion due to pain and spasm.
Pathomechanism: spasm, swelling or hematoma
Blood stasis, wind-cold-dampness
Goal of the treatment: release spasm, reduce swelling
Key points of the manipulations: combine the gentleness and toughness, local and distal. Special manipulations may be used: pressing, drawing, point pressing.
Common questions: Displaced joint or small muscle spasm;
Deep and thorough of the manipulation;
Instant cure.

C. Displacement of the joint:
Key symptoms and signs: Limited motion on certain way; blocked feeling; fixed pressing pain spot nearby the joint.
Pathomechanism: disorder of the relationship of the joint.
Goal of the treatment: adjust the joint, restore the motion.
Key points of the manipulations: Ban (turning).
The conditions of using turning method;
The functions of the turning method;
The limits and the side effects.

D. Arthritis:
Osteoarthritis and Ankylosing spondylitis.
Key symptoms and signs: chronic pain related to overuse, weather change and rest, deep pressing pain on the lumbar spine; limited motion on all directions.
Pathomechanism: damaged structure of the joints, inflammation
Combined excess and deficiency in TCM. Kidney, Liver, Blood stasis and Wind-Cold-Dampness
Goal of the treatment: stop pain, prevent the further damage on the joints
Key points of the manipulations: relax the soft tissues; drawing and vibrating; be careful on pressing and moving joints methods.

E. Protrusion of lumbar intervertebral disc (PLID):
Key symptoms and signs: shooting pain on the lower leg or foot; abnormal sense on the certain dermal segmentation; reduced strength on certain muscles; approved by CT scan or MRI.
Pathomechanism: mechanical and chemical stimulations on the nerve root; Bladder channel and Gallbladder channel; Blood stasis.
Goal of the treatment: stop pain by removing the stimulations on the nerve root; restore the nerve functions as much as we can; strengthen the lower back.
Key points of the manipulations:
Urgent stage: sharp shooting pain, not reduced during the night or lying down, SLR < 45°. Rest is the major treatment, be careful to do any TuiNa or acupuncture on the lower back area, it may make the pain worse;
Moderate stage: after sharp shooting pain reduced, limited ROM, SLR between 45° ~ 70°. TuiNa is the major method in this period, and Ban (turning) has to be used here to adjust joints and loose the conglutination around the nerve root;
Recovering stage: alternating soreness and pain, usually on the lower back or leg only, reduced sensations, weakness of the muscles, and limited time of actions. TuiNa is used to help the patient to exercise and rebuild muscles. The goal is to restore the strength and flexibility.

III. TuiNa combined with acupuncture:
A. The difference between acupuncture and TuiNa:
Acupuncture TuiNa
Point and meridians Area (big or small)
Easy be too strong Easy be gentle
Better in regulating Qi and Blood Better in relaxing muscle
Better in regulating organs Better in adjusting joint
Stop pain as pain killer N/A
N/A Easy be accepted

B. What is not good for acupuncture?
Very tender and stiff muscles;
Nerve pain;
Weak and tough muscles or tendons;
Patient who is afraid of needles.

C. How to combine acupuncture and TuiNa?
TuiNa – Acupuncture – TuiNa;
TuiNa – Acupuncture;
Acupuncture – TuiNa.
For the big tight muscle or arthritis, acupuncture can be used as the major method; for the other problems, usually use TuiNa as the major one. For electronic needling or warm needling, the effects will depend on the patient’s response.
The acupoints used in the treatments: AShi points are more useful and effective. The secret is the depth and the quantity of the stimulation.

IV. A clinical case:
♀ 46
2004-9-30
Lower back pain for 1 day.
Used to have this kind of pain once or twice a year for 10 - 15 years. Last time pain was 5 months ago. Usually relates to the weather or hard work. Also has tingling on left leg for quite a while. This time pain is more like soreness and hard to bend or straighten up the back.
Examination: Spine (-), Bend forward 10°~ 15°, backward 15°, SLR (-), reflection (-), tight muscles found on left lower back no pressing pain, L4-5, L5-S1 pressing pain (±), left side radiate to the hip.
Idea: muscle pain on the lower back.
Treatment:
1) TuiNa: pressing and point pressing on the lower back;
2) Acupuncture: left ShenShu (UB23), left DaChangShu (UB25), both L4-5 JiaJi
2004-10-7
Getting worse for the whole week, continuous pain on the lower back, especially when standing up after long time sitting. Tight muscles on the left side, L5-S1 pressing pain (+)
Treatment:
1) TuiNa: pressing;
2) Acupuncture: left ShenShu (UB23), left CiLiao (UB32), both L5-S1 JiaJi (moxa on left);
3) Ban (turn) left waist.
2004-10-14
Pain is reduced but still there. Tightness on the back of left thigh. Tight muscles on the both sides of the lower back, no pressing pain point.
Treatment:
1) TuiNa half hour: pressing, grasping and rolling;
2) Acupuncture: Both ShenShu (UB23), QiHaiShu (UB24), DaChangShu (UB25), WeiZhong (UB40)
2004-10-21
Greatly improved, still a little bit pain and tightness feeling. Tight muscles on the lower back and thigh, WeiZhong (UB40) pressing pain (+).
Treatment:
1) TuiNa: Gun (rolling)
2) Acupuncture: both ShenShu (UB23), left L4-5 JiaJi, left WeiYang (UB39)
2004-10-28
No pain, sometimes tightness feeling on the left lower back and thigh. Mild tight muscles on the left lower back, no pressing pain point.
Treatment:
1) TuiNa: on the muscles;
2) Acupuncture: left QiHaiShu (UB24), left sacral-iliac joint Ashi, left WeiZhong (UB40)

V. Final words:
TuiNa is an useful method in lower back problems. Combining with acupuncture, TuiNa can make very good effects. The key points of this therapy are:
1) Combine the meridian therapy and modern anatomy together to find out the exact problem area;
2) Find out the quantity of the stimulation which fits the certain patient;
3) Well trained TuiNa and acupuncture skill.

TuiNa Case of Lower Back Pain

Male, 40+
In the spring of year 2000
He had acute lower back pain for 2 weeks.
The pain came to the lower back in a sudden when he put his coat on in the morning 2 weeks ago. He tried physiotherapy, but no effect. The pain is always there on a fixed spot, and getting worse whenever he moves his back. He had no injury on the back, and no shooting pain down to the legs.
He is used to be quite healthy, and doing office work. He is afraid of needles.
Examinations:
Spine (-); Motions: left 0° right 0° forward 10° backward 10°
SLR (-); Pressing pain (+++) on right side of L4~5, pressing pain (+) on both sides of TianZhu (BL10), WieZhong (BL40); Stiff muscles on both side of lumbar spine.
Diagnosis:
Lower back pain (acute myofibrositis)
Treatments:
1st time:
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), and WeiZhong (BL40) for 20 minutes;
Rou (knead)/Dian (point-press) ZhiShi (BL52), ShenShu (BL23), and ZhiBian (BL54) for 20 minutes;
Rou (knead)/Dian (point-press) FengShi (GB31), KunLun (BL60) for 10 minutes;
Ca (rub) lower back for 10 minutes.

2nd time: 2 days later. No more sensitive spots on the lower back, still feels pain and cannot move freely.
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), and WeiZhong (BL40) for 10 minutes;
Rou (knead)/An (press) lower back for 20 minutes;
Dian (point-press)/Rou (knead) ShenShu (BL23), DaChangShu (BL25) 5 minutes;
Dian (point-press)/Rou (knead) ZhiBian (BL54), KunLun (BL60) for 10 minutes;
Tui (push) lower back and legs for 10 minutes;
Yao (rock)/Dou (shake) lower back for 5 minutes.

3rd time: 3 days later. Getting better, only feels pain when turning the body. The lower back still feels stiff.
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), ShenShu (BL23), DaChangShu (BL25), WeiZhong (BL40), and KunLun (BL60) for 15 minutes;
An (press)/Rou (knead) lower back for 15 minutes;
Dian (point-press)/Rou (knead) ZhiBian (BL54), HuanTiao (GB30) for 10 minutes;
¤Ban (turn) right side of the lower back;
Yao (rock)/Tui (push)/Duo (chop) lower back for 15 minutes;
Qian (draw) lower back, Yao (rock) hip joints for 2 minutes.

4th time: 3 days later. Can move freely, only feels soreness after sitting for long time.
Similar treatment of 2nd time.

5th and 6th time: once a week. Comes for relaxing.

A Lower Back Pain Case

♀ 49, 2006-09-13
Lower back pain for half day.
In the morning, just after she got up, when she banded the back, she suddenly felt the pain on the lower back. She can hardly move her back to any direction; she feels the radiation on both of her hips. There is no pain on any leg or foot. She had sciatica many years ago.
Exam: limited R.O.M. of the lumbar spine. SLR (-). The muscles on the left side of the lower back are spasm and rise up a little higher than the other side. Pressing pain and deep pressing pain (+) on L4~5 and L5~S1. Tender spots on FengFu (++), left TianZhu (++), and left WeiYang (++).

Treatment:
1) Gentle TuiNa massage 5’;
2) Acupuncture on left TianZhu, WeiYang, and FengFu (gentle reducing technique); both sides of L5 spinous process (0.5Cun, slowly puncture in 1.5Cun deep, reducing technique) 20’;
3) Cupping on lower back 5’;
4) Herbal electric stimulation with heating pad (mild) 20’.

Result:
Right after the treatment, she feels better and can move the lower back a little bit.
2 days later, called: the pain is completely gone, and can move free.

Diagnosis and Differentiations:
This case is an acute lower back pain due to wind-cold blocked the meridians (muscles). Or say myofibrositis.
The patient had no injury or big movement, no nerve pain signs. Although there was deep pressing pain on the lumbar spine (L4~5, L4~S1), but the pain feeling of the patient and touching feeling of mine was different from arthritis pain. The pressing pain is more likely coming from the deep tissues than the spinal joints. Also the time when the patient got the pain was during the weather change.
Didn’t check the tongue, because it is a meridian disorder, the tongue won’t show anything about it, and may confuse the diagnosis. Same thing happened on pulse check (unless the high pulse check skill may tell this kind of body situation).

Needle technique:
Although this is an excessive case, and the reducing technique was used, but I didn’t give strong stimulations. This is the point I’d like to discuss: reducing does not mean strong stimulation.
Reducing or tonifying, is the result of the patient’s reaction of the needle techniques. Gentle or strong stimulation is the practitioner’s choice of the needle techniques. As a practitioner, to choose to give strong or gentle stimulation is not only depending on excess or deficiency, but also on the shape (Xing) and Qi of the certain patient.
Back to this case, the lady is quite skinny, she was quite sensitive to the needles too, and the pathogen was not deep. So I decided to use gentle way, and the result proved it was right.