How does Tui Na Work on Lower Back Pain?

By Dr. David Song

TuiNa, also known as Chinese massage, is one of the therapeutic methods of TCM (traditional Chinese medicine), also named as AnMo (massage 按摩).

Normally Chinese people have known that TuiNa can relieve the chronic pain of the muscles and joints for over thousands years. The effects have been gradually accepted by the western world.

I. About the 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 <>A. The difference between acupuncture and TuiNa:
Acupuncture -
Points, Easy be too strongand, Better in regulating Qi and Blood, Better in regulating organs, Stop pain as pain killer;
Tui Na -
meridians Area (big or small), Easy be gentle, Better in relaxing muscle, Better in adjusting joint, Easy be accepted.

B. What is not good for acupuncture?
Very tender and stiff muscles;
Nerve pain (Right on the pain spot);
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.