Low back pain: when the lower back hurts

Low back pain is one of the most common reasons for consultation: the vast majority of adults will experience at least one episode. Most of the time it is benign and eventually passes, but it can be very troublesome, sometimes for a long time. Here is how I approach it as a physician acupuncturist.

What is happening in the back?

In the vast majority of cases, we speak of “common” low back pain: no serious injury is involved, but a combination of factors add up — tense or contracted muscles and ligaments, irritated or worn joints (osteoarthritis), a fatigued disc (disc disease), poor posture, repetitive movements, a sedentary lifestyle, stress, poor sleep. We distinguish acute low back pain (less than 4 weeks), subacute (4 to 12 weeks) and chronic (more than 12 weeks).

Good news: most acute episodes improve within a few weeks, and medical guidelines emphasise the importance of staying active rather than resting in bed. Imaging (X-ray, CT scan, MRI) is generally not necessary, except in specific circumstances.

How does Chinese medicine read back pain?

For traditional Chinese medicine (TCM), the lower back is the “palace of the Kidney”: this region is linked to vitality and deep energy. Depending on how the pain presents, several patterns are distinguished:

• Cold and Dampness — stiffness that worsens in cold or damp weather and eases with heat.
• Qi and Blood stagnation — sharper, more localised pain, often after exertion, an awkward movement or a long period sitting; it restricts movement.
• Kidney weakness — dull, persistent pain, with fatigue and a feeling of weak legs, especially with overwork or age.

These patterns are not diagnoses in the medical sense: they are traditional frameworks that help me choose the points to treat and lifestyle advice.

What can acupuncture offer?

I can place fine needles on the back, but also at a distance from the painful area (legs, hands…). Depending on the situation, I sometimes combine this with other techniques, such as heat (the Wei lamp or moxibustion).

For chronic low back pain, several reviews of the scientific literature show a modest but real reduction in pain compared with no treatment, particularly in the short term; international recommendations vary by country and by year. Acupuncture is not intended to replace other forms of care: it is used alongside physical activity, physiotherapy and the treatments prescribed by your doctor.

Does it hurt?

I use very small, single-use needles, much finer than a blood-test needle. Most of the time, you feel a light pinprick, then nothing more. Sometimes you feel nothing at all; and some areas are more sensitive than others. This sensation lasts a few seconds, then settles.

You may also feel, around the needle, a dull sensation of heaviness, warmth or tingling: this is an expected and harmless sensation. If something bothers you, tell me: I can adjust or remove the needle straight away.

How many sessions are needed?

It depends on how long-standing the pain is: a recent episode of lumbago generally needs fewer sessions than back pain that has been present for years. I suggest reviewing progress after a few sessions: if you get no benefit from it, there is no reason to continue.

A few everyday tips

• Move: walking is an excellent starting point. Resume your activities as soon as possible, gently.
• Avoid strict bed rest: beyond a day or two, it tends to maintain stiffness.
• Use heat (a warm hot-water bottle, a hot shower): it often eases the lower back.
• Do not neglect sleep or stress: they amplify how pain is perceived.
• Tai chi and qi gong: these slow, gradual movements suit many people, to be adapted to your situation.

This article is intended for information and educational purposes. It does not replace a medical consultation and does not constitute personalized advice.

References

• Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166(7):514-530.
• Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain 2018;19(5):455-474.

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