Note to reader: the language in this article assumes some working knowledge of Chinese medicine theories, and in particular Kiiko Matsumoto Style acupuncture. For the benefit of the non-practitioner reader, footnotes with explanations are included.
I recently treated a client suffering from acute back pain. It started in the mid back, wrapping around and down the back of the ribs. His doctor had diagnosed him with disc degeneration and osteoarthritis in the spine. After discussing, I left the room for him to change and get comfortable on the table. I was surprised to find that when I came back into the room, he was lying face down, ready for needles in the back. Makes sense I suppose. We often think if something hurts, the pain is the problem to be fixed. With KMS (Kiiko Matsumoto Style) acupuncture however, we are not just seeking to treat the discomfort; we are looking for the adaptation. The problem to solve is not the pain itself, but rather understanding how the pain is useful for the given situation, and trying to create a new situation where it is no longer “helpful” or needed. I asked him to turn over so I could feel his abdomen, the starting diagnostic point for every treatment in KMS style. I hoped the abdomen could help lead me to the why.
The abdomen showed me a hyper-vigilance in the autonomic nervous system--common with acute and chronic pain. Oketsu1 sign was present (lower left abdomen) - likely from constipation caused by pain meds. Immune2 reflex was tight (lower right abdomen), there is a global pandemic after all. And the ASIS was painful (front of the hip), ipsilateral to the back pain. There is a history of lower lumbar spine injury and surgery, and resulting sciatica. So we knew the hips were already myofascially3 involved.
The recent back issue was coming from calcification in the spinal disc and inflamed arthritis in the mid thoracic spine. My feeling was that the mid thoracic spine was taking a lot of compensation from the old lumbar injury. The spine could literally not hold itself up anymore. At least not without help. So the erector spinae muscle group (the spine stabilizers) took over to do its job. The erectors were the ones in spasm and causing the pain. After all, they were doing a lot of work to keep him upright. We found the adaptation. Now if I were to take the adaptation away, treat the pain of the spasming erectors - the weight of the body would fall back on the arthritic spine - so here we see the pain is very helpful!
This is where I make a case against IMS (intramuscular stimulation)4. Assuming that all pain and muscle/fascia tension is something to be needled away for instant results is in some way assuming that the body is not the intelligent sophisticatedly evolved organism that it is. The pain of the erectors was not the issue. It was the adaptation, the down-river effect, trying to modify a system around the original injury. Without treating the inflammation of the spine, the erectors might release temporarily while lying down, but as soon as tension was back in the system (from standing up and moving around for example) it would start to spasm again to protect the spine. I see this a lot with IMS--that the pain goes away quite quickly but is back the next day.
The other piece of the puzzle is that our muscles and fascia are neuroceptive - meaning they can sense stress and safety and respond accordingly. Having pain receptors activated sends a high amount of cortisol into the system. This signifies a global stress response that it is not safe for muscles to relax and we should prepare to fight or flee, or commonly, freeze. So then, part of the adaptation is also stress. Needling big muscle groups directly with IMS doesn’t treat global stress in the nervous system. In fact, it can make these neuroceptive tissues feel even more threatened.
Which brings me to part of my treatment philosophy that is not always easy to hear:
Pain is usually a good thing. It's a sign your body is trying to tell you something. Sometimes getting rid of your pain is not the best way to treat the whole body issue. Maybe this brings up bigger cultural issues around how we deal with discomfort, our constant strive for optimal productivity, the notion that a body in pain is something to be fixed and not listened to. Sometimes pain is very important, even necessary. In this case, the pain was essential to keeping his spine upright without causing further damage. His pain was wise.
Pain is always emotional. We can debate the chicken/egg here but the fact is that cortisol from stress increases inflammation which causes pain - pain causes more cortisol which signals stress - and the cycle goes on, no matter which came first. Culturally we are about as good at feeling our feelings as we are with waiting more than a few days for something on the internet to arrive. I don’t want to gender things to much here but I do see a connection clinically with men of the older generations, who were raised to be stoic, having chronic back pain. Just saying.
Healing is a process. The best we can do in a session is create optimal conditions for the adaptation to not be needed anymore and trust that the body is the wisest one to guide the way to safety.
I did not feel like I could treat the pain. I could not in good faith, release the spasming erectors knowing the spine was not ready to take the load. My sense was the body needed more time to find its way back to safety. But I could: help regulate the nervous system cortisol responses (through the kidney/adrenals); do moxa5 on the arthritic discs to bring down the inflammation. Treat the hip and rhomboid imbalances that were caused from of the older lumbar spinal issue, in hopes of restoring some fascial integrity to stabilize the spine. We cleared the Oketsu reflex, hoping for a bowl movement and used Master Naganos old faithful Immune points.
Did it release the erectors? Not really. Did it help the pain? Kind of. And the rest was trusting the body to do its thing.
He came back the next week. Several consecutive days with improved pain and weaning off the pain meds. The erectors were about 70 percent better and a new fascial pattern was emerging. The nervous system was markedly improved on palpation. Most importantly there was a renewed sense of ease - maybe even some trust in the bodies unfolding process of adaptation.
Footnotes
1 - Oketsu: this is a KMS style term, in Chinese medicine loosely analogous to Liver Blood Stagnation. Correlated with a blockage of optimal blood flow, likely somewhere in the abdominal, pelvic or thoracic cavities, potentially related with a congestion in the rectal veins or hepatic portal vein (the main vein taking blood to the liver for processing) but can have full-body effects.
2 - Immune: In Kiiko Style acupuncture, the Immune reflexes are related with the lymphatic system, where most of our immune cells live. It can be more gut-related, as 80% of lymphatic tissue is surrounding the GI tract; or it can be related with an "external invasion", as in bacteria/mold/virus that the system is fighting off.
3 - myo = muscle, fascia = connective tissue, therefore 'myofascial' means relating to the connective tissue surrounding muscle, and the muscles themselves. Fascia forms an interconnected web of tissue which not only keeps our body together, it holds patterns of movement and injury which interact with the ways we feel our bodies. Fascial tension is a key aspect of what changes with acupuncture treatment.
4 - IMS (intramuscular stimulation), aka "dry needling" is a common practice amongst physiotherapists and other health-care practitioners who use "acupuncture needles" to stimulate a twitch-and-release response in local areas of pain. It is generally much deeper, much more localized, induces more sensation, and does not adhere to the principles of Chinese/Japanese acupuncture within which Registered/Licensed Acupuncturists are trained.
5 - Moxa - Short for moxibustion is a practice of burning herbs over acupuncture points or the surface of the skin to promote blood flow to the area and reduce inflammation.