The Yin and Yang of Back Pain
In Chinese medical theory, the most basic distinction between types of pain is whether they are due to 'deficiency' or 'stagnation,' both at the site of pain and systemically.
In this article, we’ll look at what deficiency pain means.
Deficiency refers to a lack of one or both of Qi and blood. Each of these can be deficient in a couple of ways themselves.
A deficiency of Qi can be expressed as the inability of a muscle to fully contract and then relax, or as a functional pattern of imbalance due to neurological habituation.
Neurological habituation causes a communication line between some part of the body and the brain to become weak. In this case, Qi can be seen as the impetus of nerve signaling and the ability of the tissue to communicate with its environment.
For example, when sitting at a desk, our bodies don't generally demand the gluteus muscles to activate (we are just using them as cushions), so after a period of time our brains tend to ignore those muscles in favour of more actively used body parts such as the low back, hands and eyes. Over days, weeks and years of this pattern of inactivity, the neurological connection between our brain and our glutes becomes less robust, and it becomes more difficult to 'fire' those muscles when we really do need them, like when running.
This sets up a pattern of a different muscle activating (say, muscles of the low back) to try to perform functions which another muscle is best suited for (say, the glutes). This then leads to the overuse of the low back, but this overuse is actually due to a deficiency in another location. So pain might manifest in the low back or in the glutes (as a referral of pain from the tense low back), all because the original neurological signaling network has been compromised.
Another type of Qi deficiency, the type disallowing the muscle to truly contract and then relax, is tied into general deficiency of the body tissues. This type of deficiency manifests as people age and the muscles become more tense by default, losing the full responsiveness, flexibility and easy range of motion that we experience as children.
Blood deficiency can be due to multiple factors as well, but the two main ideas are either lack of blood flow to the site of pain, or lack of proper oxygenation and nutrition within the blood to power the full potential of the tissues.
An inability of the blood to perfuse the site of pain is compounded by many factors. Some tissues naturally receive more blood than others. For example, skin and muscle tissue have many capillaries providing blood to the tissue, while tendons, ligaments, all kinds of connective tissue and bone often have very little access to fresh blood.
The Chinese medical theory of blood deficiency includes the inability to move the blood to the correct sites at the correct times, and a lack of energy to allow the blood to reach all of the tissues in an optimal way. This impacts the rate of recovery from daily stresses on the tissues. Over time, as these stresses do not repair, they initiate dysfunction and inflammation, which may irritate or impinge nearby nerves.
Once the blood flow has been compromised and pain sets in, the ability of the area to recover blood flow is directly related to how quickly the pain will dissipate and how long it will take to recover completely. The less blood flow, generally the longer the recovery time.
Deficiencies of the content of the blood are related to the function of the organ systems as well as dietary habit. Most famously, magnesium deficiency can cause muscle cramps, so athletes are often advised to eat things like bananas and avocados, fruits high in magnesium.
However, there are many nutrients necessary for optimal function of the musculoskeletal system. According to Chinese medical theory, the ability of the blood to deliver collagen-building material to the connective tissues is just as important as the ability of the blood to deliver magnesium to muscles. Both can lead to major pain if not carried out.
Most of the stagnation-types of pain involve traumatic injury or a palpable-pathogenic process. This is an area where acupuncture and its associated modalities truly shine, treating traumatic injury such as fractures, sprains, infection of tissue and acute pain efficiently and gently. After an acute injury has been assessed by urgent or primary care, go to your acupuncturist for a complete plan of care for immediate physical recovery when other modalities such as physical therapy are not yet indicated.
1) Starting from the most superficial type of stagnation, Qi stagnation involves a type of movement that becomes stuck. Most often it manifests as a tendency to have shoulder and neck pain due to stress which goes away with conscious relaxation and mild exercise. In this case, the muscle tissue itself has not yet been affected. The most common treatments for Qi stagnation involve stress-relieving acupuncture, trigger-point and motor point acupuncture, massage and exercises. Qi stagnation is a component of all the other types of stagnation as well.
2) The next level of stagnation involves the blood. A common example of blood stagnation is a muscle that has been tense and has formed a series of knots in the tissue, disallowing the full relaxation of the muscle, often present in low back and shoulder muscles. Blood stagnation is treated with strong local acupuncture, cupping and gua sha to physically move the blood. It often presents in combination with heat, cold, damp and phlegm stagnation.
3) Heat is part of the inflammatory process, along with redness, swelling and pain. Heat stagnation can be a secondary effect of lingering blood stagnation that starts to become inflamed, or it can be a rapid onset inflammation or infection. Heat stagnation is treated with cooling techniques, using acupuncture distally to relieve heat and inflammation while applying cooling herbal poultices and/or liniments topically. Internal herbs can be used to treat infection and inflammation concurrently. Heat is often combined with damp and blood stagnation.
4) Cold stagnation can either have a fast or a slow origin of onset, with the fast type of onset a physical exposure to cold causing the tissues to tense and the local cellular metabolism to slow down. This causes sharp stabbing pains similar to muscle cramps, accompanied by a deep ache. This can be seen with low back pain after a long bike ride with the low back improperly covered, riding through a cold and rainy environment. Cold stagnation is treated with warming topical liniments and poultices as well as heat packs and moxibustion combined with acupuncture to relax and warm the area. Cold stagnation is often combined with blood or phlegm stagnation.
5) Damp stagnation involves swelling that is still soft, as in the puffiness after a sprain or around a repetitive-motion injury. This can be found around the shoulder blades from overuse of the arms or across the whole low back after intense physical labor. Dampness is treated with cupping, heat poultices, local acupuncture and constitutional body points for eliminating dampness.
6) The most bizarre and deep-seated type is phlegm stagnation: a type of hard nodule or mass the center of a deep bruise, a fatty lipoma, or the swelling of vertebrae involved in arthritis. Blood and Qi stagnation must both exist prior to the formation of phlegm stagnation. This potentially takes the longest to resolve due to the need to diminish the tissue accumulation. Strong local acupuncture, plum-blossom acupuncture, cupping, gua sha, moxibustion and topical plasters and soaks are all used to treat this more difficult type of stagnation.
These six types of stagnation interact with each other and change over the course of an injury or illness.