Lumbar herniated intervertebral disc in adults from Korean Medicine Clinical Pratice Guideline

This guideline is published at Oct. 2014 in Korea.

Evidence Based Korean Medicine Clinical Practice Guideline Development Committee for Lumbar Herniated Intervertebral Disc(Korea Institute of Oriental Medicine, The society of Korean Medicine Rehabilitation), Korean Medicine Clinical Practice Guideline for Lumbar Herniated Intervertebral Disc in adults(KMCPG_Lumbar Herniated Intervertebral Disc), Daejeon, Korea, 2014.

I'm going to share the summary of the guideline.

Ⅳ. Recommendation of this guideline

1. Treatment

(1) Acupuncture

● Acupuncture treatment is recommended as effective intervention for Lumbar HIVD patients to
relieve pain and improve their bodily functions. (Grade A)

● GB30, BL40, Lumbar Jiaji points, BL50, GB34, BL23, and Ashi points are recommended as
the main acupoints, and GB 30 is also recommended as a point that should be deeply needled.
(Grade A)

● Acupuncture treatment should be performed by taking into account the patients’ characteristics
and symptoms. Practicing ankle-three acupuncture, scalp acupuncture, warm acupuncture, fire
acupuncture, superficial acupuncture, intradermal acupuncture, equilibrium acupuncture, and
Sasang constitutional acupuncture is also recommended. (Grade A)

(2) Pharmacopuncture

● Pharmacopuncture for Lumbar HIVD should be applied to a select group of patients to relieve
their pain and to improve their motor ability and functions. (Grade B)

● The major pharmacopuncture approaches includebee venom pharmacopuncture, anti inflammatory
pharmacopuncture, neutral pharmacopuncture for extravasated blood, and Shinbaro
pharmacopuncture. (Grade B)

● Pharmacopuncture using centipede and scorpion venom may also be considered. (Grade C)

● A therapeutic approach using pharmacopuncture should be considered based on the patient’s
condition and risk of side effects. (Grade B)

(3) Herbal medicine

● Herbal medicine should be considered for relieving the pain of Lumbar HIVD patients and
should be prescribed in keeping with an accurate diagnosis. (Grade B)

● Duhuojisheng Tang is recommended to relieve pain (Grade A), and Cheongpa-Jeon and Sibjotang
may be considered (Grade C).

(4) Chuna (chiropractic)

● Chuna treatment is recommended as an effective option for relieving the pain of Lumbar
HIVD patients and for improving their bodily functions. (Grade A)

● It is recommended that Chuna treatment be combined with acupuncture and herbal medicine
treat¬ments. (Grade A)

(5) Moxibustion

● Moxibustion treatment should be considered for relieving the pain of Lumbar HIVD patients
and for improving their bodily functions, and it should also be combined with acupuncture.
(Grade B)

● The GV3, GV4. BL23, BL50, and BL40 points and the sensitive points of the legs and lower
back should be considered as the main points for applying moxibustion. (Grade B)

(6) Cupping therapy

● Cupping therapy should be considered for relieving the pain of Lumbar HIVD patients, and it
is also recommended that it be combined with acupuncture, herbal medicine, and the tuina
treatment. (Grade B)

● BL40, BL60 GB34, GB31, GB30, and the Ashi points should be considered the main points
for cupping therapy. (Grade B)

Acupuncture and Low Back Pain

Acupuncture and Chronic Low Back Pain

Low back pain remains as one of the most frequented reasons to visit a doctor. However, the most common problem is “nonspecific” or “idiopathic” low back pain, and it is this disorder that is most often associated with chronic or recurrent symptoms.

 

Alternate medicine and Traditional Chinese Medicine [TCM] treatments such as Acupuncture are helpful in treating such conditions. TCM works on the physiological system which looks at the harmony between the body, mind and spirit. Internal disharmony is believed to be due to a blockage or improper flow of the energy or Qi. Acupuncture needles inserted at specific acu-points are believed to restore the proper flow of Qi.

 

Acupuncture can be used as a multidisciplinary approach before or together with conventional treatment such as physical therapy, pain medicine etc. Caution should be taken that electro-acupuncture is not performed on patients with implanted electric devices such as pacemakers.

 

During an acupuncture session for low back pain, and based on patient history and physical examination, specific areas will be identified for needle insertion. Nonetheless, there are common acu-points that may be used to treat low back pain. Supplementary procedures such as tongue checks and or herbal medicines may be used to comprehensively treat the condition.

 

Typically post insertion of needles, the patient is advised to rest and relax for about 15-30 minutes. Manual stimulation of needles by the practitioner may be done to create a dull, localized “needle grasp” tugging sensation. Further stimulation can be done using moxibustion (burning the herb at the end of the needle) and application of heat.

 

Although number of sessions of acupuncture varies from case to case, a minimum of around 10 sessions maybe needed, with visits of at least twice a week. Major side effects from acupuncture are rare and it is mostly considered a safe practice. Acupuncture has shown to have an effect on the limbic structure post treatment for low back pain patients.

 

Acupuncture provides short-term pain relief and functional improvement and is a recommended option for low back pain treatments. Physiotherapy in the form of mild stretching and strengthening programs go a long way in aiding the acupuncture program.

 

At the end of treatment, the patient’s response, particularly - levels of pain, mood, and general activity level are checked and it is determined whether additional acupuncture treatments should be received or not.

Stability for a Healthy Lower Back

 

Core Stabilization for a Healthy Lower Back.

While specific programs that are individualized and tailor made for each patient gets betters results, there are certainly some repetitive generic points that can be used for patients undergoing spinal rehabilitation and stabilization.

·         Exercise in moderation is better than in excess. Take it slow and steady and monitor the progress. Exercises such as bending forward and touching the toes should be avoided at this time because it can damage the discs of the lower back.

·         Ideally one should balance both flexibility of the spine and its stability. Increased flexibility to a joint actually reduces its stability factor. As such moderation is a term to be kept in mind when performing spinal exercises.

·         It has been documented that the spinal discs lose fluid during the day and re-hydrate during the night and rest times. Therefore, it is advisable to avoid make any harsh quick movements on waking up early or excessively straining the back.

·         While weight lifting is a good way to build core strength, doing so while being seated is very detrimental. Other exercises such as pull ups and machine based systems for such activity are alright. Endurance building is recommended over quick sprint sets i.e. a little each day rather than a long session two to three days a week.

·         Flow with the natural curve of the spine. It is better advised to maintain a natural neutral lumbar curve while going about daily exercises and routine rather than bending or flexing it forward. 

·         Aerobic exercises are well recommended for preventing lower back pains with emphasis on brisk walking. Additionally exercises like swimming, deep water running, climbing stairs etc help with maintain both stability and flexibility of the spine.

 

Ref: yourbetterback.com

What kinds of Diseases are effective when treated using Acupuncture and Herbal medications?

Firstly, pain management. Acute pain like sprain and strains are very well treated by Traditional Chinese Medicine treatments at the Korean Acupuncture and Herb Clinic. Additionally, treatments for ankle, wrist, lower back, neck and Chronic pains like sciatica, lumbar disc, cervical disc, osteoarthritis, can achieve good results. Sports injuries, headaches, migraines are effective as well.

Secondly, functional symptoms like indigestion, constipation, chronic diarrhea, dysmenorrhea, insomnia, etc are also treated at Korean Acupuncture and Herb Clinic

Thirdly, Rehabilitation cases like post-operative pain, stroke rehabilitation, facial palsy, Traffic accidents can also be effectively treated.

Fourth, Weight loss. Electro-acupuncture is well known for the weight loss function. It helps reduce the size of the fat cells by releasing fatty acids and gycerols when stimulated and this released fat can be burned off with minimal 30-40 minutes of aerobic and an-aerobic exercises.

Lumbar herniated Disc

Approach to lumbar disc

Korean acupuncture and herb Clinic’s lumbar radiculopathy program

normal Lumbar X-ray

Normal Lumbar MRI

 

 

Lumbar Spine is very important for our ordinary life.

Because of the healthy spine, we can run, walk, love, sit, study, etc…

You probably have some concerns that how come acupuncture help lumbar disc?

Let me have some opportunity to explain to you.

 

What do you think of Lumbar disc?

 

Someone thinks that If there is protrusion or buldging on the M.R.I. image. But only image cannot match with the symptom.

Someone Thinks that if there is a symptom of radiculopathy, it could be a lumbar disc. But lumbar radiculopathy can occur when you have a tumor or stenosis. These can make the radiculopathy as well.

 

Lumbar Disc diagnosis must be matched with Image and physical examinations, symptoms and signs. We call it “symptom and sign correlation”

 

There was one study at 2001, Dr. Javic took images of normal people who don’t have any lower back pain. 91%of image was degenerative sign and 64% was buldging, 32% was protrusion, 6% was extrusion!!

 

Consequentially, The image shouldn’t be the priority for the decision to take operation.

Then, What kind of sign or symptom would be the indication of operation?

1. Severe pain isn’t reduced by aggressive treatment such as admission over 1 month

2.Herniated disc compress nerve root excessively, so that muscle weakness and atrophy occurs.

3.Herniated disc compress cauda equina, so there is some problem in urination, defecation. erection

 

How manage Lumbar Disc in Korean Acupuncture and Herb Clinic?

We are using Electro-Acupuncture, cupping, Herbal medications to reduce the pain and inflammation.

And In you place, you are going to have icing on your lower back, and nerve stretching, piriformis muscle compression

Stage1

•     When you have severe pain. And difficulty in ordinary activity

•     ->electro-acupuncture, cupping, herbal medication for inflammation

•     ->bed rest 2-3days

•     ->icing at least 90min. 5times in a day

•     ->nerve mobilization, piriformis muscle compression by tennis ball

Stage 2

When you can sleep without pain relief, and can walk in 5min, slowly

electro-acupuncture, cupping, herbal medication for inflammation

Core strengthening exercise

Icing at least 90min. 3times in a day

Nerve mobilization, piriformis muscle compression and stretching

Stage3

When you can sit over 10min, walk over 20 min. in normal spped

Electro-Acupucnture, cupping, herbal medication for inflammation

Core strengthening exercise

Icing at least 60min. 2-3times in a day

Nerve mobilization, Stretching

Stage4

When you can walk over 40 min in fast speed, or jogging

Acupuncture and cupping-if necessary

Core strengthening exercise

Nerve mobilization- if necessary

Continue rehabilitation exercise for healthy life

 

Our goal is not reducing pain, but, Healthy and happy life

 

 

Shukran.