2009
ORNELLA IELO
BACK PAIN (Chronic and Acute)
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“Each patient carries his own doctor inside him. They come to us not
knowing that truth. We are at our best when we give the doctor who
resides within each patient a chance to work.”
Albert Schweitzer, M.D.
LIVING EARTH SHIATSU SCHOOL
982 BATHURST STREET
416-591-0400
Leny Carbone, Director & Instructor
BACK PAIN
(CHRONIC AND ACUTE)
DEFINITION AND CAUSE OF SYNDROME/DISEASE –
WESTERN AND TCM:
BACK PAIN – WESTERN:
Most common causes of low back pain are mechanical disorders of the lower spine. It is
classified mechanical if physical activities make it worse and rest makes it better. Degenerative
Disc Disease (the breakdown of the cushions between the vertebras) is the most common
mechanical disc disease.
ACUTE:
Acute back pain is described to come on rapidly and lasts about one to seven days. Acute pain
can be mild to severe. It is the most common type of back pain.
SUBACUTE:
Subacute back pain is described as lasting more than a week and possibly as long as a few
months. Approximately 10% to 20% of cases can be classified as subacute.
CHRONIC:
Chronic back pain is described as long-term pain lasting more than three months. Chronic pain
can range from mild to severe. It is the least common type of back pain, about 5% to 10% of
cases.
OTHER MECHANICAL CAUSES:
SPRAINS: When ligaments in the back are torn.
SPASMS:
Overworked muscles of the back go into spasm. Painful, involuntary contractions, it’s the
body’s way of protecting itself temporarily so the person is unable to use or damage their back
further.
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RUPTURED OR HERNIATED DISCS:
Discs are weakened; the hard outer cover can rupture allowing the squishy center to bulge and
put pressure on nearby nerves.
SCIATICA – LOW BACK PAIN:
Discomfort associated with the sciatic nerve. This nerve runs from the lower part of the spinal
cord, down the back of the leg, to the foot. Can be a sharp or burning pain that radiates from the
lower back to the hip, it can follow the path of the sciatic nerve to the foot. The sciatic nerve is
the largest and longest nerve in the body, the thickness of a person’s thumb. The primary cause
of sciatica is a herniated or bulging intervertebral disc that compresses the nerve root before it
joins the sciatic nerve.
POOR POSTURE: Sitting or standing.
COCCYDYNIA: Pain in the coccyx or tail bone resulting from a fall onto the buttocks.
FACET SYNDROM: Is inflammation of one or more facet joints where vertebrae connect to
one another.
MUSCLE TENSION: Stress or tension can worsen if ignored and not taken care of.
DISEASE RELEATED CAUSES OF BACK PAIN:
ARTHRITIS: Most common, joint inflammation. The spine is made up of 48 joints.
OSTEOARTHRITIS: More common for elderly. Occurs when joint cartilage breaks down,
bone at the end of a joint can thicken and spurs can develop bony growths.
RHEUMATOID ARTHRITIS: Inflammation, joint damage and deformity.
OSTEOPOROSIS: Thinning of the bones.
PAGET’S DISEASE: Excessive bone breakdown followed by abnormal formation.
SCOLIOSIS: Spine twists to one side.
KYPHOSIS: Curvature of the upper spine, hunchback.
OTHER CAUSES:
OBESITY: Excess body weight in the abdomen area causing strain on back muscles.
PREGNANCY
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KIDNEY STONES
KIDNEY INFECTIONS
ENDOMETRIOSIS: The tissue that lines the uterus leaves the uterus and deposits on other
organs. The pain worsens around menstruation.
TRADITIONAL CHINEESE MEDICINE:
Meridian based therapies are a unified healing system that has evolved for over 3,000 years. The
natural therapies are:
1) Acupuncture
2) Herbal Therapy
3) Massage
4) Exercise
5) Diet
In TCM, prevention and treatment of disease is stressed by strengthening the body’s own selfregulation, restoring the bodies balance.
In TCM there is a Life Energy-Chi, or Ki – that flows along invisible body pathways know as
meridians. The life force circulates through the body, when it is balanced it is considered that a
person is healthy. When the Ki is blocked at specific points, illness occurs.
The paired organs meridian related to the back are the Bladder Channel located mainly along the
posterior aspect of the body which is the longest meridian in the body consisting of 67
acupuncture points; the paired meridian is the Kidney Channel.
In TCM, unlike the Western view, everything is connected as a whole. In relations to the paired
organs of the Kidney – Yin organ, Bladder – Yang organ:
Element: Water Sense organ: Ears Tissue: Bone Tastes: Salty Colors: Blue / Black
Sound: Groaning Odour: Putrid Emotion: Fear Season: Winter Environment: Cold
Direction: North Developmental Stages: Storage
EFFECTIVENESS OF SHIATSU IN TREATING BACK PAIN (Chronic and
Acute)
Shiatsu, the Japanese Ancient Art of hands on healing, using 80% of finger pressure 20%
massage, is very effective in helping the body heal itself.
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Working along specific meridians on acupuncture points and also between the Tsubos stimulates
the Ki flow through the bones, nerves, arteries and skin. Moderate pressure applied all over the
body stimulates the flow of energy. Shiatsu can help backaches and sciatica that stems from
poor circulation in the pelvis and sacro-lumbar region by stimulating the life-blood energy to
flow freely. Shiatsu also helps to structurally align the bones of spine by hand manipulation.
MAIN TREATMENT AREAS TO BE USED – CHANNEL, POINTS,
ZONES:
CHANNELS:
The channels used for back pain would be the Bladder and Kidney, Lung and Large
Intestines, Gall Bladder and Liver, Du and Ren paired meridians.
POINTS:
LOCATION ON THE BODY:
ACTION:
Lung 2
1 cun above Lung 1
Good for upper back pain
Large Intestine 4
on the dorsum of the hand
Good for any pain in the
In the web of 1st and 2nd
body when used with Liver 3
Metacarpal bones
Liver 3
Bladder 23
on the dorsum of the foot
Good for any pain in the
Between the 1st and 2nd
body when used with
Metatarsal bones
Large Intestine 4
1.5 cun lateral to
Back Shu point of the
Lumbar 2
kidney, tonifies kidney,
nourishes kidney essence,
strengthens lower back
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POINTS:
LOCATION ON THE BODY:
Bladder 25
1.5 cun lateral of lumbar 4
Back Shu point of
Large Intestines,
good for back pain,
Sciatic pain, lumbar
pain
Bladder 32
Over the 2nd posterior sacral
Formen
Tonifies lumbar,
lower back pain,
Tonifies kidney
Bladder 36
Centre of transverse cubital
crease in the depression
between the hamstring muscles
Good for sciatic pain,
lower back pain,
pain radiating down
the leg
Bladder 40
Midpoint of the transverse crease
of the popliteal fossa
Good for lumbar
pain
Bladder 52
3 cum lateral to lower border
Tonifies the kidney,
of Lumbar 2 level with Bladder 23
strengthens the back
8 cun below Bladder 40
Good for lower back
Bladder 57
ACTION:
pain, sciatica, relaxes
sinews (tendons and
muscles)
Bladder 58
7 cun directly above bladder 60,
Strengthens kidney,
1 cun inferior and lateral to
Sciatica, relaxes sinews
Bladder 57
(tendons and muscles)
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POINTS:
LOCATION ON THE BODY:
ACTION:
Bladder 60
In the depression between the external
Relaxes sinews,
malleolus and tendon calcaneus
strengthens the back,
lower back pain,
chronic back pain
Kidney 7
Gall Bladder 25
2 cun above kidney 3 on anterior
Strengthens lower
border of tendon calcaneous
back and kidneys
FMP of kidneys, anterior and inferior
Tonifies the kidneys,
to the free end of the 12th rib
strengthens the
lumbar region
Gall Bladder 30
Gall Bladder 34
1/3 distance between the prominence
Sciatica, low
of the greater trochanter and hiatus of
back pain,
the sacrum
lumbar pain
Influential point of the tendons 1 cun
Used for any pain
anterior and inferior to the head of the
in the body, relaxes
fibula
sinews, good for
back pain
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POINTS:
Gall Bladder 39
LOCATION ON THE BODY:
Influential point of marrow, 3 cun
ACTION:
Tonifies kidneys
superior to the prominence of the
lateral malleolus
Du 12
Below the spinous process of the
Helps with pain and
3rd Thoracic Vertebra (T3) in
and stiffness of the
line with, 1.5 cun lateral of BL 13
back
BSP of the Lung
ZONES:
To treat the patients I would start with the patient in the supine position, (using a pillow under
their knees for better back support and comfort.) to perform the Hara assessment. After the
assessment of Kyo and Jitsu, looking at the feet to see which one was turned out the most, I
would treat the arms and legs and feet. Kyo side first. If the patient was in a lot of discomfort I
would work on the sides to access the Gall Bladder meridian, liver, bladder. Tonify the kidneys.
If the patient was chronic I would have them go to the prone position and work on the back with
better access to the Bladder channel. I would work on the sacrum and the back of the legs and
feet. I would end the treatment in both cases with the head.
TREATMENT PROCEDURES – MANIPULATIONS, POSTURES,
SEQUENCE:
MANIPULATIONS:
Acute and Chronic:
With a patient that had acute pain, I would recommend no more than two days of bed rest before
they came to see me. I would encourage them to have diagnostic imaging and have them bring
in the written report for me to see. While treating them I would be cautions around the more
tender areas. The level of pressure I would use would range from 1 to 6.
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The greater intensity of the pressure would be used on the exterior limbs, not on the back area.
Most of my treatment would be to Tonify the kidneys. I would Tonify the kidneys via the Hara.
I would use a gentle holding technique, and would visualize bring my patient to my sacred
healing cave.
For patients with a chronic condition who were able to move more freely I would follow the
same process as above, but have them lie in the prone position so I could have better access to
the back area.
I would follow the tree steps to facilitate healing:
(1)
First clear stagnation (Jitsu area,) go in with more force less holding time.
(2)
Second, I would habituate nerves, facilitate heating.
(3)
Repair damage – Tonify Kyo, this is an excellent way to treat serious conditions. This is
the time I would bring them to my sacred healing cave.
POSTURES:
My attitude would be positive and confident to help facilitate healing. Focused, centred in
myself, calm and thinking of the patient before me. Witnessing the pain the patient is
experiencing, my touch and thoughts would be sending healing vibrations. The stances I would
use would be varied from seiza, one knee standing. I would be changing stances to remain
comfortable.
ZONES:
I would be mindful to the time, less is more. The zones I would cover would be Hara, then the
outside limbs, hands and feet. Even if I had only time to repeat a sequence once, that would be
beneficial as well. The side position would be next. If the patient was well enough to lie in the
prone position, the back and legs would be next. The head would be the last area to cover. I
would use grounding points, Kidney 1 and Gall Bladder 14. The last part of the treatment I
would assess the Hara to see if the organs balanced out.
LIFE STYLE CONSIDERATIONS – EMOTIONAL FACTORS, STRESS
FACTORS, LIFE STYLE CHANGES, DIET, HERBS, SELF CARE:
Back pain can be prevented or at least lessened through health lifestyle habits – a healthy diet,
proper posture, the right footwear choice and plenty of physical activity.
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EXERCISE:
A regular and varied exercise program can ease pain and stiffness, strengthen muscles and bones,
burn calories, improve flexibility, increase energy, improve sleep, boost your mood, increase
your sense of well-being and reduce your risk of serious diseases.
Three types of exercise:
(1) Isometric – exercises in which a force is applied to a resistant object. They would be
helpful in strengthening muscles of the back and the abdomen.
(2) Isotonic – exercise that involves moving a constant, heavy weight through a full range of
movements. Lifting free weights is an example.
(3) Isokinetic – exercise in which the maximum force of the muscles, that are capable, may be
applied through a range of motion. Rowing machine is an example.
Aerobic exercises. When walking contract your stomach muscles, don’t forget to breath.
If you have suffered or at risk for a compression fracture of the vertebrae:
AVOID THE FOLLOWING:
 Jogging
 High-impact aerobics
 Step aerobics
 Football
 Sky diving
 In-line skating
 Snow skiing
INSTEAD TRY THE FOLLOWING:
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Exercise in water, a pool or hot tub.
Yoga
Tai Chi
GOOD BACK HEALTHY HABITS:
POSTURE – when standing or sitting and walking.
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IMPROVE YOUR POSTURE:
When standing:
 Stand with your weight equally distributed on both feet.
 Place one foot on a footstool to ease the tension on your back
 Wear flat or low-heeled shoes if you are standing for long periods of time.
 Keep you back straight by tightening your stomach muscles and buttocks and doing a
pelvic tilt.
When Sitting:
 Keep stomach muscles pulled in and maintain the proper curve in your lower back.
 Keep your knees slightly higher than your hips. Use a footstool.
 Don’t sit for long periods at a time. Take a break and stand up and walk around.
Proper lifting methods:
 Face the object you are going to lift and carry.
 Bend your knees; use your leg and stomach muscles, not you back muscles.
 Hold the objects close to you.
 Straighten you legs to left the object.
 Get help to lift objects if they are too heavy.
AVOID SLEEPING ON YOUR STOMACH; RETRAIN YOURSELF TO SLEEP ON
YOUR SIDE WITH A SUPPORTING PILLOW OR SLEEP ON YOUR BACK. PLACE
A PILLOW UNDER YOUR KNEES.
DIET AND WEIGHT MANAGEMENT:
To maintain your weight your calorie input must equal your output. To reduce weight you must
make healthy food choices. Avoid High Glycaemic Index Foods. Whole grain foods take longer
to break down in your system.
FOOTWEAR:
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A durable counter (the part of the shoe that surrounds your heel).
A supportive insole should cushion your heel and support your arch.
A roomy toe box, it should allow your toes wiggle around.
A flexible sole, a sole that doesn’t bend at the ball of your foot.
A padded heel should absorb shock as you walk.
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TOBBACO USE:
Cigarette smoke is bad for your back. Smoking causes damage to blood vessels that supply the
back. Cigarette smoke is bad for your bones.
STRESS REDUCTION:
Daily life stress is one of the biggest factors in back pain. Stress causes muscles to tense, leading
to pain.
RELAXATION THERAPIES AND TECHNIQUES:
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Acupuncture / Acupressure / Shiatsu
Reflexology
MANAGING STRESS:
 Meditate
 Deep breathing
 Distraction –training your mind to focus on something other than your stress.
 Guided Imagery – closing your eyes image a beautiful beach lying in the sand listening
to the waves.
 Progressive relaxation – tense and then relax the body’s muscles from head to toe.
 Visualization – helps reduce stress by allowing you to imagine yourself anyway you like,
doing anything you want to do.
 Keeping a Journal – is helpful in reducing stress when writing down your feelings.
HERBAL REMEDIES:
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Whole herbs: parts of plants that are dried cut and powdered.
Herb teas: beverages made from steeping herbs in hot or boiling water.
Tinctures: solutions created when an herb is soaked in alcohol or glycerine.
Extracts: tinctures in which some of the alcohol has been distilled out.
Capsules and tablets: herbal preparations
Salves and ointments: topical (rub-on) preparations that contain herbal extracts.
MOST COMMON REMEDIES TO RELIEVE BACK PROBLEMS:
 Boswellia
 Cat’s Claw
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Devil’s Claw
Ginger
St. John’s Wort
VITAMINS, MINERALS, ENZYMES:
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Vitamin B3
Vitamin C
Vitamin D
Vitamin E
Boron mineral
Bromelain is protein-digesting enzyme derived from pineapple.
Calcium
Copper mineral
Fish Oil – cold water fish, such as salmon or mackerel help reduce inflammation.
Glucosamine – a natural substance that provide the building blocks for the body to make
and repair cartilage.
Magnesium mineral
GODD SELF CARE:
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Stop and smell the roses or any other flower you walk by
Give thanks to God or Innate Intelligence, The Greater Life Force
Love life and the world in its entirety
Smile, Breathe deeply, Be Happy to be alive
“Do unto others as you would have them do unto you.”
Get in touch with nature, roll around in the leaves, make snow angels
Take a walk by the beaches or in High Park, walk in the sand or water bare foot
Laugh often, it’s the best MEDICINE
It’s your choice what kind of day you’re going to have, choose a Good Day!!!
Do what you love and love what you do. Your field of work SHIATSU!
Help someone who needs a hand, it will make you feel good inside.
Making the world a better place starts with YOU!
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