Pain-free near Gonzales Bay

Acupuncture in Action, for Back Pain: A Case For Adaptation & Pain

If you wonder what a Kiiko Matsumoto japanese-style acupuncture treatment given by Carmelle LeMaistre can be like, read on. Alix Jean also shares her insights, and a photo from Kat Ao because, hey that’s what collectives do.

Introduction: The problem to solve is not the pain itself.

CL: I recently gave an acupuncture treatment to a client who suffers from acute back pain. The pain started in his mid-back, wrapped around and down the back of his ribs. His doctor had diagnosed him with disc degeneration and osteoarthritis in the spine. After our chat, 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 lay face down, ready for needles in the back. Not what I instructed but makes sense, he’s in for back pain. We often think if something hurts, the pain is the problem to be fixed.

With Kiiko Matsumoto Style (KMS) acupuncture however, we don’t just seek to treat the discomfort; we look for the adaptation. The problem to solve is not the pain itself. Rather the goals are to understand how the pain is useful for the given situation, and 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.

Method: Diagnosing the Abdomen

CL: The abdomen showed me a hyper-vigilance in the autonomic nervous system–common with any pain. Oketsu sign was present (lower left abdomen) – likely from constipation caused by pain meds.

AJ: Oketsu 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.

CL: Immune reflex was tight (lower right abdomen). There is a global pandemic after all.

AJ: In KMS, the Immune reflexes are related to the lymphatic system, where most of our immune cells live. It can be more gut-related, as 80% of lymphatic tissue is surrounding the gastrointestinal tract. Or it can be related with an “external invasion”, as in bacteria/mold/virus that the system is fighting off.

CL: And the anterior superior iliac spine (front of the hip) was painful , ipsilateral to the back pain. He has a history of lower lumbar spine injury and surgery, and resulting sciatica. So we knew the hips were already myofascially involved.

AJ: 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 treatments.

So Here We See the Pain is Very Helpful!

CL: His recent back issue comes from calcification in the spinal disc and inflamed arthritis in the mid-thoracic spine. My sense 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 work hard, spasm and cause pain. After all, they’re doing a lot of work to keep him upright. We found the adaptation. Now if I took this adaptation away, treat the pain from 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 intramuscular stimulation (IMS). To assume that all pain and muscle/fascia tension is something to be needled away for instant results in some way assumes that our body is not the intelligent sophisticatedly-evolved organism that it is.  The pain in the erectors was not the issue. The pain is the adaptation, the down-river effect, working around the original issue. 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.

AJ: IMS 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.

Part of the Adaptation is Also Stress

CL: The other piece of the puzzle is that our muscles and fascia are neuroceptive – this means they can sense stress and safety and respond accordingly. Activated pain receptors send 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. To needle 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 keep his spine upright without  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 the few days wait for that online purchase 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 and who have 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.

Conclusion: He came back the next week.

I did not feel like I could treat the pain. I could not in good faith release the spasms. Because I knew 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), and bring down the inflammation on the arthritic discs with moxa. I treated the hip and rhomboid imbalances that were caused from the older lumbar spinal issue, to help restore some fascial integrity to stabilize the spine. We cleared the Oketsu reflex, hoping for a bowel movement and used Master Nagano’s old faithful Immune points.

AJ: Moxa – Short for moxibustion. A technique that uses heat over acupuncture points or the surface of the skin to promote blood flow to the area and reduce inflammation.

CL: Did it release the erectors? Not really. Did it help the pain? Kind of. And the rest: trust 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 seventy percent better and a new fascial pattern emerged. The nervous system was markedly improved on palpation. Most importantly there was a renewed sense of ease – maybe even some trust in the body’s unfolding process of adaptation.