This low back pain report evaluated acupuncture for managing chronic low back pain in a 23-year-old professional soccer player. The athlete had a five-year history of episodic LBP, worse with straight-line-running. The treatment protocol consisted of eight acupuncture sessions over two weeks combined with strengthening, stretching, education, mindfulness, core exercises, manual therapy, and postural education.
After completing the acupuncture treatments, which incorporated points along the Bladder, Gall Bladder, and Small Intestine channels, the player reported 75% less pain as measured by the Numerical Pain Rating Scale (NPRS) during running. Furthermore, he was able to return to full squad training.
Low Back Pain
Low back pain (LBP) is a common musculoskeletal condition professional athletes report. Its occurrence can have significant financial, technical, and personal repercussions. However, there are no clear-cut guidelines or broad consensus on the best way to treat both acute and long-term LBP. This low back pain report sheds light on the benefits of acupuncture for treating this common and debilitating condition.
LBP in professional soccer players is a common occurrence typically characterized by pain, stiffness, and disability with or without associated leg pain. Although LBP is often self-limiting, it can cause a player to miss a considerable playtime and, in extreme cases, can be catastrophically career-ending.
Low Back Pain Report
Past Medical History
This player presented with a five-year history of episodic LBP without any radiating pain to his legs. However, he had a history of multiple soft tissue injuries to his hamstrings and quads in his upper legs. In addition, he suffered an ankle stress fracture on his left side.
Back Pain Symptoms
The patient in this low back pain report explained to his practitioner that standing for more than thirty minutes caused extreme pain. In addition, extension-based gym exercises, squats, and lunges aggravated the pain, while rest eased his discomfort. He also complained of an intermittent, non-specific dull ache at rest (1/10), which increased to a sharp, intense pain (8/10) in the low back during high-intensity running.
Patient Examination
The player presented with an anterior pelvic tilt and a hyper-lordotic lumbar curve. His erector muscles along his spine were tight on palpation, and he complained of tenderness over his lumbar vertebras L2-L5. Range of movement testing for his lumbar spine and hips was unrestricted in all directions. However, he did report pain at end-range lumbar extension and side flexion (left & right).
Muscle testing for power and length were all within normal limits. Hypermobility testing was negative. Sacroiliac joint and pubic symphysis joint testing for pain and function was unremarkable.
Stress and Back Pain
Stress also played a role in the athlete’s LBP. He frequently told his teammates that “something must be wrong with his back as he was in so much pain.” The injury caused him a great deal of anxiety and led him to avoid exercising and training for fear that it would further damage his back. He became hyper-vigilant of any lumbar sensations and reported significantly high levels of pain during running.
Low Back Imaging
A lumbar MRI failed to show any significant anatomical dysfunction, leading the practitioner to hypothesize that the athlete’s LBP stemmed from nerve pain. Furthermore, a tendency to stand and move in excessive lumbar lordosis may have caused repetitive end-range loading of the lumbar facet joints into extension. This overstimulation of the joint capsules may also have been a cause of his LBP.
How Acupuncture Works
Based on a western evidence-based model, one theory proposes that acupuncture modulates spinal signal transmission and the brain’s perception of pain through a neurophysiological mechanism. Inserting needles into the skin causes a painful stimulus that releases calcitonin gene-related peptides and histamine, causing a local inflammatory response.
This initial stimulus releases endorphins through the dorsal horn of the affected spinal segment, exerting an inhibitory effect on pain. Then cells within the spinal cord communicate with the brainstem and hypothalamus to release chemical neurotransmitters to block pain signals.
The gentle achy sensation which follows the acupuncture needle insertion, commonly referred to as “De Qi,” is said to be mediated by the activation of C-fibers and is thought to be integral to experiencing pain relief via descending noxious inhibitory pathways using endogenous opioid mechanisms.
Acupuncture Point Selection for Back Pain
The athlete in this low back pain report suffered from long-standing LBP. Therefore, the researchers devised a comprehensive approach to treatment. First, they selected GB30, SI3, and BL62 to activate central autonomic responses. GB30 is a crossing point for the gall bladder and urinary bladder meridians, historically used to treat LBP. SI3, when coupled with BL62 (DU master point), is utilized to elicit a strong Qi response.
In addition, BL23, BL24 & BL25 are acupoints that affect local tissue (site of LBP). BL24 and BL25 have a simultaneous effect at a segmental level due to their location along the lumbosacral plexus. Finally, they chose BL56 and BL62 for their segmental effect, which increased sympathetic activity. They retained all needles for 20 minutes.
Back Pain Discussion
The patient in this low back pain report was hyper-vigilant about his LBP and reported to the medical staff that he believed “running” was damaging his back. He became increasingly angry, depressed, and frustrated with his condition and with the people closest to him. As a result, the providers spent much time educating him about LBP and helping him introduce adaptive coping strategies such as pacing, distraction, and mindfulness.
The athlete responded well to these interventions but insisted on getting an MRI to put his mind at ease that there was nothing structurally wrong with his back. Following an unremarkable MRI, he finally understood that the pain he was feeling was not the result of structural damage but derived from nerve impingement.
Following his first session, the patient reported feeling “something had changed” with his condition. His lumbar spine felt “looser,” and he was happy to try low-level running the next day. He received acupuncture on eight occasions over the next 2-week period, during which his running intensity and volume gradually increased.
After two weeks of acupuncture, his anxiety and pain decreased to manageable levels during high-intensity running. He gradually began full-squad training, understanding that he would have to self-manage his condition during training sessions. He continued to practice mindfulness daily and was keen to have a weekly “maintenance session” of acupuncture to keep his pain at an acceptable level.
Acupuncture Results
Following eight acupuncture sessions, the patient’s back pain decreased from 8/10 to 2/10, allowing him to return to training and playing soccer. The success documented in this low back pain report is typical, with acupuncture’s long-standing success in clinical research trials over the past twenty years. And while the quest for efficacious treatment of LBP remains enigmatic, one must recognize the evidence presented here for the application of acupuncture for an athlete with LBP.
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Reference
Wilson J and Hallas T (2016) Acupuncture for low back pain in a professional footballer. A Case Report. Phys Med Rehabil Res 1: DOI: 10.15761/PMRR.1000125
Focus Keyphrase: Low Back Pain Report
Photo by Alexander Nadrilyanski: https://www.pexels.com/photo/man-wearing-blue-shirt-looking-on-ball-3684122/
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I came to Raleigh Acupuncture. After 1 treatment, my back felt better than it has in a year. I’ve had acupuncture before elsewhere and it has never been this effective.
I went in for a bulging disc in my back and a couple of days after the first treatment I had no pain in my back. Before treatment I had a constant dull pain in the middle of my back when at rest. The treatments were about a week apart and I completed 3 of them. It has been about 3 weeks since I have been and have a slight pain in my back but is nowhere near what it was before I started treatment. Before getting acupuncture I tried chiropractic and felt worse when I was done. For those that are skeptical like me, let me tell you that it works. I would definitely recommend Dr Mark in his ability to help with your pain.
I suffered from low back pain for years and tried many different remedies. When I came to Raleigh Acupuncture, they really listened to understand my issues. I can honestly say that they cured my chronic back pain. I didn’t think it was possible, after all these years. I highly recommend this practice. The doctors take the time and do good work.
