The manifestation of backache can be put down to a vast range of reasons, but often it is the result of more than one irritative factor which can find a natural placement in the thoracic-lumbar-sacral regions of the back. In effect the greater part of symptoms can be put down to imbalances in vector muscles which then cause degenerative conditions in the spinal column. The functional unit of the spine contains all tyhpes of tissues necessary for its function, some of which are pain sensors and therefore can become sources of pain. On all the extension of the spine we have the presence of longitudinal, anterior and posterior ligaments, the interspinous ligaments attached to the vertebrae etc, that join the various processes and body of the vertebrae, as well as the presence of the spinal dura mater inside the vertebral foramen, from which the nerve roots come out through the transverse foramen. All these structures can represent an important source of irritation due to an increase in mechanical force.
The fascial tissues of the thorocolombar musculature merit special consideration, in particular deep muscles and the fascia of the quadratus lumborum, psoas and diaphragm. This fascia is attached to some ribs, transverse processes and the bodies of the vertebrae, exerting a certain degree of tension and tortion following very precise lines of force. The fascial tissues then take part in spinal flexion and re-extension, as well as maintaining a static, erect stance. This knowledge should give us an opportunity to reflect on the importance that muscular tension, fascias and posture assume in maintaining a healthy spine.
Erect posture with arms which hang freely at the side of the body or crossed in front of it, is a universally-accepted standard posture, whilst sitting on a chair is less so. In fact, this latter type of posture or attitude can be considered of recent origin as at least one quarter of the population of the world still use a squatting position, whether for resting, eating or working. In the West posture attitude has slackened in the course of the last century with the exponential increase in sedentary activities and the ready availability of soft furnishing which has taken the place of hard chair with straight backs.
Postural attitude enormously influences the health of our spinal columns, given that maintaining incorrect posture can provoke weakness of the posterior longitudinal ligament, irritation of soft tissues, muscular hypertone with an increase of weight bourne by the vertebral bodies and the intervertebral discs.
Psychological factors also contribute to bad posture. Our feelings are reflected in the way we move and react spatially. Consciously but more often unconsciously, we assume and maintain the posture which reflects our inner self. Masunaga, stated: “In human beings posture reflects the attitude of the person and reveals their intention, even before they go into action. Posture changes with the movement of Ki, so that the Ki itself can be observed in the posture of the person.” (According to Masunaga many energetic disharmonies can be linked to back pain. Very often we have an involvement of the large intestine but it is very interesting to see that for Masunaga a meridian whether in kyo or jitsu condition can give rise to back ache. Sciatica can often be linked to a state of kyo or jitsu of the bladder meridian. The large intestine is not only linked to back pain but also to hip pain. Masunaga, in opposition to TCM, has given a lot of importance to small intestine meridian conditions (kyo or jitsu) in relation to lower back pain).
The impact that emotional stress has on us should not be undervalued. This is often expressed by a change in posture which increases the weight bearing load on the spine. Also all the postural patterns adopted in the first few years of life can be very difficult to correct or change in adulthood. The tissues involved become structurally the anagram of our present psychological-postural situation and they seem to retain memories of our most important traumas and emotion.
Our spinal column bears the weight of all our traumas and experiences since birth, marking the body with scars that can’t always be seen but nevertheless can influence the equilibrium of the entire receptive nervous system. A depressed person, for example, will usually adopt a posture which reflects their emotional state, with the head falling forward, with an increase of the thoracic curve (kyphosis) and shoulders hunched forward. This attitude expresses that the person is carrying the weight of the world on their shoulders, feeling too tired to cope with standing up straight. This position is the expression of severe fatigue but to maintain this posture actually requires the expenditure of a lot of energy. Very tall children sometimes adapt their posture to lower their height to fit in with their peers. Adolescents also have difficulty accepting their changing sexual function and will assume a protective posture to “hide” their developing bodies. All types of incorrect posture, however generated, require an increase energy needed to maintain them and to maintain the upright position due to the force of gravity. Energy which could be used to improve their life situation.
A healthy spine should, by definition, be free of pain, whether in the static or moving state. A person should be capable of standing upright, sitting, bending, standing up, turning round and lying down in perfect balance and without any pain. The presence of pain indicates that at least one of the tissues has been abused or traumatised. Pain represents the alarm bell which warns of possible damage to our tissues.
This type of stress is being interpreted via a transmission of impulses by the sensitive routes to the spinal chord and then up this to the cerebral cortex where the symptoms and pain become evident to the person. The most important nerve in the functional unit is the recurring nerve of Luschka, but also there is without doubt a transmission of sensation by the somatic nerves of the anterior and posterior branches through the dorsal ganglion. The intervertebral disc, contrary to popular belief, doesn’t contain sensitive nerve endings. Only recently microscopic nerve endings have been identified in the outer layer of the disc itself and the nerve which supplies contact is the recurring nerve of Luschka. The vertebral bodies also lack these sensitive nerve fibres and generally do not produce pain unless fractures, infection or tumours are present. The periosteum, however, has sensitive nerve endings and can become a site of irritation. The longitudinal anterior posterior ligaments can both be capable of inducing pain sensation because they are supplied by the recurring nerve of Luschka and by the sensitive nerves of the autosympathetic nervous system.
The condition of our spines reflects what we are and the way we live. Are we rigid in our choices, with ourselves and with others? Are we capable of taking responsibility for ourselves or, on the contrary, do we take on the weight of other people’s responsibilities? Or are we the type who follows their own path, ignoring the things that happen around us and ignoring what our bodies are trying to tell us?
Our spinal column takes the weight of our past experiences, positive or negative, it absorbs our physical and emotional traumas and distributes the increase of stress and postural weight-bearing. A flexible spine is capable of managing the demands of the living environment and can absorb any trauma it encounters without being damaged, flexibility gives us capacity for bending and adapting without danger of lesion. To have the right degree of flexibility signifies being capable of facing life and taking responsibility for ourselves, having the necessary strength to accomplish our projects and realise our ambitions. We must develop the right type of awareness that will enable us to keep ourselves centred so as to intervene immediately the first signs of imbalance appear.
LOWER BACK SYNDROME
Lower back syndrome can have different causes – in fact the term only defines a generic lumbar pain.
The reasons for such pains can be many, and therefore the intervention and procedures to be applied are varied. Just as in orthopaedics lower back syndrome can have many causes, also in Shiatsu there is no one meridian that treats it.
The most common are:
Ligament problems
Posterior articulation problems
Disc problems (protrusion)
Nerve root irritation: slipped discs
inflammation
Herpes Zoster
Neuritis
Rheumatoid arthritis
Visceral disturbances: Intestinal problems
Digestive system
Gynaecological problems
Prostate problems.
Degenerative problems: Arthrosis, stenosis of the vertebral canal
Muscular contraction
Metabolic illness (osteoporosis)
Tumours
Other factors.
LIGAMENT PROBLEMS
meaning pain related to the small and long ligaments that limit the spinal column. For example, ligament problems can cause pain when a sufferer bends forward. Most of these ligaments, in fact, are situated on the posterior aspect of the spine and when flexing forward they arestretched, consequently if this area is inflamed pain will result. All this can be caused by weight bearing, stress, incorrect posture or by brusque movement or a tear.
POSTERIOR ARTICULATION PROBLEMS
Those articulations which guide movement: rotation or a very sharp movement can provoke a block. If posterior articulation is the cause this is attached to a specific movement and, in these cases, a well done stretching exercise or a manipulation can determine the speedy resolution of the problem; the cervical tract can also be involved.
DISC PROBLEMS (Protrusion)
For a whole series of reasons, physical, postural, overweight, the disc is squashed and tends to slip forward or backwards. The spinal column is also made up of intervertebral discs: let us remember that behind this is the longitudinal posterior ligament, that, unlike the anterior ligament, is extremely sensitive. When a protrusion is present the ligament will also contribute pain thanks to its many nerve endings which are sensitive to minute movements. As time goes on the ligament gives in more and more, and at a certain point the pain suddenly becomes much stronger, the disc has pushed the ligament up to the vertebral canal which is surrounded by the dura mater, which is a impermeable “sock” that surrounds the brain and the marrow arriving in the sacrum. Under the dura mater (and the arachnoid) is the liquor and then the marrow, it is rare – fortunately – that the disc arrives at the marrow,. In these cases the pathology is extremely serious. So it begins with a constant pain, from the ligament, then after the disc slips even further back until it touches the dura mater and we have the classic back lock when the pain is strong and fixed, in neurophysiology it is defined as “dural pain” (because of the involvement of the dura mater).
NERVE ROOT IRRITATION
A slipped disc can cause a compression of the nerve root. The pain goes along the nerve, often the sciatic nerve, with classic pain along the leg, to the calf muscle, with pins and needles and loss of sensation.
ARACHNOIDITIS is fortunately quite rare and is an inflammation of the internal membrane that causes paralysis of the lower limbs, with the loss of use of the nerves of the leg and cannot be treated only by Shiatsu.
HERPES ZOSTER rarely causes lumbar pain, much more frequently the pain is dorsal. In these cases the meridians to choose are Liver and Colon because they come under inflammation of the peripheric nervous system and the Colon is “the official capable of transmission”.
VISCERAL DISTUBANCES
In orthopaedics it is known that intestinal and digestive problems and gynaeological problems can cause back ache.
Those suffering from intestinal problems will feel reflected pain in the lumbosacral area. Sciatica of the left side of the body is often linked to the intestines (pseudo sciatica), while right side sciatica is more often linked to mechanical/disc factors. A slowdown of intestinal activity can give chronic lower back syndrome.
It is evident that a very high percentage of patients affected by lower back syndrome (about 80-90%) also complain of intestinal disturbances generally linked to constipation.
We must allow that for a slowdown in the evacuative capacity we mean all the cases in which there is not a precise correlation between the number of times someone eats and the number of times that it is eliminated. In practice, if I eat two or three times a day I should eliminate the same number of times. If this doesn’t happen it means that my intestine is not functioning perfectly.
More often than not a person is satisfied with their “regularity” (I regularly go every two days!) and doesn’t realise that they are in a condition of intestinal hypofunction. This stasis of faecal material is neither useful nor salubrious for the condition of the individual.
At this point occurs the classic question: which came first, the chicken or the egg? Was it a back problem that interfered with the intestine, or vice versa? There is no one answer: in some cases of ananmesis the lower back syndrome came after the intestinal disturbance, in others (less frequently) the back problem was present before.
What is certain is that intestinal function and lumbo-sacral spine are closely connected. Here are three possible connections:
1) the correlation between the nerve supply of the visceral organs and the spine is represented by numerous anastomosis between the dorsal and ventral branches and the communication branches of the autonomous nervous system.
2) the vicinity of extremely algo-sensitive structures with very silent neuro-physiological tissues at the cortical level.
3) the difficulty that comes at the thalamic level in sending to the somato sensitive cortex an exact localisation of the seat of the pain (so-called “thalamic confusion” )
These correlations are well known in neurophysiology: the studies of Head (from which the denomination “head zone” comes) started in the 1920s.
We need to remember that an incorrect relationship between intestine and back can be responsible for chronic disturbances
In the first case we find ourselves confronting a classic, more or less continuous, lower back syndrome, which is not disabling although periods of drug treatment are required.
In the second case we are talking about a true sciatica problem, most of the time we know that it is left side, with patients stuck in bed and to whom anti-inflammatory drugs have made little difference.
Let us recall the different nerve supply from the vegetative nervous system to colon dx (pre-ganglious fibres with bulbous centres) and to colon sx (centres of S1 and S2).
Numerous American studies for training chiropractors (Goodheart, Wlather, Thie are among those best-known in Italy) up until the end of the 1960s detailed the disturbances which could set in as a result of anomalies of the ileococcal valve. One of the most common disturbances to arise is a syndrome of the intervertebral disc.
The reason is found in the retention of fluids which comes about in the body to reduce the effects of accumulated toxins because of the incorrect function of the ileococcal valve. It related swelling of the intervertebral disc can be the cause of pain in the lumbar zone and of irradiation of pain along the sciatic nerve. If we analyse the nervous structures involved in lumbar pain the over-position with nerve supply related to intestinal function immediately becomes evident (D6-11 and L1-L2).
We can also connect ourselves to the exchange of information and to the influence that exists between the various brain communication pathways and the pathways of the vegetative nervous system itself.
I would like to call attention to the fact that nerve structures (and hence extremely sensitive) are adjacent to the large colon pathway : a faecal stasis could provoke a degree of fermentation with a light but continuous inflammation of the viscerous organs. This altered state is definitely registered by the receptors but doesn’t arrive at the cortex (i.e. to US) because of the various inhibitions that, starting with the marrow, affect the visceral sensitive nerve pathways.
On the other hand another nerve structure sends communications to the brain that are much more direct than the others, the correct algoceptive stimuli. Therefore WE (the cortex) feel a pain along a peripheral nerve referenced to the trunk or and a lower limb but we aren’t conscious of the pain ability of the tissue structures that are the real cause of the pain.
If we refer to the “gate” concept we see how to correlate lumbar pain and the function of the colon. Imagine that the normal threshold after which we become conscious of the pain is 100, algocentive stimuli coming from the viscera can arrive at 70. Enough that a small stimulation of the spine provokes a discharge of 32, without any real reason, and we find ourselves in the condition to say “my back aches!”
We can also reverse the concept. To a back that chronically produces algocentive stimuli up to 72 we add a blocked intestine that produces 35 stimuli and there we have, without making extraneous movements, a pain along the sciatic nerve.
Therefore, in the treatment of people with chronic lumbar pain and also when faced with a strange sciatica it makes sense to ask ourselves (if we are capable ourselves or ask someone who knows) which are the real conditions of colonic function in that person.
The digestive system can create lumbar pain that rarely descends below the belt. The points linked to the digestive system are at the level of the 11th and 12th dorsal vertebrae and the irradiation of pain fromD11 (Spleen/Stomach) is from the spine to the pelvis, to the iliac crest.
GYNAELOGICAL DISTURBANCES
Very often we are in the presence of pain just before or during a period, depending if we are confronted with an excess, stasis or emptiness situation. There are however cases when pain can appear when women are ovulating, and this is because when the internal parts are activated, for a series of neurophysiological connections, there is a neurological activation of the corresponding nerve at an energetic level. In fact, the control of the genitals is linked to lumbo-sacral plexus in proximity of common sites of hernias. This gives the impression that the genitals could be linked to the sciatic nerve, which is not the case. Sometimes there is interference from the coil. This gives a type of pain which is not linked to strain factors and usually there is not pain down the legs. On the x-ray nothing will appear other than a small sign on the superior part of the iliac crest and this is the radiological sign for the coil. This is copper wire put along Chong Mai , copper from the energetic point of view can influence the spine. In a case like this the only solution would be to try to treat Chong Mai itself. For those who follow Masunaga the Spleen and Small Intestine meridian can often be involved. One useful point would be Sp4, if the condition doesn’t improve a visit to the gynaecologist should be considered for the eventual removal or substitution of the anti-conception device.
PROSTATE PROBLEMS and enlargement of the prostate can be a cause of reflected back pain.
DEGENERATIVE PROBLEMS
Arthrosis or stenosis of the vertebral canal, ie when the canal, whether for constitution reasons or for a series of other motives, is inflamed, a bulging in this area can push against the vertebral canal itself very often causing severe pain. In these cases whether with Shiatsu and especially with moxa we can intervene with good results. Usually we stimulate the sacral area at the foramen levels. Stenosis of the vertebral canal has typical characteristic signs such as pain that comes after a few hours of standing, pain that travels down both legs, like most hernias, which are either left or right. The precise diagnosis is possible through MIR scan. Energetically this is a type of disturbance which comes from emptiness or kyo.
MUSCULAR CONTRACTION
Muscle contraction is one of the most common cause of back pain and often these conditions can cause symptoms that at first can be interpreted as very severe. One of these conditions is given by the piriformis syndrome that manifests it’s self whith a strong pain like sciatica. This condition can be treated with GbB 30 which has a decontractig effect on the piriformis.
For muscle strain or tears we can use moxa on GB34.
METABOLIC ILLNESS
From an energetic point of view osteoporosis can be linked to kidney condition and because bones can be linked to our life path, a very important point linked to the jing and to the yuang qi is CV4. Osteoporosis can also be related to problems with the earth element and ST36 and SP6 should be used to nourish the yin.
TUMOURS
This condition has to be taken very seriously and each case has to be assessed on its own merits. However, we can still treat recent tumours but it is best not to treat any subject with severe or advanced forms of tumours or metastesies.
Most of the above mentioned conditions can be succesfully treated with Shiatsu, I personally find Shiatsu one of the best techniques to alleviate lower back pain sindrome. It’s clear that we can have many diferent shiatsu strategys and as we know, we ca find many different meridian conditions, but most important is the decontracting function that pressure has on the state of the back as a whole.
As practitioner we must strive to restore an ideal healthy back condition by improving flexibility, correct posture and restoring a proper muscular condition and function. I personally find very usefull treating with particular attention the back meridians, specially the bladder meridian untill I feel that a proper energetical condition is restored, but above all I find very usefull working with gradual whole body stretch, in order to promote a proper range of motion of the entire spine and improve the response of the sensory nervous system. In conclusion, we can see how important it is to treat the whole person when treating back pain as this frequently stems from another body system. I hope that you will be interested in studying this fascinating subject further during your practice of Shiatsu.
by Massimo Cantara
