Pain Management
Throwing my Back Out! And Self-Treatment
I’ve arrived, folks. I’ve made it! I am finally “threw-my-back-out-doing-nothing” years old.
One morning last week, I was doing my Qi Gong practice, followed by stretching. I got up off the floor, and I felt my familiar old friend—my right sacroiliac joint—a sprain-like, nerve sensation coupled with soreness, say hello for the first time in years.
In fairness, the stage had been set leading up to this relatively non-expenditure of motion. I’d spent the week before doing an inordinate amount of housework, hosting family staying with us, much more cooking and cleaning, a bit more indulging, not to mention a home’s worth of laundry after my daughter’s Lice sequel, so my body was spent. On the day before I jumped as high as I could on our trampoline and wrestled maniacally with 4-year-olds.
I spent the next morning in pain, obsessively trying to stretch, but to no avail. It was apparently too inflamed, needed first to set in before it could heal, the way it is difficult to resolve a virus in its first 12 hours—that is before it shows itself for what kind of virus it is. By afternoon I could barely walk (unfortunately in parenthood rest is rarely an option). I surely couldn’t lift anything, and wondered if I’d make it to work the next day!
- SIMPLICITY & REPETITION: I decided to minimize, to consolidate my rehabilitative routine to just a few reliable stretches, which is important in my opinion, then did them constantly. Some physical therapists make the mistake of assigning 8 or 9 daily exercises, most of which might be beneficial, but if one or two are potentially aggravating, they might keep people on the hamster wheel of suffering, not realizing they could be doing less and getting better.
- HERBS: Once in a while we are forced off of our soap boxes and bow in humility in front of that which we resist. I prescribed myself a non-holistic formula—not individualized to my unique pattern—but one simply for inflammation in the low back and lower body. Well worth it short-term, though in fact I did suffer a side effect as a result. While excitatory/warm-natured eucommia bark probably helped my back, it did impact my quality of sleep that night. I cooked it in conjunction with pearl barley, phellodendron bark, and other blood movers to promote circulation in the lower portion of the body, then drank it while my wife warmed up a heating pad for me.
- HEAT: As we say in Chinese medicine: “Ice is for dead people”—dead bodies to be exact, but most injuries are not ones of inflammation to the degree of compartment syndrome, which merits ice. Most are minor, protective inflammations surrounded by tight, hypertonic muscles and ligaments that need relaxation, which heat provides.
- ACUPUNCTURE: While lying atop my heating pad, I obviously could not needle my own lower back, but I could use “distal points” that connect the spine, ligaments, and erector spinae muscles. I used “Small Intestine 3,” located next to the pinky joint, to treat the spine, “Spirit Bone,” located at the junction of the first and second metacarpals, for its endogenous opioid-releasing effects and connection with the low back’s complementary (lung) vessel; finally “Triple Warmer 9,” atop the forearm near the elbow, also to send blood to its paired vessel. I left the needles in for thirty minutes, basically the duration of a TV show we watched (Wednesday—not thus far recommending), and when I got up to go to bed I was about 25% better. When I woke up the next morning I was 75% better, still having not taken one single, solitary NSAID. No judgement for those that need painkillers, but in my opinion, their side effects should be respected enough to reserve them for times of actual need—pain in times when we need to be active, as opposed to discomfort in times where we can relax.
I should continue to get acupuncture from someone else for this as well. Also, I must do my daily stretches, gradually incorporating more every few days, and probably call it a year on my trampoline wrestling career. I share this story not to brag—though it’s nice to brag—but to reiterate the value of constant and appropriate physical movement and attention towards our ailments. I went from being unable to walk to a full commute and pain-free workday overnight!
Slow & Steady Heals the Shoulder
At the end of 2022 I tore my rotator cuff, not throwing a baseball for some important league game, not in some random construction accident nor act of heroism. Instead, one of my first favorite paternal pastimes was throwing my daughter as high as I could into the air then allowing her to crash down on to my palm, elbows flexed, held tight by my bicep’s insertion.
Everyone says the same thing: You blink and they’re all grown up! This isn’t exactly an example of that, but I definitely didn’t take adequate note that my favorite play toy had grown from 15 to 25 pounds, and as an acupuncture colleague who was treating me for the issue remarked: “Would you throw a 25-pound weight up and down and catch it in your palm?”
To which I replied: “It depends how adorable and joyful the weight was.”
Typical presentation of a torn supra-spinatous: Pain radiating into my deltoid, especially with my arm extended to the side and/or behind me—even worse with inward rotation (trying to pour water from pitcher into our filtration system). Occasional pain while lying on my shoulder at night, and I couldn’t throw a tennis ball, let alone a baby anymore. I had to find other ways to enjoy parenthood. I also got used to pouring water with my left arm, which was probably a temporarily decent brain exercise anyway.
My funny acupuncturist friend helped a bit—a lot of sports medicine, trigger points and gua sha techniques—though no classical points, and improvement was always temporary. For two years my intermittent, moderate pain continued, and I was terrified of the notion of surgery and determined as such to avoid it.
I continued to go for treatment, occasionally poked and cupped myself at home as much as I could (though the supraspinatous is located behind the shoulder, making local self-treatment relatively impossible), and got very diligent with my daily Qi Gong practice: Shoulder rotations, shoulder rolls, neck rolls and rotations, “silk reeling” exercises, which are great for creating unique notches of negative space around the joints for the corresponding breathwork’s oxygen to enter. “Qi moves the blood,” is one of our most ancient maxims, which means where oxygen goes, fluids follow. I couldn’t tell you when it happened any more than I could when my daughter jumped from 15 to 25 pounds, but somewhere between years 2 and 3 of my injury, enough fluids got to the tendon and joint for my pain to disappear!
Today I am unsure if the tear is still there—I’m 47, not 27, so my shoulder may never again be perfect. I continue to do my Qi Gong regularly, preventively, not only for my shoulder, but other vulnerable tendons and ligaments as well. Slow and steady heals the shoulder!
If you have chronic pain it is something that requires daily attention, an at home regiment, self-massage and gentle movement anywhere from 10-20 minutes 1-2 times a day, and patience, the “patient patient,” if you will. If you stop, if you half-ass it, or give up, you’ll likely be resigned to the “blue pill,” surgery and well… literal blue pills, either of which will eventually wear off. I often recommend tailored Qi Gong homework exercises to my patients with our sessions, but if you’d like local Qi Gong teacher referrals, please let me know—happy to refer!
What do Gout, Varicose Veins, & Neuropathy Have in Common?
What do neuropathy, gout, and varicose veins have in common? In western medicine not much, aside from being awful inconveniences, ranging from sources of extreme pain to discomfort and/or a significant cosmetic preoccupation.
For neuropathy you go to the neurologist, for gout to the rheumatologist, and for varicose veins you might see your primary care, who will likely refer you to a vein specialist. The neurologist may or may not inquire about venous circulation, and it is very unlikely the rheumatologist will ask about numbness or tingling in your feet.
But from a Chinese medical perspective, all of these conditions fall under the heading of impaired circulation in the lower extremities, caused by either weakness, inflammation, or both, leading to a misdistribution of bodily fluids, which exacerbates the former, which exacerbates the latter, and so on.
They are different in specifics only as a result of individual genetic proclivities—in fundamental mechanism they are the same. Someone with a colder bodily constitution—prone more to hypothyroid or hypotension, will be more susceptible to varicosities, whereas people with warmer body types—prone more to hyperthyroid or hypertension, will be more susceptible to gouty arthritis. The former are well advised to eat plenty of lamb and red meat, while the latter might consider being mostly vegetarian.
Neuropathies can go either way in the way of temperature, as they are more telling of issues with fluid metabolism. We find that neuropathy patients are either unusually thirsty, unusually not thirsty, or they urinate excessively or not enough. In either case, their body is clearly weakened to some degree, and it is imperative they get to sleep by 11pm, so nerves can properly regenerate.
While inadequate urination obviously leads to fluid retention which can clog neurological pathways and impair circulation, excessive urination can dry vessels of their healthy synovial fluids, causing us to feel parts of our body we previously took for granted as being unaware of.
Holistic medicine should modulate the organ function that is causing the improper excretion of fluids in addition to treating local blockages causing pain or discomfort. Easier said than done of course, as such conditions generally took many years to form, plus might be aggravated by present challenges, such as diet, stress, or medications being used to treat other conditions. However, through a course of treatment of acupuncture, herbal medicines, and dietary modifications, one should see improvement over a proper course of treatment, 120 days.
Please be discerning in your choice of clinician. If you see someone—whether east or west—who is failing to assess or treat beyond the immediate site of pain or discomfort, I would highly recommend getting a second opinion.
When is Stress Actually to Blame?
I feel like in the 20th century no one was talking about stress as an etiology for disease. Possibly I am guilty of generational egocentricity, having barely reached the drinking age by 2000. Thankfully, I had very few young friends discussing ailments and how they came about.
Still, I think it is more referenced, even over-diagnosed nowadays, especially by western doctors any time they cannot explain a symptom or its etiology, shrugging shoulders and throwing their arms up, citing the most probable suspect. “Might just be stress,” they say, which for its listener might feel an implication that their complaint is a fabrication of the mind, if not something that can only be resolved or improved once everything in life is good, or they achieve spiritual enlightenment, neither of which are in the cards for most of us this go around.
While I’m all for patients having agency over their own health, things happen that are out of our control—an accident, post-viral symptoms, genetic predispositions, or just life—when it helps to have a knowledgeable clinician to provide valuable insight and hopefully effective treatment.
In Chinese Medicine stress is said to have a drying effect on the body. This is why when people “stress eat” they crave “damp-causing foods,” such as cheese, bread, and sugar.
Unfortunately, such foods do not generate healthy fluids, nor is stress-induced dryness the kind that will drain pathogenic dampness. Instead, the drying effect of stress refers to the depletion of mucosal organ fluids, beneficial stomach fluids (anyone get acid reflux or diarrhea when over-stressed?), and/or those that lubricate our orifices, gyri and sulci of the brain. Although hydration is advisable, drinking water cannot replace these fluids.
In early stages or mild cases, the best way I know to restore such fluids is through rest, sleep, and the consumption of eggs, bone broths, or red meats. For the rest of us herbal medicine is necessary. Herbs such as ginseng or licorice for the gut, puerariae root for the head and neck, ophiopogonis for the intestines, atractylodes for the intestines, trichosanthis for the orifices, or rehmanniae for the brain and blood. Always consult a (real) herbalist before taking.
Although extensive periods of stress are never helpful, it is important clinically, to thoughtfully discern between when stress is, and when it is not the primary cause of a particular symptom. Almost everyone in modern society has at least moderate degrees of stress, yet everyone is walking around in enormously different stages of health or discomfort.
From our perspective, when stress directly brings up a symptom, it informs us that dryness is probably at its root of imbalance. The body couldn’t tolerate any further depletion of fluids. Then, and only then, is when stress is to blame—not to mention the fact that most disease is multi-factorial. Systemic dryness is likely only part of the picture, which is why many people “do all the right things”—exercise, meditation, good sleep hygiene—but still experience symptoms. Because it is almost never “just stress.”
