Understanding Lower Back Pain

Kindel Media

There is a saying in Chinese medicine, “If there is free flow, there is no pain; if there is pain, there is a lack of free flow.”

In the case of your back pain, the “free flow” refers to the ability of your blood to circulate as intended. When your blood circulation is working properly, there is no pain. And, when pain is present, we can take it as a given that there is some kind of blockage to the circulatory system.

This may sound foreign or exotic but consider that a properly working muscle produces lactic acid as a normal byproduct of extended contraction. This lactic acid (along with other normal metabolic byproducts) is typically taken away from the muscle cells by your blood. Your blood goes from the large veins into a series of smaller and smaller vessels to get into the muscles of your back in order to clear that lactic acid and other waste products away from the muscle cells and transport them over to the liver or kidneys for filtration.

When this system works properly, there is no pain in the muscle. You can contract for minutes at a time without discomfort. However, if something prevents the free flow of blood into the muscle tissue, that lactic acid will build up along the cell walls with no way to get out. And as the muscle keeps working, more lactic acid will be produced. Eventually, a pain signal will be generated to let your brain know that there is an issue that needs to be addressed.

This is one of the reasons why you can’t squeeze your muscles indefinitely. When the muscle is squeezed, those smaller blood vessels are obstructed and they can’t reach all of the muscle tissue to clear away the lactic acid. Over time the acid collects until the muscles feel sore, and then painful until you have no choice but to relax and let your blood clear out that waste.

So if the question is, “why does my back hurt?” the short answer is because of a blockage to the free flow of blood through the area.

But what is causing this blockage?

In our 20 years of experience treating back pain at Rocky Coast Integrated Medicine, we have come to recognize 4 main causes. Here is a brief rundown of each:

1. Obstruction. This includes car accidents, slips, falls, and other traumas that lead to broken blood vessels and torn tissue. The reason for the pain is fairly obvious here so there is no need to dwell on it for too long. But it can be helpful to frame this pain in terms of obstruction to the free flow because then the goal of treatment becomes clear right away.

2. Repetitive strain. This is an obstruction to free flow caused by the overuse of the muscle. Good examples are poor posture while sitting at a computer, or continually lifting heavy objects. The mechanism of action is the same as obstruction, but repetitive strain deserves its own category because often the motion that is causing the obstruction can't realistically be avoided. For example, a new parent is going to pick up their child continuously, whether that parent has back pain or not. So the treatment strategy for repetitive strain injuries typically needs to be adjusted to focus more on pain management than on ending pain permanently.

3. External Invasion. This is a concept that is particular to Traditional Chinese Medicine (TCM), where the wind can blow environmental forces (cold, heat, dampness, etc.) into your body causing stagnation and therefore pain. If you have ever slept next to an air conditioner and woken up with a stiff neck, or if you have arthritic joints that ache in damp weather, you have directly experienced external invasion.

4. Qi or blood deficiency. We have spoken a lot about blood and its role in keeping your muscles healthy and pain-free. In TCM, we have a separate name for the physical blood that performs these actions and another name for the motive force that moves the blood through the veins so that the actions can be performed. That motive force is called qi. In TCM terms, the difference between a living and dead body is the presence of qi. There is still physical blood in the dead body (at least for a little while) but there is no life, no motive force, no qi. The reason this matters is because if there is not enough qi or blood present in your lower back, you will have pain. Causes of qi and blood deficiency include dietary issues, constitutional deficiencies, lack of sleep, drug overuse, chronic illness, and more.

If you would like to learn about how obstruction to free flow directly applies to your situation, please click here to schedule a telemedicine consult. One of our licensed providers can go through your entire history with you and help you figure out what might be causing your specific pain, and how best to treat it. If you are in the Portland, Maine area and would like to be seen in person, please click here.