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Bulging discs L4 right side, L5 left side, numbness felt under pad around little toe, sciatic pain


#1

Hi there,

I am treating a man who injured his back 3 years back twisting and lifting a freezer out of his car.causing bulging of the discs below L4 right side and L5 left side. With physical thereapy and exercise, his condition improved, but he has always been battling with sciatica and bouts of pain. 2 weeks ago, his back went again and he managed to limp to hospital as he was close where they gave him an epidural injection which seemed to work, but after 3 days the pain came back, but this time he had total numbness in his left foot.

He is a friend and came to me after a return to the hospital who just sent him home and asked him to make an appointment to see his doctor. He then heavily iced the area to the point where he gave himself an iceburn, but he felt this helped as the swelling went down and the pain was much better.

His doctor has booked him in for another epidural now coming in from the side, but this will be in another 2 weeks so has asked if I could help in the mean time.

I have never worked on acute case like this before, (bad flare up) but after my evaluation:

intitial pain was sharp and stabbing, after excesive icing now the pain is dull ache and stiffness in back, actually he has o pain in back just the sciatica and num,bess in left foot (S1 nerve area). So treat to cear stagnation of Qi and Blood and Cold Bi.

he had dark circles under eyes, very stressed busy person, both rear positions on pulse was very weak and deep ( tonify KD to strengthen back) . overall slightly wiry feel. ( clear stagnation)

1st treatment:

BL23, 25, 26, huatojaji L4, L5 , BL54, GB30 (affected side), BL40 BL57 (AS) 58(AS) 60(AS)

heat lamp over affected area, electro 25-26 dense disperse, huatjaji lowfrequecy (AS), then usual for my for sciatica.

feeling came back to foot within 10 mins, felt great after, but within an hour numbness came back but now like a nugget under lttle toe,and sciatica. Pain was the same.

2nd treatment pretty much same but I did electro then moxa on huatojaji (AS L5),

again same within an hour the pain just returned as bad, the promising note is the numbness has reduced tov a nugget under the little toe ( still S1 nerve dermatone)

he has come 2 times week, when I was in china I saw daily treatment for this type of flare up, unfortunately he can only come max 3 times a week, and as he is friend I am not charging him much.

Is there more I could be doing here? I could add du 4 extra point on Du under L5, BL52 etc K3 I generally try and not use too many needles.

I ask because I have only been qualified for less than a year, and normally I see pattern with all back related issues of great improvement after a few days coming back a little but a gradual improvement with each treament.

many many thanks

Edward

4 gates with ren 4 ( could do at end for 10 mins)


#2

I have also asked him to use hot water bottle.

X


#3

I generally far prefer cupping over estim and heat in most cases. Heat in particular can aggravate low back pain when there is heavy nerve involvement (vs. more muscular where it can be helpful). What you need is space not necessarily just circulation.

I think your points are generally fine and twice a week in my opinion is more than enough (too much is often counter-productive in my opinion as it doesn&#39t allow the body time to heal). I would probably do something like this:

UB 62, UB 60, GB 39, UB 40, GV 20, GB 20, huatuo at T1 (bone), T7 (circulation lower abdomen/leg), L3, L4, L5, UB 32, + local points.

After needling, use tuina to open up low back if you know it or at least stand at the head of the table (above patients head) and lock your thumbs into the low back (inside of the psis near the sacrum) and push as far forward as you can (i.e. decompression) - then cup the low back from T9 down into the sacrum.

A couple times a day if the patient is fit enough have them hang from a pull up bar or anything they can hang from for just 10 or 15 seconds - to naturally decompress the back (this does more than you might imagine).


#4

Thank you for your reply Chad.


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