Low Back Pain and Sciatica

Conditions & context

Low back pain is one of the most common reasons people seek acupuncture, and it is also among the conditions for which the evidence is strongest. Large systematic reviews, drawing on data from tens of thousands of patients, have found meaningful and lasting benefit for chronic musculoskeletal pain. The American College of Physicians includes acupuncture among the non-pharmacological treatments recommended for chronic low back pain before medication is considered, and Medicare has covered acupuncture for chronic low back pain since 2020.

Back pain has also been one of the most common conditions treated in our practice since we opened in 1999. Patients often arrive having already tried a number of approaches — sometimes with imaging findings, sometimes without a clear diagnosis, and often unsure which findings actually account for their pain. We begin with the presentation in front of us: where the pain is, what movements provoke it, whether there are neurological symptoms, and what muscular and mechanical patterns appear to be contributing.

What we treat

• Acute back strain and spasm — a back that has suddenly tightened or “locked up” after lifting, bending, sleeping awkwardly, or an unexpected movement
• Chronic low back pain — pain lasting months or years, with or without a clear precipitating injury
• Sciatica and radiating leg pain — pain extending into the buttock, thigh, calf, or foot, sometimes accompanied by numbness, tingling, or other sensory changes
• Disc-related pain — including symptoms associated with a diagnosed disc herniation or bulge
• Sacroiliac joint and pelvic pain
• Piriformis and deep gluteal pain
• Spinal stenosis — particularly when back pain is accompanied by aching, heaviness, or radiating symptoms in the legs
• Facet joint and arthritic back pain — see also our arthritis and joint pain page
• Persistent pain following back surgery, including after discectomy or fusion
• Pregnancy-related low back and pelvic girdle pain — see our pregnancy page

How we treat it

Treatment depends on what we find. Back pain may involve the lumbar muscles themselves, but the pattern often extends well beyond the place that hurts. The hips and gluteal muscles, sacroiliac region, abdominal wall, legs, and sometimes areas higher in the spine may all be relevant.

Acupuncture may be used locally in tight or painful musculature and around the affected region, while distal points on the legs, hands, or elsewhere are selected according to the presentation. In acute cases, particularly when the back is very painful to touch or movement is severely restricted, we may begin with distal treatment rather than needling directly into the painful area.

Cupping is frequently incorporated into treatment, particularly for muscular tension through the lumbar paraspinals, hips, and gluteal region. Moxibustion and heat therapy may also be used when warmth is particularly soothing or the presentation calls for it within a Chinese medicine diagnosis.

Manual therapy may also be recommended when appropriate to address areas of muscular tension, restriction, and compensation alongside the acupuncture.

Chinese herbal medicine may occasionally be incorporated into treatment for persistent or recurrent pain when appropriate.

What to expect

Acute back pain can sometimes respond quite quickly, particularly when muscle spasm and guarding are prominent. It is not unusual to see a noticeable change in pain or movement during or after an initial treatment.

For an acute episode, we may recommend several treatments relatively close together at the beginning. Chronic or recurrent back pain generally requires a longer course, often beginning with weekly or biweekly treatment depending on the level of pain and reassessing as symptoms change.

Improvement is not always linear. With longstanding pain, we often look for changes such as less intense pain, easier movement, longer periods of relief, fewer or milder flares, improved sleep, or greater tolerance for exercise and everyday activities.

If you are not making meaningful progress, we reassess. Sometimes that means modifying the treatment; sometimes it means recommending additional evaluation, imaging, physical therapy, or another form of care.

Working with your other care

Acupuncture can work well alongside physical therapy, particularly when pain or muscular guarding makes rehabilitation difficult. As symptoms settle, strengthening, mobility work, and a gradual return to normal activity become increasingly important.

If you have had imaging, bring the report with you. We are happy to work alongside your physician, physiatrist, orthopedist, neurologist, physical therapist, or other members of your care team.

If surgery has been recommended, acupuncture may also be used as supportive care before or during recovery after surgery, when medically appropriate.

When to seek medical care first

Most back pain is not dangerous, but certain symptoms require prompt medical evaluation.

Seek urgent medical care for back pain accompanied by:

• New numbness in the saddle area — the inner thighs, buttocks, or genital region
• New difficulty urinating, urinary retention, or loss of bladder or bowel control
• New or progressive weakness in one or both legs
• Fever or other signs of systemic illness
• Significant trauma, particularly in someone at increased risk of fracture

Back pain also warrants medical evaluation when it occurs in the setting of a history of cancer, significant osteoporosis, prolonged corticosteroid use, unexplained weight loss, or other concerning systemic symptoms.

When something in your history or examination suggests that your pain needs further evaluation, we will tell you.

Common questions

How many treatments will I need?

It depends on how acute the problem is, how long you have had it, and what is contributing to it. Acute muscular back pain may require only a few treatments. Chronic or recurrent pain generally takes longer. We reassess as we go rather than prescribing the same course for everyone.

Does acupuncture hurt?

Most patients tolerate acupuncture very well. Needling a tight muscle can sometimes produce a brief twitch or a deep, aching sensation. If anything feels uncomfortable, tell us and we can adjust the treatment.

I have a herniated disc. Can acupuncture help?

Acupuncture does not physically change or “put back” a herniated disc. Treatment is directed toward reducing pain and muscular guarding and improving function while the underlying condition is appropriately monitored and managed.

Should I have imaging first?

Not necessarily. Most uncomplicated low back pain does not require imaging at the outset, and findings such as disc bulges and degenerative changes are common even in people without pain. Imaging becomes more important when there are neurological deficits, red flags, significant trauma, or symptoms that are persistent or not progressing as expected.

Can I be treated during an acute spasm?

Yes. In fact, acute spasm is a common reason people come in for treatment. When the back is too sensitive to work on directly, we can begin with distal acupuncture and treat the surrounding areas as tolerated.

Will I get cupping marks?

Cupping can leave temporary circular discoloration that usually fades over several days. We will discuss it with you before using cupping, and it is never required.

Can I keep exercising?

In most cases, remaining gently active is preferable to prolonged bed rest. What you should do depends on the cause and severity of the pain, and we can help you think through what is reasonable while you recover.

Is this covered by insurance?

We are out-of-network and will check your benefits on request.