Lessons From Over a Decade of Acupuncture Practice: Lower Back Pain

by Dr Rex Ye, Acupuncturist and Visiting Master at Ayurma, Four Seasons Resort Maldives at Landaa Giraavaru from February 13th to 28th, 2026.

In over a decade of treating patients with acupuncture, lower back pain has become one of my areas of expertise. Regardless of how severe the condition, most patients experience significant relief after their first acupuncture treatment. It is not uncommon for patients who arrive in wheelchairs to leave the clinic smiling and walking unaided.

To understand why back pain is so common, let’s have a look at some of the reasons we’re prone to this condition.

Common Causes of Lower Back Pain

1. Congenital Structural Weakness

Research indicates that back pain is an inevitable part of life for many individuals. To understand this, we need to look at the structural characteristics of the human body.

Bipedal locomotion is a defining feature of humans. In quadruped mammals, the skull protects the brain, ribs protect the thoracic cavity, and muscles encase the abdominal cavity. These animals walk on all fours (hence ‘quadruped’), with their spines parallel to the ground. Their back muscles primarily coordinate limb movement, which increases load significantly during activities like running.

In contrast, human back muscles are mainly responsible for maintaining posture, experiencing significant load changes when transitioning from lying down to standing, but minimal changes while walking or running. As a result, human back muscles are particularly prone to strain. Phrases like “carrying a heavy burden” or “shouldering great responsibility” aptly describe both mental and physical stress.

By middle age, the back muscles face additional challenges. If a person lacks discipline, weight gain and changes in body shape – particularly an increase in waist size – affect balance and increase the load on the back muscles.

Increased physical activity at this age often leads to common complaints of backache. With relatively weak back muscles and heavier loads on the lumbar vertebrae, even minor triggers such as twisting, lifting heavy objects, or exposure to cold can cause significant damage. This damage could affect the intervertebral discs, muscles, or even the vertebral bones, resulting in symptoms of lower back pain.

The inherent weaknesses in our structure due to bipedalism make this a congenital issue or a ‘health condition that is present before or at birth’.

2. Acquired Functional Trauma and Blood Stasis

Moving on to acquired factors, let's consider childhood and young adulthood, where growth and development dominate. During this period, injuries are the primary concern.

For instance, fractures in one leg or foot require months of rest, during which the other leg bears more weight, leading to unequal muscle development post-recovery. Even minor repetitive injuries, such as recurrent ankle sprains, can lead to habitual overloading on one side. Uneven leg strength or length affects pelvic alignment, predisposing individuals to lower back discomfort. Women may also experience menstrual cramps as a result.

Traumatic injuries typically involve inflammation marked by redness, swelling, heat, and pain. Incomplete absorption can lead to chronic issues, affecting local blood flow and causing discomfort during damp weather.

Over time, blood stasis (slowed, pooled, or obstructed blood flow) worsens, causing more pronounced pain or spreading to other areas, potentially triggering additional health problems. Treatment for these conditions is relatively straightforward, involving blood-activating and stasis-resolving medications or external therapies.

Acupuncture, which follows the principle of “where there is free flow, there is no pain”, offers quick results.

Awareness and prevention are crucial; prompt treatment after injury helps avoid long-term complications.

3. Acquired Functional Damage Due to Dampness

As we move into middle and old age, health conditions reflect years of accumulated lifestyle habits. Over the past few centuries, human lifestyles have changed dramatically: food availability has shifted from scarcity to excess, and physical activity has decreased with prolonged periods of sitting.

In recent decades, gastric cancer has declined while colorectal cancer has risen sharply, reflecting a significant shift in patterns of digestive tract disease. This shift highlights the impact of nutritional excess on the digestive system.

The large intestine consists of four segments:

• the ascending colon starting from the lower right abdomen, moving upwards

• the transverse colon extending horizontally from right to left at the navel level

• the descending colon moving downwards from the upper left abdomen

• the sigmoid colon leading to the rectum and anus

  
  

The ascending colon must work against gravity when standing, making it easier to function when lying down – the reason most people tend to have bowel movements in the morning.

If the gastrointestinal tract is overloaded, it operates continuously, exacerbated by prolonged sitting, increasing the burden on the ascending colon. If waste cannot be promptly expelled, intestinal fluids accumulate in the lower right abdomen.

This accumulation results in increased internal dampness, affecting abdominal and pelvic organs, as well as the right-side back muscles, leading to discomfort. As fluid levels rise, they collect in the lower back at night (due to the greatest difference in muscle tension between standing and lying), causing morning stiffness and heaviness that improves with activity.

Four Key Ways to Reduce the Risk of Lower Back Pain

1. Work with Your Upright Body, Not Against It

• Maintain a healthy waistline to reduce strain on the lumbar spine

• Strengthen postural muscles gently through walking, swimming, Pilates, yoga, or Tai Chi

• Avoid sudden twisting or lifting, especially when tired or cold

2. Address Old Injuries Before They Cause Issues

• Don’t ignore recurring aches after injuries, even if they seem minor

• Seek treatment early for subtle imbalances (acupuncture, manual therapy, or physiotherapy) to restore balance and circulation

• Pay attention to asymmetry — one hip tighter, one leg weaker, one side aching more

3. Keep Blood and Energy Moving

• Explore gentle daily movement and avoid long periods of sitting

• Keep the lower back warm, especially in cold or damp weather

• Acupuncture, massage, cupping, or heat therapy can help to improve local circulation

4. Reduce Internal Dampness Through Lifestyle Habits

• Eat regular meals and avoid overeating, especially late at night

• Limit overly rich, greasy, or sugary foods

• Take short walks after meals to support digestion

• Avoid sitting for long stretches; stand up and move regularly

Summary

Lower back pain is rarely caused by one single factor. It reflects a combination of structure, movement habits, old injuries, circulation, and lifestyle choices.

Acupuncture can quickly alleviate symptoms, and when combined with simple therapeutic exercises, it can effectively resolve lower back pain. By caring for your body holistically – through mindful movement, early treatment, balanced nutrition, and regular circulation – you can significantly reduce your risk of developing it and minimise its impact if you do.