Just a quick question: I have a patient with Spondylolisthesis (L5/S1, with pain and numbness down the right leg as well), who finds it difficult to lie flat on her stomach for the actupuncture sessions (and was also advised not to lie on her stomach at all for her condition). I was thinking about getting creative with various types of sitting down positions, however it is hard to find a position that keeps her back relatively straight and also is relaxing. I unfortunately don't have a specialized chair for such things.
I have been taught that for back needling it is important that the back is more or less in a straight, aligned position. However, if she is uncomfortable during the whole needling session, then I fear more damage than good has been done.
What positions/suggestions would be practical for this sort of needling (as you can imagine, most of the needles are along the lower back)?
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Thank you for your helpful advice, now I have plenty to work with! I am looking forward to creating good sessions for this patient.
The most important part is that the patient is relaxed and can relax further during the treatment, the position is irrelevant when compared to the relaxation issue. While it is true that for back pain lying down is probably the best, you can treat it from the front if necessary, on the side is quite easy and if people need to sit (which often the acute cases do the first time or two possibly) that is fine as well. For sitting all I do is use a standard chair and I pull it up near the table, I set a pillow on the table and then let them lean and put their arms and head on the table (like falling asleep at a desk in school...) - this gives plenty of access to the back and the patient can get quite relaxed. Cupping and massage are all possible in this position as well.
If you have to do, don't forget about the plethora of regular and extra points for back pain that are all on the front of the body - while needling some locally is good and is my preferred way, it is not imperative. You can get very good results using points such as GB 34, GB 37/39, UB 62, perhaps with SI 3, Yaotongxue, etc. You can always needle front points and then do tuina or cupping which requires much less time laying down or in whatever position the person needs to be in...
The other way, you can let her lie on left side, bend right leg above left leg, then you can needling the EX-B8, EX-B9, Gb30, Gb31, 34, 39, 41, Ub36, 40, 54, 65 on right leg points.
I have found this to be true with a lot of patients as well (particularly where spondylolisthesis is present) and I have found that simply putting a pillow under the abdomen while a patient is lying face down provides sufficient relief. Hope that helps.
Thank you very much for your comments, I think I shall go with the pillow under the abdomen in this case, since this is the same patient that doesn't do well when receiving acupuncture not lying down.
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