Shiatsu for Chronic Pain in the Lower Back
Wilfried Rappenecker

Not all back-pain is identical. Even though they are common patterns, and typical causes almost always play a role in their development, the arising of each pain in the lower back is due to a singular concrete life-situation with individual emotional and physical (or in other words energetic) patterns. According to my experience, it is the understanding of the specific situation of each person concerned that makes the treatment more sensitive and more effective. With this article, I would like to encourage you to open up to the particularity of the life-situations of each client with chronic ailments in the lower back, and to explore how these life-situations manifest physically and energetically in the body.

This is the outline of the topic of this article: Shiatsu for chronic pain in the lower back (with or without radiation to the legs). Necessarily, this article is subjective and incomplete because it is based on the experience of my own practice, and on the way I practice Shiatsu. It excludes important subjects in the treatment of back-pain such as accurate meridian treatment according to one of the energetic body diagnosis systems of Shiatsu, which can be very effective. The article is not focused on acute ailments of the back caused by the singular appearance of lumbago, for example. Furthermore, I will not talk about acute or chronic pain in other parts of the back. However, the understanding prescribed in this article may be useful for such ailments as well.
 

Pain is Subjective

We are frequently able to become aware of the individual life-situation in which back-pain developed even before “laying hands” on the patient for the first time. The person affected carries around his or her history, and important parts thereof can be openly read (identified) by any interested practitioner. For some, the focus lies on the physical pain; for others, the suffering exceeds the physical level.

Pain belongs among the most subjective phenomena in life. Objectively, it does not seem to exist. The same physiologically evident nerve impulses may be experienced by one person as intolerable pain, whereas another person is able to ignore it or even find enjoyment in it. The more a person suffers from his ailments, the more pronounced the emotional component is (in most people). This emotional component can be so predominant that the physical pain may appear inessential to an outsider. There are more than a few cases in which this plays a central role regarding the maintenance of suffering.

Therefore, it is rewarding to keep an eye open for the moods of our client. In my opinion, we create our pain; it does not just happen to us. One good and simple method towards approaching the reasons why someone needs to create his energetic patterns and his pain consists of laying the hand onto the most affected area, and simply waiting for what it may tell us. If one does not forcefully try to experience something, but remains open for unexpected and exciting stories, one will often find oneself in the “middle” of things actually happening.

As an example: all at once it will become obvious that a pain due to continuous, pronounced straining of the lower back (in the case of a small and energetic woman), is really caused by the fact that this woman believes she needs to tense up in that area to be taken seriously or to be acknowledged (to stand on her hind legs, so to speak). In another case, that of a man with chronic weakness in the lumbar area, the cause may be due to the subconscious conviction of never having received enough support through his environment. In a third person suffering from tormenting pain, which has acutely increased, the practitioner touching him may have a clear perception of tremendous rage.
 

Strength to Meet Life Immediately and Fully

We can see an elementary task of the lower burner (on the back side, the body’s lumbar and sacrum area belong to this, and on the front side, the whole Hara) as meeting all the events in life immediately and fully. It seems to me that the underlying pattern in most cases of chronic pain in the lower back is the attempt of the person suffering not to live fully. Rather, such a person seeks to numb experiencing and feeling in this area, and even tries to avoid it as much as possible.

If the lower burner is not allowed to do its work (fear and avoidance patterns play the biggest role in this), other body areas will take over. Like for example, the middle burner will oftentimes take over with the energies of earth and wood. The chest will often hold back emotions of the fire and metal elements. And, almost always, the shoulders will take some of its functioning. The shoulders anyway often seem to be doing the work for all three burners.

The becoming un-lively in the lower back one can already see oftentimes, as a beginning process, in children that are 3 or 4 years old. This indicates that very early experiences respectively brought along (made) patterns of the experiencing, and are at the core of the change towards un-liveliness. Typically, this in the long term, leads to the life energy of the lumbar area moving away to substitute places. Left behind is an inactive and weakened zone, which longs for a supporting and warming hand. Because it mostly does not get what it longs for, the area has to tense itself in the muscles, the fascia, and the joints, to preserve a (reduced) stability.

Such tensions can be a cause for extremely strong and, also, less strong pains. In the case of acute Sciatica, complaints include an acute blockage joining the underlying basic pattern (many times out of the wood element), and an unlivably painful movement of the Liver Energy. I suspect that the pain is only seldomly caused through an energetic weakness, or emptiness in the lower back, alone.
 

The Releasing of the Tension Alone is not Enough

So, the goal of an effective Shiatsu treatment will be to stabilize and harmonize the area in such a way that, on the one hand, the tension (as immediate cause of the pain) becomes less, and, on the other hand, that the un-liveliness, which underlies the tension, starts making room for the beginning of reawakening. The latter will only happen if the underlying un-liveliness surrenders to integrate the weakened area into the flow of the whole back.

Just releasing the tensions is relatively easy, and often also leads to temporary relief of the complaints, sometimes even complete freedom from pain. Nevertheless, by itself, and without activation of the “un-lively” areas, it can lead to bigger weaknesses, and through this, endanger the entire area. The “reanimation” is the real, and sometimes lengthy, process being undertaken. This process can be triggered and gone through by the person involved, with the stimulating support of the therapist.

By the way, an energetic emptiness and feeling of exhaustion in the lumbar area only rarely means that the kidney energy of the person is so exhausted that it is not capable to restore vitality and strength there. Rather, it is a local imbalance, and wrong use of the energetic and physical body. Under good circumstances, the person concerned may be able to balance these fully again. But, this may take some time… maybe even years. And, first of all, it requires a strong will from the person concerned to really change something. As a rule, it will also not be enough just to receive Shiatsu. Our client will, sooner or later, have to take responsibility for his lack, and become active.
 

Slipped Disc - Western Medicine’s View of its Causes

In my opinion, western medicine has only partially understood the process that leads to back pain. It understands the pain in the lower back, for example, as being a result of tension and irritation of muscles and ligaments (of which there are many in the region, forming a unity with vertebrae and pelvic bones). This can arise through chronic misalignment (about whose cause one doesn’t think much), the pro-lapsing of an over strained disc, or through a natural anatomic irregularity - such as malformed vertebrae, an additional lumbar vertebra, or gliding vertebrae.

If there are additional, painful radiations into the legs, this will be explained with the irritation of one or more spinal nerves. If the radiations are defined (and maybe even go with a disorder of the sensitivity of the skin, and a weakness of certain leg muscles), it is suspected that the cause of the irritation is a nerve that is trapped or pinched by a disc that sticks out. This is called a protruding disc, a slipped disc, or a prolapsed disc (if the disc is damaged and the fiber ring breaks). Spinal nerves come from the spinal cord, and go to the peripheral structures of the body. While leaving the spine, they must pass through two vertebrae arches; here, they can be trapped by a protruding disc.

Sticking out, slipped discs, and trapped nerves can often be proven in the Computer Tomograph (CAT scan) of the spine. What does not fit this explanation model is the observation that, quite regularly, there is a lot of pain, but no slipped discs or trapped nerves can be seen (or nothing significant at least). On the other hand, sometimes definite causes are found, and yet they are not the source of the person’s complained about pain. The model of the prolapse explains the radiating pain, but it isn‘t convincing regarding an explanation for the pain in the lumbar area itself.

Manual medicine (physiotherapy), which is an official discipline of the school of medicine, but still is not fully recognized by the people in charge, knows (just like Shiatsu) the term of blockage. This describes a reaction series of malfunctions in the muscles, joints, nerves, ligaments, and fascia, and is, as a functional term, similar to the concept of the energetic blockage in Shiatsu. Different explanation models are discussed in “manual medicine” regarding what exactly is a blockage in the body in the understanding of the school of medicine. So far, none of them has been recognized as a serious alternative to the most mechanical of all models: the one of trapped nerves.

It seems to me, that only in a relatively small amount of the cases, prolapsed/ slipped discs are the direct cause of pain in the lower back. I find the Shiatsu and TCM propagated model of an energetic blockage as pain source to be more plausible (and in Shiatsu, more usable). On the other hand, a proven disc prolapse probably indicates a long term energetic weakening and an imbalance, not only in the area, but also in the whole person; that should be taken seriously.

Whatever might be the cause, I think it is important to let chronic lower back pain be checked out by a medical doctor before treating it with Shiatsu if the back pain goes together with disorders of the sensitivity of the skin and/ or weakness of specific muscles in the legs. It might be that the person needs intense care from a doctor or therapist with solid experience. In addition, for juristic or legal reasons (that means self-protection for the Shiatsu practitioner), these patients should be forwarded to other professionals. Of course, in the case of a slipped disc, Shiatsu treatment can be done with success. I think, though, in such cases the treatments should be reserved for experienced practitioners. Especially in the situation of an acute change for the worse of chronic pain, I recommend that “if in doubt,” not to treat, and possibly to forward the client to a more experienced practitioner.

The back has many faces. The energetic patterns and life experiences that can be the root of chronic pain (as mentioned in the beginning), can be found again in the different sections of the back. Of course, if one looks attentively and openly, the lower back is not isolated with its complaints. Oftentimes, the whole back side of the body has lost its unity and has fallen into separate parts with their own stories and their own dynamics. The bladder energy is not flowing any more, and it starts to become “lumpy.”

If it succeeds in letting the “fallen apart” areas find their way back into a common story, the lower back will have the possibility to find back its lost liveliness. This is because it seems like the blockages and irregularities in the other parts are what enable the back to hold itself in a stuck, imbalanced pattern. This can go so far that, quite frequently, in a treatment for pain in the lumbar area, this part of the back doesn’t even need to be touched directly (and often shouldn’t be touched). The restoration of the flow of the bladder energy through specific treatment with the attention, alone, attracting “other parts” (if necessary, with holding the connection to the pain zone), can release the blockages and give relief to the pain.

Every region of the back stands in a very special relationship to the blocked and weakened lumbar and sacrum areas. It is worth regarding the energetic expression of every region, and understanding the relationships therein, to be able to work specifically with those energies.

Now, I would like to describe some typical patterns as examples. I hope that the way of viewing this, and the procedure both become clear. In the order of the described areas, I don’t just follow the anatomy or the flow of the bladder energy from up to down. Rather, I would like to indicate that the meaning and interaction of the zones in a person often appear different and seemingly mixed up.

© Wilfried Rappenecker, born 1950 near Köln (Germany), is director of the "Schule für Shiatsu Hamburg" (D-22769 Hamburg, Oelkersallee 33,http://www.schule-fuer-shiatsu.de), co-founder of the GSD und author of two books dealing with shiatsu. As physician for general medicine he mainly works with shiatsu.

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