THE DAI MAI AND CURRENT UNDERSTANDINGS OF LOW BACK PAIN
By Justine Munur (Just Therapy Education)
During my studies, one of the topics that we looked into was the extraordinary channels, specifically the Dai Mai. Reading translations of Chinese Medicine texts written hundreds of years ago, I kept finding paragraphs that sounded familiar and then I realised why. A few years previously I had been to a lecture by Peter O’Sullivan where he talked about chronic low back pain and maladaptive movement patterns.The translations of the texts from hundreds of years ago, that I was reading about the Dai Mai, written by Li Shizhen included paragraphs that were echoing the work that I had heard Peter describe a few years previously.
So what is the Dai Mai?
The Dai Mai is the only channel to travel horizontally around the body, its translation being the girdle or belt vessel describes the path it takes around the trunk. It starts with the point LIVER 13 and travels through GALLBLADDER 26,27 and 28 intersecting with BLADDER 23 posteriorly. Its function is to support the other channels that run vertically through the body,much like how a belt holds up a pair of trousers. It needs to hold firmly enough that it provides adequate support to the channels, but not too firmly as to constrict their function, like an over-tight belt. As with all the channels of the body, the Dai Mai must be dynamic and respond accordingly to the ever changing flow through it, The flow through the channels must constantly alter to meet the demands of the environment, such as changes in activity and consumption of food (like loosening your trousers after a big meal!). If the Dai Mai becomes too full, it will create a compressive force on the other channels that pass through it and constrict their function, conversely if it becomes deficient, there will not be enough support to the channels and they will not be able to function effectively.
Dai Mai and the musculoskeletal system
Looking at the pathway of the Dai Mai and its function, you may already be thinking that this sounds a lot like the concept of “core stability”. In the classic text, the Huangdi Neijing Su Wen translated by Matsumoto and Birch, it gives the description that when the “yang ming (stomach) is empty the zong muscle(rectus abdominis) becomes weak, the dai mai cannot pull and the legs become weak”. This sentiment is echoed in Kibler’s description of how the core (comprising the abdominal, spinal and pelvic muscles) has to be effective so that the more distal aspects of the body(i.e. the legs) can work effectively. Hides and colleagues examined how the action of a drawing-in movement of the abdominal wall activates both the transversus abdominis and internal obliques (along which the points of the Dai Mai are located), and hypothesised that this action strengthens the musculofascial “corset” that protects the spine (note the similarities in the concept of corset to girdle). I remember from Peter O’Sullivan’s talks, how he hated the concept of core stability and the basic thought that if you hold your tummy muscles in you are protecting your back, when actually all you are doing is over-activating muscles, altering normal movement and preventing diaphragmatic breathing patterns. So like the idea of the Dai Mai, it needs to automatically move along a spectrum of activity, being more active when the situation demands it, and relaxed during more more inactive periods.
So why is Peter O’Sullivan like Li Shizhen?
Peter and his colleagues looked at chronic back pain and developed sub-groups of common maladaptive movement patterns that people with long term back pain develop. He noted that back pain sufferers often presented an “excess or deficit in spinal stability”, in essence, either over or under activity of certain muscle groups around the lower back area. The patterns of active flexion or active extension correlate with the idea of an excessive or full Dai Mai and the deficit spinal stability classification fits nicely with the descriptions of a deficient or empty Dai Mai.
How does this relate to practice?
Prior to thinking about this concept, I never really considered the abdominals as somewhere I would treat directly. Yes, I would advise to strengthen it up, but I never considered that the pain was being referred from there. If the pain was in the low back, it must be coming from the posterior structures…right? Understanding the Dai Mai led me to start palpating these points and I consistently found when people extended and experienced low back pain, there was tension/trigger points around the anterior points of the Dai Mai Channel, namely, LIV13, GB26, 27,28. So I needled them, and guess what, they could extend back further and often with no pain directly following the treatment. Their anterior “core” was overactive and the needles were releasing some of this tension and easing the symptoms. If the pain in the low back was into flexion, BL23 would be the point of choice to release the tension in the quadratus lumborum area. Often I would treat both front and back (obviously not simultaneously) and use the opening and closing points of the Dai Mai (GB41 and TE5) as distal points as a complete treatment, usually with great success. Once treatment was done, the physiotherapist advice and Peter’s cognitive functional therapy advice would come into play. I love telling people not to sit bolt upright and to actually use the back rest of the chair, they look at me like I’m insane until I explain why (I would totally recommend Peter O’Sullivan’s courses to anyone dealing with back pain).
The Dai Mai is an important channel to understand for any health professional treating low back pain. The similarities with current classifications of back pain highlights how other medical models can echo each other once you start to investigate them.
Chase, C. and Shima, M., 2010. An Exposition on the Eight Extraordinary Vessels: Acupuncture, Alchemy and Herbal Medicine.
Hides, J., Wilson, S., Stanton, W., McMahon, S., Keto, H., McMahon, K., Bryant, M. and Richardson, C., 2006. An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine, 31(6), pp.E175-E178.
Kibler, W.B., Press, J. and Sciascia, A., 2006. The role of core stability in athletic function. Sports medicine, 36(3), pp.189-198.
Matsumoto, K. and Birch, S., 1986. Extraordinary vessels. Paradigm Publications.
O’Sullivan, P., 2005. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual therapy, 10(4), pp.242-255.