Short-Term Improvement in Pain and Functional Disability Following Acupuncture and Therapeutic Massage in a Patient with L4–L5 Diffuse Disc Bulge: A Case Report

Abstract

Diffuse lumbar disc bulge at the L4–L5 level is a common cause of chronic mechanical low back pain in middle-aged and elderly individuals, often presenting with pain aggravated by prolonged sitting, travelling, and morning stiffness. Evidence on rapid, short-duration, non-pharmacological management combining acupuncture and therapeutic massage remains limited. This case report describes a 66-year-old male businessman with a one-month history of low back pain and a known case of L4–L5 disc bulge, radiologically confirmed as diffuse disc bulge with facetal thickening causing thecal sac indentation and neural foraminal narrowing with nerve root impingement. Pain was assessed using the Visual Analog Scale (VAS) and functional disability using the Modified Oswestry Disability Index (ODI). The patient underwent a combined protocol of acupuncture and therapeutic massage administered once daily for seven consecutive days. Acupuncture points included BL23, BL25, BL40, ST36, GB30, GV20, and GB20, with 20-minute needle retention followed by a 10-minute period of rest, followed by 15–20 minutes of lumbar petrissage massage. Following the seven-day intervention, VAS score reduced from 7/10 to 2/10, and the Modified ODI improved from 46% (moderate disability) to 18% (minimal disability). Straight leg raise and modified Schober test findings also improved, and morning stiffness and aggravation of pain on sitting or travelling resolved. No adverse effects were observed. This case suggests that a short-duration combined acupuncture and massage protocol may offer meaningful short-term relief of pain and improvement in functional mobility in patients with L4–L5 diffuse disc bulge. Larger controlled studies are required to confirm these findings.