copyright © 1998 David A. Merrill. All rights reserved.
Why Seek Alternative Therapies?
Here in the United States most people are raised to respect the great storehouse of knowledge pertaining to modern allopathic medicine. They are reassured by the technical skills of their physicians, and they view any expensive tests which their doctor might order as a hallmark of professional thoroughness. However medicine is not an exact science and there is no one doctor who can diagnose and prescribe treatments which will be effective in 100% of his or her cases. This is why people seek second opinions, and it is also one reason why more and more people are beginning to explore other options.
The reasons for seeking alternative therapies vary. For some it is an economic reason. Medicine's decision at the turn of the century to tie itself to technology has resulted in high-tech treatments which are now unaffordable to the people who need them. If people cannot afford to pay the bill, they must look elsewhere for help. Other patients are simply fed up with "accepted" medical practices and doctors who are too busy to really listen to their problems and treat them as a whole being, but view them only as a symptom to be treated. These people want to get away from the surgeries and the drugs which the contemporary allopathic physician prescribes, not to mention the potential side effects of these treatments. Still other patients who have put their faith in modern medical technology have had mixed results and are desperate to try anything which might relieve their affliction, even if it is outside of the orthodox medical profession.
I have suffered from low back pain since 1984, and I was indeed one of those who found it necessary to venture outside the realm of modern medicine in order to find some semblance of relief from my symptoms, including sciatica, the alternative treatments of which I have also included below. I hope that the information I have gathered together here will be useful to others with back pain, and will prompt them to consider the use of alternative therapies which might potentially improve the quality of their lives.Back to Table of Contents
Allopathic Remedies for Back Pain (including Sciatica)
According to Dr. James S. Gordon, author of Manifesto for a New Medicine, up to 80% of all Americans will have a "back problem" at some point in their life. Some will have minor strains which will disappear in days, others like myself will have chronic pain lasting for years. At any rate, 80% of the population is a staggering number, especially given the inadequate training which most medical students receive regarding the mechanics of the human back.
Sciatica can occur if the bones of the spine are damaged or just aligned poorly so that they pinch and irritate the nerve. The pain is felt travelling down the leg and into the foot. Symptoms may also be accompanied by tingling sensations and/or numbness in the leg and foot.
The standard allopathic prescription for back problems is muscle relaxants, painkillers and two weeks bed rest. In my first experience with allopathic doctors regarding my back problem I was told that there was not much they could do for me other than prescribe bed rest and hope it would go away. It did, however it came back again within a couple of months, even worse. And this time it did not go away. So they prescribed muscle relaxants to reduce the swelling and pain killers so I could sleep, and more bed rest. Eventually I was able to return to work, however I was not pain-free and I did not seem to be getting any better. I consulted a neurologist who prescribed an expensive MRI procedure and confirmed that I have a herniated disc in my lower back. He went over the option of surgery with me, explaining that the results of such surgery were not guaranteed to make me pain-free. He cited a Swedish study which had tracked back surgery patients for a number of years and concluded that while the majority of them said that the surgery had reduced their pain a significant number reported either no change or in some cases that the surgery had made the condition worse!
It was at this point that I began to consider seeking an alternative treatment to what the allopathic doctors could provide. I asked a friend for a recommendation of a chiropractor that he had been seeing. It was then that I began learning about chiropractic, physical therapy, meditation, yoga, and the other forms of alternative therapies which could be applied to improve my quality of life and make my back healthier without the use of expensive drugs and potentially risky surgery.Back to Table of Contents
There have been a number of studies done both in the U.S. and abroad which show the effectiveness of manipulation in the treatment of low back pain. Many of these studies have shown that chiropractic care has been much more effective and satisfying to patients than allopathic drugs or surgery. This certainly corresponds with my personal experiences.
Just before the turn of the century a system of diagnosis and treatment called osteopathy was formed. Osteopaths of the day, and later chiropractors, claimed to be able to cure such conditions as diabetes, gall-stones and appendicitis by spinal manipulation. Of course these maladies cannot be cured by spinal manipulation alone, and this led to manipulation being dismissed as charlatanism by the majority of the medical profession. Unfortunately the fact that a great many mechanical joint and soft tissue problems had been successfully treated by manipulation was lost admidst the charges of quackery. Therefore manipulation is only now, as we near the close of the century, beginning to be recognised as a valid adjunct treatment within the halls of orthodox medicine.
Manipulation is generally performed by chiropractors or osteopaths. Careful positioning and precise application of force to a localised region are generally employed to free a joint which was previously abnormally tight and restricted in movement. Usually a "cracking" or "popping" sound will accompany the unlocking of a joint. This is caused by the sudden gapping of the apophyseal joint, much in the same way that the joints of the fingers can be made to "pop" when one cracks one's knuckles.
Manipulation in not a panacea for back problems, however. Most problems of the cervical spine respond well to the quick thrust technique, however problems of the lumbar spine may not respond as quickly and may require protracted manipulative treatment. In addition there are other factors which may be contributing to the problem, such as one leg being shorter than the other, poor posture of the patient, or weakness of the abdominal muscles. A good manipulation therapist will check for the presence of any of these conditions at the outset of treatment and educate the patient regarding correct posture and physical therapy to strengthen the abdominal muscles so as to prevent a recurrence of the problem.Back to Table of Contents
Soft tissue techniques include a range of procedures which are commonly grouped together as "massage". The growth in popularity of generalised, non-specific massage has led to a decline in the use of massage techniques within othodox medicine. Nonetheless soft tissue work and massage are natural medical alternatives to drug therapy and surgery and are taught to physiotherapists at both pre- and postgraduate levels. Outside the halls of mainstream medicine massage techniques of various sorts have enjoyed a recent popularity and are available from an assortment of non-medical masseuses whose expertise ranges from the poorly trained to the very adept.
In massage therapy the masseuse generally strives to create an atmosphere of relaxation for the client. This might include soft music, lighting a scented candle or using incense to create a pleasant aroma. In back massage the patient lies face-down on the massage table while the masseuse works the muscles, fascia and other soft tissues of the problem area. Some masseuses may also employ techniques of acupressure, applying pressure to specific "acupoints" which are connected to the problem area. "Acupoints" are also used in Acupuncture, which is described below.
There is some debate as to how effective massage therapy is on patients with joint disturbances, however it is quite clear that massage is beneficial for those with problems of the soft tissues themselves, such as a muscle strain.Back to Table of Contents
Acupuncture has been used in Chinese medicine for over 4000 years, however it is only now beginning to be studied and recognized as a valid form of alternative treatment by western medicine. Acupuncture uses fine needles, some so thin as to appear more like wires than needles, which are inserted into the patient's "acupoints" to activate movement of the "Qi" (or "Chi") energy to remove the pain. The Chinese believe that "Qi" is the vital energy which controls the biological functions in any living tissues. "Qi" is linked both to nutrients, such as food, which the body absorbs, but also to a less substantative concept of a vital force which can explain why an otherwise healthy individual may feel lively and full of energy one day but drained any unproductive the next. Thus external forces such as stress can have an effect on one's "Qi" force causing an imbalance of energy and a general feeling of "unwellness". It is interesting to note that almost all other systems of medicine other than allopathy have, to a greater of lesser extent, applied this concept of "biological energy" in one form or another.
A set of therapeutic rules are applied to tell the acupuncturist where to place the needles to treat a specific diagnosis. For chronic low back pain the acupuncturist will use information gathered from the patient as well as observing the condition of the patient's tongue and blood pressure to make a diagnosis for needle placement, as follows:
Tongue: Normal body with greasy white coating.
Pulse: Deep and slow.
In this case low back pain is due to obstruction of circulation of "Qi". The precipitating factors may be living in cold and damp places, exposure to rain, or wading in water, or being drenched with sweat.
Severe pain in the lower back, which is generally fixed in a certain area, and is aggravated by pressure and impaired movement by bending foward or backward and turning the body.
Tongue: Dark or puplish body with purple spots.
Here the patient has a long history of acute lumbar muscle sprain which has not been treated correctly. It has lingered for a long time and become a chronic condition. Or the patient has a history of strain to the lower back on the job. Longshoremen and other workers who must carry heavy loads, or who have their backs bent for a long time can easily overstrain their backs.
Sustained pain and soreness in the lower back, aggravated by fatigue and alleviated by bed rest.
Kidney Yang Xu: Cramp-like sensations in the lower abdomen. Pale face, hypofunction of taste sense, cold limbs.
Tongue: Pale body.
Pulse: Deep and thready, or deep and slow.
Kidney Yin Xu: Irritability, insomnia, dry mouth and throat, malar flush, five center heat.
Tongue: Red body with scanty coating.
Pulse: Thready and weak, or thready and rapid.
In these cases the low back pain is generally due to congenital deficiency or weakness of the kidneys in old age. The weakness of the kidneys could also be due to overwork or excessive sexual activity resulting in poor nourishment of the meridians in the lumbar region.
By using the above diagnosis the therapist then selects the proper "acupoints" to be used in treatment. In Chinese medicine the lower back is connected to the kidney, therefore specific points are used to nourish or tonify the kidneys, and other local and distal points are used to treat the back pain itself.
Acupuncture points ("acupoints") are areas of increased electrical conductance. They have higher concentrations of nerve fibers and a more abundant blood flow than surrounding areas. Stimulation of these points alters the conduction of nerve fibers and produces a release of pain-reducing and mood-elevating compounds in the body and brain, such as endorphins, enkephalins, and seratonin.
Modern Acupuncture Clinics may use electric stimulation techniques wherein minute pulses of electricity are used to stimulate the nerves. The overstimulation causes the nerves to diminsh their sensitivity, therefore all other pain which travels along those nerves is also diminished. This has proven especially effective in the treatment of sciatica. Another alternative form of treatment is Ear Acupuncture, wherein needles are inserted into specific locations of the ear which correspond with regions of the body. Ear Acupuncture has also been shown to be effective in treating the pain associated with sciatica. Once the needles are removed seeds are sometimes taped to the ears to provide on-going stimulation to these points for a few days at a time.
Some tests have been conducted which show the effectiveness of acupuncture versus random needling and placebo efect. Still acupuncture has had a hard time being accepted by orthodox medical practitioners. However in November 1997 a National Institutes of Medicine committee of experts listed a variety of conditions which they felt would benefit from acupuncture as an adjunct treatment with contemporary biomedical medicine. These conditions include stroke rehabilitation, headaches, addiction, menstrual cramps, asthma, pains following surgery, nausea associated with chemotherapy or pregnancy, tennis elbow, carpal tunnel syndrome, dental pain following surgery, and low back pain.
Acupuncture may be able to quickly relieve the symptoms of back pain and sciatica, however like manipulation it is not a panacea. Some mechanical joint problems would still require manipulation by a chiropractor or osteopath. In addition traditional Chinese medicine incorporates a form of physical therapy called Qi Gong (or Chi Kung) which works hand-in-hand with acupuncture to direct the "Qi" in the body toward the area where the "Qi" energy is either deficient or stagnant. Qi Gong excercises are done in between acupuncture treatments. The purpose is to focus the consciousness, and therefore the "Qi" energy, on the place that needs healing. Some Qi Gong excercises require movement, others are done while sitting or standing still. In this regard Qi Gong may be likened to Yoga, which will be discussed later. There is also an external form of Qi Gong in which the practioner will transfer "Qi" to the patient's body from him or herself by placing his or her hands on the area of the body in which the "Qi" energy if deficient.Back to Table of Contents
Hippocrates, the father of modern medicine, wrote "Let food be your medicine and medicine your food." Unfortunately many contemporary physicians appear to rely on technology for prescriptions rather than take heed of Hippocrates' words to recommend natural foods which might improve a patient's health. It is a sad state of affairs that allopathic medicine has become so far removed from basic nutrition that doctors rarely counsel their patients on their dietary habits. It is one more example of how people are not treated as a "whole" person but only as a symptom to be treated.
In traditional Chinese medicine each region of the body corresponds to one or more of the major organs. The back is equated with the bladder and kidney. Thus any toxins inhibiting the functioning of these organs could be contributing to a back problem. The lung and colon are also connected to the kidney and bladder, according to Chinese medicine, therefore to treat a back problem a traditional Chinese healer might put a patient on a diet of pineapple for a week, and also prescribe hot baths with Epsom salts followed by cold showers. Pineapple contains malic acid, which affect the lungs and colon, which in turn affect the kidneys and bladder, which affect the back. Unscientific and unproven perhaps, but such treatment has been in use for thousands of years, presumably with positive overall results.Back to Table of Contents
Homeopathic medicines are available as single remedies or as formulas of two or more remedies combined together. Single remedies are recommended when the homeopath wishes to give a higher potency of a remedy than is available in formulas. Interestingly, in homeopathy the higher the dilution of a remedy the more powerful and faster the medicine acts. Formula products usually contain remedies in the 3rd, 6th, or 12th potencies. A Patient suffering from severe pain might benefit from a remedy of the 30th potency. Most homeopathic remedies are in pill form for internal consumption, however there are a select number available in ointments, gels or sprays for external application.
Several homeopathic remedies might be prescribed for a patient with back pain. Depending on the specific symptoms a homeopath might prescribe Hypericum (internal or external) for injuries with shooting pains; Ruta Graveolens for deep pains relieved by lying on the back or by pressure, or where the thighs feel "broken"; or Rhus Toxicodendron for pain and stiffness in the small of the back.
For sciatica in young persons of nervous temperament where the pain is worse at night and the patient describes it as intolerable Ruta Graveolens or Chamomilla might be used. If there is great restlessness so that the patient must get up and walk around to relieve the pain then Ignatia is indicated. In older patients who are given to more of a sedentary lifestyle Colocynth may prove a more useful treatment. When the affliction is of longer standing then Arsenicum may provide the best results. In still other chronic or obstinate cases Lycopodium, Plumbum, Sulphur or Phosphorus might be indicated for treatment. For tearing pains down the thighs Rhus Tox may prove helpful.Back to Table of Contents
The nature of many back problems is that they are often liable to recur or perhaps even grow worse unless the patient is educated in preventative measures, and is willing to make the lifestyle changes required to prevent recurrence. A good number of back problems may be attributed to muscle weakness and/or incorrect posture. It is therefore crucial to the effectiveness of any treatment that the underlying cause(s) of the problem be addressed. In my personal experience this is the main area where I found contemporary medical doctors to be lacking, while non-medical practitioners were willing and able to offer an array of techniques which could be employed as prophylaxis against recurrence or worsening of my condition.
Postural Correction As stated previously neither manipulation nor acupuncture may be viewed as a panacea for back problems. No ammount of either technique will be able to correct a back problem caused by muscle weakness or postural stress. These types of problems must be treated with specific muscle re-education and postural re-alignment in order to maintain the improvement gained by other techniques. At the very least a patient should expect to receive instruction from the therapist on how they might best keep their problem from worsening through avoidance of certain postures and activities which exacerbate the symptoms. This instruction might include proper posture for sitting in a chair, getting into and out of a car, driving a car, sleeping positions, etc. A therapist who fails to emphasize the importance of correct posture is doing a disservice to his or her patient. It is of course the patient's responsibility to follow through and make whatever lifestyle changes are necessary to ensure that poor posture will not continue to contribute to their problem.
Physical Therapy As a result of sudden or repeated trauma, such as with back pain, fibrous scar tissue forms within the soft tissues of the spine. If this scar tissue is allowed to heal without movement the fibres which give the tissue strength will form themselves into a haphazard mesh, creating a weak and inextensible scar. By contrast, if the scar tissue is excercised and stretched to an appropriate degree during the healing process the fibres will run parallel to the normal stress lines of the tissue, forming a strong, mobile scar which will not restrict movement. Therefore it is important that a patient recovering from any type of back pain should be instructed in specific mobility excercises through which they might maintain a full range of painless movement, much in the way that the traditional Chinese Qi Gong excercises are used as an adjunct to acupuncture.
Most of the physical therapy excercises for back pain focus on strengthening the abdominal muscles and stretching the lumbar muscles in the back and the hamstrings, quadriceps and thigh muscles in the legs.Back to Table of Contents
Meditation The words medicine and meditate stem from the same linguistic root. In traditional Chinese medicine meditation is an integral part of training for physicians. Here in the West the beneficial and curative potential of meditation is only beginning to be explored and understood through the work of those such as Dr. Herbert Benson of Harvard Medical School, and the staff of the Mind/Body Medical Institute of New England Deaconess Hospital, and their research on what they term the "relaxation response".
Meditation is a conscious attempt to focus the mind in a non-analytical way so as not to dwell on discursive thought. This is generally accomplished by focusing on one's breathing, or by constant repitition of a word or phrase (mantra). The basic guidelines for meditation are:
The goal in meditation is to elicit the "relaxation response", a state of mental and physical calmness which is beneficial for overall well-being. This technique counter-balances the psychological and emotional stresses to which we are exposed in everyday life. When we have calm, peaceful thoughts our body tends to have a comparable emotional and physiological reaction. When we are angry or have fearful thoughts we become emotionally and physiologically unsettled due to the psychological stress. Studies done at the Mind/Body Medical Institute of New England Deaconess Hospital have shown that prolonged stress-induced physiological reactions can directly contribute to illness. Through meditation we can counter-act the psychological stresses which can affect our physiological well-being.
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Yoga Yoga is another method of eliciting the "relaxation response". It is also useful for developing body awareness which can aid in realignment of body posture and release muscle tension. Yoga, like meditation, may be used to reinforce the experience of a "resting state" of both mind and body which can be used to release physical tension while carrying on daily activities.
There are many different types of Yoga excercises. Generally, Yoga combines focused breathing with a slow, gentle stretching activity. The goal is to elicit awareness of where the body holds muscular tension, and to reinforce the sensation of muscular relaxation. Various Yoga excercises may be done seated, lying on the floor, or standing, and thus specific excercises may be relatively easily incorporated into daily routine, such as performing certain standing or seated Yoga positions during the day while at work.
Excercise Physical activity has many benefits including relaxing the body and reducing stress. There is also exstensive evidence that regular excercise increases the level of endorphins released in the brain, which contribute to feeling good. Most physicians recommend at least 20 minutes of cardiovascular excercise at least 3 times a week.
For people with back problems walking is generally regarded as the preferred excercise as it is gentle activity which will not jar the joints and exacerbate the symptoms. However depending on the severity of the problem a patient might choose low-impact aerobics, jogging, bicycling, tennis or any number of other physical activities. The main thing is to take part in some activity which will negate the effects of our often sedentary modern lifestyle.Back to Table of Contents
With the abundance of alternative therapies now available to people with chronic problems, along with the various studies being done which demonstrate their effectiveness, one would hope that contemporary physicians would begin to make use of them and recommend them as adjunct treatments for their patients. One would also hope that one day soon the medical insurance companies will offer coverage of such alternative therapies, given that Americans spend an estimated $500 million per year on acupuncture treatment alone!
For people with back pain knowledgeable physicians should recommend a course of manipulation, acupuncture and massage before any surgery or long-term use of anti-inflammatories is even considered. In addition, emphasis should be placed on preventative techniques which patients could learn to do for themselves, such as meditation, physical therapy and yoga, as well as instruction on diet, excercise and posture.Back to Table of Contents
Benson, Herbert, M.D. and Eileen M. Stuart, R.N., M.S. The Wellness Book, Birch Lane Press, New York, NY, 1992
Gordon, James S., M.D. Manifesto for a New Medicine, Addison-Wesley Publishing Company, Inc., 1996
Hughes, Richard The Principles and Practice of Homeopathy, Leath & Ross, London, 1902
Leebov, Wendy, Ed. D. Stress - Controlling It Before It Controls You, American Hospital Publishing, Inc., 1990
Lewith, G. T. Alternative Therapies, William Heinemann Medical Books Ltd., London, 1985
Mehl-Madrona, Lewis Coyote Medicine, Scribner, New York, NY, 1997
Elixers.com Find A Remedy page, www.Elixers.com, 1998
Stone, Al, L.Ac. Chronic Low Back Pain, www.Acupuncture.com, 1998
Stone, Al, L.Ac. Sciatica, Acupuncture and Traditional Oriental Medicine, www.Acupuncture.com, 1998
Stone, Al, L.Ac. Uncle Sam Tips His Hat to the Yellow Emperor, www.Acupuncture.com, 1998
Ullman, Dana, M.P.H. Discovery Homeopathy: Medicine for the 21st Century, www.Healthy.Net, 1991
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