Alternative treatment for back
pain II
Dr. Rami Rusim
 We
continue our discussion about alternative
treatments to back pain by looking at
Physical Therapy (PT) and Acupuncture.
To make the presentation simple and
clear, we will focus on lower back pain
(LBP).
Physical Therapy (PT):
As discussed in
previous months, the back is surrounded
and supported by muscles, the goal of
which is to provide stability and
function.
Theses muscles may fatigue as a result of
repetitive use or injury.
Current research has reported that in
most cases of LBP, certain muscles of the
back are reflexively inhibited (shutdown)
after injury.
These muscles do not spontaneously
recover even if patients are pain free
and return to normal activity levels. It
is obvious that these structures will
need to undergo a rehabilitation process
to maintain their function and purpose.
Physical therapy treatment for LBP often
involves a wide range of techniques
including heat therapy, ultrasound,
massage, mobilization, exercise, and
education about posture and body
mechanics. Stabilizing and strengthening
the lumbar spine is usually carried out
through a lumbar stabilization program.
The treatment is provided by specialized
and trained team of people with extensive
knowledge about body mechanics, anatomy,
muscle function, etc.
The team could be supervised by a
specialized doctor helped by certified
physical therapists and assistants.
The team will first evaluate the patient
and then design a comprehensive
rehabilitation program with the above
listed techniques.
What constitutes a lumbar stabilization
program?
A lumbar stabilization program is a
program of back exercises designed to
teach patients strengthening and
flexibility in a pain-free range.
It not only improves the patient’s
physical condition and symptoms but also
helps the patient with efficient
movement. It provides the patient with
movement awareness, knowledge of safe
postures, and functional strength and
coordination that promotes management of
lower back pain.
During the treatment, the patient may be
given something called (TENS unit
treatment) which stand for:
Transcutaneous Electrical Nerve
Stimulator.
With the use of this unit, the patient
doesn’t feel any pain but only the
sensations that the stimulator induces in
his nerves. If this treatment produces
positive results, the patient is given a
unit to use as his needs dictate in the
convenience of his home.
Another treatment is called: Ultrasound
Stimulation. This process generates heat
in the lower back region which, along
with lessening the pain, also quickens
the healing process.
Physical therapy is also employed in
treating joint pain (as in arthritis to
maintain the joint function), chronic
abdominal pain, and other severe pain
conditions.
In summary, Physical Therapy has been
proven to be a major factor in treating
back pain and helping in regaining almost
complete muscle function.
I can’t emphasis enough its role in
improving most pain conditions in
conjunction with other treatments like
medications or injections.
Acupuncture:
Don’t worry!! You don’t have to
speak Chinese to know it. The term “acupuncture”
describes a family of procedures
involving the stimulation of anatomical
points on the body using a variety of
techniques. The acupuncture technique
that has been most often studied
scientifically involves penetrating the
skin with thin, solid, metallic needles
that are manipulated by the hands or by
electrical stimulation.
Practiced in China and other Asian
countries for thousands of years,
acupuncture is one of the key components
of traditional Chinese medicine. In
traditional Chinese medicine (TCM), the
body is seen as a delicate balance of two
opposing and inseparable forces: yin and
yang.
The concept of two opposing yet
complementary forces is described in
traditional Chinese medicine. Yin
represents cold, slow, or passive aspects
of the person, while yang represents hot,
excited, or active aspects.
A major theory is that health is achieved
through balancing yin and yang and
disease is caused by an imbalance leading
to a blockage in the flow of qi (vital
energy) along pathways known as
meridians. Qi can be unblocked, according
to TCM, by using acupuncture at certain
points on the body that connect with
these meridians. Sources vary on the
number of meridians, with numbers ranging
from 14 to 20. One commonly cited source
describes meridians as 14 main channels
“connecting the body in a web like
interconnecting matrix” of at least
2,000 acupuncture points.
Acupuncture became better known in the
United States in 1971, when New York
Times reporter James Reston wrote about
how doctors in China used needles to ease
his pain after surgery. American
practices of acupuncture incorporate
medical traditions from China, Japan,
Korea, and other countries.
Who is acupuncture for?
Acupuncture seems to be useful as a
stand-alone treatment for some
conditions, but it’s also
increasingly being used in conjunction
with more conventional Western medical
treatments. For example, doctors may
combine acupuncture and drugs to control
pain and nausea after surgery.
Scientific studies generally test
treatments against placebos, such as
sugar pills. It’s difficult to
conduct valid scientific studies of
acupuncture, because it’s difficult
to devise sham versions of acupuncture.
In fact, several studies have indicated
that sham acupuncture works as well or
almost as well as real acupuncture.
This makes it hard to create a definitive
list of the conditions for which
acupuncture might be helpful. However,
preliminary studies indicate that
acupuncture may offer symptomatic relief
for a variety of diseases and conditions,
including low back pain, headaches,
fibromyalgia, migraines and
osteoarthritis.
In addition, research shows that
acupuncture can help manage
post-operative dental pain and alleviate
chemotherapy-induced nausea and vomiting.
It also appears to offer relief for
chronic menstrual cramps and tennis
elbow.
Pros and cons?
As with most medical therapies,
acupuncture has both benefits and risks.
Consider the benefits:
§ Acupuncture is safe when
performed properly.
§ It has few side effects.
§ It can be useful as a complement
to other treatment methods.
§ It’s becoming more available
in conventional medical settings.
§ It helps control certain types of
pain.
§ It may be an alternative if you
don’t respond to or don’t want
to take pain medications.
Acupuncture may not be safe if you have a
bleeding disorder or if you’re
taking blood thinners. The most common
side effects of acupuncture are soreness,
bleeding or bruising at the needle sites.
Rarely, a needle may break or an internal
organ might be injured. If needles are
reused, infectious diseases may be
accidentally transmitted. However, these
risks are low in the hands of a
competent, certified acupuncture
practitioner.
If you’re considering acupuncture,
do the same things you would do if you
were choosing a doctor!!
Next month, will begin discussing
medication treatment for pain.
References; 1.
Acupuncture. Natural Standard Database
Web site. Accessed at http://www.naturalstandard.com on June 28, 2007. 2. Barnes
PM, Powell-Griner E, McFann K, Nahin RL.
Complementary and alternative medicine
use among adults: United States, 2002.
CDC Advance Data Report #343. 2004.
3. Berman BM, Lao L, Langenberg P, et al.
Effectiveness of acupuncture as
adjunctive therapy in osteoarthritis of
the knee: a randomized, controlled trial.
Annals of Internal Medicine.
2004;141(12):901–910. 4. American
Physical Therapy Association, http://www.apta.org/
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