Three Therapies for Aching Backs

H. L. Cunningham


       If you’ve made it to adulthood and don’t yet know what an episode of back pain feels like, count yourself among the lucky. It’s estimated that 80 percent of adult Americans will suffer from a sore back at some point in their lives, costing industry more than $50 million a year in absenteeism and lost productivity.
       To find relief, many sufferers of chronic back pain are turning from conventional medicine to alternative options — so many that the alternatives are moving swiftly into the mainstream. And three treatments once thought of as fringe — chiropractic, acupuncture and yoga — are slowly amassing clinical evidence that, while not cures, they may provide at least some relief.

Chiropractors: Back Pain is “Their Thing”
Dr. Jerome McAndrews, an osteopath and chiropractor who is national spokesman for the American Chiropractic Association, says both back pain sufferers and medical doctors are turning to chiropractic care in numbers unheard of not long ago. "I attended a Harvard conference on alternative medicine four years ago," he says, "and the medical doctors who were there wanted to learn when to refer to a chiropractor."
      The moment demonstrated to him a meeting of the minds that didn't exist a decade ago. "Chiropractic is becoming more a complementary medicine than an alternative one," he says. The proof may be in the numbers. Currently, chiropractors in the United
States are treating 25 million patients, including 46 percent of all people injured in automobile accidents and 35 percent of those injured on the job.
      The U.S. Department of Health and Human Services now recommends chiropractic as an effective treatment for the management of low-back pain. And two studies published in the New England Journal of Medicine suggest that chiropractic
treatment is as least as effective as more conventional treatment when it comes to relief from pain. The first, published in 1995, found treatment from chiropractors yielded about the same results as treatment from primary care practitioners and orthopedic surgeons. The second, published in October 1998, found patients reported less "bothersomeness" from their low back pain four weeks after initial treatment by chiropractors when compared with treatment by physicians. But by 12 weeks out, reports of pain from patients of chiropractors and M.D.'s were comparable. It pays to remember that 80 percent of back pain sufferers will be free of pain within six weeks and 90 percent will feel better within three months, even if they do nothing at all.
      Still, six weeks can be an eternity when they are spent hunched in pain. Even Dr. Peter Slabaugh, an orthopedic surgeon and spokesman for the American Academy of Orthopedic Surgeons, says chiropractors may have more success with back pain patients than more conventional practioners. He says, "They have made back pain their thing and put a lot of emotion into the patient
      The "thing" that sets chiropractors apart is their use of spinal adjustment. Chiropractors use precise and specific thrusts to correct areas in the spine or joints that they determine are not moving correctly. By manipulating these areas, which they call subluxations, chiropractors seek to restore normal motion to the back and the nerves that control pain sensations and muscle movement.
      Dr. McAndrews says back pain is caused by these subluxations, initiated when one piece of the spine is injured and the rest is left unbalanced and shifts and settles. He advocates a lifelong check-up program — beginning in infancy — to prevent the back from compensating for these injuries for too long.
      Other experts in pain and back disorders say that whether chiropractic will work may all be in the timing.
“Try it for two or three weeks,” says Dr. Slabaugh, “and if it hasn’t worked by then, it probably won’t.”
      Dr. Art Brownstein, a clinical instructor of medicine at the University of Hawaii at Manona and author of "Healing Back Pain Naturally" (Harbor Press, 1999), also thinks short-term chiropractic care is best. "I have seen people get in trouble with chiropractic," he says, voicing a common complaint, "specifically, from chiropractors who have patients come back (again and again), who get dependent and end up having manipulation when it is not needed."
      As might be expected, Dr. McAndrews takes issue with this criticism, so much so that he wrote an article published in the ACA Journal of Chiropractic defending his profession's liberal use of ongoing visits. He says the length of treatment depends on how long the back has been distorted. "If the initial injury happened 30 years ago," he insists, "you will need to come back for repeated visits."
      While she concedes chiropractic might help in the first three months of chronic back pain, Dr. Margaret Caudill, creator of the behavioral medicine pain program at Dartmouth-Hitchcock Clinics in Manchester, N.Y., says the problem with ongoing visits is that they can become a crutch. "When you get to years and years after an injury, pain sufferers need to focus on self-management and making themselves better rather than relying on a chiropractic. It takes their control away."

Acupuncture: Balancing the Flow
More than a million Americans each year seek relief from all kinds of pain with acupuncture, which consists of inserting needles into precise points in the body for 20 to 40 minutes at a time. Acupuncture has been used to counteract pain in China for more than 3,000 years. It works, practitioners say, by balancing the body's energy flow, called qi or chi.
      In November 1997, the National Institute of Health's Office of Alternative Medicine issued a statement supporting the use of acupuncture as an effective adjunct therapy for back pain. And new research indicates the metaphysical concept of acupuncture also has a traditionally scientific basis.
      Songping Han, a researcher at the St. Louis University School of Medicine and author of a study on the scientific basis for acupuncture published last year in the Southern Medical Journal,
says the pain relief acupuncture provides is due to neuroelectric stimulation, not chi. “Acupuncture stimulates nerve endings that transmit signals to the brain, activating the pain control center in the body and triggering the release of endorphins,” says Han.
      Furthermore, Han says those suffering from back pain don't necessarily need to be treated with needles to find relief, unless affected nerve endings are very deep. He says research suggests the use of electrical stimulation at the determined points is highly effective, and even the use of pressure or heat on these particular areas can relieve pain.
      Pain experts say if you are struggling with back pain, acupuncture probably can't hurt — and it seems to work for some, whether the reason for success is stimulated nerve endings or unblocked chi. "I take a pragmatic approach, start with the treatment that offers the least risk, and build up if needed," says Kenneth Lafland, head psychologist and director of the Pain and Rehabilitation Clinic of Chicago.

Yoga: Listen to the Body
Back pain sufferers know that the pain demands full attention. According to Judith Lasater, author of "Relax and Renew: Restful Yoga for Stressful Times" (Rodmell Press, 1995) it's important to slow down and listen to the painful messages the body is sending in order to find relief.
      Lasater, a physical therapist who holds a doctorate in east-west psychology, teaches yoga classes and trains yoga teachers. "Yoga can help those with back pain by helping them be aware of the ways they are contributing to their own muscular-skeletal strain," she says.
       "The body is always giving us cues and we don't listen. If it says it is tired we drink more coffee. If it says it is hungry, we say not now. Pain is the body's way of getting attention and should not be ignored."

      Yoga, Lasater says, allows those with back pain to pinpoint the places they’re holding tension and relaxes them enough that they are able to let it go.
 While scientific data specifically linking yoga to back pain relief is hard to come by, most experts agree that gentle physical activity is an important part of the healing process. The U.S. Department of Health and Human Services recommends low-stress aerobic exercise as soon as two weeks after back pain symptoms first occur to ward off further weakening, and the American Academy of Orthopedic Surgeons suggests that light activity can speed healing and recovery. "Those experiencing back pain need to take part in an exercise program that starts slow and emphasizes breathing, like yoga," says Dr. Caudill.
      The most popular form, hatha yoga, requires participants to strike a series of poses designed to relax the body and promote flexibility, while they simultaneously practice breathing exercises. The practice also aims to induce a meditative mental state.
      It is the meditation that Dr. Brownstein says frightens people, although he calls it just a natural way of relaxing. "You can meditate by simply watching a sunset or playing. Every child knows how to meditate. They do it when they are playing. Meditating means not worrying about the past or the future but being present in the moment."
      Even though it is designed to calm the mind, because yoga is a physical activity it's earned the respect of some conventional medical experts. "Exercise can be key to both avoiding back pain
and treating it," says Dr. Slabaugh, the orthopedic surgeon.
      Both Dr. Brownstein and Lasater say practicing yoga gives those experiencing back pain the time to listen to what's on their mind, perhaps eliminating the cycle of stress-induced tension they believe causes much of back pain in the first place.
       Says Dr. Brownstein, "Just the act of stopping and breathing can take you away from the pain and calm your nerves."


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