Pain | Natural Disasters
May 11, 2008 12:21 amSunday, May 11, 2008 The effects of the cyclone Nargis in Myanmar that killed over 100,000 people, with displacement of over 2 million people prompted my search of the effects of natural disasters in the causation of musculoskeletal pain and psychological trauma.
Of most frequent types of Physical Medicine and Rehabilitation (PMR) conditions of patients treated in the Astrodome Clinic after a historic hurricane Katrina showed the majority (75%) of PMR conditions presented in the first week. Most frequent were swollen feet and legs (22%), leg pain and cramps (17%), headache (12%), and neck and back pain (10%). Persons with headaches were younger than those without (41.3 vs. 46.3 yrs, P = 0.048). Persons with neck and/or back pain were older than those without those conditions (51.3 vs. 44.8 yrs, P = 0.004). Women had more headaches (20.9%) than did men (6.7%, P = 0.002). There were no Caucasians with leg pain/cramps, whereas 20.2% of African Americans had this condition (P = 0.028). (Chiou-Tan FY. Bloodworth DM. Kass JS. Li X. Gavagan TF. Mattox K. Rintala DH. Physical medicine and rehabilitation conditions in the Astrodome clinic after hurricane Katrina. American Journal of Physical Medicine & Rehabilitation. 86(9):762-9, 2007).
Severe natural disasters can cause long-term psychological impact on the survivors. This study aimed to examine the prevalence and risk factors of posttraumatic stress symptoms and psychiatric morbidity among survivors of the severe earthquake that occurred in Chi-Chi, Taiwan, in September 21, 1999. A total of 6412 earthquake survivors whose houses were destroyed by earthquake were recruited about 2 years after the disaster. The estimated rates of posttraumatic stress disorder and psychiatric morbidity were 20.9% and 39.8%, respectively. Psychiatric morbidity occurred mainly in survivors who were female, older, with low education level, and currently living in a prefabricated house and experienced complete destruction of property. The findings of risk factors suggest avenues for targeting postdisaster interventions (Chen CH. Tan HK. Liao LR. Chen HH. Chan CC. Cheng JJ. Chen CY. Wang TN. Lu ML. Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of a high-risk sample with property damage).
The post-tsunami health and nutritional statuses of survivors were surveyed three months after the disaster struck. The study group still suffered from injuries after the disaster, and complained of back pain, stress, and sleep disorders. Most in the study group had unsatisfactory health behaviors, and obesity was an increasing problem among female participants. (Kwanbunjan K. Mas-ngammueng R. Chusongsang P. Chusongsang Y. Maneekan P. Chantaranipapong Y. Pooudong S. Butraporn P. Health and nutrition survey of tsunami victims in Phang-Nga Province, Thailand. Southeast Asian Journal of Tropical Medicine & Public Health. 37(2):382-7, 2006).
At present, saving the lives of the survivors of the Myanmar Cyclone is of paramount importance since there is scarcity of food, water, clothing and shelter. These victims living under deplorable conditions need dire help. At a time when international aid organizations and United Nations is unable to supply age to these victims, we as native physicians are able to help these victims at Ground Zero level and at this very moment as we speak, we have physicians saving lives.
As President of the Alumni Myanmar Institutes of Medicine Association, we urge assistance in our endeavors. To donate, please visit:
http://www.amima.net/projects4
Organization summary
Alumni Myanmar Institutes of Medicine (AMIMA) is a PA, USA incorporated, nonprofit 501(c)(3) organization. It is organized for the purpose of providing charitable giving to nonprofit organizations promoting health, economic development and humanitarian aid in Myanmar. We have 750 physician members world-wide and have donated in 2007 to the Myanmar Dengue Hemorrhagic Fever Project and for the establishment of the medical school library of the Institute of Medicine in Yangon.
Involvement in Myanmar cyclone disaster relief.
AMIMA can reach the people needing the most help since as native physicians we are able to co-ordinate and work with members of the Myanmar Medical Council (local non-governmental organization). AMIMA has already donated $40,000 to Emergency Medical Relief Team for Cyclone Areas headed by Professor U Hla Myint, President, Myanmar Medical Council assisted by Dr. Kyi Minn, adviser, World Vision. This established Myanmar traveling medical team has dealt with previous epidemics, such as Dengue hemorrhagic fever and will provide medical care, clean water and food to prevent infectious diseases, as well as provide psychological counseling.
Donate at: http://www.amima.net/projects4
www.stopmusclepain.com Pain | Natural Disasters
pain
Pain| Disc Degeneration
May 3, 2008 11:33 pmSunday, May 04, 2008
A recent report in the Lancet medical journal reports that in a survey of 3,982 Americans, 29% of men and 27% women reported feeling some pain. Those who have higher levels of pain are usually those with lower income and less education working in manual labor and other blue-collar jobs. About $60 billion in productivity is lost each year because of workers experiencing pain and about $13.8 billion was spent on prescription medicines in 2004.
Pain can start as early as the teen years and increases to the mid-40s and then plateau to increase again after age 75. The degenerative changes seen in autopsies confirm the reason for these pain symptoms (see below).
The intervertebral discs lies between the vertebral bodies, linking them together. The components of the disc are nucleus pulposus, annulus fibrosus and cartilagenous end-plates. The blood supply to the disc is only to the cartilagenous end-plates. The nerve supply is basically through the sinovertebral nerve. The important components of the disc are collagen fibers, elastin fibers and aggrecan. As the disc ages, degeneration occurs, the nucleus dries up, and the disc flattens. During these changes, pain producing nuclear material tracks and leaks through the outer rim of the annulus. This is the main source of disc related pain. While this is occurring, the degenerative disc, having lost its height, effects the structures close by, such as ligamentum flavum, facet joints, and the shape of the neural foramina. This is the main cause of spinal stenosis and radicular pain due to the disc degeneration in the aged populations. (Raj PP. Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Practice. 8(1):18-44, 2008).
In a study of 248 sections of lumbar disc and vertebral bodies from 41 routine autopsies (range, 7 months to 88 years), these degenerative changes were noted: fibrous transformation starts in the nucleus, then annular disorganization, endplate, and vertebral body alterations progress. These changes occur predominantly in the first 2 decades and in the 5th to 7th decades. In the 3rd and 4th decades, little progression occurs. Nuclear clefts and annular tears appear later, mostly starting in the 2nd decade, with clefts preceding formation of tears. Radial and concentric tears develop similarly over time, whereas rim lesions mostly develop after the sixth decade. Significant differences are observed between upper and lower lumbar spine. Haefeli M. Kalberer F. Saegesser D. Nerlich AG. Boos N. Paesold G. The course of macroscopic degeneration in the human lumbar intervertebral disc. [Journal Article. Research Support, Non-U.S. Gov't] Spine. 31(14):1522-31, 2006.
www.stopmusclepain.com Pain| Disc Degeneration
Chronic pain| Foot Hydrotherapy
April 26, 2008 12:13 am Saturday, April 26, 2008 Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period to 20 patients with walking induced pain in the feet and lower limbs. 70% of the patients reported reduced pain after treatment, walking ability before pain and also maximal walking ability sustained up to 1-year later. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased. (Elmstahl S. Lilja B. Bergqvist D. Brunkwall J. Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms. International Angiology. 14(4):389-94, 1995).
Footbathing at 42 degrees C for 10 min, with or without additional mechanical stimulation (air bubbles and vibration) has also been shown to increase autonomic nerve and immune function. White blood cell (WBC) counts, ratios of lymphocyte subsets, and natural killer (NK) cell cytotoxicity were used as indicators of immune function. Footbathing with mechanical stimulation produced (1) significant changes in the measured autonomic responses, indicating a shift to increased parasympathetic and decreased sympathetic activity which are measures indicating pain relief and (2) significant increases in WBC count and NK cell cytotoxicity, suggesting an improved immune status. Saeki Y. Nagai N. Hishinuma M. Effects of footbathing on autonomic nerve and immune function. Complementary Therapies in Clinical Practice. 13(3):158-65, 2007
www.stopmusclepain.com Chronic pain| Foot Hydrotherapy
Headaches | Sleep Apnoea
April 17, 2008 11:36 pmFriday, April 18, 2008
In a study to investigate the co-morbidity of chronic refractory headache with obstructive sleep apnoea syndrome, seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography.
Patients diagnosed with obstructive sleep apnoea syndrome began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of obstructive sleep apnoea syndrome were identified (29.2% of the total investigated).
Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent. Multivariate regression analysis revealed that age, male gender and body mass index were associated with obstructive sleep apnoea syndrome. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases.
Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed. (Mitsikostas DD. Vikelis M. Viskos A. Refractory chronic headache associated with obstructive sleep apnoea syndrome. Cephalalgia. 28(2):139-43, 2008).
In another study, it was found that headache and neck pain were more likely among patients admitted for polysomnography compared with the general population (n = 41 340). This association was mainly restricted to those with frequent complaints (> or =7 days per month).
Chronic headache (headache > or = 15 days per month) was seven times more common among individuals with and without confirmed obstructive sleep apnoea syndrome than in the general population. There was no linear dose-response relationship between headache and neck pain and severity of apnoea or oxygen desaturation. Thus, hypoxia per se is less likely to explain the high headache prevalence among patients admitted for polysomnography. (Sand T. Hagen K. Schrader H. Sleep apnoea and chronic headache. Cephalalgia. 23(2):90-5, 2003 Mar)
It is essential to have chronic pain patients especially those on long-term narcotics complaining of sleep difficulties examined for sleep apnoea. There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. (Walker JM. Farney RJ. Rhondeau SM. Boyle KM. Valentine K. Cloward TV. Shilling KC. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing.[erratum appears in J Clin Sleep Med. 2007 Oct 15;3(6). Journal of Clinical Sleep Medicine. 3(5):455-61, 2007)
www.stopmusclepain.com Headaches | Sleep Apnoea
Neck and Thoracic Pain| Atypical Chest and Abdominal Pain
April 11, 2008 12:03 amFriday, April 11, 2008
Patients may present with atypical abdominal and chest pain that may be related to spinal problems. The key features on history that point to spinal referred pain are pain on movement, tenderness and tightness of musculoskeletal structures at a spinal level supplying the painful area, and an absence or paucity of symptoms suggestive of a nonmusculoskeletal cause. Harding G. Yelland M. Back, chest and abdominal pain - is it spinal referred pain?. Australian Family Physician. 36(6):422-3, 425, 427-9, 2007 Jun.
In those who have chest/abdominal pain due to musculoskeletal causes, the prevalence of thoracic intervertebral dysfunction could be as high as 65.5%. Intervertebral dysfunction prevalence could be even as high as 72.0% in those with back pain and 79.0% in those with back pain with chest/abdominal pain. Chest pain was more commonly associated thoracic intervertebral dysfunction compared to abdominal pain.
For those with cervical problems having pain in the back, chest and/or abdomen, there was an association with pain on active movements and overpressure at end range and with loss of range of motion. Range of motion restriction was not noted in patients with thoracic intervertebral dysfunction.
The minimum examination for the detection of intervertebral dysfunction is testing for pain with spinal movements and palpation for tenderness. The interpretation of positive signs requires knowledge of their prevalence in pain free controls and in patients with visceral disease. The prevalence of thoracic intervertebral dysfunction was 25.0% in controls. Yelland MJ. Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?. Australian Family Physician. 30(9):908-12, 2001 Sep.
eToims treatments for atypical chest and abdominal pain involve not only treating paraspinal muscles supplied by cervical and thoracic nerve roots but also the chest and abdominal wall musculature. Treatments must also involve the paraspinal muscles of the lower spine and even the muscles of the upper and lower limbs.
© 2008 copyright all rights reserved www.stopmusclepain.com Neck Pain and Thoracic Pain| Atypical Chest and Abdominal Pain
Neck Pain| Temporomandibular Joint (TMJ) Pain
April 4, 2008 6:38 pmFriday, April 04, 2008
The temporomandibular joint (TMJ) is in front of the ear and the joint movements can be felt if you place your finger at that level. To examine the movements of this joint, the rhythm of the closing and opening of the jaw must be noted. The jaw should open and close easy and the teeth come together and separate easily.
If there is jaw pain, that will be a break in the arc of motion on the painful side with obvious movement of the jaw to one side or the other. When the mouth is closed, the line drawn between the tip of the nose and midpoint of the chin will be in the same vertical line and the jaw is centered well. The teeth can also close symmetrically in the midline. When the patient has pain in the jaw, the line drawn from the tip of the nose will not be able to go through the midpoint of the chin since the jaw will not be centered well.
With problems of the temporomandibular joint, jaw movements may create a clicking sound, due to problems with that joint cartilage. Problems with the inner lining of the joint known as the synovium may also be the cause that causes the joint to click. In such situations with trauma to the joint cartilage, the joint may dislocate when the mouth is opened as wide as possible.
This joint is prone to trauma especially in auto accidents where the head is thrown backward and the mouth opens wide in a sudden and forceful motion. The joint may dislocate in these positions. The cartilage as well as the joint capsule can be torn. Joint overload may occur when the head is placed in traction, or when a person has poor dentition or when a person grinds his teeth during sleep.
Testing of range of motion of this joint involves examining the movements of the mouth and jaw. Normally, the mouth can be opened wide enough to insert three fingers between the to and bottom teeth. Horizontal movements should be free enough so that a person when sliding the lower jaw forward, the bottom teeth can be placed in front of the upper teeth. Limitations in range of motion can be due to pain from arthritis of the joint or from muscle spasm.
Muscles involved in opening the mouth are:
- External pterygoid muscle supplied by the mandibular portion of the fifth cranial nerve.
- Hyoid muscles.
Muscles involved in closing the mouth are:
Primarily masseter and temporalis muscles aided by the internal pterygoid muscle. All these muscles are supplied by the trigeminal nerve.
In all cases of TMJ problems, it is essential to examine the movements of neck and shoulders and spine. Patients with neck pain who keep the head forward and downward can cause abnormalities in the line of action of the muscles which open and close the mouth and eventually put wear and tear on the jaw joint.
Therefore, treatments directed only to the TMJ will not alleviate the jaw pain problems unless head and neck posture is also corrected. Examine the muscles of the jaw and the masseter muscle, is easiest to examine. You can feel this muscle just above the angle of the jaw as you clench your teeth.
If there are myofascial pain problems, tight and tender myofascial bands can be felt in the masseter muscle. There can be tenderness in the temporalis muscle also which can be felt at the side of the head above the ear. It is essential to treat the myofascial pain problems not only for the muscles responsible for jaw movements but the treatments must include muscles of the neck in order to alleviate jaw pain problems.
© 2008 copyright all rights reserved www.stopmusclepain.com Neck Pain| Temporomandibular Joint (TMJ) Pain
upper body topics
Low Back Pain| Running
March 28, 2008 12:50 pmFriday, March 28, 2008
This study was to investigate the incidence, prevalence, and possible risk factors for low back pain among a group of runners and walkers. A survey with 539 responses who participated in either a 10-kilometer run or 4-mile recreational walk showed previous history of low back pain in 74% of respondents. Prevalence of low back pain at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for low back pain. (Woolf SK. Barfield WR. Nietert PJ. Mainous AG 3rd. Glaser JA. The Cooper River Bridge Run Study of low back pain in runners and walkers. Journal of the Southern Orthopaedic Association. 11(3):136-43, 2002).
Another study evaluated whether athletes with a history of low back pain would, on average, perform slower on a timed 20-m shuttle run as compared with a normal athletic population. Of 211 athletes evaluated, 27 had been treated for low back pain during the previous year. Currently asymptomatic athletes with a recent history of low back pain were slower (6.3s vs 5.8s) during performance of the timed 20-m shuttle run than athletes without low back pain (P=.0002). (Nadler SF. Moley P. Malanga GA. Rubbani M. Prybicien M. Feinberg JH. Functional deficits in athletes with a history of low back pain: a pilot study. Archives of Physical Medicine & Rehabilitation. 83(12):1753-8, 2002)
The same authors found significantly slower response time on the 20-meter shuttle run in college freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). They concluded that kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. Clinical relevance of the study was that there are residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting. (Nadler SF. Malanga GA. Feinberg JH. Rubanni M. Moley P. Foye P. Functional performance deficits in athletes with previous lower extremity injury. Clinical Journal of Sport Medicine. 12(2):73-8, 2002 Mar).
Comments: The application of findings from these studies involve that even though injuries may have been presumed to be healed through absence of symptoms such as pain, subclinical involvement of motor components of the spinal nerve roots may still be ongoing. When pain fibers are not involved, that will be no pain symptoms. Athletes should be examined for presence of muscle stiffness and tightness presenting as limitation of joint range of motion. The most important sign of subclinical irritation of spinal nerve roots is presence of muscle tenderness at palpable myofascial bands or nodules. These points are known as trigger points. Athletes with such findings will be prone to injuries and it is essential that myofascial treatments that help heal the active trigger points be done prior to sporting activities. The most effective stimulation of deep myofascial trigger points is best achieved with such as eToims Twitch Relief Method.
www.stopmusclepain.com Low Back Pain| Running
lower body topics
Neck and Back Pain| Cycling
March 21, 2008 10:50 amFriday, March 21, 2008
30-70% of cyclists suffer from cervical, dorsal, or lumbar back pain. There is a tendency towards hyperextension of the pelvic/spine angle which resulted in an increase in tensile forces at the sacral promontory. These forces can easily be reduced by appropriate adjustment of the seat angle–that is, by creating an anterior inclining angle. The incidence and magnitude of back pain in cyclists can be reduced by appropriate adjustment of the angle of the saddle. (Salai M. Brosh T. Blankstein A. Oran A. Chechik A. Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine. 33(6):398-400, 1999).
It has been found that many of these cyclists suffer from discogenic disease. The number of previous sports-related injuries, was predictive of neck and back pain, and a strong tendency toward neck and back pain was observed for athletes with more total years of participation in sports due to overuse injuries. Causative factors are thought to be prolonged forward flexion, flexion-relaxation or overactivation of the erector spinae, mechanical creep and generation of high mechanical loads while being in a flexed and rotated position. A pilot study was performed to examine whether differences existed in spinal kinematics and trunk muscle activity in 9 cyclists with and 9 cyclists without non-specific chronic low back pain using electromagnetic tracking system and EMG was recorded bilaterally from selected trunk muscles. Data were collected every five minutes until back pain occurred or general discomfort prevented further cycling. Cyclists in the pain group showed a trend towards increased lower lumbar flexion and rotation with an associated loss of co-contraction of the lower lumbar multifidus. This muscle is known to be a key stabiliser of the lumbar spine. The findings suggest altered motor control and kinematics of the lower lumbar spine are associated with the development of LBP in cyclists. (Burnett AF. Cornelius MW. Dankaerts W. O'sullivan PB. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects-a pilot investigation. Manual Therapy. 9(4):211-9, 2004).
Inappropriate saddle positions may also be a cause of lower back pain. Partial and complete cutout saddle designs may increase anterior pelvic tilt, and saddles with a complete cutout design may increase trunk flexion angles under select cycling conditions. A saddle with a partial cutout design may be more comfortable than a standard or complete cutout saddle design. (Bressel E. Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. (Medicine & Science in Sports & Exercise. 35(2):327-32, 2003 Feb).
A radiographic study conducted to evaluate dorso-lumbar angular values (angle between the mid-back at T12 and lower back at L3) to define the most physiological sitting position during cycling. Two different pedal unit positions were tested; the first one in a bicycle frame type with pedals in front of the saddle axis and the second one with the pedals behind the saddle axis, in order. The findings showed that the incidence and importance of low back pain in cyclists can be reduced with appropriate pedal unit position; the position with pedals behind the saddle axis permits more physiological spine angles in comparison with the classic one having the pedals in front of the saddle axis; this fact is due to a different pelvic position which coincides with lumbar angles. (Fanucci E. Masala S. Fasoli F. Cammarata R. Squillaci E. Simonetti G. Cineradiographic study of spine during cycling: effects of changing the pedal unit position on the dorso-lumbar spine angle. Radiologia Medica. 104(5-6):472-6, 2002).
www.stopmusclepain.com Neck and Back Pain| Cycling
Low Back Pain| Sitting| Stiffness
March 15, 2008 12:42 amMarch 15, 2008
Prolonged sitting may alter the passive stiffness of the lumbar spine. Consequently, performing full lumbar flexion movements after extended periods of sitting may increase the risk of low back injury.
A study was performed on 12 normal subjects to quantify time-varying changes in the passive flexion stiffness of the lumbar spine with exposure to prolonged sitting and to link these changes to lumbar postures and trunk extensor muscle activation while sitting. The participants performed deskwork for 2 hours while sitting on the seat pan of an office chair. Moment-angle relationships for the lumbar spine were derived by pulling participants through their full voluntary range of lumbar flexion on a customized frictionless table.
It was found that lumbar spine stiffness increased in men after only 1 hour of sitting, whereas the responses of women were variable over the 2-hour trial. Men appeared to compensate for this increase in stiffness by assuming less lumbar flexion in the second hour of sitting. Changes in the passive flexion stiffness of the lumbar spine may increase the risk of low back injury after prolonged sitting and may contribute to low back pain in sitting. (Beach TA. Parkinson RJ. Stothart JP. Callaghan JP. Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine 5(2):145-54, 2005
Here is a study showing how to treat low back pain by drawing in the abdominal wall as a specific exercise for the transversus abdominis muscle (in cocontraction with the multifidus). Clinical effectiveness has been demonstrated to be a reduction of 3-year recurrence from 75% to 35%.
Biomechanical effect of this specific exercise on the mechanics of the sacroiliac joint was examined on 13 healthy individuals in the prone position during the two abdominal muscle patterns by means of Doppler imaging of vibrations and simultaneous electromyographic recordings.
Contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. This decrease in laxity is larger than that caused by a bracing action using all the lateral abdominal muscles supporting the use of independent transversus abdominis contractions for the treatment of low back pain. (Richardson CA. Snijders CJ. Hides JA. Damen L. Pas MS. Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 27(4):399-405, 2002
This is a very simple exercise that can be performed while sitting, standing, walking or lying down for those who have low back pain as well as very useful as a preventive exercise for those who are not in pain.
www.stopmusclepain.com Low Back Pain| Sitting| Stiffness
Back Pain| Alternative Medicine|eToims Differences
March 7, 2008 2:58 pmMarch 7, 2008
An article by Sherman KJ. Cherkin DC. Deyo RA, et al, discusses that patients frustrated with conventional care for back pain, turn increasingly to complementary and alternative medicine. Between 10% and 20% of visits to chiropractors, massage therapists, and acupuncturists is due to chronic back pain. Also back pain is the most common condition these providers treat.
Treatments given by each of these professions share certain similarities. Each has a hands-on technique at the core of its treatments (ie, needling the body, manipulating the spine, or massaging the soft tissues), although many different variations of these techniques are used. These techniques are repeatedly used during successive visits, often in conjunction with various adjunctive modalities.
Each profession has a prototypical approach. For acupuncture, the typical approach includes assessments that are foreign to the biomedical community (eg, tongue diagnosis), regular body acupuncture using the approach of Traditional Chinese Medicine, and heat. Chiropractic typically includes spinal and soft tissue examinations at the first office visit followed by spinal adjustment, most often using the “diversified technique.” Massage therapy usually includes tissue assessment and a massage involving three major treatment styles: deep tissue, Swedish, and trigger point. Self-care recommendations are also a standard part of visits to acupuncture and massage practice and chiropractors. All three professions make self-care recommendations, with exercise being part of those recommendations for all professions.
Implications for Physicians: The article also states that in advising patients about the use of CAM therapies, physicians should be guided by evidence on effectiveness and safety. The amount and quality of evidence on effectiveness varies for these therapies. Spinal manipulation appears to be superior to sham and known ineffective therapies but not superior to effective conventional treatments for chronic low back pain. Previous acupuncture studies are generally of poor quality, so the effectiveness of acupuncture for treating low back pain is unclear. Although only three studies have evaluated massage for back pain, all three studies were positive.
While there is some variability in the treatment provided to chronic back pain patients by acupuncturists, chiropractors, and massage therapists, physicians may be reassured by this study’s data that the treatments used by these practitioners are relatively well characterized and “mainstream” for these professions and rarely include modalities that can be dangerous. (Sherman KJ. Cherkin DC. Deyo RA. Erro JH. Hrbek A. Davis RB. Eisenberg DM. The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists. Clinical Journal of Pain. 22(3):227-34, 2006)
eToims Twitch Relief Method is an individualized therapy with similarities to the work and soft tissue healing effects provided by acupuncturists, chiropractor and massage therapists. We emphasize on self-care techniques and guided exercise to prevent or limit further trauma to already injured nerves and muscles that can occur because of activities of daily living, work, sports, recreation, etc.
However, the practice of eToims Twitch Relief Method vastly differs from the above three alternative medicine practices since eToims Twitch Relief Method is a medical system that requires a sound knowledge of anatomy and electro-physiology. The eToims practitioner has to undergo significant training to be able to have skills to be able to locate and noninvasively stimulate irritable neuromuscular junctions (trigger points) within the time affordable by the patient for a treatment session.
The treatment results are determined by the patient's ability to have immediate reduction in pain, improvement in range of motion and other measured physiologic parameters compatible with pain reduction. Muscles are individually exercised in eToims and different body positions are used so that even the deep layers of muscles can be stimulated and exercised. Tight and problematic muscles are individually stretched through active twitch muscle contraction with the stretch emanating from the neuromuscular junctions where most of the shortened muscle fibers concentrate. This relieves pain through releasing the constricting effect of the tight muscles on intramuscular nerves, blood vessels, bone surfaces and joints.
The twitch induced exercise also aids in the circulation of fresh blood to the areas where blood could not flow previously due to muscles in spasm and removes stagnant fluids and pain producing chemicals from the same region. This removes pain and encourages nerves and muscles to heal.
eToims Twitch Relief Method is safe and efficacious and is the only treatment that delivers reproducible pain relieving results in neuromuscular pain such that patients are willing to pay out of pocket for chronic durations for increasing their quality of life. After three weekly sessions of eToims Twitch Relief Method, our retention rate is 85% for weekly return visits with self-pay patients.
© 2008 copyright all rights reserved www.stopmusclepain.com Back Pain| Alternative Medical Treatments
