Acupuncture is a centuries old form of Chinese medicine that uses small needles to help open and balance energy channels throughout the body.When the channels are open and balanced, life force energy, or Chi, can flow freely and keep the organs, muscles, hormones, and mind functioning well. Acupuncture has been gaining popularity in the United States over the years, and can be effective for many musculoskeletal disorders. People with back pain, headaches, neck pain, tendinitis, and various nerve injuries can benefit from this ancient healing technique.

Though not often covered by insurance, acupuncture may be worth paying for out of pocket if more conventional treatments have failed. The National Institute of Health’s National Center for Complimentary and Alternative Medicine (http://nccam.nih.gov/health/acupuncture/) provides valuable information about the practice of acupuncture, associated risks/side effects, costs, how to find a practitioner, and research findings.

If you are considering acupuncture, talk with your primary care doctor, physical therapist, or chiropractor who may be able to provide a referral to somebody in your area.

Before you run scared at the thought of meditating as a pain management practice, know that meditation is simply focusing attention on one thing (breath, mantra, or object) while allowing your mind to detach from other thoughts.

So how does it help with pain?

• Takes mind away from pain by focusing on something else (breath)
• Relaxes muscles and any tension which can help alleviate pain.

In a recent stress relief workshop, I concluded with a guided muscle relaxation. One participant had been experiencing shoulder pain for weeks. At the conclusion of the exercise she told the group her shoulder pain had disappeared. Two weeks later I saw her again and asked “How is your shoulder?” She replied “I haven’t experienced pain since that relaxation exercise.”

GETTING STARTED

While the act of meditation is not difficult there are a few things to consider as you get started.

• Create a quiet and comfortable space free of distractions.
• Start slow - 5 minutes at a time to start. You will know when
  you’re ready to increase the duration.
• Practice - Consistency is the key to reaping the benefits
  meditation offers, whether daily, weekly or monthly.
• Have patience - You may find it easy to say “I’m bad at this”.
  Instead tell yourself “I’m new to meditation and with practice I
  can do this!” Anything new takes time to learn.
• Enjoy it. It’s time carved out for you.

SIMPLE AT HOME PRACTICE
Sit comfortably on the floor or a chair, using pillows and blankets as
necessary. You may find it helpful to set a timer to avoid clock
watching during the practice.

Take deep breath (inhale)

Hold it for 5 seconds

Exhale slowly through nose or the mouth (whichever you are most
comfortable with)

As you exhale, allow the breath to carry out tension.

Repeat.

Remember, as thoughts come in, silently notice or label them as thoughts
and then bring your attention back to your breath.

Guest post by Stacey Shipman, M.Ed, speaker, writer and producer of the
CD, Let it Flow: Short Guided Meditations. Visit her blog at
www.staceyshipman.com.

Some people learn best by reading how to complete a task. Others learn best by observing somebody else do it first. For others, listening is the best way for them to pick up on information. When it comes to rehabilitation and exercise, there’s now a resource designed to suit all types of learners.

Wellness Professionals – the leader in joint pain relief, has comprised a video library of rehabilitation exercises specific to the most common musculoskeletal injuries. It was designed to be useful for people with any learning style. The videos allow you to watch the exercise being done, listen to a description of how to perform it with correct technique, and also gives written instructions for you to be able to follow through on your own.

I invite you to check out the video library and share your thoughts, experience, and feedback here.

These days, with rising prices of food, gas, and higher education, spending on such “luxuries” as massage therapy, shiatsu, and acupuncture may nit be practical. However, these forms of complimentary health care may be exactly what you need to recover from an injury. Here are a few tips on finding ways to make these therapies more affordable.

1. Sign up for your employer’s flexible spending account. These accounts allow you to set aside pre-tax dollars (so you save money by not having to pay tax on your income) that can be spent on approved medical expenses, including massage therapy, acupuncture, nutritional assessments, and chiropractic care, among many others. There is some bookkeeping and organization required on your part as receipts must be kept and faxed or mailed, but the savings can really add up.

2. Some practices may be able to waive or offer reduced copays. Talk with your practitioner and see if this is an option…it never hurts to ask. The co-pays can really add up. With physical therapy, for example, you may require 2-3 treatments a week for a period of 6 weeks. With an average copay of $15-20, that means you could total over $250/month for that alone, not to mention copays for prescriptions and doctors visits.

3. Explore the option of volunteering or bartering. Many yoga studios will give people free classes if they volunteer to help at the sign in desk before and after class. I also know of Reiki practitioners and chiropractors who provide free care in exchange for such services as yard work, web design, painting, marketing, and cleaning. Think about your talents, as well as any physical limitations you may have, and talk to your provider to see if they might be interested in bartering.

4. Check out local schools in your area. Many of the massage, Shiatsu, and acupuncture schools have student clinics where you can receive treatment by a student who is approaching their graduation and is supervised by faculty/staff. You can benefit from these therapies usually at less than half the cost of going to a private center.

5. Check with your health insurance to see if they offer any discounts for using “preferred providers.” This means that although the insurance company doesn’t pay for your treatment, they have relationships with certain providers who will offer their subscribers as much as a 20% discount on services.

6. Get early care! The sooner you address the problem, the fewer secondary effects you will experience and the less likely you are to develop a chronic condition.

7. Treat yourself well. Eating right, exercising, managing stress, and getting enough sleep are all important for your overall health and well-being and for injury prevention and management. The healthier you are, the less likely you are to suffer an injury, lost days from work, and the financial hardship that accompanies all those appointments, prescriptions, and products.

I hope some of these tips are helpful. Complimentary therapies can really contribute to the speed and success of your recovery and should not be viewed as unnecessary splurges.

I recently posted a link to a news article that suggested back pain may “be in your head”. If you’re interested in exploring the mind body connection and how pain, your identification with pain or an injury/illness, and the development of your ego as it relates to your experiences affects you, this book may be of interest.

Though it’s not a self help book for coping with physical pain, Tolle provides a new way to look at situations and experiences with awareness and spends a great deal of time explaining the ego and how it contributes to such feelings as anger, frustration, and fear. His writing delves into how situations of pain or illness may in some way serve the individual or their ego. Now that may seems ridiculous, because as anyone who suffers with pain knows, it’s not enjoyable. However, the pain may serve a different purpose, such as excusing you from other life roles or stressors, or perhaps providing validation in some way to boost the ego.

A lot of his suggestions seem similar to concepts within mindfulness meditation, of bringing awareness to each moment. To really feel and live each moment, and that with that awareness, the ego will start to dissolve and the individual can enjoy the experience of being.

This book takes the reader on a philosophical journey towards self discovery and healing from both physical and emotional pain.

Well, I didn’t make it to watch the 11:00 news last night, but I did read the story this morning. Check out this link to see why one New York doctor thinks the cure to back pain is all in your head.

http://www.thebostonchannel.com/health/16301412/detail.html

This morning as a gift to myself on mother’s day, I escaped for an early morning yoga class at a studio I’d never been to before. They specialize in hot, power yoga classes, which is not the style of yoga I typically practice, but do enjoy once in a while.

The heat was set to about 98 humid degrees, and the teacher was pushing the 40 or so of us that filled the room at 7am to our limits. During my peaceful hour and a half, I remebered why I enjoy subjecting myself to classes of this sort:

1. Being pushed to the limit and realizing how strong you are can be empowering.

2. Sweating (and I’m talking about the dripping, soaking wet kind of sweating that you don’t often experience) really does leave you feeling lighter and like you released a lot of toxins. (And I always replenish and rehydrate with lots of water afterwards.)

3. Varying your practice or exercise routine is a challenging, stimulating, and highly effective way to optimize your overall fitness level.

4. Any yoga leaves my mind and body feeling more at ease.

And I started thinking how all of these points relate in a way to my own experience of injuries, and those of my patients. (And I hope may help you)

1. As a PT, I am the one sometimes pushing the patient to their limit…and I’ve worked with many patients who push themselves to the limit. This can be good when they are motivated and work hard, but this can also lead to overuse injuries, so it’s important to find a good balance.

2. As far as sweating, well, this one doesn’t relate as much. However, the process of releasing toxins is so beneficial. Massage and water therapy, such as a warm whirlpool, are two ways to experience a release and should also always be followed up with adequate rehydration.

3. When recovering from an injury, it’s important to change and progress your exercises in order to continue making gains. If you stick with the same 3 exercises forever, you may not see results.

4. Finding a means of relaxation and stress relief helps to reduce overall pain levels. The more stressed you are, the more likely you are to tense up your muscles, restrict circulation, and lose muscle flexibility. If yoga’s not for you, it’s important to find some other form of phsical or mental therapy to help induce a state of mental peace.

So maybe today you will think about trying something a little bit different. Your health care provider may have some helpful suggestions if you’re not sure where to begin.

Over the years, I’ve learned to very easily distinguish between the pain I feel when I injure a joint versus a muscle. And I’ve had my share of injuries… plantar fasciitis, Achilles tendinitis, chondromalacia patella, ITB syndrome, SI sprain, thoracic/rib sprain, rotator cuff strain, cervical sprain, and I’m probably leaving out a few.

Though I’m not into extreme sports and I exercise regularly, I have some structural skeltal abnormalities that have predisposed me to these many injuries just with somewhat normal activity (especially running…which I love but my body doesn’t share the sentiment.)

The pain from the joint injuries or sprains is quite distinct from muscular injuries. Joint pain is often felt or described as being:

1. Sharp

2. Localized

3. Worse with specific movement patterns

For example, when I sprained my wrist, I could pinpoint the exact joints/ligaments that were affected, and it only hurt in the one spot when I extended my wrist back. When I sprained my SI joint, the pain was again, very specific to the SI joint, and it hurt when I brought my leg out to the side and extended my spine as if into a backbend.

A muscle injury, or strain is usually experienced differently. The pain tends to be:

1. Along the length of the muscle or tendons

2. Worse when the muscle contracts and stretches

3. More difficult to pinpoint to just one spot

4. Tenderness to the touch with or without muscle spasm

When I strained my rotator cuff, it hurt to both reach my arm up (as it contracted) and reach my arm around my back (as it stretched). When I pressed on the tendon it was very sore to touch, and the pain seemed to travel all around my shoulder.

The treatment for both types of acute injuries is the same: rest, ice, compression, and elevation. In terms of rehabilitation, it’s important to consult with a doctor regarding the best form of treatment for your specific injury. You may find that for joint injuries, a chiropractor or physical therapist may offer the most relief. Muscular injuries may respond well to massage and/or physical therapy. Again, I can’t stress the importance of early access to evaluation and treatment to prevent a chronic condition from developing.

Back pain during the childbearing year affects up to 80% of women as a result of the vast changes happening in the body as the baby grows. During pregnancy, the joints throughout the body become more mobile due to the production of several hormones. The spine is therefore more easily sprained or pulled into sub-optimal alignment. This can result in muscle spasm, inflammation, pain, and a decrease in functional and recreational activities. In addition, women gain on average 25-35 pounds over a short period of time, with the majority of that weight distributed at the abdomen and breasts. This change in her shape shifts the woman’s center of gravity forward and upward, resulting in changes in her posture. She tends to stand with an excess arch in her lower back and her upper back rounded forward. These postural changes place stress on the muscles and ligaments surrounding the spine which can also lead to pain and functional limitations. Although back pain during pregnancy is a common problem, it often goes untreated as it is often perceived as an inevitable side effect of pregnancy.

Research findings suggest that the majority of cases of pregnancy-related back pain go unreported, with only a third of women discussing the problem with their maternity providers. Within that group, only 25% of their providers recommended a specific form of treatment.1 Women do not, however, have to suffer through their pregnancies with back pain. There are several safe, effective treatments that can help them manage their pain and optimize their well-being throughout pregnancy and into the postpartum period. A description of each follows, as well as some pros and cons.

Independent Exercise Program

Exercise is beneficial in preventing back pain, as well as helping to manage and reduce existing pain. In fact, research findings suggest that regular exercise during pregnancy can result in a significant reduction in the intensity of back pain. 2,3 Achieving a good balance between the strength and flexibility of the muscles surrounding the spine and pelvis can help provide stability and decrease the risk of injuries. In particular, the abdominal, back, and pelvic floor muscles should be targeted, as they are often most impacted by the physical changes that occur during pregnancy. Prenatal fitness classes offer a nice way for women to improve their cardiovascular fitness, strength, and flexibility, with the added benefit of socializing with other women. Prenatal yoga and Pilates are nice options as they target the spinal stabilizing muscles while focusing on alignment and posture. If such classes are not accessible or affordable, there are numerous book and video resources that can help women design their own programs.

Pros:

• May help prevent pain
• Can do exercise when it’s convenient
• Inexpensive
• Can use as an adjunct to individualized treatments for optimal results

Cons:

• If exercises are done incorrectly, pain and injury could result
• If lacking motivation, women may not be consistent with an exercise program
• Exercise may not be suitable for women with high risk pregnancies

If attempts to exercise independently are unsuccessful or pain initially prohibits exercise, individualized treatment by one of the following professionals could be beneficial.

Physical Therapy

A physical therapist experienced in treating pregnant women can evaluate the woman’s posture, spinal and pelvic alignment, joint mobility, muscle flexibility, strength, and tone. The physical therapist can perform safe, gentle techniques to re-align joints, improve joint motion, and reduce muscle spasm. In addition, a physical therapist can design an exercise program specific to the client’s needs in terms of muscle strength and flexibility, as well as teaching her how to move, position herself during sleep, and optimize her posture during daily activities. The treatment modalities physical therapists commonly use, including ultrasound and electrical stimulation, are for the most part contraindicated during pregnancy, but moist heat or cold packs could be used to help reduce pain and spasm.

Pros:

• Postural re-training will help during pregnancy and throughout motherhood to decrease stress to the spine, thereby decreasing risk of injury
• The pregnant woman can stop seeing the physical therapist and continue independently with her individually designed exercise program once she is ready
• Most health insurance covers the cost of physical therapy minus a co-payment

Cons:

• Depending on the facility, patients may not receive one on one treatment
• Not all therapists are experienced in treating pregnant women, so it is advised to inquire with local facilities to find an experienced provider

Massage Therapy

A massage therapist trained in prenatal massage will evaluate the client’s muscle tone and address any areas of tightness or restriction. The pregnant woman may be treated on her side, and some massage therapists use special pillows with a cutout for the abdomen so the woman can lie on her belly. Using various techniques, the massage therapist can help improve the circulation to the muscles, reduce stress, and promote relaxation, which can in turn improve posture. One study also found that pregnant women receiving massage therapy for 20 minutes twice a week experienced less anxiety, improved mood, better sleep, and a reduction in back pain.4

Pros:

• Improves circulation to muscles in pain or spasm
• Promotes relaxation and improved posture
• Gives the pregnant women an opportunity to rest and unwind, which is often much needed

Cons:

• Can be costly, even if subsidized by insurance
• Without exercise to help address muscle weakness and inflexibility, relief may be temporary
• As with physical therapists, one should find a massage therapist trained in prenatal massage

Chiropractor

A chiropractor experienced in treating pregnant women will assess the client’s posture, alignment, muscle tone, and mobility for regions of restricted movement or mal-alignment which would contribute to swelling, pain, and muscle spasm. S/he will then use various techniques to adjust, manipulate, or realign the joints. This restoration of joint positioning helps to reduce pain and improve movement and function. Some chiropractors will also recommend appropriate stretching and strengthening exercises to help maintain the corrections in alignment. In addition, one study found that women with back pain who were treated with spinal manipulation experienced less back pain during labor. 5

Pros:

• An effective way to correct an alignment problem
• Can sometimes provide immediate relief
• Effective if done in conjunction with the appropriate stretching and stabilization exercises

Cons:

• Can be costly depending on insurance
• Manipulating joints that are already more mobile (as a result of hormonal changes) could result in pain and injury if done incorrectly, so it is important to work with a chiropractor experienced in treating pregnant women
• If done without incorporating exercise, relief may be temporary

Acupuncture

Acupuncture, an ancient form of Chinese medicine, continues to gain popularity as a treatment for back pain in the general population. Recent studies have found that acupuncture helps improve function and reduce the intensity of back pain during pregnancy.6 An acupuncturist will perform a comprehensive exam including an evaluation of the client’s appearance, color, speech, pulses, tongue, and physical condition to determine where the flow of energy is obstructed. The treatment consists of fine needles (generally painless) being inserted into specific points throughout the body to help open the energy channels, thereby restoring balance, reducing pain and muscle spasm, and improving mobility. Acupuncture is safe during pregnancy, with the exception of specific points around the ankle that may stimulate the uterus.

Pros:

• A safe alternative treatment for back pain and restoring good flow of energy
• May also help reduce morning sickness in early pregnancy

Cons:

• Can be costly depending on insurance
• Patients need to be open and receptive to a alternative medicine
• People who fear needles may be intimidated by it

It is important to discuss with your OB/GYN or midwife to determine what type of treatment is best suited for you.

1 Wang, S et al. Low back pain during pregnancy: Prevalence, risk factors, and outcomes. Obstet Gynecol 2004 Jul;104(1):65-70.

2 Garshasbi, A, et al. The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet. 2005 Mar;88(3):271-5.

3 Kihlstrand, M et al. Water-gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstet Gynecol Scand Mar 1999;78(3):180-185.

4 Field, T et al. J Pregnant women benefit from massage therapy. J Psychosom Obstet Gynaecol. 1999 Mar;20(1)31-8.

5 Diakow, PR et al. Back pain during pregnancy and labor. J Manipulative Physio Ther. Feb 1991;14(2)116-8.

6 Guerreiro da Silva, JB et al. Acupuncture for low back pain in pregnancy. Acupuncture in Medicine. 2004 Jun;22(2):60-7.

“Too young to Feel Old: The Arthritis Doctor’s 28-Day Formula for Pain-Free Living,” was just released a few months ago. Written by rheumatologist, Dr. Richard Blau, this book offers recommendations and information regarding over the counter products, medications, exercise, alternative treatments, and diet. It also includes recipes designed to help improve overall health and arthritis symptoms.

The book can help to jump start you on a comprehensive way to manage your arthritis.