Acupuncture for back pain

If asked "do you think acupuncture is effective?" I tend to respond "yes. A recent meta analysis from Pedro concluded that included 13 studies stated that acupuncture does reduce back pain. The study also concludes that the effect of acupuncture was no different to sham acupuncture ( random application of needles at arbitrary points around the body). The following study illustrates the effects of sham surgery- . It seems to me that the effectiveness of any treatment relies on the scale of manipulative intervention, that is to say that the homeopathic approach, which consists of no manipulative therapy and focuses on verbal communication will not be as effective as an approach on the other end of the spectrum in regards elaborate nature of the treatment such as sham surgery-http://www.qoh.com.au/resources/newsletters/does-arthroscopic-lavage-and-debridement-surgery-for-osteoarthritis-of-the-knee-work. I would suppose then that the placebo affect increases as elaborate nature of the treatment increases, we can therefore grade the placebo effect of various treatments from homeopathic, massage, acupuncture, sham surgery.

 

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North London Massage

Massage is the manipulation of superficial sports massage north london and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being.[1][2] The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle" or from Latin massa meaning "mass, dough",[3][4] cf. Greek verb μάσσω (massō) "to handle, touch, to work with the hands, to knead dough".[5] In distinction the ancient Greek word for massage wasanatripsis,[6] and the Latin was frictio.

Massage involves acting on and manipulating the body with pressure – structured, unstructured, stationary, or moving – tension, motion, or vibration, done manually or with mechanical aids. Target tissues may include muscles, tendons, ligaments, fascia, skin,joints, or deep tissue north london other connective tissue, as well as lymphatic vessels, or organs of the gastrointestinal system. Massage can be applied with the hands, fingers, elbows, knees, forearm, and feet. There are over eighty different recognized massage modalities.[7] The most cited reasons for introducing massage as therapy have been client demand and perceived clinical effectiveness.[8]

In professional settings massage involves the client being personal training muswell hill treated while lying on a massage table, sitting in a massage chair, or lying on a mat on the floor. The massage subject may be fully or partly unclothed. Parts of the body may be covered with towels or sheets. Those who practice massage as a career are referred to as massage therapists.[citation needed] Most states back pain, shoulder pain knee pain north london in the US have licensing requirements for massage therapists.

Posture and Lower Back Pain

Above is a picture described by Alois Brugger as the "cogwheel" sitting posture.  On the left the figure displays a common sitting posture which leads to both a posterior pelvic tilt and a forward head.
In this position of spinal flexion a maximum amount of pressure is distributed onto the lower vertebrae causing trauma and lower back pain.
To correct this the lower back must be extended to create a healthy lordosis which in turn brings the head back and the pelvis forward.

Lower Back Pain- The core is the cure

If you have low back pain the cause is likely that you have little or no control over your stabiliser muscles- the multifidus and transversus abdominus muscles.
With low back pain sufferers these muscles are used as phasic muscles, which means they cannot endure long periods of activation and aren't being used for their primary purpose as stabilisers.
The goal of  the practitioner is to convert these muscles into stabiliser muscles by reconditioning the body's nervous system.
The method by which this is done is a slow and deliberate procedure whereby the client learns to activate their stabiliser muscles with small movements whilst maintaining a healthy pelvic tilt.

The first step is to acquire a normal pelvic tilt in a prone position and to become conscious of the transverses abdominus muscle. This is done by sucking the belly button toward the spine.  During this activation the client must breath normally without reducing the tension on their Transversus Abdominus.

The client must be reminded that the tension on their TA is only about 20% of their overall strength and that control is the key not strength.

Evaluating the pelvic tilt can be done via a biofeedback unit or more roughly by standing against a wall and making sure your thenar eminence can fit between the wall and your lower back.
As the sessions proceed, the movements the client are asked to perform become more varied and more weight is applied by having the client perform movements from the prone and supine position to standing and sitting positions.
Once the client has accomplished moving correctly and confidently without being consciously aware of  their core muscles the core muscles themselves become load bearers instead of the spine and its attaching ligaments. Once this occurs, there is a considerable reduction in the level of low back pain.

It has been proposed that the spine itself is not a load bearing structure and studies on cadavers have shown that with the spines stabiliser muscles removed, the spine degrades and segmentally breaks down with only a little weight added to it.

In contrast to before treatments began, the client now activates their core stabilisers before any movements are precipitated regardless of direction.

the function of this early activation is to utilise the intra-abdominal pressure which acts alongside the muscles to give structure to the body. 

Eventually the client can proceed to activating the perineal muscles and diaphragm alongside the stabiliser muscles to integrate the concept of intra-abdominal pressure for complete control of the core region, this can also help with incontinence issues and develop proper breathing patterns, reducing strain on the thoracic region and accessory respiratory muscles.

For a more detailed account of this process read “Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain”.

Take note that this is a long and sometimes frustrating process of reconditioning the motor system but in the long run highly successful.

Alex Nielsen

www.massagemuswellhill.co.uk