“Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to work.” Albert Schweitzer, M.D.

Leny Carbone, Director & Instructor

ORN

ELLA IELO

BACK PAIN (Chronic and Acute)

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BACK PAIN

(CHRONIC AND ACUTE)

DEFINITION AND CAUSE OF SYNDROME/DISEASE – WESTERN AND TCM:

BACK PAIN – WESTERN:

Most common causes of low back pain are mechanical disorders of the lower spine. It is classified mechanical if physical activities make it worse and rest makes it better. Degenerative Disc Disease (the breakdown of the cushions between the vertebras) is the most common mechanical disc disease.

ACUTE:

Acute back pain is described to come on rapidly and lasts about one to seven days. Acute pain can be mild to severe. It is the most common type of back pain.

SUBACUTE:

Subacute back pain is described as lasting more than a week and possibly as long as a few months. Approximately 10% to 20% of cases can be classified as subacute.

CHRONIC:

Chronic back pain is described as long-term pain lasting more than three months. Chronic pain can range from mild to severe. It is the least common type of back pain, about 5% to 10% of cases.

OTHER MECHANICAL CAUSES:

SPRAINS: When ligaments in the back are torn.

SPASMS:

Overworked muscles of the back go into spasm. Painful, involuntary contractions, it’s the body’s way of protecting itself temporarily so the person is unable to use or damage their back further.

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RUPTURED OR HERNIATED DISCS:

Discs are weakened; the hard outer cover can rupture allowing the squishy center to bulge and put pressure on nearby nerves.

SCIATICA – LOW BACK PAIN:

Discomfort associated with the sciatic nerve. This nerve runs from the lower part of the spinal cord, down the back of the leg, to the foot. Can be a sharp or burning pain that radiates from the lower back to the hip, it can follow the path of the sciatic nerve to the foot. The sciatic nerve is the largest and longest nerve in the body, the thickness of a person’s thumb. The primary cause of sciatica is a herniated or bulging intervertebral disc that compresses the nerve root before it joins the sciatic nerve.

POOR POSTURE: Sitting or standing.

COCCYDYNIA: Pain in the coccyx or tail bone resulting from a fall onto the buttocks.

FACET SYNDROM: Is inflammation of one or more facet joints where vertebrae connect to one another.

MUSCLE TENSION: Stress or tension can worsen if ignored and not taken care of.

DISEASE RELEATED CAUSES OF BACK PAIN:

ARTHRITIS: Most common, joint inflammation. The spine is made up of 48 joints.

OSTEOARTHRITIS: More common for elderly. Occurs when joint cartilage breaks down, bone at the end of a joint can thicken and spurs can develop bony growths.

RHEUMATOID ARTHRITIS: Inflammation, joint damage and deformity.

OSTEOPOROSIS: Thinning of the bones.

PAGET’S DISEASE: Excessive bone breakdown followed by abnormal formation.

SCOLIOSIS: Spine twists to one side.

KYPHOSIS: Curvature of the upper spine, hunchback.

OTHER CAUSES:

OBESITY: Excess body weight in the abdomen area causing strain on back muscles.

PREGNANCY

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KIDNEY STONES

KIDNEY INFECTIONS

ENDOMETRIOSIS: The tissue that lines the uterus leaves the uterus and deposits on other organs. The pain worsens around menstruation.

TRADITIONAL CHINEESE MEDICINE:

Meridian based therapies are a unified healing system that has evolved for over 3,000 years. The natural therapies are:

1) Acupuncture 2) Herbal Therapy

3) Massage 4) Exercise 5) Diet

In TCM, prevention and treatment of disease is stressed by strengthening the body’s own self-regulation, restoring the bodies balance.

In TCM there is a Life Energy-Chi, or Ki – that flows along invisible body pathways know as meridians. The life force circulates through the body, when it is balanced it is considered that a person is healthy. When the Ki is blocked at specific points, illness occurs.

The paired organs meridian related to the back are the Bladder Channel located mainly along the posterior aspect of the body which is the longest meridian in the body consisting of 67 acupuncture points; the paired meridian is the Kidney Channel.

In TCM, unlike the Western view, everything is connected as a whole. In relations to the paired organs of the Kidney – Yin organ, Bladder – Yang organ:

Element: Water Sense organ: Ears Tissue: Bone Tastes: Salty Colors: Blue / Black Sound: Groaning Odour: Putrid Emotion: Fear Season: Winter Environment: Cold Direction: North Developmental Stages: Storage

EFFECTIVENESS OF SHIATSU IN TREATING BACK PAIN (Chronic and Acute)

Shiatsu, the Japanese Ancient Art of hands on healing, using 80% of finger pressure 20% massage, is very effective in helping the body heal itself.

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Working along specific meridians on acupuncture points and also between the Tsubos stimulates the Ki flow through the bones, nerves, arteries and skin. Moderate pressure applied all over the body stimulates the flow of energy. Shiatsu can help backaches and sciatica that stems from poor circulation in the pelvis and sacro-lumbar region by stimulating the life-blood energy to flow freely. Shiatsu also helps to structurally align the bones of spine by hand manipulation.

MAIN TREATMENT AREAS TO BE USED – CHANNEL, POINTS, ZONES:

CHANNELS:

The channels used for back pain would be the Bladder and Kidney, Lung and Large Intestines, Gall Bladder and Liver, Du and Ren paired meridians.

POINTS: LOCATION ON THE BODY: ACTION:

Lung 2 1 cun above Lung 1 Good for upper back pain

Large Intestine 4 on the dorsum of the hand Good for any pain in the

In the web of 1st and 2nd body when used with Liver 3

Metacarpal bones

Liver 3 on the dorsum of the foot Good for any pain in the

Between the 1st and 2nd body when used with

Metatarsal bones Large Intestine 4

Bladder 23 1.5 cun lateral to Back Shu point of the

Lumbar 2 kidney, tonifies kidney,

nourishes kidney essence, strengthens lower back

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POINTS: LOCATION ON THE BODY: ACTION:

Bladder 25 1.5 cun lateral of lumbar 4 Back Shu point of Large Intestines,

good for back pain, Sciatic pain, lumbar

pain

Bladder 32 Over the 2nd posterior sacral Tonifies lumbar, Formen lower back pain, Tonifies kidney Bladder 36 Centre of transverse cubital Good for sciatic pain, crease in the depression lower back pain, between the hamstring muscles pain radiating down the leg

Bladder 40 Midpoint of the transverse crease Good for lumbar of the popliteal fossa pain

Bladder 52 3 cum lateral to lower border Tonifies the kidney,

of Lumbar 2 level with Bladder 23 strengthens the back

Bladder 57 8 cun below Bladder 40 Good for lower back

pain, sciatica, relaxes

sinews (tendons and

muscles)

Bladder 58 7 cun directly above bladder 60, Strengthens kidney,

1 cun inferior and lateral to Sciatica, relaxes sinews

Bladder 57 (tendons and muscles)

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POINTS: LOCATION ON THE BODY: ACTION:

Bladder 60 In the depression between the external Relaxes sinews,

malleolus and tendon calcaneus strengthens the back,

lower back pain,

chronic back pain

Kidney 7 2 cun above kidney 3 on anterior Strengthens lower

border of tendon calcaneous back and kidneys

Gall Bladder 25 FMP of kidneys, anterior and inferior Tonifies the kidneys,

to the free end of the 12th rib strengthens the

lumbar region

Gall Bladder 30 1/3 distance between the prominence Sciatica, low

of the greater trochanter and hiatus of back pain,

the sacrum lumbar pain

Gall Bladder 34 Influential point of the tendons 1 cun Used for any pain

anterior and inferior to the head of the in the body, relaxes

fibula sinews, good for

back pain

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POINTS: LOCATION ON THE BODY: ACTION:

Gall Bladder 39 Influential point of marrow, 3 cun Tonifies kidneys

superior to the prominence of the

lateral malleolus

Du 12 Below the spinous process of the Helps with pain and

3rd Thoracic Vertebra (T3) in and stiffness of the

line with, 1.5 cun lateral of BL 13 back

BSP of the Lung

ZONES:

To treat the patients I would start with the patient in the supine position, (using a pillow under their knees for better back support and comfort.) to perform the Hara assessment. After the assessment of Kyo and Jitsu, looking at the feet to see which one was turned out the most, I would treat the arms and legs and feet. Kyo side first. If the patient was in a lot of discomfort I would work on the sides to access the Gall Bladder meridian, liver, bladder. Tonify the kidneys. If the patient was chronic I would have them go to the prone position and work on the back with better access to the Bladder channel. I would work on the sacrum and the back of the legs and feet. I would end the treatment in both cases with the head.

TREATMENT PROCEDURES – MANIPULATIONS, POSTURES, SEQUENCE:

MANIPULATIONS:

Acute and Chronic:

With a patient that had acute pain, I would recommend no more than two days of bed rest before they came to see me. I would encourage them to have diagnostic imaging and have them bring in the written report for me to see. While treating them I would be cautions around the more tender areas. The level of pressure I would use would range from 1 to 6.

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The greater intensity of the pressure would be used on the exterior limbs, not on the back area. Most of my treatment would be to Tonify the kidneys. I would Tonify the kidneys via the Hara. I would use a gentle holding technique, and would visualize bring my patient to my sacred healing cave.

For patients with a chronic condition who were able to move more freely I would follow the same process as above, but have them lie in the prone position so I could have better access to the back area.

I would follow the tree steps to facilitate healing:

(1) First clear stagnation (Jitsu area,) go in with more force less holding time.

(2) Second, I would habituate nerves, facilitate heating.

(3) Repair damage – Tonify Kyo, this is an excellent way to treat serious conditions. This is the time I would bring them to my sacred healing cave.

POSTURES:

My attitude would be positive and confident to help facilitate healing. Focused, centred in myself, calm and thinking of the patient before me. Witnessing the pain the patient is experiencing, my touch and thoughts would be sending healing vibrations. The stances I would use would be varied from seiza, one knee standing. I would be changing stances to remain comfortable.

ZONES:

I would be mindful to the time, less is more. The zones I would cover would be Hara, then the outside limbs, hands and feet. Even if I had only time to repeat a sequence once, that would be beneficial as well. The side position would be next. If the patient was well enough to lie in the prone position, the back and legs would be next. The head would be the last area to cover. I would use grounding points, Kidney 1 and Gall Bladder 14. The last part of the treatment I would assess the Hara to see if the organs balanced out.

LIFE STYLE CONSIDERATIONS – EMOTIONAL FACTORS, STRESS FACTORS, LIFE STYLE CHANGES, DIET, HERBS, SELF CARE:

Back pain can be prevented or at least lessened through health lifestyle habits – a healthy diet, proper posture, the right footwear choice and plenty of physical activity.

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EXERCISE:

A regular and varied exercise program can ease pain and stiffness, strengthen muscles and bones, burn calories, improve flexibility, increase energy, improve sleep, boost your mood, increase your sense of well-being and reduce your risk of serious diseases.

Three types of exercise:(1) Isometric – exercises in which a force is applied to a resistant object. They would be helpful in strengthening muscles of the back and the abdomen.

(2) Isotonic – exercise that involves moving a constant, heavy weight through a full range of movements. Lifting free weights is an example.

(3) Isokinetic – exercise in which the maximum force of the muscles, that are capable, may be applied through a range of motion. Rowing machine is an example. Aerobic exercises. When walking contract your stomach muscles, don’t forget to breath.

If you have suffered or at risk for a compression fracture of the vertebrae:

AVOID THE FOLLOWING: Jogging High-impact aerobics Step aerobics Football Sky diving In-line skating Snow skiing

INSTEAD TRY THE FOLLOWING:

Exercise in water, a pool or hot tub. Yoga Tai Chi

GOOD BACK HEALTHY HABITS:

POSTURE – when standing or sitting and walking.

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IMPROVE YOUR POSTURE:

When standing: Stand with your weight equally distributed on both feet. Place one foot on a footstool to ease the tension on your back Wear flat or low-heeled shoes if you are standing for long periods of time. Keep you back straight by tightening your stomach muscles and buttocks and doing a

pelvic tilt.

When Sitting: Keep stomach muscles pulled in and maintain the proper curve in your lower back. Keep your knees slightly higher than your hips. Use a footstool. Don’t sit for long periods at a time. Take a break and stand up and walk around.

Proper lifting methods: Face the object you are going to lift and carry. Bend your knees; use your leg and stomach muscles, not you back muscles. Hold the objects close to you. Straighten you legs to left the object. Get help to lift objects if they are too heavy.

AVOID SLEEPING ON YOUR STOMACH; RETRAIN YOURSELF TO SLEEP ON YOUR SIDE WITH A SUPPORTING PILLOW OR SLEEP ON YOUR BACK. PLACE A PILLOW UNDER YOUR KNEES.

DIET AND WEIGHT MANAGEMENT:

To maintain your weight your calorie input must equal your output. To reduce weight you must make healthy food choices. Avoid High Glycaemic Index Foods. Whole grain foods take longer to break down in your system.

FOOTWEAR:

A durable counter (the part of the shoe that surrounds your heel). A supportive insole should cushion your heel and support your arch. A roomy toe box, it should allow your toes wiggle around. A flexible sole, a sole that doesn’t bend at the ball of your foot. A padded heel should absorb shock as you walk.

10TOBBACO USE:

Cigarette smoke is bad for your back. Smoking causes damage to blood vessels that supply the back. Cigarette smoke is bad for your bones.

STRESS REDUCTION:

Daily life stress is one of the biggest factors in back pain. Stress causes muscles to tense, leading to pain.

RELAXATION THERAPIES AND TECHNIQUES:

Acupuncture / Acupressure / Shiatsu Reflexology

MANAGING STRESS: Meditate Deep breathing Distraction –training your mind to focus on something other than your stress. Guided Imagery – closing your eyes image a beautiful beach lying in the sand listening

to the waves. Progressive relaxation – tense and then relax the body’s muscles from head to toe. Visualization – helps reduce stress by allowing you to imagine yourself anyway you like,

doing anything you want to do. Keeping a Journal – is helpful in reducing stress when writing down your feelings.

HERBAL REMEDIES:

Whole herbs: parts of plants that are dried cut and powdered. Herb teas: beverages made from steeping herbs in hot or boiling water. Tinctures: solutions created when an herb is soaked in alcohol or glycerine. Extracts: tinctures in which some of the alcohol has been distilled out. Capsules and tablets: herbal preparations Salves and ointments: topical (rub-on) preparations that contain herbal extracts.

MOST COMMON REMEDIES TO RELIEVE BACK PROBLEMS: Boswellia Cat’s Claw

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VITAMINS, MINERALS, ENZYMES:

Vitamin B3 Vitamin C Vitamin D Vitamin E Boron mineral Bromelain is protein-digesting enzyme derived from pineapple. Calcium Copper mineral Fish Oil – cold water fish, such as salmon or mackerel help reduce inflammation. Glucosamine – a natural substance that provide the building blocks for the body to make

and repair cartilage. Magnesium mineral

GODD SELF CARE:

Stop and smell the roses or any other flower you walk by Give thanks to God or Innate Intelligence, The Greater Life Force Love life and the world in its entirety Smile, Breathe deeply, Be Happy to be alive “Do unto others as you would have them do unto you.” Get in touch with nature, roll around in the leaves, make snow angels Take a walk by the beaches or in High Park, walk in the sand or water bare foot Laugh often, it’s the best MEDICINE It’s your choice what kind of day you’re going to have, choose a Good Day!!! Do what you love and love what you do. Your field of work SHIATSU! Help someone who needs a hand, it will make you feel good inside. Making the world a better place starts with YOU!

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