Treatments for Neuropathy

Neuropathy is a painful and sometimes severe condition where nerve damage causes pain, tingling, and numbness from affected sensory nerves, and lack of coordination or control in motor nerves. It can be caused by cancer treatment medications, high blood sugar levels, and other conditions, and is most common in the feet and legs. Effective treatment calms the nerves and restores blood and oxygen flow so that the damage can heal.

Acupuncture is one of the most effective treatments for neuropathy, with an over 75% success rate after a course of 4 or 5 weekly treatments. Most people maintain their improvements unless the condition is caused by medication they are still taking. The treatments work to improve nerve conduction and reduce the stagnation of energy in the limbs, restoring balance to the flow of the body.

Bodywork and massage treat neuropathy by focusing on restoring blood circulation to the small vessels that provide oxygen to the nerves in the feet and hands. Without enough oxygen, the nerves malfunction and send signals of pain, tingling, burning, and numbness. Treatments need to be at least 60 min once/week and focus on working as deeply as is comfortable, with the goal of eventually flushing all the stagnant blood out of the tissue. It is also important to do at least 15 min a day of self-massage and range of motion exercises at home to support the detailed work of the treatments and continue to make progress.

Therapeutic movement classes, like yoga and tai chi, strengthen the communication between nerves and brain and also help treat neuropathy. Opening up the front of the body increases oxygenation and improves blood circulation, helping to nourish the affected nerves. Classes also are generally calming to the nervous system, which helps ease the pain symptoms. Regular classes, especially when taken along with other treatments, help keep the pain from getting worse and support the healing process.

Neuropathy is an often painful condition that can be treated, and acupuncture, bodywork and massage, and movement classes like yoga and tai chi all help reduce pain, increase circulation, and support healing for damaged nerves. Because nerve pain is often due to a lack of oxygen, increasing blood flow can go a long way toward easing symptoms and creating health.

How Mindfulness Reduces Pain

Mindfulness is a specific form of meditation that has been proven to reduce pain. Clinical trials have shown it to reduce chronic pain by 57%, and accomplished meditators can achieve even higher levels of pain relief. Other studies have shown that it does not use the body’s own natural production of opioids or endorphins to accomplish these reductions, so how does it work?

The practice of mindfulness brings quiet, focused attention to the body and its sensations. Typical exercises help you observe with the mind’s eye, and just notice what is happening. When we are in pain, our minds spend a lot of time thinking about it, trying to solve it, and worrying if it will ever end. Mindfulness allows you to observe painful sensations as you feel them, and quiet the mind’s reactions and struggle.

This process has the biological effect of soothing the brain patterns of your pain perception. With regular mindfulness practice, these changes will alter the structure of the brain itself so that pain is not felt with the same intensity.

This works because there are two layers to the perception of pain. First, there is the sensation of the illness, injury, or damage to the body that is causing the pain. Second, there is the brain’s reaction to this sensation. The brain is trying to protect the body from further damage or injury and so it focuses on the sensations of pain. This effectively turns up the “volume” and increases suffering. For chronic pain, this process becomes a feedback loop, and the brain gets better and better at feeling more pain.

Mindfulness practice effectively turns the volume back down again, so that the brain does not amplify the pain signals the body is sending. This in turn reduces the pain-related anxiety, stress, and depression, and creates room for the body to begin to relax and then heal.

On the Psychology of Muscle

Your muscles take on the shape that they are accustomed to being in for hours every day. Any one thing, any repetitive motion, will shape the muscle and shape the fascia that surrounds it. The body responds so that the form follows the function, or that the function will make the form. What we want, then, is for our bodies to assume variable positions and activities throughout the day and throughout our life.

Changing positions can be challenging, though. It takes more than stretching to release a muscle, and we can’t force ourselves into a position when our body isn’t ready. Muscle fibers require a neurological signal in the form of a chemical messenger in order to release, and even though that signal comes from the brain, we don’t necessarily decide if our brain will send that signal. We can’t just tell our hamstrings to be less tight. What needs to happen is that the brain needs to feel that it is safe enough for that muscle to release.

So don’t over-stretch yourself into being over-burdened and over-committed. Dive into a conversation with yourself, befriend yourself, and gain an understanding of what your end stretch is and how much you can take on. There are times when we can take on a whole lot, and life circumstances change and we can take on even more. But nothing is constant, everything ebbs and flows, and it is our responsibility to listen to that ebb and flow and know if we need to back off or engage. What you did last summer may be very different from what you can do this summer, but if we go in with hearts wide open we can find opportunity.

Stay buoyant and responsive to where you and your body are in the process of holding and changing positions. We can’t force these processes, but we can work with them by knowing the parts of ourselves.

Cultivating Healthy Posture

Posture is one of the foundations of our overall health, and cultivating healthy posture is particularly important for our sense of wellbeing. The body’s ability to heal comes through movement, and every movement informs our posture, even as our posture informs our movement. The building blocks of healthy posture include ease and economy of motion, coordination, body-mind integration, and a balance between stability and mobility.

Postural issues can get locked into chronic holding patterns in the muscles of the body, causing ongoing muscle tension and discomfort. However, there is always a need for a certain baseline of healthy muscle tension to hold us upright and stable against the pull of gravity. This means that cultivating healthy posture is a complex process of supporting the tonic “anti-gravity” muscles even as we work to ease and release the dysfunctional chronic tension.

When we have pain, it signifies that we have dryness in the tissue, which means that the fibers have become rigid. We need to shift it back to being supple and juicy. One way is to learn to control those core and intrinsic muscles that help hold you upright. You can learn to engage the right muscles in the right order for certain movements, and to then relax any extra muscles that your body is trying to use instead of using its core. You can also use something called sensorimotor awareness, where you pay attention to certain parts of the body and how they move, and then adjust them as needed. Imagery can help you find the right alignments.

Working on healthy posture is progressive. The more you can learn to engage the right muscles and relax the extra ones who are trying to “help”, the better your posture will be. It is fundamentally a process of cultivating awareness, and can have tremendous benefits for overall health and wellbeing.

Treating Plantar Fasciitis

Plantar Fasciitis is foot pain, often in the form of a stabbing pain at the heel, and can be worst in the mornings. The pain comes from the plantar fascia, which is a band of connective tissue that connects the heel to the toes along the bottom of the foot. The arch of the foot is an important part of how the foot absorbs the force of the body against the ground (which can be 3-4 times your body weight with each step while running), and the plantar fascia is an important part of maintaining the right tension in the arch, so that it is neither too loose nor too tight.

The pain of Plantar Fasciitis usually comes from biomechanical issues like imbalanced posture, how you walk, or the shoes you wear. Though plantar fasciitis has traditionally been treated as an inflammatory problem, recent research indicates that it is not inflammation so much as collagen degeneration in the fascia. Treatment, then, needs to focus on the biomechanical dysfunction of the foot and how it relates to the rest of the body.

Bodywork like massage and myofascial release are especially effective at addressing these kinds of issues. There are fascial connections that run all the way from the bottom of the foot, along the back of the calf and thigh, and continue up the back and neck to the head. Tightness anywhere along these connections can then tighten the plantar fascia and cause pain. This means that releasing tight back muscles can relieve foot pain! Working with the body as an interconnected system helps address the dysfunction that is causing the plantar fasciitis in the first place.

The other key to addressing plantar fasciitis is blood and fluid flow. Fascia needs to be hydrated in order to stay healthy, and many shoes constrict circulation in the feet, even as they misalign or stress natural foot structures through raised heels, raised toes, and/or narrowing the toes in a pointed shape. Changing shoes and stimulating the nourishing flow of blood and fluid in the feet can help the fascia repair and rebuild its collagen. Massage, therapy balls, and gua sha are all effective for this kind of stimulation.
Plantar Fasciitis is a symptom, indicating a larger problem in how the body is standing, walking,  and/or running in general. Effective treatment needs to address much more of the body than just the feet and should be customized to the specific needs of each client. Bodywork and massage is especially effective at addressing the body in this way, and at HaLe’, we know how to treat the whole person in order to ease the pain and address the dysfunction of plantar fasciitis.

How Often Do You Need Self-Care?

Our bodies require regular care in order to thrive and heal, and one of the best ways to make sure we are on top of our self-care is to put it on our schedule instead of trying to fit it in around everything else. As a manual medicine and self-care practice, HaLe’ has experience with what kinds of schedules work best. Here are our recommendations, based on the state of your body:

Acute Pain: 3 classes/wk, bodywork every week

Acute pain is an active, painful flare up or injury. The body needs frequent treatment in order to release secondary tension, stimulate the parasympathetic nervous system, support the lymph system, and generally assist the healing process.

Sub-acute: 1-2 classes/wk, bodywork every 2 weeks

Sub-acute pain falls between acute pain (sudden and awful) and chronic pain (long term, constant/consistent pain). It means that something hurts, but it hasn’t been hurting for a very long time and it isn’t terrible. The body is not in crisis but still in need of support and healing, so regular treatment until it resolves is recommended.

Chronic: Start with 2-3 classes/wk and bodywork every 1-2 weeks, then taper down

Chronic pain is long term pain that is not healing or getting better, and can be anywhere on the spectrum from unbearable to really annoying. Addressing chronic pain involves a combination of treatments to reduce overall pain levels and to treat the root cause of the chronic condition. This usually means coming often at the beginning, and as treatment makes progress at interrupting the pain cycle, tapering off gradually until treatments reach a maintenance level.

Maintenance: 1-2 classes/wk, bodywork every 4 weeks

To maintain a level of general good health and low pain, we recommend a basic self-care schedule. This helps resolve issues before they begin to hurt, reduces baseline stress levels, hydrates the connective tissue (fascia), and promotes a general sense of well-being. People who are very active or athletic may need more frequent self-care maintenance.

What Really Works for Back Pain

Back pain is one of the most common reasons people go to the doctor, and there are new guidelines on how to treat it. Researchers analyzed more than 150 studies to understand what really works and what doesn’t. The conclusion: instead of medication, try yoga, massage, or mindfulness.

These guidelines, published by the American College of Physicians on Feb 13, 2017, say to use techniques that speed up the healing process to relax muscles, joints and tendons. This can be done through massage, acupuncture, and spinal manipulation, as well as mind-body therapies like yoga, tai chi, and mindfulness-based stress reduction.

This new recommendation is in alignment with the new CDC & FDA guidelines for the usage of opiods, which are now known to be inappropriate for chronic pain management. It instead recommends trying massage, yoga, and mindfulness first, then NSAIDS like ibuprofen and naproxen to reduce inflammation. Acetaminophen is not recommended, since it does not reduce pain or inflammation.

Low back pain is common, and the way it is currently treated in medical settings is a good example of low value health care: expensive tests and therapies that don’t fix the problem. Moving to more effective treatments for both acute and chronic conditions by recommending yoga, massage, and mindfulness will help reduce suffering in patients and frustration in those who treat them.

At HaLe’, our manual medicine therapists and our self-care class instructors are experienced in treating low back pain. For regular aches and injuries, we recommend you come to class or make an appointment. For more severe conditions, please talk with us so we can guide you to the right treatment plan for your body.

 

Managing Pain from Injury, Activity, and Aging

HaLe’ can help you manage your pain. Things like repetitive motion, poor posture, highly active lifestyles, and accidental injuries can cause long or short term pain issues for everyone. We can help.

Injury: Recovering from an injury is sometimes a long and frustrating process. Classes based on mindful movement help you to support your healing process and relieve the tension in the other parts of your body that are compensating while the injury heals. Bodywork and massage therapies can go a little deeper to help reduce inflammation, nourish the injury with blood and nutrients, and reduce pain signals.

Athletic Performance: Highly active lifestyles like running, rock climbing, and kayaking all come with their own sets of challenges. Pushing your body to higher levels of performance and fun requires additional recovery and maintenance in order to prevent serious injury. Classes to support full relaxation, rebalancing, and core strength are a wonderful counterpoint to always being on the go, as they help the body recover and nourish itself. Therapies like massage and cupping therapy improve recovery time and can increase athletic performance.

Aging: Getting older also sees an increase in pain levels as the results of various repetitive motions, posture habits, and old injuries make themselves felt. As the body ages it can become rigid and brittle, and movement classes can do a lot to reinvigorate and reactivate the body. This improves muscle tone, balance, and the ability to get up and down. Small imbalances accumulate into aches and pains, and they can be corrected through awareness and practice in the classes, especially when complemented with massage to address deeper levels of dysfunction at the same time.

Therapies and classes at HaLe’ are designed to increase your sense of wellbeing. All healing is self-healing, and HaLe’ is excited to partner with you in order to help manage pain and create health together.

Rolf Therapy for Low Back Pain

from Will Ravenel

Lower back pain is the second most common complaint people bring to their doctors. Often chronic pain is structural in origin, and if it is structural, it is best treated through myofascial release. The structure of the body is determined by the fascia, which is connective tissue that surrounds and connects all muscles and systems of the body.

If the fascia is healthy, then the body is organized. If the structure is unhealthy, then the body is constantly fighting to achieve structural integrity. By working with the fascia, we can organize the body and restore its natural structural balance.

A body that has gone out of structural alignment won’t be fixed by chiropractic, because chiropractic focuses on realigning the skeleton and the skeleton is not what determines structure. The fascia determines structure. If fascial thickening is the cause of pain, only moving fascia will change the quality of the fascia. Stretching, Pilates, and yoga do not move fascia. Neither does Swedish massage nor using a foam roller.

Will Ravenel is the Myofascial Release and Structural Integration therapist at Ha.Le’, offering both single sessions and the full 10 Series of Rolf Therapy. In his extensive experience, low back pain is almost always caused by fascia issues.

Structural Integration as a treatment for chronic pain is not just about the bodywork sessions themselves. It is a collaboration between the therapist and the client. Will can teach an individual a more appropriate way of walking, sitting, and standing more efficiently within gravity, and more efficient movement means less energy expended and more balanced alignment. The client has to be open to learning a new way of living within gravity to do that. Once the sessions are over, the client can continue to achieve structural balance on their own.

Pain relief in general for structural issues like low back pain is best treated with myofascial release generally and with Structural Integration specifically.

Treating Pain with Integrative Health Care

from Janice Cathey

Two weeks ago we discussed Dr Jackson’s TED talk about the inadequacy of opioid drugs and surgery for addressing chronic pain. Last week we talked about Central Sensitization, a biological process where pain modifies the way the nervous system works, making things hurt worse than they should and pain last longer than it should.

As the health care field grows its understanding of where pain comes from and how we need to change our approach to treating it, it is our great honor to be care providers in relationship to individuals.  HaLe’ is grassroots, which means we are growing an innovative way, building from modern research and ancient modalities to better cope and deal with health issues.

Evidence shows that only 20% of medical issues can be 100% dealt with by the medical field. We have a great regard and respect for what surgery and medicines and other western medical practices can do for us, and want them available for ourselves, our families, and others. Yet there is so much more to health than what western medicine can fully treat.

What we do is collaborate and partner, drawing understanding of the body’s dynamic response that happens daily in our practice. Every time a person comes in and connects with their breath­­, when there is movement, when there is connection, then there is a dynamic response that happens. We are not bringing people a shallow patina of “feel better”; we are delivering a systematic method of health and well being that is accessible to every single person no matter what your age, medical history, or where you come from.

Integrative medicine is not a new way of treating health and wellness; it is an objective. It increases connectivity for an individual because that is what integration is. This is not about one system of the body, but about many systems working in unison for the betterment of whole health. There is a bottom up response coming from the patient as they demand care on a holistic level, and that broader scope is where the care paradigm begins to switch. We are here to provide support and create space for that to happen.

Health is a dynamic system of balance and counterbalance that is complex and interconnected. Every person should walk away feeling better than when they came in our door. Even when you aren’t feeling bad, there is still room to feel better and to engage in the processes of health.

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