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.

 

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.

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.

Cupping therapy is an important part of our integrative health practice because it supports the process of many of our treatments. I talked with several of our talented therapists about how it complements the work that they do. Every session of Ha.Lé Bodywork is adjusted to meet the needs of the client in the moment. For example, our therapists may take a sports massage focus for highly active bodies, a therapeutic or medical massage focus to treat pain and structure issues, or a lymphatic focus to move fluids and support the healing process. Often a combination of techniques are used, and cupping therapy helps support many of these treatment goals.

Sports bodywork:

Cupping therapy helps to jump start myofascial release. The negative pressure of the suction combined with movement gives a different sensation than other myofascial techniques and helps the muscle reset itself to where it needs to be because the fascia has released. It is a great complement to other techniques and can sometimes create shifts that provide instant relief and allow chronic problems to just fade away.

Therapeutic bodywork:

Using cupping therapy after an Ashiatsu treatment really helps to bring the blood flow to the area, especially any area that is feeling stagnant, like the back or arm. The suction also helps to release the muscle when it is contracting, making for a faster release and bringing blood flow more quickly to the area. Afterward, people tend to feel either really energized or like they just ran a marathon.

Lymphatic bodywork:

Cupping can be very effective in helping to break up scar tissue that is impeding lymph flow, but it is not usually indicated for treating lymphadema or other lymphatic issues directly because it can be too aggressive for the lymph system. However, cupping works through the use of negative pressure, and there is ongoing conversation in the lymphatic massage community as we learn more about how to use cups and other negative pressure tools gently enough to support the lymphatic system.

Acupuncture:

Cupping facilitates better movement of blood and qi in an acupuncture treatment because of the openness of the tissue. The cups create negative pressure, as compared with massage, which uses positive pressure. This negative pressure opens up muscle and tissue, which works in concert with acupuncture needles to move qi.

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.

by Chelsea Henry

Pain can modify the way the nervous system works, making the body more sensitive to less stimulation, in a process called Central Sensitization. This happens mostly through changes in the brain and spinal cord, and means that little things hurt worse than they should, and that it takes longer for the pain to fade. We found this wonderful article, Central Sensitization in Chronic Pain by Paul Ingraham, which is a jargon-to-English translation of rock star pain researcher Clifford Woolf’s published paper.

As explained in the article, it is hard to know when a person is feeling more pain than they should, because we do not yet have a test we can run to show how much pain someone is feeling. That means that we only have our own experiences to go by, and without a defined “normal”, it is easy to not know that we are in more pain than we should be.

Central Sensitization is very well-documented and easy to create in lab settings. It also shows up so often as a complication of painful problems that some researchers think it might be a common denominator. It could be what puts the “chronic” in chronic pain.

Though we know that Central Sensitization exists, we do not yet know why it happens to some people and not others, and we do not have a good way to diagnose it. It could be a part of any case of chronic pain, but it is not clear how to separate the pain that comes from a problem in the tissue from the pain that comes from Central Sensitization.

When a person has Central Sensitization, it basically means they have a hyper-active warning system and the body is no longer giving useful, sensible pain signals. On a fundamental level, pain is about your brain’s assessment of safety: unsafe things hurt. Therefore we can treat Central Sensitization by being kind to our central nervous system. We can decrease stress and increase a feeling of safety and ease. Yoga, yoga therapy, massage, meditation, and mindfulness can all help create the felt experience of wellness the body needs in order to start turning off the alarms. Feeling safe and good, and having therapeutic experiences that are pleasant, easy, and reassuring, can go a long way in calming the nervous system and bringing the body back out of excessive pain.

by Chelsea Henry

Dr. Tracy Jackson spoke at TEDx Nashville about “The Hardest Pill to Swallow”, regarding chronic pain. We at HaLe’ feel inspired, because we see the evidence of the effectiveness of our holistic approach on the pain levels of our clients and students every day.

Chronic pain steals your mojo on every level. It is the #1 presenting complaint to doctors and top reason people are out of work, and yet US outcomes and treatment of chronic pain are among the worst in the developed world. We have a limited and flawed understanding of chronic pain, and we don’t want to accept what we do know.
Pain is a perception, and how do you prove it to doctors who are trained to diagnose and treat physical symptoms in the body? People with chronic pain go to 10 min doctor visits and present their case so that the doctor perceives their perception of their pain correctly. The worst that can happen is if the doctor thinks it is all in your head. But ALL pain is literally all in your head!

Think about a kid who doesn’t want to go to school because there is a test, or a monster under the bed. They get a tummy ache. They get a physical symptom based on an emotional issue. As adults, we deny that pain from mental stress manifests as pain in the body. But we cannot feel pain without a functioning brain. Chronic pain causes central sensitization, and our mood, sleep, and pain pathways all overlap. It all feels like pain in the body.

Americans are prescribed enough opioid pain pills for every person to take 3 pills a day for 42 days every year. The #1 cause of accidental death in the US is opioid overdose, which is more than car accidents. And yet no scientific study shows that opioids are effective for chronic pain after 6 months, and after that they start to change the body so that it feels more pain. They also mess with mood, sleep, immune function and sexual function. Chronic pain is not about a lack of pain pills. We are missing something.

Everything is connected in the body. You have to move regularly if you have chronic pain, it is the cornerstone of all effective treatment. It is significantly even more effective if that movement incorporates breathing and mindfulness techniques, like yoga. Some doctors ask how can that work if surgery and oxycontin don’t, but it has been proven to drastically reduce the pain experience by changing the way we think, breathe, and move. Harvard neuroscientists have shown that we can change the very structure of our brains and can reverse the changes caused by chronic pain by using the breath.

Pills and procedures do work for some people, but if they don’t work for you, you have to accept it and do something different. We can admit that stress and lifestyle choices contribute to and cause chronic pain at any age. We can hold ourselves accountable to seek out the longer, more durable path to real relief. We can advocate for more holistic functional rehabilitation resources (which have been thoroughly proven to work!) available to all of us, and teach that we can be active participants in our own healing and our own lives. The hardest pill to swallow is that there is no quick fix to chronic pain. But there is a fix!

Watch Dr. Tracy Jackson at TEDx Nashville

by Katherine Casey, LAc

If you have never had any experience with acupuncture before, you are probably concerned about the needles. This is understandable, because the only needles we are familiar with are hypodermic needles, which are hollow-bodied, and designed to either take something out of us (blood), or put something in us (medication). Neither experience is ever very pleasant!

Acupuncture needles are completely different from hypodermic needles. They are very thin, solid body (meaning, they aren’t hollow like hypodermic needles are), and they serve the purpose of delivering a message. They direct qi (that animating force that keeps us alive, pronounced “chi”) to do something, like “go over here and nourish the lungs because this body has a bad cold.”

Another concern people often have about acupuncture needles is whether or not they are reused. And the answer to this is an unequivocal and emphatic NO. Acupuncture needles arrive from the supplier in sterile packaging, and they are single use only, just like hypodermic needles. They are disposed of in a sharps container just like the ones found in doctors’ offices and hospitals. Acupuncture needles are never, ever reused.

by Katherine Casey, LAc

The history of cupping is documented in the medical histories of many parts of the world, including countries of Africa, Europe, the Middle East, as well as Asian countries. Cupping is the practice of applying specially designed cups to the skin using suction for the purpose of relieving muscle pain, reducing swelling, and increasing the circulation of blood and qi to an injured area. It can be used to assist in lymphatic drainage and in reducing cellulite. Cupping can also aid in alleviating digestive issues, such as constipation. Facial cupping can aid in the reduction of fine lines and facial puffiness.

Historically all kinds of items were used for cupping– animal horns, bamboo, stone, and sea shells are some of the materials used for cupping. Nowadays, in the modern clinic setting specially designed glass cups are used, as well as cups made of polycarbonate plastic or silicone, all of which can be easily cleaned after use.

How does it work? In order to answer this question let’s compare massage therapy and cupping. Massage therapy creates “positive pressure” by compressing tissue to relieve muscle tension. In constrast, cupping uses suction to create “negative pressure.” The suction action of cupping expands and opens up the layers of body tissue, allowing better circulation of blood and qi.

Cupping will often leave round marks, commonly referred to as bruises, though the marks are not true bruises, like those that occur from a compression injury. The marks gradually disappear a few days after treatment.

from Elmo Shade

The most common reasons people come to a Mindfulness Practice are

  1. Physical pain or chronic pain
  2. Emotional pain due to loss, death, or serious or potentially fatal diagnosis
  3. Inability to manage the day to day stressors of life

The benefits of mindfulness are known and well-documented. It reduces levels of stress, meaning the autonomic nervous system is not in fight, flight, or freeze mode. This then reduces both anxiety and depression, reduces fatigue and burnout, and reduces periods of restlessness. This leads to an increased ability to pay attention and concentrate and higher cognitive performance, particularly while learning. It enhances hormonal balance for women, and enhances the immune system of men and women.

Chronic pain, many of our physical ailments, and even diseases that we are experiencing are not actually illnesses or diseases. They are a result of the body system storing stress and pain that has never actually been released in a healthy manner. Mindfulness helps to reduce the discomfort of pain, both emotional and physical, and increases our capacity for compassion for ourselves and others.

Because Mindfulness Practice is about paying attention to physical, mental, emotional, and spiritual energies, it often leads to increased levels of energy. It can decrease fatigue and increase stamina. This higher energy level then brings increased movement. The American Psychiatric Association shows we spend 6-12 hours a day not moving, and this does not count the time we spend sleeping. Having the energy to move is a tremendous benefit.

Mindfulness Practice is evidence-based and proven to benefit quality of life through the reduction of physical pain, emotional pain, and chronic stress. Our collective stress levels are higher than they have ever been, especially for women, and that takes a toll on our health. We can bring ourselves back into balance through mindfulness.