Relieving Back and Hip Pain
By RICHARD LEVITON •
February 8, 2000
Everyone knows what back pain feels like, but what causes it? Common sense says back pain is caused by a pulled or strained muscle or a damaged or misaligned spinal vertebra, and common sense is often right, just not always.
Back pain specialists within the field of alternative medicine have a host of other theories-and the clinical proof, in the form of healed patients, to support them. According to these practitioners, while back pain may of course be precipitated by a physical strain, back pain also may be caused by chronic constipation, old surgical scars, and imbalances in the body's vital energy flow.
So if you're one of the 70% to 85% of adults who experience back pain, before agreeing to anti-inflammatory drugs or back surgery, consider the alternatives, such as massage therapy, chiropractic, herbal and dietary therapy, neural therapy, and acupuncture. Any of these approaches, as the following case histories show, can get you back to your life without pain recurrence or toxic drug side effects. Back Pain Caused by Untreated Physical Injury Elliot Greene, N.C.T.M.B., a nationally certified massage therapist, based in Silver Spring, Maryland, sees a lot of back pain cases which are the result of initial physical injuries left unaddressed, sometimes for years.
Consider the case of Lytton, 48, who came to Greene's office complaining of painful shoulder pain and spasms. They were sufficiently severe as to prevent him from playing tennis; even writing became nearly impossible as his arm and shoulder would be seized with cramps. Six months earlier, while chopping firewood, Lytton had felt a muscle pull around his right shoulder blade. The pain and disability progressed steadily from that point, he told Greene. He'd start playing tennis, then his right arm would freeze up with pain. Lytton went the usual round of standard consultations, getting steroid shots from one doctor, physical therapy from another, but his condition did not improve. "He came to see me as a last resort," says Greene.
When he first touched Lytton's shoulder blade muscles, Greene found them to be as hard as rock-"extensively contracted, as nearly all the muscle fibers had been 'recruited' to produce the chronic spasm. The spasm made it difficult and painful for Lytton to move his shoulder and arm."
In a serious strain, such as Lytton's, many of the fibers of muscles and connective tissue rupture and tear. Then the body attempts to heal this by growing scar tissue in the area. Trouble occurs when the site, without proper intervention, never gets fully healed and remains a little inflamed, painful, and in spasm, Greene explains. "Further complications can result if the scar tissue has grown so it interferes with the normal functioning of the muscle fibers. This can lead to painful movement and less range of motion."
In Greene's professional perspective, Lytton's case was perfect for deep-tissue, hand-delivered massage therapy. He explains that the massage has to focus on "restoring circulation, reducing chronic muscle tension, and influencing how the scar tissue has formed so that it doesn't interfere with the ability of the muscle fibers to contract and lengthen properly nor adhere to adjoining structures." To do this safely and effectively, a thorough knowledge of human musculoskeletal anatomy is required, which happens to be a massage therapist's specialty.
Greene treated Lytton weekly for ten months, working the muscles around the painful shoulder blade and the rest of his back. With this type of injury, improvement is dependable, although gradual. After about four weeks, Lytton felt a marked improvement. He started taking stretching and yoga classes to promote greater flexibility.
Lytton, when younger, had been more physically active, but as his forties progressed, he tended to minimize the role of exercise in his life. After his initial injury, he ignored the signals his body was sending, thinking the problem would "go away," until he could barely move his arm without pain.
Now, as he recovered from this disability, "he saw he needed to take a more active approach to his physical fitness," comments Greene. At the end of the treatment, Lytton had regained full use of his shoulder with completely pain-free range of motion. He also started to understand that the next time he had a physical strain, "getting the treatment started sooner rather than later would be a much better idea," says Greene.
In his second case study, Greene shows what happens when you let a serious back injury go for 15 years before getting correct treatment for it. Neville, 40, a former soldier, had, when he was 25, fallen seven feet out of a hovering helicopter and landed square on his shoulder with all the weight of his equipment on it as well. He received emergency first aid, enough to suppress the pain, and was sent back into battle.
"Neville never really had any therapy for his shoulder injury," Greene notes and, over the next 15 years, his shoulder became painful and steadily lost its range of motion.
When he examined Neville's shoulder, Greene found that the tissue scarring was so extensive that it had adhered to the outermost layer of bone (producing stabbing pain) and was starting to calcify. As Greene explains, sometimes a very deep tear in a muscle disturbs the tissue covering the bone, which leads to new bone being laid down on the muscle wound. "This area of calcified scar tissue was about the size of a 25¢ coin and felt like bone," says Greene.
The goal of treatment, then, was to loosen this adhesion, break up the scar tissue, increase blood circulation through it, let the body absorb the bony part of the muscle wound, and restore the muscle's normal range of motion. It took about a year of regular massage treatments, but at the end of it Neville was able to move his arm again without pain. In fact, he was so impressed with Greene's therapy, that afterwards he became a massage therapist himself.
Old Scars Can Pain Your Hip
In one of the surprising interconnections in human physiology, a scar above the pubic bone from a hysterectomy can be the primary cause of unremitting hip pain. Lawrence D. Cohen, M.D., who practices in Danbury, Connecticut, explains, through the case of Delia, 42, how this connection works.
Delia reported having problems in flexing her left hip (although there was no pain) since earliest childhood. The problem became worse at age 35, growing more aggravated, and after the birth of her second child (at age 36), the sensation in her hip progressed to steady arthritic pain.
Before seeing Dr. Cohen, Delia consulted an orthopedic surgeon who, after x-raying her hip, concluded it showed signs of degenerative joint disease. He gave her cortisone injections, prescribed anti-inflammatory drugs, and said if the pain got so bad that she couldn't stand it, "we'll replace the hip."
Delia was not impressed with that prospect, knowing that hip replacements usually fail after a decade, requiring further surgeries and rehabilitation. And the drugs she was taking weren't helping much. Her range of motion was so constricted that after walking a short distance, she would start limping with severe pain. She was fortunate to hear about Dr. Cohen who offered a more effective, less invasive alternative.
Upon examining Delia, Dr. Cohen noted that she had surgical scars in her lower abdomen from two gynecological surgeries for ruptured ovarian cysts. Understanding scars is at the heart of neural therapy, one aspect of Dr. Cohen's medical approach. Most people think of a scar as a gristly strip of essentially inert flesh. Not so, says Dr. Cohen.
According to the principles of neural therapy, a medical system developed in Germany and now practiced in the U.S. by a smattering of physicians, scars are electrically active and can disrupt the bioelectrical activity of cells, tissues, and muscles in the immediate area and even elsewhere in the body.
"The normal voltage of tissues and organs in the body is around -70 millivolts," explains Dr. Cohen, "but the voltage in a scar can be as high as 1 or 2 volts. That's 14 to 28 times stronger." Delia's two pubic-region scars were acting as electrical irritants to her pelvis, generating what neural therapy calls "interference fields" throughout that body region, Dr. Cohen says.
During his first treatment with Delia, he injected both abdominal scars with a local anesthetic (procaine, known by its trademark name Novocain). The change was instantaneous, he says. "Delia got up and immediately felt almost full relief of her hip pain and was able to lift her leg above her waistline, something she had been unable to do for years."
The local anesthetic deactivated the electrical charge emitted by the scar; this cancelled the irritation it was generating and the muscle triggers it was evoking; so the hip pain disappeared. "When I 'turned off' the scar, it allowed the hip to calm down," Dr. Cohen says.
A week later, in his second treatment, Dr. Cohen injected procaine into Delia's pelvic floor (the area surrounding her uterus) to "bathe" the nerves with anesthetic. It is not that the anesthetic cures anything; rather, it gives the charged area a respite, during which it can rebalance itself, electrically and biochemically, and eliminate the irritation it causes, says Dr. Cohen.
He fitted Delia with a flexible orthopedic device (an arch support) to stabilize her arch when she walked. Dr. Cohen also got her started on glucosamine sulfate and chondroitin sulfate, which are supplements commonly given for relief of arthritic pain and joint degeneration.
A few weeks later, he began the next phase of Delia's treatment, using prolotherapy to stabilize and tighten the ligaments in her pelvic girdle. Like neural therapy, prolotherapy involves injections, but this time it's not with an anesthetic but a substance (often sugar) that will produce a localized, beneficial irritation in muscle, tendon, or joint tissue. Inducing a controlled inflammation by reinjuring the damaged or degenerating tendon can stimulate the body to heal itself, even to grow new tissue, says Dr. Cohen.
As an additional measure to eliminate the last vestiges of Delia's hip pain, Dr. Cohen injected a small amount of bee venom with Novocain into the hip joint. Bee venom, formerly disparaged as a "folk remedy," is now under increasing consideration by North American physicians for its ability to reduce pain and inflammation associated with arthritis, multiple sclerosis, and other painful conditions.
"What little pain was left from her remaining arthritis resolved with that treatment," says Dr. Cohen. "Today, from this combination of therapies, Delia is pain free, back to walking up to 11/2 miles four times weekly, doing gym exercises three times weekly, and lifting weights."
Results like Delia's are common, says Dr. Cohen, when you remove the source of the electrical imbalance producing the pain. "I inject scars all the time and I often get phenomenal responses." He relates the recent case of Mira, 72, who complained of severe back pain, had back surgery and did not get better, because the problem actually stemmed from her right big toe. Mira would be golfing or walking the links and the pain would start spreading up her leg and then her back. An orthopedic surgeon said she had spinal stenosis-narrowing of the spine from arthritic spurs on the bone compressing the spinal cord, thereby pinching nerves. Learn to live with the pain was his advice. A neurosurgeon's diagnosis was a damaged vertebral disc; he recommended back surgery.
She had the surgery (called a discectomy, the partial or complete removal of a disc), but it made no difference and the pain came back again. Mira consulted another specialist who gave her an epidural steroid (injected into the dura mater, or outermost layer of the spinal cord) but this had no pain-reducing effect either.
Dr. Cohen didn't waste Mira's time with fruitless surgeries. He examined her feet. "I always check the patient's feet," he says. He often finds that back problems originate with problems in the feet. Mira had never mentioned pain in her feet, but when Dr. Cohen probed her right big toe, she winced. There was arthritis in that toe, he observed. Then he watched Mira walk. He saw that with each step she twisted her right ankle and turned her right leg out to avoid bending, and thus hurting, her right big toe. But every time Mira did this, her hip muscles had to contract to compensate for the imbalance in posture, and this produced the back pain.
"In other words, the low back pain was the result of her body's adaptation to avoid pushing off on that big toe with every step," says Dr. Cohen. He injected the tender foot joint with procaine and had Mira walk again. The leg and back pain were gone and Mira could walk freely, without pain.
Back Pain Caused by Depleted Kidneys and Adrenal Glands As with the modalities of the last two practitioners, traditional Chinese medicine offers a view strikingly different from the conventional explanation of back pain as a mechanical (muscular, skeletal, and/or vertebral) problem.
According to acupuncturist and herbalist Michael Tierra, L.Ac., O.M.D., of Santa Cruz, California, numerous factors-fatigue, overwork, feebleness caused by prolonged illness, aging, emotional stress-can deplete the kidneys and adrenal glands of basic life force or vitality. Put in simplest terms, an energy balance can upset the metabolic (energy-converting) and hormonal activities of the body, which in turn destabilize the physical structure and produce pain and discomfort.
In the language of acupuncture, a person's inherited energy potential, called essence, is stored in the kidneys, Dr. Tierra explains. This essence can be depleted through lifestyle choices and it is hard to replenish. If the level of energy in the kidneys or adrenal glands is low, it can develop into a deficiency of kidney qi and/or essence. This in turn makes them more susceptible to cold or dampness, and this then starts to weaken the spine and bone tissue and produce low back pain. In other words, Dr. Tierra says, the structural misalignment and pain follow the energy deficiencies.
The nature of and medical thinking behind acupuncture's approach to back pain is easier to see in the context of a patient case. Desmond, 43, came to Dr. Tierra complaining of lower back pain with secondary symptoms such as feeling cold easily and infections of Candida albicans and other fungi, notable in his toenails. Desmond had previously received acupuncture and Rolfing (deep tissue massage and manipulation) treatments but felt no better from them.
Dr. Tierra's diagnosis was that Desmond's back pain was produced by "coldness and deficiency of Kidney Yang." He explains: "In Chinese medicine the kidneys represent the entire endocrine system, and Kidney Yang-yang is the more active, fiery expression of qi, yin the more passive, watery-is associated with a generally slow metabolism, poor blood circulation, and possibly diminished libido. Desmond's was a common example of lower back pain resulting from a metabolic imbalance of hormones caused by stress and lifestyle imbalance."
With this in mind, Dr. Tierra put together a treatment program comprising acupuncture, magnets, and herbs, noting that "the powerful role herbal remedies can exert in treating lower back pain" is often overlooked in the rush to administer mechanical "fixes" to back pain patients.
First, he gave Desmond acupuncture on his back and applied north-facing, 9,000 gauss-strength Acuband magnets to certain points on his back and behind his knees. "Pain is caused by stagnated or congested qi and magnets stimulate qi to move. So when you place a north-facing magnet, which disperses qi and moves it away from a site, you're likely to have a pain reduction," Dr. Tierra explains. South-facing magnets will tonify qi, bringing it into an area, he adds.
Next, Dr. Tierra started Desmond on a Chinese herbal formula called Rehmannia Eight (containing rehmannia, cornus berries, mountain peony, poria, Dioscorea root, cinnamon bark, and aconite) to tonify or rebalance the kidney energy. Dr. Tierra also gave Desmond a formula called Angelica Du Huo and Loranthus Combination (containing many herbs, including Angelica pubescens and Loranthus mistletoe). This formula is specific for lower back and joint pains and is "very effective for all forms of arthritic conditions, especially of the lower extremities," says Dr. Tierra.
At Desmond's second weekly visit, he reported feeling considerable pain relief in his back. At his third visit, Dr. Tierra gave him two remedies to address his fungal and Candida infections: an herbal tea mix of pau d'arco, sarsaparilla, sassafras, stillingia, yerba mansa, echinacea, burdock, prickly ash, lobelia, and ginger; and Flora Balance, a homeopathic remedy. It was not long before Desmond reported that his toenails were growing in normally again, free of all signs of fungus.
One month after beginning treatment, at Desmond's fourth visit, he reported his back pain "continued to lessen" and that the magnets, which he applied himself when the pain flared, reliably and immediately reduced the pain, by at least 60%. On subsequent visits, Desmond said that his back pain was mostly corrected with only occasional minor sensitivity.
Dr. Tierra's second case shows how metabolic imbalances, produced by stress, overwork, and inappropriate diet, can combine with a previous physical injury (such as a car accident) to create chronic back pain and early-stage arthritis. Eleanor, 34, came to Dr. Tierra, bearing a medical diagnosis of rheumatoid arthritis, with stiffness, pain, and swelling in all her joints-all were warm to the touch-especially her neck, shoulders, back, and hips.
Eleanor said her symptoms began soon after she sustained injuries in a car accident three years earlier. While she maintained healthful practices (meditation and yoga), ate a reasonably wholesome diet (no refined carbohydrates, alcohol, or coffee), and had tried other forms of alternative treatment (chiropractic, colon therapy, and acupuncture), Eleanor's pain and discomfort had progressed to the point she was taking Motrin (a conventional drug to relieve inflammation) on a regular basis.
"All of her symptoms were aggravated by overexertion, stress, and exposure to cold," says Dr. Tierra. "She had very low energy and her pale skin suggested anemia." In Dr. Tierra's view, Eleanor's condition was due "to an unbalanced diet with too much cold, raw food which caused internal stress, and by emotional stress caused by overwork. These factors compromised her immune system, resulting in her presenting condition."
In Dr. Tierra's view, the standard conventional medical protocol of prescribing anti-inflammatory drugs and symptomatic analgesics would "do absolutely nothing for the underlying immune deficiency." In fact, Dr. Tierra adds, "they would further injure the immune system, making the patient potentially dependent for the rest of her life on such questionable drugs with known harmful side effects."
Only through a "holistic approach combining completely safe but effective herbs, magnets, and acupuncture together with a proper diet and lifestyle adjustment can such a condition be truly healed," says Dr. Tierra, who is well qualified to make such statements. He is the founder of the American Herbalists Guild, the author of four books, including Planetary Herbology (Lotus Light Press, 1988), and the formulator of Planetary Formulas herbal products.
In addition to acupuncture and magnet treatments, Dr. Tierra put Eleanor on several Chinese herbal formulas. First, he gave her Angelica Du Huo and Loranthus Combination to enhance the circulation of qi and blood and to relieve pain.
Next, Dr. Tierra gave her ma huang (Ephedra sinensis) to "warm and stimulate circulation of qi and blood" and eliminate any blockages in that system. He also started her on Chinese ginseng (to tonify, or balance the qi) and prepared aconite (an herb specifically indicated for "chronic cold-type arthritic conditions;" "prepared" means its toxic alkaloids have been neutralized). At her second visit, Eleanor reported she was "doing much better" and had "significantly less pain." But she did complain of swollen ankles, gas, and bloating, for which Dr. Tierra provided more acupuncture and herbs, bringing her relief.
On the third visit, using a procedure called moxibustion, Dr. Tierra placed moxa cones on six treatment points on her back. Moxa is a little mound of mugwort herb which, when lit like a candle (the "bustion" part) and allowed to burn above, but not on, the skin, imparts warmth and healing herbal fragrances to the acupoints on the skin. Moxibustion also helps tonify the immune system, adds Dr. Tierra. After this, Eleanor reported that she was almost pain free.
However, job-related stress (an international business trip) brought a relapse of all her symptoms, demonstrating how powerful an effect stress can have on the body. After Dr. Tierra reinstituted the elements of his program (including the magnets, which Eleanor had stopped wearing), "she felt better immediately."
Eleanor had a total of 11 treatments; by the end of this period, she was able to handle the stress of business-related travel and to have only minimal and transient setbacks when under stress, says Dr. Tierra.
Restoring the Body's Deep Energy Flow to Curtail Back Pain
In Dr. Tierra's two cases, you can see how disturbances in the flow of qi, or basic life force energy, can contribute to physiological and functional problems.
But another system, called polarity therapy, credits the involvement of energy disturbances in the creation of ill health even deeper in the essence of the body. Polarity therapy combines the Western structural approaches of chiropractic and osteopathy with the energy modalities of acupuncture and Ayurveda.
That essence is energy, says registered polarity practitioner Gary Siegel, R.P.P., based in Poughkeepsie, New York. "Generally, healing and health are attributes of energy flowing in its natural and unobstructed state, while disease is the reflection of energy in an obstructed condition," Siegel states, relating one of the modality's prime views. "Polarity means the energy is in balance, flowing both ways, in and out of its source, but when you lose this polarity, you start getting health problems, as you will see in the case of Celia."
Celia, 47, had intermittent lower back pain since childhood, but ever since she delivered her first baby at age 23, her back pain had intensified and visited her more frequently. It got to the point where, as she told Siegel in her first visit, "it never really went away."
One of the strategies of polarity therapy is to examine the physical structure of the patient and to see if the energy flow through and around the body is abnormal, says Siegel. "Then a direct energy assessment follows to confirm or deny this, and to work out the specifics of these inferences." This assessment, of course, requires considerable sensitivity on the practitioner's part because unless you're psychic, you have to rely on your hands to relay differences in energy flow as they rest on and just above different portions of the patient's body, Siegel explains.
You may feel the energy flowing smoothly from the stomach to the pubic bone as your palms register subtle sensations, and then suddenly it feels blocked, disrupted, or perhaps stagnant. This was the case with Celia. Siegel's initial exam of Celia indicated that her discomfort seemed to originate in the sacrum, both the physical bones of the hip and the energy fields associated with that region of the body.
As Siegel began to gently palpate the area and "move energy," Celia experienced some unexpected sensations. She said she felt cold and started to shiver; as she discussed her sensations with Siegel, Celia experienced a release of emotions that she had evidently stored there, Siegel explains.
"Emotional release would play a large part in her healing process," Siegel comments. He explains that the polarity therapist follows the changes in energy flow and expression in the patient and provides stimulating or sedating contacts as appropriate. "Sedating means applying a very gentle contact, while stimulating means pushing with pressure."
Sometimes the patient needs to slow down the process of energy rebalancing in order to process emotions or to allow the body to take stock of the subtle adjustments, Siegel says. "The body leads, I follow." Re-establishing polarity is the key focus. "If the energy can't get into an area, you have to help it in, but if the energy is too built up, you have to help drain it."
Celia came to Siegel for about a year, first weekly, then monthly, then every six weeks. For a fair part of the early sessions, the issues most strongly contributing to her back pain were centered around a sense of "woundedness" she was carrying in her sacral area, says Siegel.
This emotional wounding seemed to have begun in childhood and was expressing itself through abdominal muscle tension between the sacrum and belly button. "It is common that when a person gets injured or develops a disability, it is often located in an area of the body where the energy is restricted, where the vitality is low, and sometimes where emotions are being held," Siegel observes. To his sensitive hands, Celia's lower abdominal energy seemed to be "frozen, in shock," and this quality was physically expressed in the form of contracted muscles and a tilted (misaligned) sacrum.
A clearer picture of how emotional wounding and physical discomfort interrelate emerges in this capsulized case history of another patient, says Siegel. Percival, 52, had endured middle-back pain for many years. During a polarity therapy session, Percival remembered an incident from childhood. He had fallen on a fence and painfully hit his back.
But his family was of the stiff-upper-lip variety and discouraged him from expressing his pain, Siegel notes. Percival was expected to remain strong and not cry. "So the pain, instead of coming out in tears, lodged inside Percival's body and got expressed as tightness, a constriction which led to chronic back pain. When he became aware of where this unexpressed hurt had been stored in his body, Percival was well on his way to healing, says Siegel.
It was similar with Celia, but the healing (and the emotional processing) came in stages over the course of a year's immersion in polarity therapy. However, her presenting symptoms were all eliminated after six months of treatment, says Siegel. She had no more back pain. Polarity therapy, he says, had "opened up that well of energy that naturally belongs to the body and allowed Celia's energetic system to become full again."