Spinal Health Back Care UK

Acute back pain is defined as a pain lasting 3-6 months or a pain that’s directly related to tissue damage.

This type of pain occur when you for example touch a hot surface to pricking your finger, the pain generators can be identified in this situation and remedied.

The longer a pain continues the more the chance of developing chronic back problems, acute pain can be treated successfully as the condition is due to a diagnosable and treatable problem if no pain generator can be identified it is usually considered chronic back pain.

Long term acute back pain can set up pathway in the nervous system that continues to send pain signals even though any original tissue damage has long disappeared, this happens when the nervous system itself misfires and creates the pain this is called Neuropathic pain.

Different people will experience pain differently and the effectiveness of a particular treatment depends on the person, not all patients with similar conditions develop chronic pain and a condition that relatively seems minor can lead to severe chronic pain.

Acute pain can result from trauma caused by a sports injury, work around the house or in the garden
A sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.

What to do when you have an episode of back pain

• Do not rest unless you have to and then 2 to 3 days maximum. Rest is not a treatment for lower back pain and can lead to stiffness, weakness.

• Normal activities should be continued but give yourself smaller goals and resting form time to time.

• Pace your activities - do normal daily activities but cut them up into small blocks of time so that you can easily manage.

• Medication should be taken in fixed doses at fixed times, and not when you feel like it or the pain gets too bad. Drugs that are used need to be discussed with your doctor.

• Recognise negative beliefs and deal with them. Look upon the episode as a relapse, not a disaster

• Spine manipulation can be useful to provide short-term improvement in pain and abilities.

• Use relaxation techniques like soothing bath or a massage.

• Do not expect to be completely pain free before resuming normal activities

• You should have returned to normal activities and work by six weeks after the start of your episode. If not you may need to join an exercise programme under supervision or at the gym to prevent long term problems.

Why not see a specialist? Back Doctor

Rolfing was invented by Ida P. Rolf (1896-1979), who received her PhD in biochemistry and physiology from Columbia University in 1920.

She went on to work at the Rockefeller Institute in the departments of chemotherapy and organic chemistry. Finding the available therapy methods of her time inadequate, Dr. Rolf investigated the effects of structure on function in her search to find solutions to health-related problems.

The catalyst to this search was a deal she made with a piano teacher that suffered from muscular dysfunction in the hands. Dr. Rolf wanted very much for her children to learn piano from this particular teacher. If she was able to improve and correct the teacher’s disability Dr. Rolf did improve the piano teacher’s disability and thus began to teach classes on Rolfing worldwide. In 1971 she established The Rolf Institute in Boulder Colorado. In addition, there are currently Rolfing centers in the United Kingdom, Europe, Asia, South America and Australia.

What Does ROLFING DO?

To see how Rolfing works is to look at the body in the gravitational field as a a fish in a body of water. As a fish is supported and lifted by water, we as humans can be supported and lifted by gravity. It is easy to see the lack of structural balance in an older person, bent over a cane. These imbalances don’t happen over night, they continually deteriorate the body’s capabilities. All of an individual’s history is recorded in their tissues, including falls, illnesses and psychological stress. Even the way a child copies a parent leaves a memory.

The human body’s adaptive nature will always work to integrate an injury. Rolfing helps release the body’s structure from the effects of time and trauma so that the body can do its job more effectively and efficiently. Preferably, Rolfing is used as preventive care, but when an injury is present it can enhance and expedite the healing process.

Who Can Benefit FROM ROLFING?

Rolfing can help anyone and everyone move closer to balance and vitality. The question is are you ready? In Rolfing, the client must actively participate in bringing their body back to balance in and out of the session. The session is only the beginning with increasing change continuing in the body as the client moves through their daily routine.

What Can I Expect in a ROLFING SESSION?

First of all, Rolfers are specialists in facilitating rapid and intense results. The goal is not pain instead its mechanisim is to melt the restrictions that are located at the origin and insertion points on the bone.

With pressure and direction from the Rolfers hands and joint movement from the clients, synchronicity happens. Different tissues respond differently to pressure, the Rolfers job is to unlock the code for the different levels of tissure and fluide that surround the particular parts of the body.In some ways, like a hot iron press ironing out melting adheasions from dehydration, adheasions, lactic acid, injury, etc. Rolfers encourage rehydration and fluid consistancy at all spectrums of bodyily operations to support and maximize connection to the bodily fluids that promote regulartory functions for tissue health.

Clients can expect to move limbs and joints while the Rolfer with presssure, moves and holds certian tissues to create an energetic and yet physical release to allow tissues to resume a more healthy and balanced state. Every body is different so every body has it's own centerpoint, in respects to what bone alignment pattern is for them, balanced. The Rolfers job, is to help find what that is for the individual, their a guide of sorts, that facilitates growth at the mechanical level and for some also at the behavioral level. After all, there is the body, mind, spirit connection that is spoken in all tongue's, religons, cultures, myths, and legends.

To create a successful session, the client must be willing to explore new ways of operating in the body. This will help the client find a new and improved manner of movement and function that supports daily physical duties and personal expectations. This attitude will fuel the ability to interact effectively and efficiently in one’s own environment.

The Rolfing format is primarily an educational process and therefore implies an ongoing communication between the Rolfer and client.

The client is often asked to make certain moves while the Rolfer is working. This helps the client to find and feel the new patterns of movement. The relationship between the Rolfer and client is a unique one. As trust, honesty and openness develop, the Rolfing process becomes an arena for personal transformation on the part of both individuals.

All Homeopaths refer to "the Law of Infinitesimal" and the "Law of Similars" as grounds for using minute substances and for believing that like heals like, but these are not natural laws of science. If they are laws at all, they are metaphysical laws, i.e.beliefs about the nature of reality that would be impossible to test by empirical means. Hahnemann's ideas did originate in experience.

That he drew metaphysical conclusions from empirical events does not, however, make his ideas empirically testable. The law of infinitesimal seems to have been partly derived from his notion that any remedy would cause the patient to get worse before getting better and that one could minimise this negative effect by significantly reducing the size of the dose. Most critics of homeopathy balk at this "law" because it leads to remedies that have been so diluted as to have hardly a single molecule of the substance one starts with.

Working on the principle of similarities, Hahnemann created remedies for various disorders that had symptoms similar to those of the substances his provers had taken. However, "methods of proving are highly personalised and of individual relevance to the homeopath or experimenter." In other words, one hundred homeopaths preparing a remedy for one patient might well come up with one hundred different remedies.

Hahnemann may be praised for empirically testing his medicines, but his method of testing is obviously flawed. He wasn't actually testing the medicines for effectiveness on sick people but for their effects on healthy people.

In any case, he had to rely upon the subjective evaluations of his provers, all of who were his disciples or family members and all of whom were interrogated by the master himself. (Later investigators would use more controlled methods of proving.) But even if his data was tainted by the possibility of him suggesting symptoms to his provers or their reporting symptoms to impress or gain the approval of the master, it is a belief in magic that connects this list of symptoms with the cure of a disease with similar symptoms. In logic, this kind of leap of reasoning is called a non sequitur: It does not follow from the fact that drug A produces symptoms similar to disease B that taking A will relieve the symptoms of B. However, homeopaths take “Customer Satisfaction” with A as evidence that A works.

Today's homeopaths should know that because of the complexity of each individual human body, fifty different people might react in fifty different ways to the same substance. This makes doing clinical trials on potential medicines a procedure that should rarely claim dramatic results on the basis of one set of trials. Finding a statistically significant difference, positive or negative, between an experimental (drug therapy) group and a control group in one trial of a drug should usually be taken with a grain of salt. So should not finding anything statistically significant. It is not uncommon for twenty trials of a drug to result in several with positive, several with negative, and several with mixed or inconclusive results.

Before attempting to explain why so many people believe homeopathy works, let me first defend the claim that homeopathic remedies are ineffective. There have been many reviews of various studies of the effectiveness of homeopathic treatments and not one of these reviews concludes that there is good evidence for any homeopathic remedy (HR) being effective. Homeopaths have had over 200 years to demonstrate their wares and have failed to do so, as yet.

Yes, there are single studies that have found statistically significant differences between groups treated with an HR and control groups, but none of these have been replicated or they have been marred by methodological faults. Two hundred years and we're still waiting for proof! Having an open mind is one thing and I do on the vast majority of Alternative Healthcare practices; waiting forever for evidence is more akin to wishful thinking.

Nevertheless, homeopathy will always have its advocates, despite the lack of proof that its remedies are effective. Why? One reason is the prevalence of a misunderstanding of the causes of disease and how the human body deals with disease. Hahnemann was able to attract followers because he appeared to be a healer compared to those who were cutting veins or using poisonous purgatives to balance humors. More of his patients may have survived and recovered not because he healed them but because he didn't infect them or kill them by draining out needed blood or weaken them with strong poisons.

Hahnemann's medicines were essentially nothing more than common liquids and were unlikely to cause harm in themselves. He didn't have to have too many patients survive and get better to look impressive compared to his competitors. If there is any positive effect on health it is not due to the homeopathic remedy, which is inert, but to the body's own natural curative mechanisms or to the belief of the patient (the placebo effect) or to the effect the manner of the homeopath has on the patient.

Stress can enhance and even cause illness. If a practitioner has a calming effect on the patient, that alone might result in a significant change in the feeling of wellbeing of the patient. And that feeling might well translate into beneficial physiological effects. The homeopathic method involves spending a lot of time with each patient to get a complete list of symptoms. It's possible this has a significant calming effect on some patients. This effect could enhance the body's own healing mechanisms in some cases.

My main concerns are with regard to the possible harm that may ensue from classical homeopathy. It is not likely to come from its remedies, which are probably safe but ineffective, though this is changing, as homeopathy becomes indiscernible from herbalism in some places. One potential danger is in the encouragement to self-diagnosis and treatment. Another danger lurks in not getting proper treatment by a conventional medical doctor in those cases where the patient could be helped by such treatment, such as for cancer or bladder, or yeast infection.

Homeopathy might work in the sense of helping some people feel better some of the time. Homeopathy does not work, however, in the sense of explaining pathologies or their cures in a way which not only conforms with the data but which promises to lead us to a greater understanding of the nature of health and disease.

*Note: Since homeopathic preparations are very diluted mixtures of natural substances, they are completely safe and without undesirable side effects.

Sadly one of the most common musculoskeletal symptoms experienced by an estimated 8 out of 10 people, chronic low back pain may be caused by a range of diseases (inc. obesity) and disorders affecting the lumbar spine. Low back pain is often accompanied by sciatica, a disabling pain from an entangled sciatic nerve, which is typically felt in the thighs as well as lower back and buttocks.

People who are overweight carry a high risk of chronic musculoskeletal pain, specifically low back pain. As well as osteoarthritis and other degenerative conditions, a number of other pain and problems in the low back may be aggravated by obesity. Back pain frequently occurs as a result of the excess weight pulling the pelvis forward which strains the lower back. Recent research from the American Obesity Association indicate that women who are obese or who have a large waist size are especially at risk for lower back pain.

In some obese patients, the spine can become tilted and suffer additional stress. Over time, this can deprive the back of proper support and an unnatural curvature of the spine may develop.

Recent studies by (Fishman L., Ardman C. Back Pain: How to Relieve Low Back Pain and Sciatica) explains how obese patients may incur sciatica and low back pain from a herniated or "slipped" disc. This type of back pain in the lumbo-sacral spine occurs when discs and other spinal structures are damaged from having to adjust to the pressure of extra weight on the back. In addition, when excessive weight is pushed into spaces between bones in the low back area, the patient can experience compressed nerves and even piriformis syndrome. (Deep Pain in Your Buttocks)

People, who are overweight, or worse obese, face many consequences, which have the ability to become a daily nightmare. For some it is their lifestyle choices, which has led them to become obese, others perhaps have gathered the extra weight through no fault of their own.

To live this overweight and obese life can be difficult, people have to face every new day with the fear of prejudice from others making it hard to live in the world which demands perfection and looks down upon them. It's a sad reality that many people have to face, a reality, which comes at a great personal cost.

Persons self image and their self-esteem depends almost entirely on how other people perceive them, or perhaps how other people perceive them. It is very hard to totally ignore the criticism and not care about the opinions of others. With excess weight, of course, the more you weight the harder it will get. People will stare at you no matter where you go, not to mention that snickering and jokes are a real way of helping to lower your self-esteem.

Unfortunately this can often led to a self destructive circle leading people to become depressed and complacent with their weight which can lead to more weight gain. Obese people may stop going out doors, therefore they receive less exercise, which leads to weight gain, which lead to less exercise and so forth. This low self-esteem has the ability to manifest itself in a way that makes it increasingly difficult for a person to motivate himself or herself in order to make an improvement in their life.

Relationships can be very difficult for obese people to enjoy when they are overweight. Sex can be become awkward with couples becoming self-conscious about their bodies. The extra weight in the bedroom can make performing very difficult and excessive sweating is probably not the sexiest thing either. If they don't already have a partner it can be difficult for obese people to find a lover. The fact that they do not go out to social events as often as they should coupled with their low self esteem often results in many people giving up.

If you want to deal with your obesity problem you need to motivate yourself. But even then motivation may not be enough, outside support is mandatory. Other people helping you can make the difference between succeeding and failing; these people also often stop you from eating that extra food you should be avoiding.

Food addiction can be a very difficult thing to overcome; when someone who eats a lot first cuts back the body can have withdrawal symptoms from sugars and fats, often leading to depression. The extra support around for this week or two can make a world of difference.

Becoming obese is the easiest part but now you have to lose those pounds and this is the hard part. It will be a struggle at first, but you need to stay strong, the health, social and emotional benefits of the new you will be unbelievable. A life of less food and more exercise sounds scary to a lot of people but it doesn't have to be, if you make sure you have good support it will be easier to achieve this goal. Just think how good you will feel when you look into the mirror and walk down the street with your new body and new confidence.

At least 80% of us will experience some form of Back Pain in our lives and more than 1 in 4 people will become clinically obese in their lifetime, don't let it be you.

(NMT) Neuromuscular Therapy.

Neuromuscular Therapy (NMT) is a very specialised form of manual therapy. A therapist trained in NMT is educated in the physiology of the nervous system and its effect on the muscular and skeletal systems. The Neuromuscular Therapist is also educated in kinesiology and biomechanics and how to work in a clinical or medical environment.

By definition, Neuromuscular Therapy is the utilisation of static pressure on specific myofascial points to relieve pain. This technique manipulates the soft tissue of the body (muscles, tendons and connective tissue) to balance the central nervous system.

Neuromuscular Therapy will be used to address five elements that cause pain:

1. Ischemia: Lack of blood supply to soft tissues which causes hypersensitivity to touch

2. Trigger Points: Highly irritated points in muscles which refer pain to other parts of the body

3. Nerve Compression or Entrapment: Pressure on a nerve by soft tissue, cartilage or bone

4. Postural Distortion: Imbalance of the muscular system resulting from the movement of the body off the longitudinal and horizontal planes

5. Biomechanical Dysfunction: Imbalance of the musculoskeletal system resulting in faulty movement patterns (i.e., poor lifting habits, bad mechanics in a golf swing or tennis stroke or perhaps computer keyboarding)

For a variety of reasons, when we strain muscles and fascia, either through impact or through a build up of chronic stress, the muscles go into spasm. This spasm can restrict blood flow and cause pain, as well as restricting mobility.

Sometimes muscles can be in tension for so long that they lack the energy to release, and form tight "knots" or "trigger points", a "contracture" or little hard bump in the muscle which can be responsible for debilitating back pain or neck & shoulder pain referring to other parts of the body. Fibromyalgia is a different condition, but it seems many patients with fibromyalgia have significant trigger point discomfort also.

Inflammation is a necessary part of the healing process, bringing nourishment into the area, and reducing flow away, which reduces the spread of infection. If allowed to continue and become chronic, however, it can lead to restrictive adhesions and thickening of connective tissue.

Neuromuscular Therapy involves releasing Trigger Points in muscles & fascia, and encouraging flexibility in muscle and connective tissue.

Pressure is applied to these Trigger Points, until the congestion diminishes. A release of tension relieves pain and increases mobility. Greater blood flow will allow the healing process to take over.
Stretching the muscle and fascia afterwards helps to consolidate the relaxation, and you will be shown some stretches to practice after the session.

Your therapist should conduct a postural assessment to evaluate which areas to address.

Neuromuscular Therapy can be researched easily on the web, and it is gaining ground as a key modality for the repair of soft tissues.

Our Back

Our spine is made up of 24 moveable bones, called vertebra, between the skull and the sacrum. The spine continues as the sacrum, which is actually 5 more vertebra fused together, and the coccyx or tail bones. The front part of each vertebra is called the body, and between the bodies of two adjacent bones is the disc. The body is designed to support your weight and structure and although the disc is technically a joint but is better considered a flexible union to cushion shock and allow movement. Behind the body on either side is a joint, these ‘facet’ joints control the movement allowed by the disc, they are also the ‘managers’ of movement receiving information about the position and the loads through the are and organising the support necessary form the muscles.

The ligaments between the bones hold the vertebrae together preventing excessive movement and reporting to the controlling facet joints about loads and position. The disc, the facet joints, ligaments and muscles contain small sensors that tell the body what loads are present in the spine and what position it is in.

The muscles then may alter the position of the bones and joints to control the loads put through the spine. The muscles support the posture and enable movement to occur responding to the instruction of the facet joints and the instructions of the brain and central nervous system.

According to Boos and Hodler (1998), lower back pain is often spontaneous, not identified using current technology and traditional care is rarely curative.

What happens in a soft tissue injury?

Ligaments hold the bones in the body together; they also support the joints. If you sprain your ankle you tear the ligaments holding the bones together. If the ligaments surrounding the joint capsule are damaged the joint will swell as the healing cells of the body pour into the joint. Unfortunately the swelling quickly stretches the joint, which increases the pain.

With an ankle you know how you damaged the joint, you can see the swelling, most people understand that treating the swelling with Rest, Ice, Compression and Elevation (RICE) will allow the swelling to go down and the injury will heal, usually within 2 to 6 weeks. This is very painful, but you know it is not usually serious and therefore it is not frightening. Within 2 to 3 days you know you are getting better and can start to use the ankle gently.

The joint needs to be mobilised, using it will help the swelling, stop it from getting too stiff and improve the healing. However, if you do too much too soon then the problem will worsen and the time for recovery will lengthen. It requires a little common sense.

Back Injuries

Back pain caused by injury may well begin in the same way as a sprained ankle. Most of the patients we see know when the pain started and often describe it in much the same way as an ankle sprain. However the mechanism of onset is seldom traumatic, there is almost never evidence of bleeding from damaged tissues (consider the bruising seen in an ankle sprain) and on reflection the feel that the reason for the onset is not clear.

Acute back pain (ABP)

Acute back pain is defined as back pain lasting a short period if time. A reasonable definition would be that it makes a recovery within normal tissue healing time. It does not relate to severity of pain, injury or damage.

The disc, the facet joints and the ligaments contain small sensors that tell the body what loads are present in the spine and what position it is in (proprioception). The muscles then control the position of the bones to make it as strong as possible. When things go wrong it is this mechanism that fails to work properly. If a disc, a ligament or one of the controlling joints is damaged, even a little, the load sensors send a message to the muscles to tighten up and protect the damaged structure from being stretched; this is called a Protective Muscular Reflex, it is automatic. This response always takes place into extension (arching backwards). Here is the difference between a back injury and a sprained ankle.

Unfortunately if the joint is damaged then the protective muscular reflex responds at the same time as the swelling takes place, this muscular tightness causes arching backwards and can compress the swollen joint too much making the sensors call for more muscle tightness because they feel you are applying more load and the joint is at risk of further injury.

At this point a vicious circle leads to a spiral or cascade: the injury causes soreness, tightness and swelling, the tightness causes more soreness, more swelling and more tightness until it is in complete spasm and very sore. This gives the sharp pain that you feel when you stand on a sprained ankle, but when it is the back it could be there even when you are lying down. It is so sharp that patients may describe it as a “trapped nerve” but it is usually not.

This pain is very much more severe than the injury which triggered it and although it hurts a lot when you move there is no evidence to suggest that it does more damage. Pain in this case does not mean harm. You need to move carefully and relax, and most of all avoid long periods of rest. Panic and anxiety about your problem will make it worse. Thinking about what is happening that your pain is mostly caused by your body reacting rather than the damage you have done and understanding that the pain you feel is not going to cause more problems will help you to relax and you soon you will find that you can learn to control your pain, gradually being more and more active and go on to make a good recovery.

Chronic back pain (CBP)

Chronic pain has been varyingly defined, usually in the context of LBP it is between 7 and 13 weeks, chronic pain is purely a definition based on time. It does not relate to severity of pain, injury or damage.

A more relevant definition would be based on tissue healing time. Of the 97% of LBP patients who have simple back pain most have a soft tissue injury of some sort, for example a strain. This kind of injury cannot be seen on even the most sophisticated scanning and therefore it is not possible to measure it. However in appearance and history these cases are usually recognisable from other types of back pain. A strain takes between 2 and 6 weeks to heal so if back pain lasts longer than that time there is something preventing the healing, or something preventing the pain easing once tissue healing has occurred.

Recent research suggests that CBP that is likely to go on to last more than 8 weeks can in fact be identified at 2 weeks; this suggests that it is a different condition to ABP rather than an unresolved episode of ABP.

Confused? We are not surprised. At Back Trouble UK we know a great deal about back pain, unfortunately there is still a great deal that nobody knows!

Understanding of chronic pain has increased hugely since the early 1990’s. An in depth knowledge of the precise neurophysiology and psychology is not necessary, to grasp the principles may be enough, however you will need to have your wits about you and you will need to look hard at yourself. Think about it though, there is a lot of evidence that if you have long term back pain this is the only way you can get better. You may at this pointy decide you need help and guidance, The vast majority of Registered Back Trouble (UK) Practitioners or Therapists can provide that, as can some of the other better informed health care professionals in the back pain field. You can read on and see how you do.

Pain

Pain is not a sensory feeling; rather it is a response from the brain to a plethora of information being fed to it after an initial warning message of tissue damage (nociception). The pain message detected by distant sensors in damaged tissue transmit to the dorsal horn of the spinal cord, and then via an ascending pathway to the primitive (lower) parts of the brain. These have a responsive action and will usually serve the patient well; it is the higher centres that can get the patient into trouble.

If the pain does not provoke fear in the lower brain centres, the amygdala (responsible for fear, fear conditioning and addiction) will naturally use descending pathways to the spinal cord to suppress the pain message. The amygdala has been described as the ‘emotional computer’ of the brain.

Shall I stop there and explain?

Damage is detected in the tissues, a message is sent to the spinal cord. Here it divides and one part initiates an appropriate response. If the damage is to the skin, touching something hot with a finger for example, the response will be to withdraw the limb. This is achieved by activating the flexor muscles of the arm. If the damage is to the deeper tissues the response is to extend, to spasm around a back injury for example. The other part makes its way up the spinal cord to the brain to inform it of the damage so an appropriate strategy can be constructed. The initial response is in the primitive parts of the brain. Should you run away, hide or fight etc. No consideration as to the cause of the pain is given it is an emotionally driven response based on is the pain a threat? Is the building burning down or is there a sabre tooth tiger hanging onto your arm?

So far so good? Excellent.

Now a message is sent to the mapping part of the brain, the sensory cortex. The area of damage (don’t forget it is still not pain) is reported and considered, a report is sent to the thinking part of the brain, the frontal cortex. Here it meets the emotional report from the primitive part of the brain. The thinking part of the brain tries to make sense of what is going on, it will recruit all other information from the senses, sight, sound, smell, taste, and touch. It will consider its previous experiences and beliefs about a particular threat and then decide whether to consider you should feel pain, PAIN.

If you have a sabre tooth tiger hanging off your arm you will confirm with all your senses that the tissue damage represents a threat, your experience and beliefs will confirm that you are in danger (of being eaten) and your brain will conclude that a good bolt of PAIN might jolt you into some kind of action to preserve your life. But let us consider a more contemporary threat. Stinging nettles cause a minor skin irritation, a small swelling response and a slight itching. The huge majority of people stung recover without concern. Should that be considered pain? Well that rather depends upon your expectation. The damage report will be the same in most people, the response will vary. Would you expect a small child to cry if stung? Would you expect a grown adult to cry? The difference would be experience and belief. A child being stung for the first time does not know what to expect, and what the consequences may be, and adult does. Interesting isn’t it?

So then what happens?

The ‘thinking’ parts of the brain will consider the pain message and make a ‘value judgement’ based on beliefs, expectation and experience. As already explained if the pain does not provoke fear in the lower brain centres it will naturally use descending pathways to the spinal cord to suppress the pain message.

However if the damage is considered a threat then the thinking part of the brain will inform the amygdala, which will stop the pain suppression, this is called negative affect. Once this pattern of reduced pain message suppression is established the brain may increase the importance of the pain report using descending nerve pathways that will increase or amplify the tissue damage message.

So is that it? Well no, not really, it gets worse.

As a result of the increase in damage report because of the descending nerve pathways there is an alteration of neurophysiologic mechanisms, which increase the frequency, duration and magnitude of nociceptive transmission giving increased sensitivity to damage from the original site to the spinal cord (hyperalgesia). Over a period of a few days changes in the layout of the nerve pathways (the wiring of the body) known as ‘neuroplastic change’ allows other sensations to be transmitted as damage reports (nociception) giving the sensation of pain instead of other sensation (allodynia). Together these changes are called central sensitisation. The brain then attends to this increase in damage reports (nociception) with fear, perpetuating the attention paid to the injury site.

This is looking bad, surely that must be it? Not exactly.

The injury may then heal but the reaction to it is perpetuated, as we have already explained any change in sensation in the area of original damage is interpreted as pain. The more intense this reaction and the longer it continues the more negatively conditioned the amygdala becomes and the harder it is to recondition, and therefore recover. This is chronic pain.

So what happens in Chronic Back Pain?

There must be an explanation as to why the pain caused initially by a minor injury (don’t forget there is seldom enough tissue damage to cause bleeding) persists beyond tissue healing time. The changes seen in central sensitisation in the spinal cord that lead to hyperalgesia or allodynia can occur just as easily in the soft tissues of the spine as in the skin. Here the threatening impulse is a mechanical load or movement sensor (proprioceptor). Normal proprioceptive output due to normal loads are transmitted via a neuroplastic connection or ‘sprout’ with the ascending nociceptive (damage report) neurone (nerve pathway) and is re-interpreted as nociception. Thus movement perpetuates pain even in the absence of continuing injury; movement is therefore painful unsurprisingly giving the impression that movement causes damage.

This reluctance to move will be associated with de-conditioning changes resulting from inactivity giving a tightening of long muscles and a weakening of short muscles. This imbalance will lead to postural fatigue and increase chemical irritation in the muscles and yet further reports of damage.

BackTrouble.co.uk

The original model of cranial osteopathy belief is that intrinsic rhythmic movements of the human brain cause rhythmic fluctuations of cerebrospinal fluid and specific relational changes among dural membranes, cranial bones, and the sacrum. CST Practitioners believe they can palpably modify parameters of this mechanism to a patient’s health advantage.

William Garner Sutherland DO Dr. Sutherland (1873-1954) invented Cranial Osteopathy. Over the years, CST practitioners convinced themselves that gentle palpation of the cranium, guided through the understanding of Sutherland’s “Primary Respiratory Mechanism,” could improve an astounding range of conditions manifesting throughout the human body. Over the years, in both formal (e.g., classroom) and informal (e.g., clinical) settings, many more students and practitioners learned of Sutherland’s mechanism and abundant anecdotal success with patients.

Patients were healed, health careers were established, and all was good.

Then one has to ask the question?

1 Does evidence and biological common sense entirely invalidate Sutherland’s mechanism?

From what I can research, diagnoses based on this mechanism feature not just low reliability but no reliability. There is no evidence, whatsoever, that different practitioners perceive similar phenomena or even that perceived phenomena are real.

No successful, properly controlled outcome analysis has been published. Practitioners have no scientific evidence that their therapeutic actions however grounded in biology or metaphysics have any direct effect on patient health.

Many papers and articles have been published challenging the claims made by the followers of Sutherland; significant research work has been published by Dr. James Norton and Dr S Hartman.

Hartman, SE. Norton, JM. Sci Rev Altern Med. 2. 8,2. 2004. A review of King HH and Lay EM, “Osteopathy in the Cranial Field,” in Foundations for Osteopathic Medicine; pp. 24– University of New England.

Hartman SE, Norton JM. Craniosacral therapy is not medicine. Physical Therapy. 2002;82:1146–1147. University of New England.

Many CST practitioners deflect criticism by focusing, instead, on their perceived yet scientifically almost meaningless personal clinical success. Even though there is no evidence of the efficacy of Craniosacral Therapy, Cranial osteopathy, as a belief system, powers onward.

Yet scientific inquiry has become integral to almost everything physicians do. Without science, medicine would still involve little more than applying bandages, setting bones, and administering placebos. Perhaps Cranial osteopathy/Craniosacral therapy is not a medicine for our time. Perhaps properly controlled outcome studies will show that, though biologically anomalous, these techniques nonetheless produce a direct and positive effect on patient health.

All I can say is that in my study and observations, I have concluded that cranial osteopathy is a pseudoscientific belief system, maintained by both patients and practitioners through operation of well and widely understood principles of human personal and social psychology. From that standpoint, practitioners simply have defended passionately held views to which they have long been both indoctrinated and committed.

References:
Upledger, JE.; Vredevoogd, JD. Craniosacral therapy. Chicago: Eastland Press; 1983
Hartman SE, Norton JM. Letter critical of Trevitt, 2003 (The Osteopath, July and August). The Osteopath. 2003;October:29–30.
18.Kappler RE. Osteopathy in the cranial field: Its history, scientific basis, and current status. The Osteopathic Physician. 1979;February:13–18.