I am looking at back pain again. Mainly because the latest innovation in back pain treatment is less interested in where it hurts than in which of your movement habits, built up over a lifetime, are responsible for the pain.
The theory is that when major muscles shorten in one direction, there is an immediate compensatory adjustment in both nearby and distant muscles of the body. Rather than massaging or stretching the hurting section itself, the treatment is focused on muscular chain therapy, which aims to change posture to ensure that all those muscles are firing synergistically (Int. J. Ther. Massage Bodywork, 2014).
Global postural re-education, as it is also known, can ease the pain, not only of specific syndromes like ankylosing spondylitis, an inflammatory condition of the spine that can lead to fused vertebrae, but also of generalised chronic lower back pain.
One study of this approach in 61 patients with chronic low back pain found that after 12 weeks of weekly sessions, there were improvements in pain, physical functioning and general vitality (Am. Rheum. Dis, 2013).
In 100 patients treated with either MCT or ultrasound, just a single session of MCT provided relief. It is also proved superior to segmental stretching, which aims to stretch one muscle at a time. I have looked at some of the most popular postural re-education therapies, with the greatest evidence of success.
Egoscue – this was started in the 1970s by physical therapist Pete Egoscue of San Diego, California. After a bout of intense physical debilitation, he was determined to find a form of natural self-healing.
Combining postural analysis with specific corrective exercises, Egoscue not only healed himself of chronic pain and dysfunction, but founded an entire system of self-healing.
The practitioners of this therapy firstly record the client’s symptoms. They then identify the problem areas by visually assessing both the person’s posture and gait during walking. Photos of the client’s posture are taken from the front, back and sides, then fed into a computer. This then compares these images with the correct postural stance. After analysis, the programme provides a list of individualised corrective exercises which the practitioners then tweak, based on the patient’s input and their own visual assessment.
The method enabled me to know my limits and work within them
Crystal Sallee, director of Egoscue University in San Diego, says: “We look at the body as one solid unit. If you have a symptom in your knee, for example, we acknowledge that symptom. But we’re looking for the underlying cause. We look at the entire body to see where that symptom is originating from.”
The initial visit takes around two hours, there are then follow-up assessments where the exercises (which can take up to an hour a day) are changed to match the patient’s progress.
Currently there are 25 Egoscue clinics across the US and one is due to open in the UK later this year. However, there are hundreds of practitioners and trainers worldwide. Sallee said that there has recently been an influx of Western surgeons and doctors of physical therapy: “They are coming to us to supplement their practices,” she said. “Some are switching practices altogether.”
The basis of this therapy is to teach the body to move properly and re-train the muscles to hold the bones in a correct position.
The Gokhale Method – This technique also uses healthy posture and movements to heal back pain and other problems. Like Egoscue, it was founded by a practitioner, whose own health issues forced her to find new solutions.
Crippling back pain during her first pregnancy and unsuccessful back surgery set Californian-based acupuncturist Esther Gokhale on a crusade to find the root cause of back pain. She travelled to Brazil, Portugal and India to examine the native populations and discovered that, unlike westerners chained to their desks, people involved in less restrictive daily activities not only had no back pain but also had an entirely different kind of posture, which she called ‘primal posture’.
As she writes in her book 8 Steps to a Pain-Free Back: “It’s quite different than American spines. If you look at an American’s spine from the side, it is shaped like the letter S. That S shape is actually not natural. It is a J-shaped spine (where the lower back in not another curve, but more vertical and upright) that you want.”
Unlike Egoscue, the Gokhale Method has no lengthy exercise regime. The focus is on re-training patients how to sit, sleep, stand, walk and bend in ways to prompt the spine back to its natural J-shaped primal posture. As the muscles and bones realign, pain and disability are eventually cleared.
John Carter, a practitioner in Bristol, UK, says: “The principle is if we can get extra length in our typically compressed spines, while going about our lives, that changes sitting (walking or bending) from something that hurts to something that heals.”
Claire Robinson, a client in Bristol, lived with myofascial pain and knots in her muscles for over 10 years. She had tried traditional treatments, all to no avail. “Since I started practising the Gokhale Method, my symptoms are now virtually non-existent,” she says.
“The method enabled me to know my limits and work within them.” However, it didn’t happen overnight and Robinson emphasises it took a long time to create new habits of sitting and moving again.
Next week I will be looking at another method and compare all three methods.
kathryn@maltanet.net