From the Greek “kheiro,” meaning “hand,” the field of chiropractic traces its origins to the 19th century and a practitioner in Iowa named D.D. Palmer. It has had a history of emphasizing the relationship between structure and function. It distinguished itself from orthodox medicine by espousing the restoration of health rather than the approach of disease eradication that had been the focus of orthodox medicine. Chiropractic uses spinal manipulation and adjustments in conjunction with the body’s natural healing capacity to affect change.
Chiropractic has diverged from orthodox medicine also in part due to litigation with the American Medical Association that went on for more than 50 years. This history of litigation and some “extremist” practices within the field has tarnished its reputation and obscured its philosophical and holistic underlying tenets. Chiropractic should be considered separately from these tarnishing factors.
“Prolo” is short for proliferation, because the treatment proliferates (grows) new ligament tissue in areas where it has become weak. Prolotherapy involves the use of an injectable agent of dextrose (sugar water) into the spine. Dextrose is thought to trigger the body’s natural inflammatory response that causes subsequent stiffening of the supporting structures, thereby helping heal the weakened structures.
This therapy derived from the Latin word for “bath,” involves soaking of the body in water supplemented with minerals like sulfur. It has been shown to be superior as a pain reliever when compared with a regular bath of tap water.
Willow Bark and Capsaicin Cream
The bark of the white willow tree (salix alba) has pain-relieving properties similar to aspirin. It has an ingredient that is converted into salicylic acid. Capsaicin cream is derived from chili peppers. When applied topically, it creates heat and pain relief. Both may be applied topically.
Yoga has long been considered an effective treatment for back pain. I have heard colleagues say that patients with back pain never practice yoga and those who practice yoga never have back pain. My own review of the literature is less convincing, however.
One of the problems with discussing the benefits of yoga regarding back pain is that yoga comes in many forms and difficulty levels, therefore “yoga” is not one single thing. That being said, there are elements of yoga — including flexibility, core strengthening, relaxation techniques, mood elevation and self-efficacy — that undoubtedly will contribute to improvement in back pain.
Hands-On Therapies (Massage)
“Hands-on” therapy is a good option for pain that arises from the soft tissue or connective tissue. This is a difficult area to navigate because there are many specialists (including chiropractors, osteopaths, massage therapists and physical therapists) and many different techniques (such as Rolfing and active release therapy) that make up this type of treatment. There is no perfect way to determine which specialty or technique is best suited for your specific needs. Once you have selected a specialty, there is, similarly, no perfect way to select among providers short of a recommendation followed by trial and error.
Muscle and Connective Tissue
Therapy on the muscles and connective tissues comes in many forms, including Rolfing, structural integration, Hellerwork, neuromuscular therapy, myofascial release and active release techniques. These therapies are done by therapists trained in each particular technique. The training varies in terms of rigor and consistency.
As a pain management option, these treatments often work, particularly if the muscle or fascia is the primary cause of pain. Muscles can cause pain when injured and can also cause pain when not used. In the latter case, the pain may arise from an ensuing stiffness, from an alteration of the closely related function of the joints or from a change in posture or form.
Manual or other variants of applying pressure to muscles have been shown to have the following beneficial effects:
• Pain relief
• Immune system boosting
• Vasodilatation from mast cell activation (more blood supply)
• Recruitment of blood supply to the muscles
• Reduction of muscle spasm
• Facilitation of healing
• Stimulation of local metabolism
• Increased lymphatic drainage (decreased swelling)
In addition, the application of pressure to the connective tissue can alter the local electric environment of the intracellular and extracellular spaces that, in turn, serve to align the collagen fibrils and promote growth of capillaries and the synthesis of collagen. Put simply, this type of therapy makes the tissue stronger and healthier and can modify scar tissue as well as structural tissues. Collagen fibers connect to each other with hydrogen bonds, and when tension is applied the bonds become more aligned and stronger. This, too, will strengthen the connective tissue. Exercise will aid manual therapy with this strengthening.
Finally, the connective tissue that surrounds and permeates the muscles can be heated through a process called thixotrophy. When heated with hands-on therapy via massage or Rolfing, for instance, the connective tissue becomes more like a liquid and less like a gel. This allows for a reorientation of the connective tissue, which results in improved flexibility and strength and less pain.
Acupuncture is frequently requested by patients as a potential “noninvasive” treatment for back pain. Western medicine attempts to provide a pathologic basis for this effect but has yet to come up with a complete and substantiated explanation for the positive effects that acupuncture often delivers. Developed in China, acupuncture alleviates an inharmonious balance between the extremes (yin and yang) of the life force (qi).
Over the past 20 years, I have seen some patient’s back pain respond favorably to this treatment. Though, admittedly, I have been unable to predict who these patients will be. More importantly, improvements are nearly always temporary, and because the cost is often not covered by insurance, the out-of-pocket burden is sometimes prohibitive. Nonetheless, acupuncture is safe and a viable option for the patient with the patience to try alternative treatments that may not be permanent and with the financial means to pay for them.