BOOK REVIEW: Pain: Considering Complementary Approaches by NCCIH

Pain: Considering Complementary ApproachesPain: Considering Complementary Approaches by National Center for Complementary and Alternative Medicine
My rating: 4 of 5 stars

Online here

 

The National Center for Complementary and Integrative Health (NCCIH) has put out a new edition (dated 2019) of its pamphlet (about 50 pages) about how useful various complementary practices are in helping patients reduce, or cope with, pain. The NCCIH is a center in the National Institutes of Health (NIH) that serves as a clearinghouse for information about how alternative and complementary practices perform in treatment of various ailments. While alternative (instead of mainstream medicine) and complementary (in conjunction with mainstream medicine) are quite different, in almost all cases this work herein is reporting on the latter basis. The complementary practices in question include: yoga, taiji, meditation and mindfulness, massage, acupuncture, chiropractic manipulation, relaxation methods, and others.

Complementary approaches to treatment of pain is a particularly salient topic these days as the mainstream medical approach (giving patients pills to gobble down) has resulted in what many have called a “crisis” of opiate addiction. So, if it’s possible to reduce the grip of pain with practices that at best have numerous other health benefits and at worst do no harm, than that’s a pretty good outcome.

Chapters three through eleven form the pamphlet’s core, and all but the last of those look at one complementary practice each, including (in order): acupuncture, massage, meditation, relaxation techniques, spinal manipulation, taiji (a.k.a. tai chi, or tai chi chuan), yoga, and dietary supplements and herbs. Chapter 11 discusses a few additional (less popular) practices. These chapters follow a three-prong approach: 1.) is it safe? 2.) does it help mitigate pain? and 3.) where can I find more information? [Spoiler alert: In almost all cases the answer to #1 is roughly “Yes, for most people, but possibly not for you. Check with your doctor,” and to #2 is usually something like: “there is some preliminary evidence that in certain cases certain people may have benefited.”] The chapters before (ch. 1 & 2) and after (ch. 12 to 14) provide background context and additional information.

On the positive side, it’s great that this information has been gathered together and packaged into a readable format with pictures and easy to read text.

On the down side, this was clearly a document put together by a committee of bureaucrats in consultation with lawyers. It is so laden with qualifiers and spongy speak that it’s impossible to discern how strong the evidence is for the various practices or how one compares to another. I felt that they could have given the same information in a three-column table in which the first column is the practice, the second column is “can’t hurt to try*” [*provided your physician concurs,] and the third column would be “nah, this stuff is fake.” [Spoiler alert: almost everything besides homeopathy would have the first column checked, but the consensus seems to be that homeopathy is pseudo-scientific quackery designed to sell water at medicinal prices.]

This booklet is available on the web for free, so if you’re interested, check it out. But don’t expect to come away with any profound insights. It’s not that kind of booklet.

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BOOK REVIEW: Prescriptive Stretching by Kristian Berg

Prescriptive StretchingPrescriptive Stretching by Kristian Berg
My rating: 4 of 5 stars

Amazon page

 

Many people have problems that they are only aware of through symptoms like head aches or back pain that result from imbalances in muscle tightness. This book explores stretching, systematically.

The book is divided into four parts. The first, entitled “Stretching Fundamentals,” presents fundamental principles and background information. Besides basic guidelines for stretching, it also discusses anatomy and physiology of the muscular system at a rudimentary level.

The second part is about targeted stretches, and it forms the heart of the book. This section, literally, goes from head to toe (and then back to the arms) explaining techniques for stretching major skeletal muscles. For some muscles, there is more than one stretch shown, but for others there is just one. Each entry on a muscle is divided into two parts. The first, “Muscle Facts,” describes the muscle, the causes of tightness, the symptoms of tightness, tests to gauge how tight the muscle is, and any precautions that should be considered when stretching the muscle. The second presents the stretching technique with a line drawing and mention of any mistakes to avoid. There are a mix of solo and partner stretches, as well as those using a ball.

The third part presents programs for pain relief. There’s a useful section that discusses morning aches and pains, and the ways in which one is sleeping might be leading to a crick in the neck or shoulder pain. This section not only lists the muscles that one should stretch to address various issues, but it gives little anatomical drawings in the context of the stretch that both help show what one is stretching and gives a reminder of the stretch.

I came to this book from the perspective of a yoga practitioner and teacher. If you’re wondering how these stretches differ from yoga, a major factor is that balance is taken out of the equation. The stretches in the book are done in a stable position. The downside of this is two-fold. First, if you want to build and maintain balance, you need to do an entirely separate set of exercises for that (depending upon the condition of the individual that could be necessary or a waste of time.) Second, one needs access to a wide range of equipment such as tables, adjustable benches, etc. (not to mention a partner, in some cases) to make these exercises work. The upside is that the individual is in a safe and stable position, so if they have poor balance they are at minimal risk.

The last section is one assessing flexibility and muscle balance. People think more about the former than the latter, but for most people, how balanced opposing muscle groups are probably contributes more to painful problems in the body. Because some muscles are easier to stretch than others, a book that shows how to get to the more challenging muscles is a great thing to have.

The ancillary matter includes a variety of graphics (mostly line drawings and anatomical drawings), a section upfront on the major components of the muscular and skeletal systems, and a references section in back.

I found this book to be useful and informative. I’d recommend it for individuals such as trainers, yoga teachers, athletes, and others who want to understand stretching at a level beyond technique.

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BOOK REVIEW: Piriformis Syndrome by Loren Fishman, M.D.

Piriformis Syndrome: Diagnosis, Treatment, and Yoga: Pain in the ButtPiriformis Syndrome: Diagnosis, Treatment, and Yoga: Pain in the Butt by Loren Fishman
My rating: 4 of 5 stars

Amazon page

 

This short book (<50pp.) describes piriformis syndrome, what causes it and how it’s diagnosed and treated. Piriformis Syndrome is a malady in which a nerve is pinched by the piriformis muscle. Because of the way pain (and other sensations) radiate, it’s not necessarily easy to differentiate this syndrome from a low back injury. However, the descriptions of the specifics of this condition, and the test used to diagnose, it may give one insight as to whether one is looking in the right direction for the cause of one’s butt and leg pain.

One nice feature of this book is that it explains how yoga can be used both as part of the treatment regimen and as a preventive measure. The yogic treatment consists of just four classical postures of Hatha Yoga: Janu Shirshasana (head to knee pose), Parivrtta Trikonasana (twisted triangle pose), Matsyendrasana (a simple twisting pose named for a sage), and Parivrtta Parsvakonasana (twisted side angle pose.) However, yoga teachers who have students who’ve been diagnosed with this condition will find it nice that the book gives modifications and clarifications pertaining to use of the postures to help such people.

There are seven chapters in the book. The first describes the condition and its cause. The second chapter explains the connection between the condition of piriformis syndrome and the symptom of sciatica. Chapter three clarifies the ways in which this condition may be misdiagnosed, and this is followed up by the chapter that shows how it is diagnosed by both physical examination and by imaging technology. Chapter five gives a basic overview of the available treatment options including injections, drugs, physical therapy, surgery, and yoga. The next chapter talks about the state of research. The last chapter explores the yoga asana that can be used to help treat or prevent piriformis syndrome. There are a few graphics. These include line drawings such as of the diagnostic physical exam, and photos of modified versions of the yoga postures.

I’d recommend this book for those who’ve been diagnosed with this ailment, who believe they might have it, but also for yoga teachers who are interested in expanding their understanding of the afflictions of which their students may suffer—so as to be prepared to help them or, at least, not hurt them.

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POEM: The Pain

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pain advances its speary phalanx
i watch–a dispassionate witness
like some Buddha once told me to
it’s sour march is not so daunting

 

and yet it makes for cruel, cruel masters
kicking at a puppy for peeing on the rug
when everyone knows a puppy is a lovable bundle of carpet-peeing madness
its service to help one see the beauty entwined in all happenings despised
elsewise, how might one learn the futility of despising?

BOOK REVIEW: Touch by David J. Linden

Touch: The Science of the Sense that Makes Us HumanTouch: The Science of the Sense that Makes Us Human by David J. Linden
My rating: 5 of 5 stars

Amazon page

 

“Touch” is a neuroscientist’s perspective on the human sense of touch, and the profound impact it has on life in our species.

It’s a short book, only about 200 pages of substantive text, arranged into eight chapters. The first chapter considers the role that our sense of touch plays in our lives as social animals. There are a number of studies described in this chapter, but I’ll cite only two that I think give an idea of what the chapter is all about. The first considers why a person holding a cold coffee is likely to be viewed more negatively than if that same person was holding a hot coffee after a handshake. The second reports that survey takers in a mall were more likely to gain compliance if they engaged in gentle, casual, and non-creepy touch—e.g. fingers to forearm.

The second chapter explores the combination of sensors we have in our skin—particularly in our fingers–that allow us to conduct feats of dexterity that (while we take them for granted) are phenomenally difficult. For all the billions put into robotics research, robots are nowhere close to being able to complete tasks that any five-year old can do. The third chapter examines how humans are uniquely geared to be able to give and recognize a particular type of touch sensation, the caress. Throughout the book there are a number of interesting stories, some of them are scientific case studies and others… not so much. This chapter begins with the story of a man on trial for flying into a rage because his girlfriend couldn’t get the pressure right when engaging in manual stimulation. (The author was actually on the jury.)

The fourth chapter delves more deeply and explicitly into sexual contact. Whereas chapter 3, dealt largely with hand against random skin, this chapter deals in genitals and erogenous zones more specifically. There are also a number of fascinating cases / stories herein. A lot of the chapter deals in how we experience and interpret pleasure.

Chapter five explains a specific type of sensation, that of temperature. It considers why crushed chili feels hot but crushed mint feels cool to the skin. While the focus of the book is on human anatomy, physiology, and social interaction, there are many cases from other species throughout the book. This chapter offers a prime example. It explains how Vampire Bats have a unique ability to sense infrared. This is of benefit to them, since they only take blood meals and, therefore, need to be able to sense where the blood is flowing and has the least insulation (fur) over it.

Continuing the examination of specific kinds of sensation, chapter six is about pain. This is where the neuroscientific perspective offers some interesting insight. In particular, because it considers why soldiers who had multiple gun wounds could do their job on the battlefield with nary a peep of complaint, but then would raise holy hell about a bad blood stick a few days later in the hospital. The case of a medic who was badly shot up but not cognizant of it until later is discussed in some detail.

Chapter 7 deals in the itchy, and asks and answers the question of whether or not itchiness is a particular case of low-intensity pain. By low intensity, I’m not speaking of the compulsive behavior sometimes spurred by such sensations.

Chapter 8 is also highly neuroscience influenced. It deals with various illusions of sensation, and how these illusions come about through the interaction of sense and the brain. While the most famous example of such an illusion is phantom limb pain experienced by amputees, Linden addresses less traumatic and more work-a-day tactile illusions for most of the chapter. (This may be because there are a number of popular works of neuroscience that deal in phantom limbs—most notably V.S. Ramachandran’s books.)

I enjoyed this book. It conveys significant technical detail, but does so in a fashion that is easy for a non-expert to follow both because of readable writing and the use of stories. The author uses frequent graphics to help clarify points, and the graphics (mostly line drawings and graphs) do their job by being easy to follow and interpret.

In short, the book was highly readable, concise, and informative. I’d recommend it for anyone interested in the sense of touch.

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Rewiring the Brain about Pain: All That Isn’t Pleasure Isn’t Pain

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I see people staring at the railing on which they will stretch their hamstrings just like they would look at a side-by-side refrigerator unit that they have to move down a flight of stairs, psyching themselves up for the stretch. Or maybe they are weighing the question of whether they really need to stretch as one might ponder whether it would be better to get an engine overhaul or replace a car altogether. The point is that there seems to be an element of anxiety or dread associated with actions like stretching that aren’t necessarily pleasurable.

 

I have a theory about why this is the case.

First, people falsely equate discomfort with pain.

Second, the entire point of true pain is to tell one how not to move so as to avoid exacerbating an injury.

Third, this results in a desire to avoid pursuits that cause such physical discomfort.

Fourth, people create a self-fulfilling prophecy in which they tense muscles in the area of the stretch to counteract the aching stretch, but this just increases the discomfort level.

 

Your body has a clever little device called the myotatic reflex arc (MRA.) That’s when a muscle tenses to avoid injury because the muscle seems to be stretching too fast for comfort. However, that reflex is only relevant to dynamic movement and the fact that it’s a reflex arc means that the signals don’t go through the brain–thus–aren’t consciously controlled. The MRA is different from the tension one holds in a slow and controlled stretch. It’s fun to see people who’ve been encouraged to breath and relax into the stretch realizing that the stretch isn’t as bad as it seems.

 

Of course, many intense physical activities that cause discomfort may also result in a sufficient endorphin (natural painkillers) inflow and adrenaline / cortisol (stress hormones) outflow to result in net feelings of pleasure. While stretching results in endorphin release, the action of holding the muscle stretched may be too much for our natural painkillers to counteract, particularly when one is breathing easily and thus the body is not under the level of whole-body stress that might encourage the big endorphin dumps desired.

 

The problem is that one can’t achieve flexibility without pressing against one’s limits any more than one can make strength gains without lifting more or by employing more repetitions. If one just goes to the point at which one is no longer comfortable, you may be able to prevent losing flexibility, but you’re not going to make gains.

 

Another part of the problem is that people often go into stretching cold, and thus maximize their discomfort. Doing warm-ups and joint articulations before any kind of intense stretching is a good practice. These warm-ups should not test the fullest range of motion, but should move with sufficient quickness to get the muscles and the synovial fluid in the joints warmed up.

 

The problem with seeing stretching as painful is that it discourages it. Some individuals fail to stretch altogether, and others focus only on the major muscle groups (hamstrings and quads) and miss muscles that adduct, abduct, rotate, and generally stabilize and support the primary agonist or antagonist muscle pairing. The most common injury in the Japanese martial art that I study is a knee injury attributable in part to insufficiently flexible external rotators and abductors and the inability to keep the knee in line with the toes–thus putting too much torque on the joint and too much load on the ligaments.

 

Wrong: knee is not pointing over toes

Wrong: knee is not pointing over toes

 

Martial artists, in particular, need to avoid equating discomfort with pain. When discomfort becomes pain, pain becomes agony, and agony become intolerable. There are many factors that can determine the outcome of a combative event, including technical proficiency, physical fitness, and the ability to persevere. The last one may mean the ability to take a licking and keep on ticking as the Timex people used to say.

 

The good news is that it’s possible to rewire one’s brain to avoid equating the discomfort of stretching with pain.

Step 1: Get a yoga face. In the martial arts, we talk about having a warrior face, which is an expression that conveys one’s intensity and seriousness. For yoga and stretching one should ditch the agony face and replace it with a serene face. My personal recommendation is that you aim to emulate the faces on the Bayon at Angkor.

Yoga face as seen on the Bayon at Angkor

Yoga face as seen on the Bayon at Angkor

 

Step 2: Keep your mind on your breath, and away from the sensation of the stretch. There’s a reason yoga teachers harp on breath, it will help one reduce one’s overall tension.

 

Step 3: Stop using the word pain (in your own mind or when speaking out loud) to refer to the feeling of a stretched muscle. You may not be able to replace the word “pain” with something as euphemistic as “stretch bliss,” but try to avoid giving it a name with a negative connotation. It’s simply the sensation of a stretched muscle

 

Step 4: When you find yourself wearing an agony face and squeezing out the protective muscular tension, ease off the stretch until it’s comfortable. Then ease back into the stretch, keeping the surrounding muscles relaxed and the breath even and deep.  You can visualize expelling the tension with one’s exhalation if that helps.

 

Step 5: When you experience real pain, have no guilt about heeding it and giving that part of the body time to heal. Of course, this requires an ability to differentiate stretch sensation from true pain.

 

Now I’ll segue into a discussion of actual pain. When I was having a lot of problems with my lower back–eventually diagnosed as arthritis–I had a bizarro interaction with my healthcare provider. When I first went to the doctor, I faced this unsubtle wall of suspicion because back injuries are a common fraud device for persons addicted to painkillers. That’s because there are many forms of back injury that are hard to witness externally. However, when they x-rayed my back they could see clear indication that something was wrong. Then they were surprised when they tried to foist painkillers on me, and I wasn’t interested.

 

Here is how I look at painkillers. Imagine the “check-engine” light came on in your car, and you took the vehicle to the mechanic. The mechanic has your car for a brief time and comes back to you with a nominal bill. At first you are thrilled, and then you ask the inevitable question, “So what was the problem?” Your mechanic then says, “Oh, I have no idea, I just disconnected the light. That light won’t be giving you any more trouble.” Needless to say, you are decidedly less thrilled. You wanted the underlying problem fixed.

 

Don’t get me wrong, I’m not saying that there’s no place for pain-killing medication. If one has pain that is so severe that one cannot rest, one’s body won’t be able to heal itself properly.

 

However, if you pop painkillers to do away with bodily aches, you should reconsider. Those aches are what being alive feels like, and if they come from exercise or labor they should be welcomed and not be framed in a negative light. If they are an indication of a postural misalignment or some sort of systemic problem, you should look into fixing the underlying problem.

 

[To be fair to my aforementioned doctor, I think people aren’t conditioned to the notion that they are the key participant in their own healthcare and that fixing problems will often require hard work on their part. So a part of the problem in some places–most notably America–is that healthcare isn’t profitable unless they are pushing surgery or expensive medications. However, another part of the problem is that people just want to go to the doctor and have the expert fix them without requiring the personal effort of fixing postural deficiencies or cutting weight. I can understand why doctors are a bit fed up with suggesting people do the work only to get no response. I saw a statistic recently that only 1 in 8 people threatened with a lethal illness would make a behavioral change recommended by a doctor to reduce the threat of the ailment–e.g. stop smoking, stop drinking, cut weight, etc.]