Acupuncture

This technique is derived from Chinese traditional medicine and involves placing needles into specific points found on “meridian lines” that extend all over the body. These lines are complex and were defined by the technique’s developers centuries ago. The diagnosis is, amongst other things, determined by examining features of the pulse also not recognised by Western medicine. How the technique works is unexplained but for many it gives relief. Chinese medicine also has its own often herbal based pharmacy and involves other techniques such as Moxibustion and Cupping. Acupuncture is not only practiced by Chinese traditional practitioners but has been learnt by many medics who use it in a modified form alongside other standard Western therapies. In the UK it is self regulated by the British Acupuncture Council. See also Dry Needling.

www.acupuncture.org.uk

Classification: Passive

Alexander Technique

Named after Frederick Matthias Alexander, (1869-1955), he described it as an educational process that helps individuals realign their posture and avoid muscular and mental tension in everyday life e.g., standing or sitting with body weight unevenly distributed or holding the head incorrectly, walking or running inefficiently, and responding to stressful stimuli in an exaggerated way. He believed that if muscles are used incorrectly then emotional responses suffer. People have since used it in sport e.g. the Steven Shaw Art of Swimming. It is good for “office neck”.

www.alexandertechnique.co.uk

Classification: Passive

Aroma Therapy

Aromatherapy uses plant oils and other scents to alter mood, cognitive processing and psychological or physical well-being. Based on smell it reaches back to the earliest origins of our consciousness.

Probably, as single cell organisms one of the earliest things we learnt to do, in the past mists of our evolutionary history was, smell i.e., detect chemical gradients, food, and so move towards it. This actually poses one of the most taxing and unresolved questions of evolutionary biology; why did a cell evolve a flagellum that allowed it to move if it could not smell and likewise why learn to smell if you cannot move? Let’s leave that for now.

Today a brain smells, or in other words detects a chemical gradient, with the olfactory nerve. Whether you are a reptile, bird or mammal you have the same unique mechanism. Unique because it is a direct extension of the brain and the only direct contact the brain has with the outside world. The olfactory nerve runs forward under the front of the brain to the top of the nose where it pierces the skull through series of holes in what is called the “cribriform plate” – in humans this is an area of the skull half the size of a teaspoon with multiple holes through which the nerve protrudes. The holes are each big enough to house a fat sowing needle. Here fingers of brain poke down into the top of the nose to directly engage smell. Quite literally it is where “you get some air to your brain”. All other, all other, sensory interaction that our brain has with the world that surrounds us is via a peripheral nerve, an intermediary which lies outside the brain and acts as a messenger. Touch, temperature, sound vision, vibration all come via these peripheral or outside interpreters. Smell instead, and uniquely, hard wires directly into our brain. Primeval, pure, unadulterated it drives straight into the under surface of consciousness. Stamping into our awareness its power to change behaviour, and thereby make “sales”, is testified to by the bakery in every supermarket. Some do not actually bake the bread they just scent the air with an artificial bakery smell so as to enhance purchasing.

The more primitive and ancient a brain is the more it is devoted to smell. Moles stopped evolving 30million years ago. Almost blind, quite deaf and exceptionally dim they have a brain that is over 60% devoted to smell. In dogs it is perhaps 30%. Even in humans 5% of our DNA codes for smell!

Now, a therapy that taps directly into the ancient origins of our conscious underbelly might well help in a sense of general well-being and indeed the use of essential oils for spiritual and ritualistic purposes goes back to the ancient civilizations of China, India, Egypt, Greece, and the Romans. Each scents in cosmetics, perfumes and drugs. In World War II the French surgeon, Jean Valnet, used essential oils to treat wounded soldiers. Today aromatherapy is used to treat a variety of conditions: pain, anxiety, fatigue, short-term memory, hair loss, eczema.

The two basic mechanisms by which it may work are the direct effect on the brain and perhaps a pharmacological activity the essential oils used.

Aromatherapists have voluntary regulation in the UK by the Aromatherapy Council.

www.aromatherapycouncil.org.uk

Classification: Passive

Bikram Yoga

Also known as Hot Yoga it is practiced in a room heated to 40 °C (104 °F) with a humidity of 40%. It is a form of hatha yoga named after its founder Bikram Choudhury and is delivered via a franchise, Bikram Incorporated, based in Los Angeles and also founded Choudhury. It is a “one size fits all” set of 26 postures.

www.bikramyoga.com

Classification: Active

Bilates

This combines Pilates with ballet based exercise. It is in general more active/aggressive than pure Pilates.

Classification: Active

Body Balance

Relatively new this blends a series of simple yoga moves with elements of Tai Chi and Pilates and is performed to an inspiring soundtrack. Breathing is controlled throughout all the exercises. It attempts to strengthen the entire body and produce a feeling calm. It is offered in gyms by fitness instructors.

Classification: Active

Bowen Technique

This involves a practitioner performing rolling motions along muscles, tendons, and fascia. The intervention is minimal and pauses form an integral part of the treatment. These breaks in treatment “allow the body to reset" itself. Derived from techniques first developed by the Australian physical therapist, Thomas Ambrose Bowen (Tom Bowen) (1916–1982), the precise techniques vary as do the names by which it is known: Smart Bowen, Fascial Kinetics, Neurostructural Integration Technique (NST), Fascial Bowen and Bowenwork.

www.thebowentechnique.com

Classification: Passive

CHEK Therapy

Paul Chek describes himself as working in the fields of “corrective and high-performance exercise kinesiology”. Kinesiology is the study of body movement. He set up the “CHEK” Institute in California; referring not to his name, (really!), but to “Corrective Holistic Exercise Kinesiology”. He recommends “treating the body as a whole system and finding the root cause of a problem” by addressing six areas: -

• Thoughts – suggesting that “the biology of your body is linked to your mind – healthy thinking produces a healthy body.”
• Movement – expressing the belief that “movement is life and life is movement - exercise pumps your organs, removes waste, improves metabolism, and cultivates energy.”
• Nutrition – he promotes organic foods “eaten according to your Primal Pattern Diet Type” suggesting this will “fuel your body for success”
• Breathing – by optimising breathing he attempts to maximize “the most important nutrient – oxygen” suggesting this “removes waste, and energizes your body”. (Now, whilst we have avowedly avoided recommending any particular therapies here we can clearly and unreservedly endorse this element of Chek’s thinking; life without oxygen is miserable, short and often quite desperate. If you want to get the most out of life you must remember to breath, all day actually.)
• Hydration – on the basis of the old adage that “the solution for pollution is dilution” – they suggest “water is an essential cleaning agent for the body”. Drink water.
• Sleep – believing “we get stronger when we rest” they promote 8 hours of sleep each night as being essential for rest & repair.

This is a whole way of life and is not for the faint hearted.

www.chekinstitute.com

Classification:Passive; Active; Prevention/ergonomic

Chiropractic/chiropractor

Invented by Daniel David Palmer a charismatic healer from Iowa USA in 1895 the initial theory was that all kinds of illness could be relieved by spinal manipulation; like its older rival osteopathy, also invented by an engaging American from the mid-West. Palmer’s first patient, Harvey Lillard, had apparently gone deaf when “something popped in his spine” and a few days after some spinal adjustments his hearing returned. Initially surrounded by theories that today sound laughable it is now one of the largest alternative medicine professions. Chiropractics are skilled in musculoskeletal diagnosis and deliver a range of therapies aimed at relieving symptoms and aiding in healing and prevention. Their work very much focuses on spinal disorders. Extensively practiced around the world many chiropractors work in elite sports whilst others are integrated into GP services. In Denmark they study during their first years with standard medical students. Like with all the professions there are good and bad ones but most now address the three pillars of spinal care. chiropractic students in the UK study for four to five years to gain their Integrated Masters in Chiropractic (MChiro) degree. In the United Kingdom, chiropractors are Statutorily Regulated by the General Chiropractic Council (GCC)

www.gcc-uk.org

Classification: Passive; Active; Prevention/ergonomic

Cognitive Behavioural Therapy

A form of psychotherapy, or “talking therapy” it was originally designed to treat depression, but is now used for a many other mental disorders and chronic pain changing unhelpful thinking and behaviour. It focuses on specific problems and assists in developing specific strategies to help address them. This is different from psychoanalysis where therapists look for the unconscious meaning behind the behaviour and then diagnose the patient.

It is used in the treatment of mood, anxiety, personality, eating, addiction, dependence, tic, and psychotic disorders as well as a multitude of chronic pain states including low back and neck pain, fibromyalgia, arthritis, regional pain syndromes in addition to a variety of other chronic conditions such as tinnitus (a constant ringing in the ears) and chronic fatigue syndrome. It attempts to challenge "errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing with more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behaviour.” In chronic pain the technique is used to help individuals diminish the impact of their condition – the condition remains but its effect on well-being is diminished.

CBT uses a number of different methods: exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behaviour therapy, and acceptance and commitment therapy.

A typical programme would consist of face-to-face sessions between patient and therapist, made up of 6-18 sessions of around an hour each with a gap of a 1–3 weeks between sessions. However, this varies. It may be delivered via a live remote computer interface, (CCBT), there are standalone computer based programmes, (some now utilising artificial intelligence), it may be delivered in book format or group sessions and it can be combined with other cognitive therapies such as Mindfulness.

In February 2006 NICE recommended that CCBT be made on the NHS and here is what they say of it: it is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems …… CBT cannot remove your problems, but it can help you deal with them…..it is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle…...CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts”

ww.nhs.co.uk

The British Association for Behavioural & Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK 

www.cbtregisteruk.com/Default.aspx

The British Psychological Society (BPS) likewise has a directory of chartered psychologists but only some will specialise in CBT.

www.bps.org.uk/bpslegacy/dcp

For a good review of its use in chronic pain:

www.apa.org

Classification: Active; Prevention/ergonomic

Complimentary and Alternative Medicine

This term refers to all of the physical therapies and treatments excluding physiotherapy, podiatry/chiropody and all types of therapy excluding Western/modern medicine.

In 2015 the Australian Government's Department of Health published a review of alternative therapies. Whilst those practicing many of the therapies it covers may criticise the report for looking at them through the wrong lens, a Western objective “evidence based” lens, it is a good read.

Regulation and standards are an issue in this field as it is in many. The European Federation for Complimentary and Alternative Medicine EFCAM is instead mainly concerned with “equality of access for citizens to CAM across Europe, and, to gain the right of all appropriately trained providers of CAM to practice”.

However, in the U.K. the Complementary and Natural Healthcare Council (CNHC), a regulator for complementary therapists was set up with government support to protect the public by providing voluntary register of complementary therapists. CNHC's register has been approved as an Accredited Register by theProfessional Standards Authority for Health and Social Care for: Alexander Technique, Acupuncture, Aromatherapy, Bowen Therapy, Craniosacral Therapy, Healing, Hypnotherapy, Massage Therapy, Naturopathy, Nutritional Therapy, Reflexology, Reiki, Shiatsu, Sports Therapy, Yoga Therapy.

www.cnhcregister.org.uk/newsearch/

www.efcam.eu

www.cnhc.org.uk

Classification: Passive; Active; Prevention/ergonomic

Core Muscle Exercises

The “core” relates to the muscles of the abdominal wall, pelvis, lower back and diaphragm: transversus abdominis, internal and external obliques, quadratus lumborum , errector spinae, multifidus and the diaphragm muscles. The action of these muscles contracting together upon the incompressible contents of the body, your giblets, supports and protects the spine. The core is thought of as the body’s centre of gravity and as essential for stable safe movement. However, many studies have questioned if core stability training has any more benefits than general, non-specific exercise and even walking. Some studies have failed to demonstrate preventative benefits against injuries or to improve performance in sport. Most believe that it is important to keep the spine in a neutral position and to increase intra-abdominal pressure before doing movements that might risk the spine. This is often now referred to as “lumbar motor control”. Training methods for developing and maintaining core stability include Pilates, Swiss ball stability work and yoga.

Classification: Active

Cranio-Sacral Therapy

Craniosacral therapy (CST, cranial-sacral therapy, cranial osteopathy, and cranial therapy) is a form of alternative therapy that uses light touches to a patient's cranium, spine and pelvis. Practitioners believe that this manipulation regulates the flow of cerebrospinal fluid and aids in "primary respiration". Based on observations made by the osteopath William Sutherland (1873–1954) in 1898–1900 craniosacral therapy was further developed by John Upledger, D.O. in the 1970s. Craniosacral therapy is the more common name in the USA whereas in the UK the term "cranial osteopathy" is often used. Not all therapists will have had formal osteopathic training. The evidence base for CST is sparse, the underlying theories are biologically ridiculous and there is a complete absence of well-designed clinical trials. However, its popularity reflects the many patients that find “a sense of relief”. It is so gentle that harm is clearly unlikely providing, as the UK organising society recommends, that it is used alongside other standard treatment.

www.craniosacraltherapy.org

www.craniosacral.co.uk

Classification: Passive

Cupping

This stems from the same tradition as acupuncture and involves suction cups being placed along meridian lines.

Classification: Passive

Dry Needling

This is a Western version of acupuncture whereby fine needles are placed into painful “trigger” points in muscles to relieve spasm and pain. It is often used by physiotherapists and not infrequently by osteopaths and chiropractors who of course may also employ traditional acupuncture too.

Classification: Passive

Ergonomics

Regulated by the Chartered Institute of Ergonomics and Human Factors, ( CIEHF) the two terms are often used interchangeably, though for some “ergonomics” infers the physical aspects of the environment such as desks and chairs, while ‘human factors’ more relates to the wider way in which activity is undertaken.

It is very much a derived science based on multiple disciplines: anatomy, physiology (a branch of biology that deals with the normal functions of living organisms and their parts), cognitive psychology (concerns mental processes like perception, thinking, learning and memory), organisational psychology (concerns the way people interact), engineering, biomechanics (the study of the mechanical laws relating to the movement and structure of living organisms), kinesiology (the study of the mechanics of body movements) industrial design, and anthropometry (the study of the measurements and proportions of the human body) and statistics. With these tools it seeks designs that complement the strengths and abilities of people whilst minimising the adverse effects of their limitations. As a science it has to accommodate our variable population with its differing ages, sizes, strengths, cognitive abilities, prior experiences, cultural expectations and goals. It aims to match a product, workplace or system design with the people who need to use it. In short, it aims to do things better.

“Good design should go unnoticed giving no cause to be.”

Poor design is noticed; an airport with poor signage, a machine with incomprehensible instructions, poor packaging. The nuclear sector has led the way in understanding, measuring and improving human reliability and in the UK is seen by many as having delivered a gold-standard. In healthcare, improving equipment design and communications between teams of doctors and nurses is seen as a way to reduce harm and maximise gain. Its knowledge can be transferable; the CIEHF website gives a powerful example; “Great Ormond Street Hospital studied Formula 1 pit stops in order to understand methods and efficiencies in teamwork for application in paediatric heart surgery”. The International Ergonomics Association states on its website that proper ergonomic design is necessary to prevent musculoskeletal disorders like repetitive strain injuries and chronic low back pain.

Ergonomics is an old art. The Ancient Greek Hippocrates in the 5th century BC described how a surgeon's workplace should be designed and his tools laid out in ergonomic terms whilst the early Egyptian dynasties had displayed similar principles in their design of tools and household equipment nearly 3000 years before.

Modern ergonomics is a product of the 20th Century. In 1911 the American Quaker Frederick Winslow Taylor, also a national golf and tennis player, published The Principles of Scientific Management. His contemporary Americans, Frank and Lillian Gilbreth, then developed the "time and motion study", which in eliminating unnecessary steps, improved efficiency; they reduced the number of motions in bricklaying from 18 to 4.5 thereby increasing the laying rate from 120 to 350 bricks per hour. Most famously, on the 1st October 1908 the World saw its first production line role out the Model T Ford.

Meanwhile the Russians, in the throws of revolution, focused on the well-being of the worker. At the First Conference on Scientific Organization of Labour in1921Vladimir Bekhterev and Vladimir Nikolayevich Myasishchev criticised Taylor's proposal to turn man into a dull machine and suggested a new discipline of "ergology" or "ergonology that would place health and well-being at the centre of the massive re-organisation of labour Russia was to oversee. Reality, meet vision!

Ergonomics emerged as a discrete science in the 1940’s as a consequence of the physical and cognitive demands placed on the human operators of the new technologies spawned by World War II. Poor performance was linked to the difficulties the human operators encountered interfacing with their new weapon systems. The “Tayloristic” approach of matching man to machine was thrown into reverse, designing machines that man, with his limits and strengths, could use most effectively. By 1943 and with the appalling losses in the air a lieutenant in the U.S. Army, Alphonse Chapanis, showed that "pilot error" could be hugely reduced with logical and more differentiable cockpit controls. As these technologies expanded into civilian applications disharmony between people and equipment increased and stimulated research into the interactions between people, equipment and their environments. The early focus had been on work environments though increasingly it began to include consumer product design.

Its reach is indeed now wide and vital; driver error is estimated to contribute to over 40% of fatal road traffic accidents so ergonomists work on how road users gather and process information and adjust road layout and signage to improve their decision making.

The term ergonomics was coined at a meeting of physiologists and psychologists at Britain’s Admiralty in 1949 and derives from the Greek roots ἔργον pronounced “ergon” meaning “work” and νόμος pronounced “nomos” meaning “natural law”. Later that year the Ergonomics Research Society (ERS) was formed; it was the World’s first such professional body. In 1977 the ERS became the Ergonomics Society (ES) in recognition of the increasing focus on the practice of ergonomics. It then became a Registered Charity, number 292401, and a Company limited by guarantee, number 1923559, in 1985.

The term “human factors” was coined in the USA and in 2009 the ES was renamed the Institute of Ergonomics and Human Factors (IEHF) to reflect the popular usage of both terms and to emphasise the breadth of the discipline. Finally, in 2014, the discipline’s importance was recognised officially by the award of a Royal Charter that allows it to confer Chartered status on members who fulfil certain criteria and by the end of that year the CIEHF had 294 members.

Meanwhile in 1953 the European Productivity Agency founded in Switzerland, became the International Ergonomics Association in 1961. Until 1976 it was a society of individual members. At that point the IES changed to be the association of federated societies worldwide. In 2011 the IEA became a not-for-profit organisation. It remains based in Zurich.

Comprised of three main subspecialties, physical, cognitive and organisational ergonomics: physical ergonomics is the science of designing user interaction with equipment and workplaces to fit the user; cognitive ergonomics concerns the mental processes, (perception, memory, reasoning), that affect interactions between users and systems; organisational ergonomics concerns the optimisation of system structures, policies, and processes with relevant issues including communication, crew resource management, working times, teamwork structures, and quality management.

There are many specialisations within these broad categories; in physical ergonomics there is visual ergonomics and within cognitive ergonomics human–computer interaction, and user experience engineering.

Ergonomists employ a great variety of tools and a considerable jargon.

They may use “ethnographic analysis” observing the uses of technology in a practical environment focusing on "real-world" experience and pressures especially relevant to early product design. “Focus Groups” produce qualitative data on opinions about technologies or processes at any stage during development. “Iterative design/prototyping” involves users at several stages of development to correcting and refining a product. Meta-analysis examines a wide body of already existing data to identify trends, form hypotheses and aid design. Two subjects, “subjects-in-tandem”, may work concurrently on the same task while vocalizing observations and by "co-discovery" feed off of each other to generate stronger ideas than they would working alone. Surveys and questionnaires can generate large amounts of data though as any electoral opinion pollster knows, not always accurately. “Task analysis” is a method of analysis which aims to aid in the matching of systems and processes to human capabilities. The “think aloud protocol” is just as it sounds; a researcher gains insights as to the users' analytical process and so identifies design requirements that affect output or user. “User analysis” creates the persona of the user at the outset of a design process focusing on their needs. The "Wizard of Oz" technique involves an operator remotely controlling a device to simulate a computer program obviating the early need to actual build programmes. A “methods analysis” breaks down each task into its component steps to for example see precisely where a “repetitive strain” occurs. Time studies, work sampling and “predetermined time systems” are methods for analysing “time and motion”. The “cognitive walkthrough” imagines a user’s perspective of scenarios to guide design and workflow. The Kansei method is a system for converting consumer feedback into design specification. “High Integration of Technology, Organization and People”, (HITOP), is a step by step manual procedure that exposes the human and organizational aspects of a technology that should lead to a more efficient integration of it into a workplace. Likewise “Top Modeler” helps identify the organisational changes needed when new technologies are introduced and “Computer-integrated Manufacturing Organization, and People System Design”, (CIMOP), does this in the computer sector. “Anthropotechnology” concerns the transfer of technology from one culture to another. The Systems Analysis Tool, (SAT), comparatively evaluates work-system intervention alternatives whereas Macroergonomic Analysis of Structure, (MAS), analyses the structure of work systems according to their compatibility with certain sociotechnical parameters and Macroergonomic Analysis and Design, (MEAD), uses a ten-step process to achieve a similar goal. Virtual Manufacturing and Response Surface Methodology, (VMRSM), uses computerised tools and statistical analysis in workstation design.

When you look at the beautiful and unbeaten ergonomic of a stone-age hand axe you wonder how, without MAS, MEAD, HITOP or SAT, they ever did it? “They” were our early Acheulean forebears in Africa, Homo habilis, 1.76 million years ago! Now, Henry Ford, what in your Model T have you got to say about that?

The point is ergonomics and prevention is important, often very technical and encompasses all aspects of life. If you do not address the prevention and ergonomic end of your condition’s seesaw you will require more treatment at the other end before it tips into remission, more pills, needles and operations. It will take longer and recurrence, the seesaw tipping back into pain and disability, is more likely.

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Where to get OT/ergonomic equipment for spines:

www.spinegroup.co.uk/

www.ergonomics.org.uk

www.hse.gov.uk/pubns/indg90.pdf

www.hsl.gov.uk/health-and-safety-training-courses/ergonomics

Classification: Prevention/ergonomic

Healing and Healers

This consists of a very mixed group of practitioners who use a variety of techniques, often the laying on of hands, and claim various powers to relieve illness and stress. Unregulated and not at all standardised they vary from country to culture.

www.internationalnaturalhealersassociation.com

Classification: Passive

Hydrotherapy

This involves doing physiotherapy in water, usually a specifically designed very warm small pool, with a physiotherapist trained in the technique. It is very useful for patients who are “non-weight bearing” after orthopaedic injury or surgery. In the context of spinal conditions it is used by patients whose spine is too painful or stiff for them to be able to exercise or stretch on land. It is used at the beginning of a treatment plan that will move out on to land based physiotherapy as a condition improves.

www.arthritisresearchuk.org/arthritis-information/therapies/hydrotherapy.aspx

Classification: Active

Hypnotherapy

A complementary therapy that uses hypnosis, an altered state of consciousness, to relieve chronic often habit related conditions. Scientists disagree about whether and how it works. Some see it as a relaxation technique. The National Institute for Health and Care Excellence (NICE) has nevertheless recognised hypnotherapy as a possible treatment for irritable bowel syndrome, IBS, in those who haven't responded to other treatments. It has been widely tried in smoking cessation, weight control, eczema, anxiety and phobia. It can be used in conjunction with cognitive behavioural therapy (CBT).

As long ago as 1892, the British Medical Association (BMA) set up a committee to look at the effectiveness of hypnotism and concluded that it “is frequently effective in relieving pain, procuring sleep, and alleviating many functional ailments” – by the latter they meant what today is termed psycho-somatic complaints and anxiety disorders. They repeated the process in the 1950s concluding it “may be the treatment of choice in some cases of so-called psycho-somatic disorder” and that “there is a place for hypnotism in the production of anesthesia or analgesia for surgical and dental operations”. In 1958, the American Medical Association (AMA) then endorsed the BMA’s report. More recently in 1995, the US National Institutes of Health (NIH) concluded that “the effectiveness of hypnosis in alleviating chronic pain associated with cancer seems strong” and likewise “other chronic pain conditions, which include irritable bowel syndrome, oral mucositis, temporomandibular disorders, (a form of jaw pain), and tension headaches” In 1999, the British Medical Journal (BMJ) published a Clinical Review supporting these views again. Likewise the British Psychological Society in 2001 concluded "there is convincing evidence that hypnotic procedures are effective in the management and relief of both acute and chronic pain….”

Hypnotherapy is practised by doctors, psychologists and counsellors for treatment but also by non-professionals, some with little training and often for entertainment. Ultimately it is regulated in the UK by the Complementary and Natural Healthcare Council (CNHC) though this is voluntary. Further regulation rests with the Confederation of Hypnotherapy Organisations (UKCHO) which is a non-profit umbrella body for hypnotherapy founded in 1998. Their website includes a National Public Register of Hypnotherapists.

Classification: Passive

Mackenzie Exercises

The McKenzie Method is a method of care developed by the New Zealand physical therapist, Robin McKenzie, (1931 to 2013) who gained an OBE for his work. He developed the method in the late 1950s and called it Mechanical Diagnosis and Therapy, MDT. It is a system applicable not only to the spine but also conditions affecting the limbs. The system categorises patients' complaints not on an anatomical basis but by the clinical presentation of patients. Its other characteristic is its reliance on self-treatment minimising the passive manual therapy. McKenzie training teaches that passive procedures should only to be used if an individual’s “self-treatment” program is not fully effective. By self-treatment he referred to active, exercise based treatment i.e., two pillars with the second one being the most important. He argued that self-treatment is the best way to achieve a lasting improvement of back pain and neck pain. Launching his programmes in the 1980’s he was very much part of the movement towards exercise. When one views this in comparison with the history of Yoga and Ti Chi it is perhaps not so much a case of West meets East as West catches up!

At its heart is a philosophy of active patient involvement and education. There are four key steps: assessment, classification, treatment and prevention.

Assessment: the clinician listens to the symptoms and examines the patient by asking them to repeatedly make certain movements and sustain specific postures. This information is used to categorise the problem.

Classification: each condition is categorised into one of four syndromes. The first three are mechanical with the forth, “Other Subgroup” including serious pathologies, non-mechanical causes, true chronic pain.

Treatment: this consists of specific exercises and advice regarding postures to adopt and postures to temporarily avoid. The therapist may need to add hands-on techniques until the patient can self-manage. The aim is to use the least number of sessions. The underlying strength is that a treatment performed five or six times a day by the patient on their own is that much more likely to be effective in a shorter period than treatment administered by a therapist once or twice per week. The patient has to be actively involved. In the event of recurrence most patients can successfully then treat themselves.

Prevention: according to the McKenzie website this is actually just more treatment; “problems are more likely to be prevented through self-maintenance than by passive care.” This does not really address the third pillar of what it is an individual or activity is doing to create symptoms and how this can be prevented.

In 1982 McKenzie established the McKenzie Institute to carry out further research and training and there are now 28 branches Worldwide. He also invented the McKenzie Lumbar Roll and McKenzie Neck Roll to help patients prevent a recurrence of pain.

www.mckenzieinstitute.org

Classification: Passive; Active

Massage

There are more types of massage than we have space for. Some are very arduous and have the capacity to aggravate rather than relieve – Thai massage should be undertaken with some caution if there is already a back condition or osteoporosis, (thin bones – to be differentiated from osteoarthritis which means “wear and tear” arthritis). Others are very gentle. It forms an integral part of physiotherapy and many osteopaths and chiropractors will use it. It addresses muscle tension and spasm but may also be used on ligaments, (bands of tough tissue that bind two bones at their joint), and tendons, (bands of tough tissue that bind muscles to bone).

The Council for Soft Tissue Therapies works “in the best interests of the profession”, defines the core curriculum required for registration with the Complementary & Natural Healthcare Council (CNHC) and describes itself as the governing body for massage and soft tissue therapies that form all bodyworks and soft tissue techniques in the UK.

www.gcmt.org.uk

Classification: Passive

McTimoney Chiropractic

Although derived from a different discipline in reality it is very like cranial osteopathy or cranio-sacral therapy. They begin from the stand point “that a healthy spine facilitates a healthy life”. Developed by the late John McTimoney over 50 years ago it is taught only at the McTimoney College of Chiropractic near Oxford. They suggest that the “gentle nature of chiropractic the McTimoney method makes it suitable for people throughout their lifetime from babyhood to those in later life”. Practitioners may specialise in pregnancy, paediatric, sports or later life chiropractic care. Apparently around 150,000 new patients consult a member of the MCA each year and UK members are registered with the General Chiropractic Council. It “involves light touch” along with a “whole body approach” and may not just be directed to the area where the pain is located.

www.mctimoneychiropractic.org

Classification: Passive

Mindfulness

An English word for the Buddist term “sati” it is a form of meditation that promotes a sense of well-being and the perception at least of good health. Popularised by Jon Kabat-Zinn it is used therapeutically to alleviate a variety of mental and physical conditions: depression, stress, anxiety and drug addiction. In addition it is used by many to enhance mental and physical performance and has gained worldwide popularity as a method of controlling emotions and reducing avoidance behaviour. It is used by many in high powered, high performance and demanding occupations.

Practiced sitting upright with eyes closed and cross-legged on a cushion or chair, breathing is the initial focus of thought. Starting with short 10 minute sessions a day these are gradually increased as it becomes easier to keep the attention focused on breathing. Eventually awareness of breathing is extended to thoughts, feelings and actions. It is not surprising that scientists have shown alterations in brain function with this meditation.

A two-component model has been proposed: first, by focusing attention on immediate experience awareness of that experience is enhanced; second the adoption of curiosity, openness, and acceptance of one’s emotions reduces their control over you.

The aim is to avoid trying to produce a particular mental state such as relaxation but instead simply to notice states as they arises in the “stream of consciousness”.

In Buddhism Sati is one of the seven factors of enlightenment. Right mindfulness is the seventh element of the noble eightfold path. An antidote to delusion it is considered as a 'power'.

In 1979, Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts to treat the chronically ill. In mindfulness-based cognitive therapy (MBCT) it is combined with traditional cognitive behavioral therapy (CBT).

In the business world interest in Mindfulness arose from the need to succeed. Books abound: Awake at Work (Carroll, 2004) and Resonant Leadership: Renewing Yourself and Connecting with Others Through Mindfulness, Hope, and Compassion; The Mindful Leader (Carroll, 2007) Leading companies provide training programmes: Procter & Gamble, Monsanto and Unilever. Top executives recommend it include the chairman of the Ford Motor Company, Bill Ford, Jr., and CEO at the Monsanto Corporation, Robert Shapiro.

Other uses have seen: Harvard University held a workshop on "Mindfulness in the Law & Alternative Dispute Resolution”; it being taught in prisons to reduce violence and improve self-esteem. Even the British Parliament organised a mindfulness-session for its members in 2014, led by Ruby Wax!!!

Of Mindfulness the NHS says it “can help us enjoy life more and understand ourselves better ….. mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment …… an important part of mindfulness is reconnecting with our bodies and the sensations they experience ….. waking up to the sights, sounds, smells and tastes of the present moment ….. the feel of a banister as we walk upstairs….. another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment……becoming more aware of the present moment can help us enjoy the world around us more and understand ourselves better…… most of us have issues that we find hard to let go and mindfulness can help us deal with them more productively”.

By way of explanation the NHS quotes Professor John Williams of Oxford: "It might be useful to remember that mindfulness isn't about making these thoughts go away, but rather about seeing them as mental events. Imagine standing at a bus station and seeing 'thought buses' coming and going without having to get on them and be taken away. This can be very hard at first, but with gentle persistence it is possible.

Mindfulness is recommended by the National Institute for Health and Care Excellence (NICE) as a way to prevent depression. Chronic pain is a potent source of depression and low mood is often reported by those enduring lasting episodes of either chronic low back pain or neck pain. A large US study showed Mindfulness was effective in relieving chronic low back pain, equally as effective as cognitive behavioural therapy.

Div table grids are great to layout website sections on the page!

www.bemindful.co.uk/

www.nhs.uk/conditions/stress-anxiety-depression/pages/mindfulness.aspx

www.nhs.uk/news/2016/03March/Pages/Mindfulness-may-be-effective-for-treating-low-back-pain.aspx

The Mental Health Foundation has an online mindfulness course at:

www.bemindfulonline.com/

They also have a teacher locator on:

www.bemindful.co.uk/learn-mindfulness/

Classification: Active; Prevention

Moxibustion

This is part of Chinese traditional medicine practiced in conjunction with the needling of traditional acupuncture. It involves burning wool over certain points again derived from the meridians that underlie their system of medicine and diagnosis.

Classification: Passive

Myofascial Release

“Myo” refers to muscle. “Fascia” is the tissue, often in quite tough sheets, that separates the organs and muscles of the body as well as every bone, nerve, artery and vein. Myofascial Release is a form of massage focused on stretching the muscles and fascia stiffened by disease and trauma. This shortening may not show up on scans. It is a hands on passive treatment that has to be combined with all the other essential elements of a comprehensive treatment package if it is to be effective long term. The therapist uses their hands to find areas that feel stiff and fixed instead of elastic and movable. These may not always be at the source of pain but are thought to restrict muscle and joint movements and so produce pain in other muscles adversely loaded by that restriction. Manual pressure and stretching loosens up the restricted movement, leading indirectly to pain relief. Whilst the detection of the restricted areas is done by gentle palpation, (feeling with the hands), the stretching is often sustained and strong. Some practitioners use blunt blades to aid the stretching. Often practised by physiotherapists, chiropractors and osteopaths as part of a treatment package there are pure myofascial release therapists who may or may not add the other elements of a treatment programme.

www.myofascialtherapy.org

Classification: Passive

Naturopathy

Naturopathy or naturopathic medicine uses an array of "natural" modalities such as homeopathy, herbalism, and acupuncture, as well as dietry advice and lifestyle counselling. Holistic and non-invasive it aims to reduce the need for surgery and drugs. Considered by many to be ineffective the term was coined in 1895 by John Scheel and popularized by Benedict Lust, often referred to as the father of U.S. naturopathy. The 1970’s saw its popularity rise.

The basic concept is old; Hippocrates, advocated natural cures. The Scot, Thomas Allinson, promoted his "Hygienic Medicine" in the 1880s; a natural diet and exercise, no tobacco and not too much work. The philosophy became less grounded when Lust started to promote it in spiritual and “vitalistic” terms with "absolute reliance upon the cosmic forces of man's nature". He founded the American School of Naturopathy in New York in 1902. After a period of rapid growth, naturopathy went into decline with the advent of penicillin and other modern medicines.

A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination. Treatment is traditionally confined to lifestyle changes and alternative remedies such as botanical medicines, vitamins, minerals and homeopathy.

Represented in the U.S.A by the American Naturopathic Association (ANA) naturopathy is not regulated in the United Kingdom.

Classification: Passive; Prevention/ergonomic

Neural Glides

This is a physiotherapy technique whereby nerves that may have become tethered, perhaps by disc herniations, narrowing of the nerve canals, under muscles/tendons or by scars formed after surgery, are stretched across or through the obstruction. It forms part of the rehabilitation phase of your treatment.

Classification: Passive; Active

Nutritional Therapy

Medical nutrition therapy (MNT) aims to treat medical conditions with specifically tailored diets devised and monitored by a registered dietitian. A classic use of MNT is to reduce the risk of developing complications of conditions such as diabetes, renal failure and high cholesterol. It is little used in spinal disorders though diet and weight reduction is of relevance to some back pain patients.

Classification: Prevention/ergonomic

Occupational Health/Therapist

At its core occupational therapy concerns the occupations of people and their effect on health. Occupations vary so much that OTs work with a wide range of techniques. Indeed their work is not confined to the employed. They will work with whatever “occupies” people: they help people of all ages, abilities, disabilities and with all manner of illnesses and conditions including a substantial amount of back pain and neck pain patients. They cover activities ranging from computing to the activities of daily living: dressing, cooking, and eating.

Physical exercises may be used to improve strength and coordination and mental exercises to improve visual acuity, short term memory, decision making and problem solving. They may use other techniques cognitive behavioural therapy.

Classically they have two roles: work with spinal cord injury and stroke patients on adaptive equipment, including wheelchairs, orthotics, and aids for eating and dressing, they may even design and make special equipment for home or at work; in the work place they will perform work station assessments to prevent problems arising and with individuals whose abilities are either temporarily or permanently impaired.

They will often work within a multidisciplinary team with chronic back pain patients on “self-management strategies” the return to work. They may work in a clinic, the community as part of GP services, the workplace, school or nursing home

In the UK delivery is fragmented and varies depending on the setting and condition. Many employers have OTs. If you are ill then for short-term conditions, such as after an operation, OT is provided by the NHS via the hospital or GP. However, for long-term conditions, such as a permanent physical disability, occupational therapy has to come via a local council. Chronic back pain will probably fall into this latter category as would permanent weakness/paralysis. It is also available privately.

The professional body for OTs in the UK is the British Association of Occupational Therapy which includes the College of Occupational Therapists. Only healthcare professionals registered with the Health and Care Professions Council are allowed to use the title "occupational therapist".

Where to get OT/ergonomic equipment for spines:

www.spinegroup.co.uk/

Patient information leaflet on OT:

www.cot.co.uk/leaflets/leaflets

Information link about OT:

www.nhs.uk/Conditions/occupational-therapy/Pages/techniques-and-equipment.aspx

Health and Care Professions Council on:

www.hpc-uk.org/

Check the registration of your OT:

www.hcpc-uk.org/check/

Information on how to access NHS/Council OT:

www.nhs.uk/Conditions/social-care-and-support-guide/Pages/what-is-social-care.aspx

OT Bodies:

www.cot.co.uk/

www.cohpa.co.uk/

www.som.org.uk/

Physiotherapists specialising in OT:

www.acpohe.org.uk/

Classification: Active Prevention/ergonomic

Osteopathy, Osteopath

This is a type of alternative medicine that emphasizes the physical manipulation of the body's muscle tissue and bones. There is "good" evidence for osteopathy as a treatment for low back pain and "limited evidence” for other conditions. The term osteopathy was coined in 1874 by the physician and surgeon Andrew Taylor Still in Kansas, USA at the time of the American Civil War. It has a long history in the UK; the first school was established in 1917 and it was accorded formal recognition by Parliament in 1993 by the Osteopaths Act. Regulated by the General Osteopathic Council an osteopath must hold a recognized qualification and there are currently more than five thousand osteopaths registered in the UK. Just as in any speciality there are good and bad ones. For a good outcome any specialist needs to address all three pillars of spinal care. (In the USA there is a potential confusion as they have to be differentiated from osteopathic medicine which refers to a medical doctor specialising in orthopaedic/bone medicine cf the USA use of the term physical therapist for physiotherapist.)

www.osteopathy.org

www.bso.ac.uk

Classification:Passive; Active; Prevention/ergonomic

Physical Therapist

In the UK and most of the World this is a collective term for physiotherapists, osteopaths, chiropractors, McTimoney Chiropractors, Cranio-sacral therapists etc. In the USA it is the name given to physiotherapists and has to be distinguished from consultant doctors specialising in “Physical Medicine” a field others term musculoskeletal medicine.

These physical therapists, (physiotherapists, osteopaths and chiropractors), can be differentiated from medics as instead of using medicines they utilise some physical manipulation of the patient to effect relief. Just as medicine has developed over the years so too have these specialties. It matters less which is seen than that the overall treatment plan addresses all three pillars of spinal care.

Classification:Passive; Active; Prevention/ergonomic

Physiotherapy

The most established and common of the physical therapies this aims to make people better by improving their mobility, strength and function. They may work independently or in conjunction with medics. It goes back a long way. Physicians like Hippocrates and later Galen are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy and techniques like hydrotherapy as long ago as 460 BC. However, physiotherapy as a profession dates back to Per Henrik Ling who founded the Royal Central Institute of Gymnastics (RCIG) in 1813. Sweden was the first country to give official registration to physiotherapists and in 1894 four nurses in the UK formed the Chartered Society of Physiotherapy, still their regulatory body, a full 20 years ahead of the USA.

A physiotherapist, like an osteopath or chiropractor, will take a history, examine the patient, reach a diagnosis, develop a care plan including information/education, symptom relief, rehabilitation and prevention.

The aim is to restore movement and function when someone is affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They work with all ages and will specialise in one of many fields. Spinal physiotherapists will overwhelmingly restrict their activities to that field though spinal disorders make up such a large percentage of musculoskeletal medicine that all will have significant experience of it.

This is what the CSP says of themselves – “Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, which includes the patient’s general lifestyle. At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.”

Some of the main approaches used by physiotherapists include:- education and advice, movement, tailored exercise and physical activity advice, manual therapy – where they use their hands to help relieve pain and stiffness

www.csp.org.uk

Classification: Passive; Active; Prevention/ergonomic

Pilates

A physical fitness system developed Joseph Pilates in the mid1900’s and now practiced worldwide. Pilates called his method "Contrology" emphasising the need for precision and control. He developed his system of exercises believing that mental and physical health were interrelated. The concept of "corrective exercise" and "medical gymnastics" was very much alive in the early 20th Century.

Along with many Germans he was interned in Britain during World War I on the Isle of Man where taught his fellow internees exercises and began developing a variety of equipment from the bunk beds. The most popular apparatus today is the Reformer though there is now a full complement of equipment:- Cadillac, Wunda Chair, High "Electric" Chair, Spine Corrector, Ladder Barrel and Pedi-Pole. There is range of difficulty from beginner to advanced and the intensity can be increased over time as the body conditions and adapts to the exercise.

The six "principles of Pilates" are: concentration, control, centre, flow, precision, and breathing. "The Pilates Method teaches you to be in control of your body and not be at its mercy." The “centre” refers to the abdominal muscles and those of the lower and upper back, hips, buttocks, and inner thighs. Known as the "powerhouse" all movement in Pilates begin there and flow outward to the limbs. The aim is for an elegant economy of movement that with precision flows out from a strong core. Pilates saw considerable value in increasing the intake of oxygen which he saw as cleansing and pointed out that forced exhalation is the key to full inhalation, obviously. “Squeeze out the lungs as you would wring a wet towel dry.” In order to keep the lower abdominals close to the spine the breathing is directed deep into the back and sides of the rib cage. When exhaling the deep abdominal and pelvic floor muscles are fully engaged. Breathing has to be coordinated with movement; breathing instructions are given with every exercise.

Though recent reviews have seen little evidence it promotes health, (2015 Australian Government's Department of Health review of alternative therapies), it is now widely practiced and for the treatment of lower back pain, there is evidence that Pilates may provide greater benefits than other types of exercise. Certainly there is strong evidence that exercise helps back pain. Clearly acute and extreme back pain prevents exercise. However, chronic low back pain is less common in those that exercise and core muscle weakness is a feature of those with chronic low back pain and those who have repeated acute episodes of low back pain – so called “acute relapsing low back pain” where sufferers get bad episodes lasting days or months, usually brought on by trivial triggers such a bending over or getting out of a car, and which are interspersed by long periods of little or no pain during which they can do strong exercise without a problem. In addition sufferers get relief from the exercise element of any rehabilitation programme. The key publication in this regard was in 1987 when Professor Claus Manniche of Denmark published his results of an active exercise programme in back pain patients in the leading medical journal The Lancet. When compared to the then standard recommendation of rest the exercise group completely outstripped those prescribed rest. It was a revolutionary idea which received much initial criticism – back pain was attributed to “wear and tear” and so logically rest would promote healing and exercise would only generate further damage. Manniche had proved the reverse was true and as acceptance of this truth grew the world and his wife took up exercise witnessing a global explosion of Pilates and all manner of other exercise methods. It was Manniche’s group that 25 years later discovered an association between certain forms of chronic low back pain and bacterial colonisation of discs so adventing antibiotic therapy.

Pilates is unregulated though the Pilates Method Alliance provides an international organization to connect teachers, studios, and facilities, promote quality training and so the legacy of Pilates and his exercise method.

Web content composed with the free online HTML editor. Please purchase a membership to remove promotional messages like this.

www.pilatesmethodalliance.org

www.pilates.co.uk

Classification: Active Prevention/ergonomic

Podiatry

Podiatry concerns the diagnosis, and medical and surgical treatment of disorders of the foot, ankle and lower extremity. The term podiatry has become the commonest name for the speciality; the older title of chiropody. The qualification, training and scope of the practice vary among countries. In the USA they are trained in a specific podiatric “medical” school where the curriculum includes anatomy, physiology, general medicine, biochemistry, neurology, pathology, genetics, embryology, microbiology, histology, pharmacology, rehabilitation, sports medicine, research, ethics and general orthopaedic surgery as well as foot and ankle surgery. Like medical doctors they rotate through major areas of medicine during a “residency programme”

The practice has long roots; the ancient Egyptian Ankmahor tomb, dating from 2400 BC, has relief sculpture depicting attendants working on the hands and feet of others. Corns and calluses were described by Hippocrates who invented skin scrapers. Until the early 1990’s they worked separately from organised medicine but were well recognised for their skills; the Kings of France, Napoleon and President Abraham Lincoln all had one.

The first society of chiropodists was established in New York in 1895 and one year later the British established a society at the London Foot Hospital where a training school was established in 1919.

Podiatrists will take a medical history and complete a physical examination. Their treatments include: minor foot surgery, the administration of local anaesthetic, prescribe limited medications, treat sports-related injuries, prescribe and fit orthotics, order or to some degree perform physical therapy, take and interpret X-rays, ultrasound, MRI's and other imaging studies. They often form part of a community health team in general practice. In the UK they can supply some prescription only medicines, perform injections and non-invasive surgery e.g. performing partial or total nail resection and removal, with chemical destruction of the tissues. This is similar in Australasia.

www.nhs.uk/Livewell/foothealt

www.scpod.org

www.iocp.org.uk

www.bcha-uk.org

Classification: Passive; Prevention/ergonomic

Reflexology

Reflexologists apply pressure to the feet and hands of the patients in the belief certain areas on the feet and hands, “reflex areas”, correspond with “zones” in the body and that they can effect physical change and improve the organs within those zones by manipulation of the feet and hands. They use specific thumb, finger, and hand techniques without oil or lotion. Traditionally they divide the body into ten equal vertical zones, five on the right and five on the left and believe that the blockages of energy, the invisible life force “Qi”, weakens the body’s ability to heal. Many now feel they relieve stress and pain in other parts of the body through the manipulation of the feet and some have hypothesised it operates via the release of the body’s own chemicals such as endorphins.

In the U.K., whilst registration is voluntary, it is governed by the Complementary and Natural Healthcare Council (CNHC). Registrants are required to meet Standards of Proficiency outlined by Profession Specific Boards. In many other countries it is unregulated. Certainly it is popular; in Denmark a 2005 national survey apparently showed that 21.4% of the population had used it at some point in life and 6.1% within the last year.

Practices resembling reflexology are documented in Chinese and Ancient Egyptian history though it was introduced to the USA 1913 by William H. Fitzgerald, M.D. (1872–1942), an ENT specialist who used it to aid anaesthesia on other areas of the body. Modified in the 1930s and 1940s by Eunice D. Ingham (1889–1974), a nurse/physiotherapist, she mapped the entire body into "reflexes" on the feet renaming "zone therapy", reflexology. Her nephew, Mr. Byers, is now the director of the “International Institute of Reflexology” in Florida; primarily a teaching organisation it claims some 25,000 customers, “members”. In the UK the Association of Reflexologists is a membership and training organisation.

Both sites emphasise it is not aimed at diagnosis or primary treatment and that it “should not be used as an alternative to seeking medical advice”. They suggest, and many report it as so, that “your tension may be reduced and you might feel relaxed …. notice yourself sleeping better and find your mood and sense of wellbeing improving…… (you) may also find that other aspects (of health) improve too”

Use the Word - HTML converter to avoid dirty code and messy markup!

www.aor.org.uk/home/what-is-reflexology

www.reflexology-usa.net/

Classification: Passive

Reiki Therapy

A form of alternative medicine developed in 1922 by the Japanese Buddhist Mikao Usui. It uses "palm healing" or "hands-on-healing", with practitioners believing they transfer "universal energy" and encourage healing and emotional well-being. It is based on a belief in "chi", the universal life force. The word reiki, or in Japanese 霊気, means variously "mysterious atmosphere” or “miraculous sign" and was first used in over a thousand years ago. It combines"rei" meaning soul or spirit and "ki" meaning vital energy. Usui suffered a stroke and died on 9 March 1926. His memorial stone records that Usui taught his system of Reiki to over 2000 people during his lifetime.

www.reiki.org

www.reikimembership.com

Classification: Passive

Rolphing

Developed by Ida Rolf, (1896-1979), it is a physical technique for manipulating the body’s connective tissues with the aim of releasing “stress patterns within the human form”. It is a gentle and precise technique. Her belief was that the cause of human discomfort, both physical and emotional, may lie in our internal connective tissue and the relationship it has with the earth’s gravitational field. She argued the importance of the interaction between “self and gravity” and that if you correct any “misalignment (it) may eliminate or limit the stress”.

“Connective tissue” connects and separate different types of tissues and organs in the body and divides all animal bodies into functional units. Fascia is a firm sheet like type of connective tissue that adapts in response to demands placed on an individual's body and likewise physical damage. If it over compensates rather than helpfully stabilising movement it may instead reduce mobility change posture and altered movement patterns.

Rolf suggested that through deliberate, accurate and targeted movement of this tissue could deliver “over all relief and wellbeing”. Through the “Rolfing touch”, the elasticity and sliding capacity of the tissue can be restored and the body realigned in such a way that it is can function with more ease. Whilst we might be risking fundamentalist attack there appear to be clear links here to the thinking of Mackenzie and Myofascial Release Therapy with gravity/body weight being used as an additional tool to aid exercise.

Rolf began working on clients in New York in the 1930s and in 1971 founded the Rolf Institute of Structural Integration in Boulder, Colorado. Rolfing is described in two parts: “somatic (means body as opposed to mind) education” and "bodywork" the hands-on massage element. Typically performed in a progression of 10 sessions aiming to educate the body to improve alignment within gravity. Rolfers manipulate the fascia until they believe it is operating in conjunction with the muscles use a combination of active and passive movement retraining.

Separating fascial fibres manually to loosen them and allow effective movement is not controversial. Whilst Rolf’s claim of an association between emotions and the soft tissue has not been supported by scientific studies anyone who has had a massage, or indeed any hands on physical therapy, and the attention and interaction that it involves, will recognise the sense of wellbeing patients report.

www.rolfing.org

Classification: Passive

Shiatsu

Shiatsu means "finger pressure" in Japanese and techniques entail massage with fingers, thumbs, feet and palms; assisted stretching; and joint manipulation and mobilisation. The examination often involves palpation and, sometimes, pulse diagnosis.

Shiatsu derives from a Japanese method of massage called anma which was itself adapted from tui a Chinese technique that arrived in Japan in the 8th century. The first college was founded in the 1940's in Japan by Tokujiro Namikoshi (1905–2000) who is credited with inventing modern shiatsu. The term shiatsu had earlier appeared in a book published 1919 called Shiatsu Ho, "finger pressure method", by Tamai Tempaku. And in 1925 the Shiatsu Therapists Association began distinguish itself from Anma massage.

Anma as distinct form of massage had developed in the thirteen hundreds and was then popularised by the acupuncturist, Sugiyama Waichi, in the sixteen hundreds and around that time the first books appeared including a "Manual of Anma".

At this time masseurs in Japan were often nomadic and frequently blind. Indeed there were a number of medical schools set up in this period specifically for the blind who were taught the method. Even today a large proportion of the Japanese blind community continue in the profession.

Modern history has not always been kind to the technique and its practitioners. The Allied occupation of Japan following World War II saw many aspects of traditional Japanese culture banned. Under General MacArthur this included traditional medicine and a large proportion of Japan's blind community were thrown into hardship. The Japanese beseeched him to reverse the ban. Eventually, the remarkable deaf blind writer and activist, Helen Keller, successfully joining the campaign.

Namikoshi's school taught Shiatsu within a framework of western medical science though others have since sought to reconnect it with its traditional eastern philosophical origins. Zen Shiatsu and Hiron Shiatsu, taking a more holistic and spiritual approach to healing are practiced mainly in Switzerland, France and Italy where their founders opened schools. They refer to an energy, "Ki", flowing through a network of acupuncture like meridians, and which has to be channelled to promote healing. You can just see how subversive McArthur must have found it.
www.shiatsusociety.org

www.shiatsufederation.eu

Classification: Passive

Tai Chi

In Mandarin tàijí 太極 is an abbreviation of tàijí quán 太極拳 and means "Supreme Ultimate Boxing". Originally a Chinese martial art it is mainly practiced now not for self-defense but as a health tool.

It has its origins in Taoist and Confucian Chinese philosophy, where it represents the fusion of yin and yang into a single “ultimate”, represented by the taijitu symbol . However, when it became a distinct entity is variously attributed to the 12th or 17th century with the name first recorded only in the 18th.

There are five elements: taolu - hand and weapon routines; neigong - breathing, movement and awareness exercises; qigong – meditation; tuishou - response drills; sanshou -self defence techniques. Typically a solitary exercise of slow, peaceful movements some styles have a faster pace and others partner exercises or martial arts forms.

In China, tai chi is categorized as a Wudang or "internal art" as distinct from the Shaolin a "hard/external" or combative martial art. Its widespread promotion for health arose only in the early 20th century and it then developed a worldwide following. Whilst many martial arts require a uniform in general, tai chi teachers simply advocate loose, comfortable clothing and flat shoes. This makes them hard to spot.

The movements use of leverage through the joints, coordination and relaxation as opposed to the muscular tension of other exercise and thereby remains suitable for the frail and elderly –visit any Chinese square or park and you will see groups of the elderly in slow swing.

Originally there were five major styles named after the Chinese families who developed them (Chen, Yang, Wu Hao, Wu Ch’uan-yu and Sun) with Yang being the most popular though now there are many new and hybrid offshoots such as the Zhaobao and Fu styles. The differences lie in their tempo and size of movement.

Accurate, repeated movement over the centre of gravity either empty handed or with a weapon, often a wooden sword, is said help posture, circulation and flexibility. Breathing exercises are coordinated with these physical movements, c.f., Pilates

From the mid-nineties it became as common as Yoga and even more associated with health benefits. The NHS site claims that “studies have shown that tai chi can help people aged 65 and over to reduce stress, improve balance and general mobility, and increase muscle strength in the legs”, that “Some research suggests that tai chi can reduce the risk of falls among older adults who are at increased risk” and that “there is some evidence that tai chi can improve mobility in the ankle, hip and knee in people with rheumatoid arthritis (RH). However, it is still not known if tai chi can reduce pain in people with RH” but in regard osteoporosis “there is currently no convincing evidence that tai chi can prevent or treat the condition.” In a remarkable omission it makes no comment in regard back pain, a condition way more common than any of the above, though it does comment that as a “low-impact exercise …….it won’t put much pressure on your bones and joints” but “you may need to take certain precautions if you’re pregnant, have a hernia, back pain or severe osteoporosis..”

In regards this advice it is important to remember that in chronic back pain or chronic neck pain any exercise is better than none. People who exercise have less back pain and for the majority, not all but the majority, people with back pain get better with exercise. If a system works for you, if it motivates you to exercise and is accessible and providing it doesn’t make the pain worse it is probably doing you good.

The Tai Chi Union for Great Britain (TCUGB) was founded in 1991 with the aim of promoting the art.

Web content composed with the free online wysiwyg HTML editor. Please subscribe for a membership to remove promotional messages from the edited documents.

www.taichiunion.com

www.nhs.uk/Livewell/fitness/Pages/taichi.aspx

Classification: Active

Yoga

Yoga is a physical, mental, and spiritual discipline developed in India perhaps in the Northeast Indian, pre-Vedic, Indus Valley Civilization of 3300–1900 BC. History here is hampered by our failure to unravel their particular hieroglyphical language so all their writings are as yet inaccessible to us – a massive and ancient civilisation that we cannot hear. Concentration and bodily postures described in the Vedas period 1700 – 500 BC lead to an identifiable movement probably in around the sixth and fifth centuries BC.

The term yoga could have derived from one of two roots in 6th century Sanskrit, yujir to “yoke” or yuj samādhau to concentrate. It has since been linked with many other meanings: to listen, add, join, unite, attach, harness, use, employment, application, performance, exertion, liberation, endeavour, zeal, diligence, connection, contact, union, method, application, addition, performance. Hatha yoga texts emerged around the 11th century.

With deep roots in the religions of Buddhism and Hinduism, yoga gained prominence in the West in the 20th century taking off in the 1980s. Now, apart from the spiritual goals, the physical postures of yoga are used to alleviate health problems, reduce stress, improve flexibility, often a problem in spinal problems, and by others simply as an exercise program.

There are a variety of schools and practices with perhaps the most well-known types including Hatha yoga and Rāja yoga. Bikram is a recent addition. They reflect the history of its evolution.

When Alexander the Great reached India in the 4th century BC his comrade, Onesicritus, described yogis practicing "different postures – standing or sitting or lying naked – and motionless". The Middle Ages saw the development of Hatha yoga with the earliest references being in Buddhist works dating from the eighth century. Compared to the seated meditation posture of Raja yoga it utilises 'postures' and is the style that many people associate with yoga today. Yoga came to the attention of an educated western public in the mid-19th century along with the Hindu teacher, Swami Vivekananda, touring Europe and the USA in the 1890s. By the early 20th century the West equated "yoga" with Hatha yoga and its asanas or “postures” seeing it primarily as a form of exercise. The 1980’s saw the second "yoga boom" when Dean Ornish connected it to health presenting it as a purely physical system of exercise unconnected to any religious denomination.

Its growth has continued; in the USA the number practicing yoga increased from 4 million in 2001 to 20 million in 2011. The 21 June 2015 saw the first international day of Yoga was when around 35,000 people, including Indian Prime Minister Narendra Modi, performed 21 Yoga postures for 35 minutes at Rajpath in New Delhi and the day was observed by millions across the world.

Barack Obama recently commented "Yoga has become a universal language of spiritual exercise in the United States, crossing many lines of religion and cultures”. (According to Foyle’s Philavery to obamulate is an obscure word meaning “to wander aimlessly”. How has that not come out?) The American College of Sports Medicine supports its integration into health exercise regimens and in chronic low back pain, a UK study found yoga 30% more beneficial than “usual care” with an American study showing a drop of 80% in the use of pain medication. A small number suffer physical injuries analogous to sports injuries so some caution and common sense is required e.g., headstands are not sensible if you have neck pain.

www.nhs.uk/Livewell/fitness/Pages/yoga.aspx

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