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“That second client you saw about his lower back pain, he called reception and wanted to know something…”

I broke into a slight panic. It was early in student clinic and I was trying to knock out as many hours as I could as quickly as I could to qualify. The kind of keenness that comes with being new at something, I was brimming with it. And a lack of experience. I was yet to understand exactly how to ‘over-work’ an area leading to aggravated symptoms. I was also yet to fully understand many other things, but the trust of what I had learned was being put into action on as many people as I could get to treat.

Several months before we were told: “Backs and necks. They’re the bread and butter of a manual therapist. Get good at them, you’ll see them a lot. Get good results and the client will send others”.

I was in the midst of attempting to be getting good at working on backs and necks. Full of keenness, and paper thin confidence. So the phone call was unexpected.

If I recall correctly he was a chef, and the long hours on his feet took a toll on his back. The long shifts, slight forward bend and unfavorable working environment can take a toll on anyone and he was more than a few years into the business of his craft. The college was located close to the city centre and the student clinic attracted a variety of people, business trade, and nearly everything in between. Perhaps our opening hours were suitable, maybe he worked nearby. Either way, that day, his lumbar spine ended up on my table.

In a nervously asked for more details: “Is everything OK? Is the client alright?” Fearing negativity, I braced for the reply.

“He wanted to know what the hell that was you did to his back. He hasn’t been pain free in years and wants to know what the treatment was so he can book in again.”

Even as a student with basic experience, Tui Na provided relief for someone who had been experiencing discomfort for years.

In 2014/15 it was estimated in that over 16% of Australians (4,000,000+ people) suffer from chronic back pain (https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001). A report from the Asia Pacific Journal of Public Health back in 2003 estimated the direct “cost of illness” of lower back pain (LBP) to be 1.02 billion AU dollars. The indirect cost was calculated at 9.17 billion AU dollars and “represents a massive health problem with a significant economic burden” (https://www.ncbi.nlm.nih.gov/pubmed/15038680).

Elbow Pain | Tennis Elbow – a crushing, unbearable pain on picking things up.

Unable to hold objects for a length of time, or suddenly drop them.
Opening a door is painful with intense elbow pain.
Shaking hands/cooking/using tools/painting is another level of pain Dante didn’t know about…

Tennis Elbow (Lateral Epicondylitis) is classified as pain that persists at the lateral (outside) elbow for more than six weeks. Although it is primarily a muscle strain, it is the attachment of the muscle to the bone via a tendon where the problem arises.

Our forearms are in constant use and certain repetitive movements, or movements that have additional load to them (like using a screwdriver) can irritate the tendon attachments at the outside of the elbow. This can lead to microscopic tears at the bone, which typically result in pain, swelling, muscle weakness and lack of confidence in using the arm.

It doesn’t necessarily require you to be playing tennis to acquire the problem. The risk factors increase with obesity, repetitive tasks, and for people between the ages of 45 – 54. As with an increase in exercise frequency, or commencing any new movement, it can take time for muscles and tendons to build strength and acquire thickness to cope with the new load placed on them. If your exercise regime has intensified either through weight or repetition, this can predispose the tendons to injury.

According to the Royal Australian College of General Practitioners, people suffering Lateral Epicondylitis can take a wait and see approach, with signs and symptoms improving usually within 6–12 months if the patient follows simple advice including:
• remain active and do not restrict arm or elbow movements
• do not perform movements and tasks that provoke pain greater than 3 out of 10 (where 10 is the worst pain imaginable)
• do not immobilise the elbow or upper limb
• do not lift an object with hands in the face-down position
(https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/HANDI/Physiotherapy-lateral-epicondylitis.pdf)

For those who cannot wait and see, manual therapies can be an effective treatment option for the problem. Tui Na addresses both the muscles and connective tissue that are related to the condition as well as the site of injury itself. While many manual therapies will work with the muscles only, we believe better results can be obtained with work that incorporates the tendons and other tissues that are notoriously stubborn to heal.

Tui Na has a variety of techniques that promote the flow of blood through the irritated site. Unlike many recommendations, Chinese Medicine does not advocate the use of ice in conditions such as these. While it numbs the pain, it constricts blood vessels which in turn delays the ability of tissues to heal. Muscle, or tissues of any sort, require blood flow to bring healthy nutrients to tissues, and to take waste products away.

While Tennis Elbow can be a stubborn condition to resolve of it’s own accord, we have found Tui Na to be clinically effective in addressing the immediate signs and symptoms of pain, restricted movement and loss of grip strength.

It might be something worth looking into if an unhappy elbow persists.

To read more on other arm and hand related conditions, see RSI, Carpal Tunnel or De Quervain’s Syndrome articles

Recognising and treating Thumb Pain (De Quervain’s Syndrome)

Thumb Pain, or as it is correctly known as, De Quervain’s Syndrome is inflammation of the two tendons that move the thumb, and the sheath they run through. Commonly seen as an R.S.I. injury, the causes can be varied but are mainly due to repeated movements from work, hobbies or lifestyle. Higher risk factors include those over 40 years of age, and females. Pregnancy is also an increased risk factor.

Diagnosis of the De Quervain’s Syndrome is normally obtained from a physical examination including the Finkelstien’s orthopedic test. X-rays or other medical examination may be used to rule out other possibilities such as fracture, arthritis or other casues.

Corticosteroid injection, splinting, rest, ice and NSAID’s are the common methods of treatment, with surgery being a final option.

A friend of mine asked about treatment for her thumb pain and wrist discomfort.  As a hairdresser she was never really able to give the arm a rest and the increasing pain in the cutting hand was reaching an unbearable level. Her doctor had recommended surgery.

We began treatments once a week and discovered that pain reduction was quickly achieved, improved movement was restored and quality of life generally was better. Including sleep. The pain would wake her frequently throughout the night.

The only problem was her work. There was little chance of her being able to take a break to allow the wrist and forearm to settle. So we moved the treatments to twice a week, with very good results.
Surgery was avoided.

A wonderful thick French accent filled the room when he spoke. Unbearable pain from his left wrist often woke him up at night. He couldn’t pick anything up in that hand, support weight, or complete small tasks that had been once so easy. Was there anything that could be done?

It turned out that decades of holding a painting palette had taken a toll on that thumb, wrist and forearm. He is a painter, restores artwork and also specialises in gilding, the art of applying gold leaf to objects. We started treatments once a week but after 3 weeks there was little change. With so many years of work contributing to the condition we decided to get an x-ray of the joint to determine how bad things were.

The report wasn’t good.

The thumb joint had degenerated significantly, there was significant arthritis and very little cartilage left. Even with this news we proceeded with treatments, twice a week, just to see if things would change.

Thankfully it didn’t take long.

After all of the years of painting with brushes, he had moved to computers and electronic methods of achieving the same quality work that his clients knew him for. The thumb and forearm were not being used while being treated, and the shift in treatment frequency from once to twice a week brought about a quick change. Sleep improved with the reduction in pain. Small tasks, once impossible, were now easily achieved. Thing were looking good, and it wasn’t long before I was able to say goodbye to the lovely French gentleman and wish him well.

But not before grabbing a business card. I had just found the person to illustrate the channels we needed for the book we were writing.

For more information on other arm/hand related issues go to the RSI, Tennis Elbow and Carpal Tunnel Syndrome blogs.

Tui Na and Anxiety treatments

 

Why does disease and illness affect people in different ways even they seem to be living their lives in exactly the same way. We know that diet, environment, exercise and our genes have an important influence on our health and longevity. Now we are also realising that the way we think, and thusly how we react have a huge impact on our physical health. This is something that has been spoken and written about for millennia in Taoist and other ancient forms of medicine throughout the world. Negative stress and anxiety are two common commonalities in our all-round health.

Stress is normal in the natural world and is a characteristic of the “fight or flight” predisposition within all of us and was and is necessary for our survival. It only becomes an unhealthy problem when that stress continues far too long. We weren’t designed for the long stresses we have created, especially in the last hundred years with debt, work, wars, over-population, expectations either from the society, family or belief systems that you belong to etc. Humans need down time, socialising, feeling safe and enjoying the things that we work so hard to achieve.

Robert Sapolsky, a Stanford University neuroscientist author of several books including “Why Zebras Don’t Get Ulcers” stated: “Just a century or so back, the primary threats to human life were pneumonia, tuberculosis, childbirth, the flu and the like. Nowadays, relatively few people die from the flu; instead most humans die of ailments that are relatively new to our species, such as heart disease, cancer, diabetes and Alzheimer’s disease. These are all diseases that are either caused by or being worsened by stress. Homeostasis, is a state in which an organism or group is in balance, meaning for example, that there is an ideal level of glucose in the blood stream and the body’s temperature is favourable. A stressor is anything in the outside world that knocks an animal out of homeostatic balance”.

He continued to say, “You’re a zebra, a lion has leapt out, ripped your stomach open and you still need to get out of there, this counts as being out of homeostatic balance. The stress response is what your body does to re-establish homeostasis. That’s all you need to know about the subject if you’re a zebra. In the case of humans, however, the definition is expanded. Humans can anticipate that something unfavourable is about to happen to them and can have a stress response prior to the event, which could help them cope. On the other hand, if a person believes they are about to be knocked out of homeostatic balance, but they are really not and this belief continues, then they are dealing with chronic stress”.

Because everyone will experience some form of anxiety at different stages of their life, it is hard to gauge when we have had too much. For that reason, the circumstances that create our anxiety aren’t all that apparent and develop slowly over time, the symptoms also are not that noticeable. We are designed for normal anxiety which has a limited time such as an interview for work. We aren’t designed for frequent and persistent situations such as mortgages, bills, family and social issues, work and long-term illness etc, but these impact on day to day functioning and our quality of life.

Symptoms of Anxiety

There are many symptoms which depend on the specific situation, these are some common ones:
• Physical: panic attacks, gut tension, hot and cold flushes, racing heart, tightening of the chest, quick breathing, restlessness, headaches or feeling tense, wound up and edgy
• Psychological: excessive fear, worry, catastrophising, or obsessive thinking
• Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life

Chinese Medicine’s power comes from its intrinsic holistic approach to illness of all types and the use of the 5-elemental model.
Is the individual’s anxiety good or bad, what is the cause of your anxiety, and does it come from their emotions, constitution or disposition? An individual’s constitution is their natural disposition, those things that we are prone to. This is the way we were born and our nature, with some people being affected by certain emotions quicker than others but being aware of these traits can help us stop it before it becomes a health issue. Our moods can be affected by the environment such as Cold, Damp and Heat etc, but also by reasons that are apparent to us such as work we find we hate and stressful relationships. Repressing one’s nature can lead us to having problems, where as understanding our nature can help us deal with things that press our buttons in a much healthier way.

Tui Na works like acupuncture by working on the channels and pressure points using soothing movements, stagnation and Qi deficiencies can be moved. Abdominal Tui Na can help with stuck emotions held in the viscera by aiding digestion and bowel movements and eventually the mind.

Carpal Tunnel

Associated pain and numbness

Carpal Tunnel Syndrome (CTS) is the entrapment of the median nerve inside the common tendon sheath through the wrist. Common signs and symptoms are pain, numbness, tingling, loss of strength and a progressive loss of muscle tone. The median nerve controls the movement of the thumb, first and middle fingers, so these are most affected. Pain is usually worse at night, and most of the clients I have seen have experienced pain that wakes them in the early morning. It is the most common of the nerve compression syndromes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314870/

It is easy to have sympathy, I have had this condition twice. It’s no fun.

“I wish you were in Queensland right now, my wrist and hand are terrible”.  Well, as a matter of fact…

Diagnosis of Carpal Tunnel Syndrome is usually based off signs and symptoms but may include diagnostic imaging such as x-ray to rule out any other possible causes such as fracture. In some cases, an electromyogram or nerve conductivity test may be used to confirm the diagnosis. Increased risk factors include being female, pregnancy, obesity, diabetes, rheumatoid arthritis and neurological conditions. Any work related task that involves the wrist being bent on either direction for prolonged periods is also a risk factor https://emedicine.medscape.com/article/1243192-overview

In the case of my friend on the phone, it was drumming.

As with many other strain injuries, the common methods of treatment are rest, splinting, ice, corticosteroid injection with surgery used in severe cases.

I was visiting Brisbane, scouting in the event of moving interstate to study acupuncture. I don’t recall how we came to be in contact that day but he was up from Melbourne and had called in on a former band mate. On his break from rehearsing and playing, his left wrist had begun to cause some issues. The hand was painful, pins and needles would wake him early in the morning and taking a grip on objects was challenging. The drums were proving difficult. During our brief chat on the phone the signs and symptoms sounded familiar enough. With some scrawled treatment notes in my pocket I made my way round to say hello, catch up, and see if Tui Na could do anything to help.

There’s a good chance you know someone that has been through this condition. Even worse, you might have had it yourself. Early in my student clinic time, a Canadian carpenter introduced me to this condition. He could not pick up a large coin first thing in the morning. The pain was excruciating, often keeping him awake from 4am onwards. At work his hand felt better as the morning progressed, his grip became stronger, but it was a cycle that had been on repeat for a long time. His shoulder and elbow had become effected as well as the body compensated in an attempt to take load off the affected joint. Over the weeks the signs and symptoms improved even though he was unable to take a break from work.

My drummer friend had a quick and positive outcome. It’s not always the case but Tui Na can tackle some conditions that other massage styles are not able to. With a good understanding of anatomy and physiology as well as the benefits from the energetic side of Chinese Medicine, results can be swift even in the conditions that are notoriously stubborn to treat.

See other blogs for more information on RSI, Tennis Elbow and De Quervain’s Syndrome