Thursday, September 21, 2017

The Role of bodywork in Integrative Medicine

"What do you mean by bodywork?"


This is one of the most frequent questions I receive in my practice - what do you mean by bodywork.  

The importance of bodywork as a part of general maintenance cannot be overstated, and the topic is so vast I almost don’t know where to begin.  First, let’s clarify what I mean by bodywork: chiropractic, therapeutic massage, acupuncture and oriental massage, bioenergetics, feldenkrais, and yoga therapy are just the tip of the body-work iceberg and play an important role in both the healing process and general preventive maintenance.

In the beginning…One of the basic tenants in traditional Chinese medicine (TCM) is the adage “Where there is blockage, there is pain.” We learned it on our first day of graduate school, and continued to hear it throughout our education.  From the standpoint of classical acupuncture, whenever the free-flowing nature of qi is blocked or moved from its natural
course, it will accumulate and cause pain or internal disease.  To keep things simple, we will discuss a few basic reasons for this:  excess, deficiency and stasis/stagnation.  You may find it helpful to keep in mind the idea of a stream bed for this principle.

Picture, if you will, a mountain stream with ample water running through it so that the water moves freely, and is clean, clear; it stays within its natural boundaries, and it is fresh – nourishing to what surrounds it.  This is a good metaphor for the movement of qi through the body in the absence of disease.   Now a river at the end of the summer or during times of drought has less volume moving in thecreek bed; it pools up in places because there is not enough water to push through the rocks, due to a deficiency.  When water pools, it becomes stagnant (with all the bugs and scum floating on the top).  Now translate this principle into the human body:  when there is a deficiency of qi so that there is not enough to flow through its natural course, it will pool and stagnate.  If left unattended, it will
accumulate to cause pain or disease (maybe that is our layer of scum at the top of
the pool…)

Similarly, a creek bed in the springtime after the snow melt will often overflow the banks, with water flooding outside the normal course.  This is due to too much water flowing through the river bed, causing flooding and damage to the surrounding area.  This also results in stagnation – only this time due to an excess, which also will cause pain or disease if left unattended. 


The purpose of regular bodywork is to ensure that the body’s vital energy moves in its proper direction, that there is enough of it so that things do not pool up and become stagnant, or overflow and cause ‘flooding.’   How much and what type of bodywork to get may seem confusing, but there are some general concepts to keep in mind that may be helpful when exploring this for the first time. 

Structural IntegrityFans of Star Trek (my favorite analogy) will have heard about ‘structural integrity’.  in terms of the ship staying in one piece.  Our physical body is similar to the Enterprise – it is the vessel for our travels though time and space.  In this case, I
define structural problems as musculoskeletal (and joints).  The large muscle groups support the alignment of the body: the quadriceps, periformis, psoas, and hamstrings support the alignment of the pelvis, the erector spinae on either side of the spinal column help maintain the spine in its proper curvature, shoulder and cervical muscles connect in the neck region.  While it may be obvious that sprain/strain, insufficient exercise, injury and trauma will cause these muscle groups to move out of balance (resulting in inflammation and pain), you may not understand that it also takes qi or vital energy to hold bones and muscles in their proper alignment, not just strength and flexibility.   It is how someone with a TCM diagnosis of kidney deficiency may have mild low back pain as a symptom.  The
vital energy of the kidneys (separate from Kidney organ function) help to strengthen that area of the body.  It is also why someone with an excess of liver qi may experience sharp pain down the sides of the legs – the energetics of this organ influence this region of the body.  Because a long-term deficiency or excess can result in a structural problem even in the absence of an injury, regular bodywork is essential to maintaining structural integrity.

In my private practice, I use acupuncture and oriental medicine to regulate qi flow,
since it is wonderful for relieving the pain of stagnation whether it caused by
excess or deficiency (usually things are a mixture of both).  We build up the body
when there is not enough “water” moving through the stream, and drain areas
when there is too much.  Generally, my patients with chronic back pain often
require a structural adjustment from a chiropractor followed by deep tissue
massage or acupuncture to breakup the scar tissue or muscle tension that moved
the vertebrae out to begin with.  The muscles of the body have memory – and it
takes time and physical manipulation to coax them back into proper alignment,
and relieve the pain of inflammation.

How quickly someone responds to treatment is a mixture of things:
•        How long have you had the condition?
•        How severe is the problem?
•        How healthy were you to begin with?  Do you have an underlying internal
condition that hampers your recovery?
•        Are you willing to take supportive measures such as yoga and strength
training to prevent recurrences?

For patients who are particularly deficient from chronic endocrine disorder such as
hypothyroid or diabetes, immuno-compromised, or undergoing multiple drug
regimens, it will take longer to experience physical relief because the body is often
too weak to hold itself together properly for any length of time.  It is why you may
feel really good for a day or two after a treatment, only to find the body returning
to the old pattern a few days later.  Rest assured it is a good sign - your body is
responding to treatment.  The muscles have just not healed enough to stay in
their proper position.

A good rule of thumb is to allow one month of regular treatment (regular meaning 2x per week) for every month you have had the condition.  Multiple modalities, such as massage with acupuncture and chiropractic will generally yield faster results that are more complete, because  you are addressing several aspects at the same time – bones (chiropractic), muscles (deep tissue massage), pain/ inflammation/ weakness and atrophy (acupuncture and oriental medicine) .