Many complementary therapies are of particular value in treating musculosketal disorders (MSDs). But alternative therapists need to have work experience within the NHS and in a multidisciplinary setting if they are to work effectively with other healthcare practitioners.
In particular, they must be aware of the strengths and limitations of the therapy they practice, and those of other therapies. Such education and training is now available for many of the complementary therapies, within universities working in collaboration with the professional bodies concerned.
Complementary therapists (CTs) frequently consider that they are able to offer a holistic approach to treatment in which not just the symptoms of the patients are addressed but an attempt to identify and address the underlying cause is pursued.
Although many therapies consider that this holistic approach is achievable, in practice, few CTs are actually able to address problems in such a way. However, there is no doubt that this approach does extend the repertoire of approaches to address MSDs.
To address MSDs, as with many other conditions, it is necessary to consider many aspects of the patient. These dimensions would include the structural, nutritional, environmental, psychological, emotional and spiritual. Many CTs attempt to treat as many of these aspects as possible. In addition, those adopting a holistic approach aim to maximise the patient’s own capacity for self-healing and wherever possible focus on empowering the patient.
A number of alternative therapies address MSDs through a structural approach. Osteopathy and chiropractice have an emphasis on the manipulation not only of the axial but also peripheral joints to correct the body alignment of the individual. These professions are now statutory, and research is being conducted to establish an evidence base. Therapeutic bodywork or massage covers a wide range of approaches that tend to focus on working with the muscles and soft tissues of the body to address MSDs.
Acupuncture is also well established in the UK, both within the NHS and in private practice, with its proven effectiveness for analgesia and anti-inflammatory action. However, many acupuncturists trained as traditional Chinese medicine practitioners consider that the use of only one of the modalities of their repertoire limits their ability to address causes as well as symptoms. In addition, many acupuncturists would be uncomfortable about working only on the apparent symptom without addressing the issue of balance for the whole body.
For many MSDs poor sitting, standing and dynamic posture are aggravating if not causative factors. Alexander technique offers a means by which patients receive individual tuition to optimise posture in everyday activities. The symptoms of MSDs may to some extent arise from stress related symptoms, sometimes referred to as ‘somatisation’. The most obvious example is the patient who presents with neck pain and during the case history taking comments that “my supervisor is a pain in the neck.”
Yoga and pilates offer self help approaches to improving balance and flexibility of the musculoskeletal system. In addition, patients frequently report improved stress management and relaxation that may help to reduce any somatisation component of their condition.
Each of the main prescribing therapies can also make a unique contribution. Nutritional therapy and the use of supplements contributes to optimising health and in can promote the healing of the tissues affected by MSDs.
Herbal medicine provides ointments; poultices and medicines to address the symptoms, and may provide support for the tissues affected by the MSD. Homeopathy has been used by doctors within the NHS to treat damaged tissues particularly when iatrogenic side effects contraindicate the use of drugs. And there are remedies that may be directed at repairing muscles, tendons and ligaments as well as the somatisation component of symptoms.
Some complementary therapies may be considered to provide relief from MSD through a mind-body approach that will assist in reducing stress or providing balance and therefore prevent the re-occurrence of symptoms. Reflexology, shiatsu and Thai yoga massage are considered to optimise energy flow through meridians or points in the body.
In addition, healing methods may provide relief from MSDs especially if a significant component of the underlying cause is related to stress management, work-life balance and the patient’s concern about their focus or direction in life.
Particularly when somatisation is a significant component to MSDs, psychotherapeutic interventions may be considered. Approaches such as psychotherapy and hypnotherapy may provide relief by addressing underlying contributory factors. Hypnosis is of particular value if a patient is suffering chronic pain.
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Many of the complementary therapies have a strong focus on empowerment with the patient taking the responsibility for making a contribution towards the correction of musculoskeletal imbalance through for example exercises, and stress management by relaxation exercises. For this reason, the self-help therapies of yoga and meditation may have a part to play in empowering the patient to become more involved in regaining their health.
There are such a wide range of complementary therapies available that it is not surprising that many patients are able to find an approach that will not only provide relief from symptoms, but which may address the cause, and prevent reoccurrence.
Brian Isbell PhD, DO, MRN is head of the Department of Complementary Therapies at the University of Westminster
