An alternative route

growing interest among the public and many employers in the value of
complementary therapies, is it time for them to be added to the OH
battery?  By Sara Bean

Interest in complementary therapy among the general population has never been
higher, with an estimated 5 million people consulting a complementary therapist
in one year1. Sometimes referred to as ‘alternative’ or ‘holistic’ medicine,
complementary therapy is difficult to define. Professor Edzard Ernst, chair in
Complementary and Alternative Medicine at Exeter University has provided
perhaps the most useful definition2:

"Complementary medicine is diagnosis, treatment and/or prevention which
complements mainstream medicine by contributing to a common whole, by
satisfying a demand not met by orthodoxy or by diversifying the conceptual
frameworks of medicine."

By taking a holistic approach to the whole person, not just the condition or
disease, complementary and alternative medicine (CAM) is increasingly being
seen as an effective adjunct or ‘complement’ to conventional medicine for a
range of conditions, from muscular pain to cancer. But with a plethora of
therapies available, ranging from iridology to re-birthing, which therapies do
their patients any good? And can complementary therapy really have a place in
the occupational health department?

While it seems unlikely that an OH department will be offering its clients
crystal healing any time soon, a growing number of employers are embracing the
best understood and medically researched therapies such as aromatherapy,
reflexology, the Alexander technique, massage, acupuncture and homoeopathy (see
box). Therapists report a growing interest in their treatments by employers as
a way of dealing with higher incidents of stress, muscular pain and escalating
sickness absence.

Says Chris Wilkie of Vision Consultancy and member of ISMA (The
International Stress Management Association), who offers a range of stress
management therapies, "A lot of occupational health departments are
opening up their place of work to holistic therapists, providing a room for
employees to go for their treatment. For example, many employers are using back
massage to help staff avoid stress-related problems."

Evidence that complementary treatments have a positive effect is still being
gathered. According to the Department of Health in its report Strategy for
Action, which looks into the development of better research into the
effectiveness of complementary therapies: "Research shows active
practitioners find it difficult to compete for research funding because of a
perceived or actual lack of methodological expertise and therefore

Individual disciplines have carried out their own research. For example, the
effects of regular massage in the workplace was studied by the Touch Institute
at the University of Miami (1996), which found that after five weeks, a group
of employees who had twice-weekly 15 minute massages in the office fared better
than a control group of employees who were just told to close their eyes and
relax in a chair for 15 minutes twice-weekly. It has also been suggested that
the best way to measure the effectiveness of CAM is to compare sickness absence
levels before and after treatments start.

Benefits difficult to quantify

Given the fact that the benefits of complementary therapy are so difficult
to quantify, the question for many OH practitioners remains, do they have the
time or the inclination to arrange a complementary therapy service on top of
their other duties?

Says OH consultant and chair of the society of occupational health nurses in
Northern Ireland, Jane McCallum, "My view is that a lot of employers would
count it as second in importance to arrange complementary therapy within the
workplace, they’re more interested in what is legally beneficial and
cost-effective. And OH staff must also ask themselves if it encroaches on an
employer’s costs and facilities."

Ultimately it is down to the management to decide if they want to pick up
the bill for a complementary therapy service. According to Alice Whitney of
chair massage therapists Positive Touch, who actually pays for treatment
varies, with some organisations simply offering the therapist a room in which
to practise and perhaps the services of the OH department to schedule appointments.
In these cases employees pay for their own treatments, but in some
organisations the employers pay for half or, in some cases, all of the
therapist’s costs.

Whitney says that her clients report reduced stress levels among staff
because of her regular 15-minute chair massage sessions and adds: "This
sort of service makes staff feel nurtured and cared for by the

Lack of regulation

If OH staff do become involved in hiring complementary therapists, they will
have to check and double check their credentials before letting them anywhere
near their staff, because unfortunately, the industry is still not regulated.
Following the House of Lords report on complementary and alternative medicine
in November 2000, the Government is looking into the regulation of therapists,
but until that happens the advice is to tread carefully.

Warns Chris Wilkie: "Aromatherapy, for example, can be very dangerous
if not understood properly. People who don’t properly understand what they’re
using may for instance use lavender in the car to calm them down, but it may
make them so calm they fall asleep. And clarysage is a wonderful oil,
particularly good for menstrual problems, but if it is used on a pregnant
woman, it could cause a miscarriage."

When looking for a therapist, industry bodies such as the British
Complementary Medicine Association and the Guild of Complementary Practitioners
are a good place to start, although most therapies also have their own
individual associations, such as the Aromatherapy Organisations Council.
Therapists must also be checked to ensure they have adequate public liability
insurance and of course be able to show qualification certificates. For the OH
practitioner however, once a therapist is in place, constant monitoring may also
be advisable.

Says Gail Cotton, past president of the AOHNP and head of OH for Leicester
Fire Service: "In the first instance it’s a good idea to use a fully
qualified third party, but you’ve got to be aware it’s a quality issue and
ensure strict standards are adhered to."

Complement your practice?

Occupational health practitioners who are interested in offering staff
complementary therapy may be content to hire a third party with the necessary
expertise. However, there is also a growing interest among nurses in learning
complementary medicine in order to offer it in their practice.

According to Frances Baker, who has spent more than 40 years in occupational
health and currently lectures on the BSc course in Homoeopathy for Nurses at
Napier University, Edinburgh, the fastest growing entity in the RCN is the
Complementary Therapies Forum, with members already practising massage,
reflexology and aromatherapy. She believes there is an active part for
complementary therapy to play within the OH department.

Says Baker: "When I started in occupational health, aspirin and
plasters were the order of the day. It’s moved on to the ‘hands off’ approach
over the years. Yet I would refer you to the Hanasaari model, which includes
teamwork, research, health promotion and CARE! With the first OH nurse
graduating from the university with a BSc in homoeopathy, it’s a very exciting

Baker first learned about homoeopathy on a course in Glasgow, paid for by
her employers, aimed at nurses interested in the subject. She says it gave her
a level of knowledge in dealing with conditions that make life difficult for
people. For example, a forklift truck operator who complained of stiffness that
got worse as the day progressed, derived great benefit from the rhus tox

Baker says that interest among companies has grown and cites a major
financial company in Edinburgh that pays for its staff to visit a homoeopath.
So in the future could homoeopathy be routinely used within an OH practice?

Says Baker: "Of course OH nurses can’t administer remedies just like
that, but now that courses are being opened up, this thing will grow and it
suggests an approach to care for the 21st century."


1. Budd S, Mills S (2000) Professional Organisation of Complementary and
Alternative Medicine in the United Kingdom 2000: A Second Report to the
Department of Health. University of Exeter.

2. Ernst E et al (1995) Complementary Medicine – A Definition [letter]
British Journal of General Practice, 5:506. British Complementary
Medicine Association  Registered charity that provides information
on complementary medicine.  The International Stress Management
Association (ISMA) Guild of Complementary

The main categories of therapy

In November 2000, The House of Lords Science and Technology Select Committee
on Complementary and Alternative Medicine grouped complementary therapies into
three main categories.

– The first cover the ‘big 5’, two of which, chiropractic and osteopathy,
are already regulated by Acts of Parliament. Of the other three, acupuncture,
herbal medicine and homoeopathy, are all already being provided through the NHS
and their availability is expected to increase

– The second category defines therapies most often used to complement
conventional medicine and includes aromatherapy, the Alexander technique,
massage and reflexology. Some of these therapies are being offered on the NHS,
particularly to the terminally ill

– The third category covers ‘more diverse’ disciplines that rely on a more
philosophical and less scientific principle. These include some
well-established therapies such as Chinese medicine and others with a ‘less
creditable’ evidence base such as crystal therapy and kinesiology

Some complementary therapies

There are hundreds of complementary therapies in use, and
unfortunately we don’t have space to go into the details of each one. Below is
a brief guide to those that may have the most practicable effect within a
workplace situation.

Acupuncture This ancient
Chinese art is based on the theory that Qi energy flows along meridians in the
body and healing can be stimulated by inserting fine needles at specific points

Alexander technique Devised by
FM Alexander (1896-1955), an Australian actor, who lost his voice and found
that by realigning his posture his voice returned. The technique teaches
participants to return the body to its normal position and so allow the brain
to recognise and retain the realignment. The head and neck positioning are
particularly important. Used in the treatment of musculoskeletal as well as
vocal problems

Aromatherapy Holistic
treatment that uses essential oils of plants for healing. It works on the
olfactory centres that go straight to the brain and can be applied by various
forms of massage (within a carrier oil), or by scent within a vapouriser, bath
or lamp

Chair massage Primarily
acupressure massages that are experienced clothed, and are carried out in an
ergonomically designed chair. Pressure is applied to the back, arms, hands,
shoulders, neck and head. Benefits are said to include increased alertness and

Homoeopathy Works on the
principal that what makes a healthy person unwell can be used to treat the same
symptoms in someone who is unwell. By using a highly diluted form, like is
treated with like. Because a homoeopathic remedy does not treat the presenting
symptom but the body’s ability to heal itself, prescriptions for the same-named
disease may be different in each case

Reflexology A type of deep foot
or hand massage based on the meridians or zones that run through the whole body
from the feet or hands to the brain. By massaging the hands or feet,
reflexology works to break up any blockages that may have occurred along these
meridians and help promote healing

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