Yoga Now Standard Treatment for Vets with PTSD

Yoga's not usually the first thing that springs to mind when thinking about treatment for post traumatic stress disorder in veterans. But from the Veterans Administration to the Pentagon, yoga classes are becoming not just commonplace, but in some rehabilitation programs mandatory.

One of the places in the forefront of change is the Newington Yoga Center, in Newington, Connecticut.

About 20 veterans train to become yoga teachers. Suzanne Manafort of the Veterans Yoga Project, said what began as a small project has burgeoned into programs across the country. Manafort taught yoga for years before using it as a treatment for PTSD. She said she had no idea she might need to make adjustments to her teaching, until she made mistakes.

"Touching is a mistake. In yoga classes we touch all the time. But to somebody whose been sexually assaulted that's a huge violation. Walking behind them is a huge mistake because it feels like they have to pay attention to what's going on in the room instead of just practicing their yoga practice," Manafort said.

She said ultimately it was veterans themselves that guided her, in some cases just by the courage it took simply to stay in class.

"Some of the men and women that I work with are Vietnam Veterans so they've been at home suffering for 40 years," said Manafort. "And when they come into this treatment program and they're told they have to do yoga, 'they're like are you kidding me?'"

"I thought it was a joke," said Vietnam veteran Paul Gryzwinski. "And I remembered actually laughing out loud and they said no we're really not kidding you're going to be going to yoga."

Gryzwinski is training to teach yoga to veterans. Many years after returning from the war, PTSD hit him hard. He ended up turning to the VA. Where he first encountered yoga.

"And I just thought of myself in like, tights with you know a bunch of women. And I know that sounds sexist — and I'm not, so forgive me — but it was such an alien concept to me," Gryzwinski said with a chuckle.

And Gryswinski's early misperceptions are one reason that Dan libby, a co-founder of the Veterans Yoga Project, said the 12 week yoga training for treating vets with PTSD tries to strip all the new-agey stuff out.

"We really emphasize, 'leave all the Sanskrit names at home, right. Leave the candles at home, don't talk about you know moonbeams and chakras and all these things,'" he said. "It's really just about learning about your body and your experience; learning to breathe."

Lt. Col Melinda Morgan deployed right after 9-11 and started teaching yoga to those who had served and those who were preparing to go to Afghanistan.

"So I started teaching veterans 10 years ago and one of those veterans that I taught became an instructor himself. And so in 2007 when he was in Iraq and I was in another location, he writes me a note that said, 'I have to teach yoga and I don't think I can.' So I'm like, 'yes you can.' I wrote it down all of the poses, emailed it to him and helped him on his way to become a certified teacher," Morgan said.

Today, Morgan teaches at the Pentagon, and she said classes once sparsely attended are now full every day. But despite an increased demand for yoga paired with a growing number of alternative treatment programs in the military and the VA, there's scant hard science about why yoga or most of the other alternative programs work.

Yoga instructor Dan Libby hopes the government does some studies soon, because without more data, returning troops won't take the programs seriously.

This article originally appeared on pri.org
Host Marco Werman
Reporter Susan Kaplan

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Everything You’ve Ever Wanted to Know About Stretching and Flexibility

Being flexible isn’t about being able to do the splits or crazy contortionist backward bending. It’s about having a level of mobility that isn’t holding you back from what you want to be able to do.

If you’re not flexible enough to touch your toes, you’ll have a difficult time bending down to tie your shoes or lift your 2-year-old. If your shoulder range-of-motion is limited, you’ll have a hard time reaching overhead to get something from a high shelf.

Simply put, flexibility is important for everyone.

With that said, there’s a lot of misinformation and controversy about stretching, so in this post, we’ll address some of those, and make some recommendations about best practices.

Myths About Stretching

There are many misconceptions about stretching, but we’ll just look at a few here. When you read an article or hear someone talking about why you shouldn’t stretch, they’re usually going to be coming from one of three main arguments:

  1. Stretching is dangerous
  2. Stretching is unrealistic
  3. Stretching isn’t real

Let’s break these down.

Myth #1 – “Stretching is Dangerous”

This is absolutely true. Other things that are dangerous: eating (poison), breathing (car exhaust), and sleeping (in the bath tub).

Yes, that’s right. Anything can be dangerous if you do it wrong, and stretching is certainly no exception. Sure, I’m guilty of cherry picking extreme examples above to make my point (logical fallacies can be fun sometimes), but anyone who claims outright that all stretching is dangerous is at least as guilty.

You see, there are in fact dozens of studies showing that, under certain circumstances, certain kinds of stretches can increase the chances of certain types of injury in certain activities.

For example, excessive static stretching of the prime antagonist muscles immediately prior dynamic movement can result in increased likelihood of muscle strain due to over-relaxation and temporary lengthening of the muscle fibers.

(In English, that means that stretching the hell out of a muscle will ‘loosen’ the muscle, and if you do this before an activity that requires that muscle to contract quickly, it might not be prepared to respond, and you could hurt yourself.)

The are also certain stretches that are contraindicated (e.g., you shouldn’t do them) for people who have various injuries.

For example, if you’ve had a lower back injury, some stretches for the hamstrings and hip flexors could strain that area and cause pain or exacerbate your injury. Of course, if you’ve been injured, you should be working with a doctor or physical therapist to determine which exercises you’re capable of doing.

The point is that, yes, stretching can be dangerous, if you do it wrong! Just like anything else.

Myth #2 – “Stretching Is Unrealistic”

Pop Quiz: A mugger jumps out of a dark alley and demands you hand over your wallet and your keys. Do you:

  • A) Run like hell,
  • B) Comply with his demands, or
  • C) Ask him to wait five minutes while you stretch and warm up so you can adequately defend yourself?

OK, in all honesty, you may not be too enamored of any of the choices above, but you have to admit that, of the three, choice C sounds pretty ridiculous.

This is the logic of certain “tactical” schools of thought on the subject of warming up.

And it’s good logic too, but it depends on the assumption of a certain goal in training: to be tactically ready at a moment’s notice for life or death performance. This is a necessity for soldiers, police, firefighters, and probably the guys on Ninja Warrior too, but for most of us, it’s a distraction.

There are two broad classes of training at play in this example:

  1. training to increase your capabilities, and
  2. training to increase your ability to make use of your capabilities without notice

In the latter case, warming up may be counterproductive, but if you’re just trying to get stronger, practice some fun movement, and get better at using your body for everyday stuff, you definitely want to be warming up.

A proper warm-up including some stretching does a lot to prepare your nervous system, your cardiovascular system, and your muscles themselves to be pushed towards their limits, and pushing your limits is how you expand them. We do this by exploring movement and trying different things out, which we’ll look at in the next section.

If you’re not a first responder, there’s very little utility in training tactical response.

Slow down. Warm up. Give your body the optimal environment in which to get better at the things that matter.

Myth #3 – “Stretching Doesn’t Exist”

This myth is the “I think my clever semantic observations about the word ‘stretch’ nullify the experience of millions of people who have successfully stretched and gotten more flexible” argument.

This, too, is true, in a sort of weird hair-splitting way.

As the argument goes, muscles don’t actually stretch; a fully relaxed muscle is up to 50% longer than a muscle in it’s typical semi-contracted state. Therefore, “stretching” a muscle doesn’t so much elongate its fibers as it simply trains them to hold less unnecessary tonus.

People who make this argument will also tend to plead a case for prioritizing the development of “mobility” instead of “flexibility.” And again, we think this is just a semantic issue.

The fact is, you can call it what you like.

We “stretch” in order to increase our functional range of motion of various joints in various positions. Yes, we could probably come up with much more accurate and technical-sounding ways to describe that, but we’d much rather spend our time designing super-effective programs, testing them with real people, and teaching them to our clients.

Stretching may not be the best possible word to describe our method for increasing flexibility/mobility, but it’s something that people understand, and it works.

How to Practice Stretching in a Safe and Effective Manner

There’s all kinds of variations of stretching – it’ll make your head spin in confusion! Contract-relax, ballistic, weight-assisted, and good old “sit there and hold it for 30 seconds.”

So which variation should you use?

Truthfully, if you practice any of them for long enough, as long as you’re not moving too much into pain, it’ll work. It’s just a matter of finding what works for you.

A Dynamic Alternative to Sitting and Stretching

If your flexibility and mobility are quite limited, you’ll benefit from spending some dedicated time on a stretching program.

But if you’ve already spent a fair amount of time on more traditional flexibility work, and you’re ready to try something new, I recommend using animal movements – specifically, the Bear, Monkey, and Frogger – for challenging your flexibility in motion.

Bear Walk for Flexibility

In the Bear, you’ll start in an A-Frame (or downward dog) position, then move your right hand and left foot simultaneously, then vice versa.

Depending on where you place the emphasis on the movement, or depending on your particular limitations, the Bear can be used to help you stretch your:

  • hamstrings
  • shoulders
  • thorax
  • calves

If you have limitations in your calves, for instance, you can focus on locking out the knee and driving the heel to the floor.

Monkey for Flexibility

In the Monkey, you’ll start in a bodyweight squat (go as deep as you can), then place your hands on the ground in front of you and to the side. If you are moving to the right, you’ll place your left hand in front of your right foot, then hop your feet to the right, landing with your left foot behind your right hand.

If you have trouble getting into a deep squat, the Monkey can help by stretching your:

  • hips
  • calves
  • adductors
  • upper back
  • lats

If you have tight lats, for instance, a variation of the monkey that would be great to work on is the monkey cartwheel, where you reach your arm overhead to create the momentum for the cartwheel. This creates a nice stretch in the lats.

Frogger for Flexibility

The frogger is similar to the monkey, in that it starts in a deep squat, but instead of moving side to side, you’ll place your hands in front of you, then hop your feet forward to meet your hands, moving forward in succession.

Much like the Monkey, the Frogger will help you out tremendously with your squat flexibility, but with a slightly different angle. Putting the Frogger in motion will stretch your:

  • hips
  • calves
  • adductors
  • upper back

If your squat is limited by calf tightness, reaching further forward in the Frogger will help stretch your calves a bit more.

Common Questions About Stretching

Flexibility and stretching play a big role in all of our programs, so we get a lot of questions on the topic. Here are some of the most common questions we get.

When is stretching appropriate?

Stretching is appropriate when you lack the range of motion, or flexibility, to do the movements that you want to do.

These movements could be squatting all the way down to your heels, or simply reaching behind you to the back seat of the car when you are belted in.

Just like with many things, it’s all dependent upon your particular goals. Some people actually need to stretch just to be able to do normal daily activities. They have either gotten stiff over the years, or they’ve had some type of injury.

So, maybe if I don’t have a particular reason to stretch, then I don’t need to?

Maybe not.

If you’re engaging in a regular exercise program that takes you through full ranges of motion for your joints and you don’t have any difficulties, then that may be enough stretching for you.

Take a simple pushup, for example.

Done in proper form, this takes your chest and anterior shoulder muscles through their full range. We all often notice that the first set (or reps) feels a little tighter in the beginning, then it feels like you free up more. Congratulations, you’ve “stretched” out!

This is why such blanket statements as “stretching is bad for you”, don’t really make sense.

When is the right time to stretch?

If you are doing a warm up for an activity, you probably don’t want to hold a stretch for a long time (static stretching).

This is probably where people have gotten the idea that stretching is a bad thing.

Static stretching before a sporting activity has been shown to decrease your muscle strength and power (for a short time afterwards). So, don’t do it then!

A general body warm up with active motion through the joints you are going to be using is more appropriate for that time.

So when is the right time for a good static stretch?

After your workout or training session is a good time. Your body temperature will be higher and you will benefit from that warmth to lengthen the tissues you want to work on.

Does stretching help to prevent injury/soreness?

There is very little evidence that stretching, in general, prevents injury or soreness in muscles.

Pretty much all the research regarding whether stretching after exercise reduces DOMS (delayed onset muscle soreness) says it doesn’t help at all. And I buy this, based on personal experience, and also from the reasoning that whatever damage that triggers the pain of DOMS would unlikely be alleviated by stretching.

The studies that have been done in regards to “injury prevention” looked at rates of injury in those that worked on flexibility exercises versus those that haven’t (and usually with the metric of injuries occurring in the sporting activity).

There’s a bit of a problem with this, because again, it makes sense that there are some specifics left out of that equation. It depends on the individual and the nature of the sport. The person may already have flexibility that is adequate for the performance of the activity.

For example, running is what we call a “midrange” activity. Most runners’ knees and hips don’t go through a full range of motion (even in people with the longest running strides).

What does this mean? You don’t have to be very flexible to run (and a lot of runners aren’t). So stretching wouldn’t really help prevent injuries there.

But imagine a sport like wrestling or jiujitsu where your opponent is attempting to bend you like a pretzel. If your shoulder is forced into a position, and you have less than adequate flexibility (and strength, of course) you’re more likely to be injured.

It makes sense that some appropriate flexibility work there would have been helpful, and should thus be incorporated into a training routine.

Are there any other benefits to stretching besides improving range of motion?

Well, whether psychological or physiological (most likely a little bit of both), proper stretching tends to feel good. Not very scientific I know, but it’s true!

The same mechanisms that temporarily reduce strength and power output in a statically stretched muscle, also work in promoting relaxation in that same area.

This is why stretching out after a good workout feels good. The tension buildup from working out can be alleviated with a nice stretch. This also happens in a muscle that is chronically “tight” – direct stretching to the muscle decreases that hypertonicity and, at least for a little while, helps you to feel better.

When you can move more freely after stretching, does that mean your muscles/tendons/ligaments are actually longer?

Stretching as a means of increasing range of motion most likely doesn’t “stretch fibers out,” but is more a neurological decrease in muscle tonus.

In fact, you really don’t want to stretch your tendons and ligaments to a significantly greater length. You may end up compromising your joint’s stability. Imagine a rubber band that has been overstretched and doesn’t spring back to its original length, but sags and loses its elasticity.

You can see how that would be bad in structures that are supposed to be holding your joints together.

Stretching hasn't worked for me in the past. Is there anything I can do?

Sometimes, people come to us saying they haven’t gotten results from their stretching efforts. If that’s been the case for you, there are some reasons that might be. I’ll explain further in this video:

The bottom line for flexibility training is: if you cannot actively attain a position you’d like, then you need to find a way to get to that range of motion.

Stretching does that for you.

It has for countless years, and will continue to do so for many more. Whether you play semantics and say its because you are improving joint motion vs. muscular lengthening or changing neural patterns, it’s the same thing.

Working stretching techniques correctly gets you there, regardless of whatever is specifically happening physiologically.

Addressing Your Particular Flexibility Needs

Flexibility is not just about being able to put your legs behind your head or anything like that. It’s about making your regular activities, as well as your training goals, more accessible.

And to make sure you’re working towards making your activities more accessible, you need to make sure your flexibility program addresses your particular limitations.

 

This article originally appeared on https://gmb.io/stretching/ and was written by Jarlo

Back Pain: Intervertebral Disc Conditions

The term ‘disc’ is short for the ‘intervertebral discs’, the spongy cushions that separate the block-like bones (vertebrae) of the spine. These discs have a number of important functions including shock absorption, keeping the vertebral column stable and giving the vertebrae ‘pivot points’ to allow movement. 

A disc is made of two parts: the elastic outer shell (annulus fibrosis) and the jelly-like contents (nucleus pulposis). It can handle quite a lot of pressure without damage, but certain types of pressure can damage the shell and push its contents out. 

Symptoms of disc problems

The symptoms of a damaged disc can vary according to its location and severity. Many people who show evidence on scanning of damaged discs have no symptoms. This means that, most commonly, there are no symptoms at all. However, general signs may include:

  • Back pain
  • Pain radiating down the legs
  • Worsening pain associated with bending over or sitting down for a long time
  • Worsening pain associated with activities like coughing or sneezing
  • Numbness or pins-and-needles in an arm or leg.

Risk factors for disc problems

Some people are more susceptible to disc problems than others. Risk factors include:

  • Obesity
  • Poor muscle tone
  • Lack of regular exercise
  • Cigarette smoking
  • Advancing age
  • Poor posture
  • Incorrect lifting techniques.

Often, however, there is no recognisable risk factor present.

Types of disc problems

Common disc-related problems include degenerative disc disease, ruptured (or ‘slipped’) disc and sciatica (nerve pain).

Degenerative disc disease

The discs of a young child are plump and moist, but the water content reduces with age until the discs are comparatively thin and hard. As a result of this, friction between the bones is thought to increase, resulting in growths called bone spurs around the discs.

In many cases, these age-related changes cause no problems, but some people experience a painful condition called degenerative disc disease. The most common symptom is back pain caused by holding the same position (either sitting or standing) for too long. It’s among the most common causes of chronic back pain in older people. 

Ruptured disc

The term ‘slipped disc’ suggests that a disc has moved out of position, but this is not accurate. The discs are held firmly in place by various structures (including ligaments, muscles and the vertebrae themselves).

Terms like ‘ruptured’, ‘herniated’ or ‘prolapsed’ describe the situation better, as the real problem is not that the entire disc ‘slips’, but rather that a crack in the tough outer shell of the disc allows the soft jelly-like contents to ooze out. When this material comes into contact with other structures, especially the spinal nerves that run nearby, this can cause pain and alter nerve function. 

The most common site for a ruptured disc is the lower back, and chronic lower backache can be a symptom. As we get older, the risk of rupturing a disc declines because the discs dry out and the contents are less able to ooze through any cracks.

Sciatica

Sciatica is nerve pain from the sciatic nerve that runs from the spine into the buttock and down the back of the leg. A common cause of sciatica is a ruptured disc. The spinal cord normally has room to slide up and down inside the spinal column whenever the body moves. However, a bulging disc can protrude into the spinal column and press against the spinal nerves, hampering its movement and causing pain. 

Diagnosis of disc problems

Diagnosis of disc problems involves:

  • Taking a medical history (to determine risk factors and predisposing conditions)
  • A physical examination.

Other investigations are carried out if surgery may be required.

Treatment for disc problems

The majority of disc problems will resolve regardless of treatment. Bed rest is occasionally best for initial management of severe sciatica, but most people can keep active with some restrictions according to the level of pain. Good pain control and allowing the person to move is often a good approach. 

Some common treatments include:

  • Heat treatment
  • Regular massage
  • An exercise program designed to improve strength and flexibility
  • Non-steroidal anti-inflammatory drugs (NSAIDs) or steroids
  • Pain-relieving medication
  • An injection of anti-inflammatory steroids into the region of the disc
  • Uncommonly, in severe cases of ruptured disc, an operation may be needed to trim the protruding bulge (laminectomy)
  • Also uncommonly, in severe cases of degenerative disc disease, an operation may be needed to remove the disc and fuse together the two vertebrae on either side.

Remember, most disc problems resolve without specific treatment. 

Self-help for disc problems

Given time and the right conditions, a ruptured disc can heal itself. Ongoing maintenance can reduce the risk of disc problems in the future. Be guided by your doctor or health professional, but general suggestions include:

  • Try not to sit still for long periods of time.
  • Avoid lifting heavy objects.
  • Remember that movements such as bending and twisting (especially at the same time) can increase pressure on your damaged disc.
  • Work on increasing your abdominal strength. Strong stomach muscles help to support the back. People who work hard on their abdominal muscles probably have much less recurrence of back pain over the long term, but only if they keep doing the exercises.
  • Pay attention to posture while sitting, standing and walking.
  • Flexibility exercises, performed regularly, can improve mobility and help reduce muscle tension and back pain.
  • Include a gentle program of back-strengthening exercises.
  • Yoga is recommended by some practitioners as an excellent form of strengthening and stretching for people with back problems.

Other causes of back pain

There are many other causes of back pain, so see your doctor if pain is strong. Important other reasons for back pain include:

  • Muscular pain – probably even more common than disc rupture. It is usually localised to the back, without the pain spreading to the legs and very likely to fix itself without specific treatment
  • Fracture – especially in elderly people, or those with osteoporosis
  • Malignancy – some cancers can present with back pain. See your doctor if you have strong pain, night pain, have experienced weight loss or any other symptoms you are worried about.

Where to get help

  • Your doctor
  • Physiotherapist
  • Osteopath

Things to remember

  • Intervertebral discs are spongy cushions found between the vertebrae of the spine.
  • Common problems include degenerative disc disease and ruptured (or ‘slipped’) disc.
  • Risk factors for disc problems include obesity, advancing age, lack of exercise and incorrect lifting techniques.

This article originally appeared on www.betterhealth.vic.gov.au

It’s Official: Acupuncture Doctor Approved

The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.” [1]

A major goal of the recommendation is for acupuncture and other nonpharmacological therapies to replace drug therapy as a primary source of pain relief. Treatment with opioids is only recommended, with an official “weak recommendation,” when other modalities do not provide adequate relief. A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation. [2] The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut). 

The American College of Physicians notes that approximately 25% of USA adults have had, at the very minimum, a one day lower back pain episode within the past three months. The socioeconomic impact of lower back pain in the USA was approximately $100 billion in the year 2006 . The costs include medical care and indirect costs due to lost wages and declines in productivity. [3] Recommendations for treatment options, including those for the use of acupuncture, include considerations of positive medical patient outcomes, the total number of back pain episodes, duration between episodes, alleviation of lower back pain, improvement in function of the back, and work disability reductions. Recommendations are for both radicular and nonradicular lower back pain.

The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .” [4] In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain. [5]

These findings are consistent with those published in Mayo Clinic proceedings finding that acupuncture is effective for the treatment of lower back pain. The same Mayo Clinic report notes that acupuncture does not cause any significant adverse effects. [6] The Mayo Clinic findings apply to both nociceptive and non-nociceptive pain. Nociceptive back pain includes musculoskeletal inflammation and pain involving nerve cells wherein nociceptors are activated. Nociceptors are afferent neurons in the skin, muscles, joints, and other areas. For example, nerve impingement (often referred to as a “pinched nerve”) produces one type of nociceptive pain.

Non-nociceptive pain does not involve inflammation and is more relevant to pain processing in the central nervous system. One type of non-nociceptive pain condition is fibromyalgia and acupuncture has been confirmed as an effective treatment modality for this condition. The Mayo Clinic proceedings note, “Martin et al. found a significant improvement between electroacupuncture vs sham electroacupuncture. Differences were seen on the Fibromyalgia Impact Questionnaire (FIQ) scores for fatigue and anxiety.” [7]

 

Learn more about how to alleviate fibromyalgia related pain in the acupuncture continuing education course entitled Fibromyalgia Syndrome Treatments. Click the following to learn more:

Fibromyalgia Online Course >
 

The Mayo Clinic and American College of Physicians findings are consistent with additional quality research. Memorial Sloan Kettering Cancer Center (New York) and University of York (United Kingdom) researchers note “We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed.” [8]

Doctors understand the true need for effective pain management. Nonpharmacological solutions are important for a variety of reasons including prevention of addiction, effective relief of pain, and prevention of adverse effects. This is often of heightened concern during pregnancy and for children. As a result, university hospitals integrate acupuncture into usual care settings to improve patient outcomes. For example, pediatric doctors at the UCSF Benioff Children’s Hospital San Francisco provide acupuncture to children, including non-needle laser acupuncture. At the University of California hospital, acupuncture is made available for both inpatients and outpatients. Dr. Kim notes that acupuncture reduces nausea up to 70%. She adds that acupuncture is also effective for significant reductions in post-surgical pain and chronic headaches. [9]

Recently, researchers have discovered how acupuncture stops pain and provides other forms of relief for patients. Breakthrough research conducted by University of South Florida (Tampa) and Fujian University of Traditional Chinese Medicine (Fuzhou) researchers documents how acupuncture stops pain. The researchers note, “acupuncture exerts a remarkable analgesic effect on SCI [spinal cord injury] by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” [10]

Microglia are central nervous system immunity cells that secrete proinflammatory and neurotoxic mediators. Acupuncture reduces pain by attenuating this response. The researchers also document that acupuncture provides neuroprotection. The researchers note that acupuncture prevents brain damage in the hippocampus by “preventing microglial activation.” The University of South Florida members of the research team were from the Department of Neurosurgery and Brain Repair and the Department of Pharmaceutical Sciences. Funding was provided by the United States Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.

The aforementioned research reveals an important biochemical mechanism involved in acupuncture’s ability to alleviate pain and reduce harmful inflammation. Researchers focus on other mechanisms activated by administration of acupuncture treatments. For example, laboratory investigations reveal how acupuncture regulates blood pressure.

University of California (Irvine) researchers find acupuncture effective for the treatment of high blood pressure. In a controlled laboratory study, University of California researchers have proven that electroacupuncture at acupoint ST36 (Zusanli) promotes enkephalin production, which dampens proinflammatory excitatory responses from the sympathetic nervous system that cause hypertension. Specifically, electroacupuncture regulates preproenkephalin gene expression, a precursor substance that encodes proenkephalin, which then stimulates the production of enkephalin. [11]

The formal recommendation for the use of acupuncture in cases of lower back pain by the American College of Physicians is based on modern research. Mayo Clinic findings and research from the Memorial Sloan Kettering Cancer Center (New York) and the University of York support this recommendation. In response to the needs of patients, doctors have already implemented acupuncture into several hospitals throughout the USA and both inpatient and outpatient acupuncture treatments are available.

Now, modern scientific investigations reveal how acupuncture works. University of South Florida and Fujian University of Traditional Chinese Medicine researchers confirm acupuncture’s ability to attenuate microglial activation. University of California researchers have quantified acupuncture’s ability to control inflammation by regulating enkephalins. In addition, the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) provides professional certification for acupuncturists, which ensures standards of excellence for licensed acupuncturists. Given the large body of supportive research and the administrative support for providing safe and effective acupuncture to the general public, expect to see greater implementation of acupuncture into usual care settings.

Accessibility to care is dependent upon both availability and financial capabilities. Insurance companies have been providing health insurance coverage for acupuncture for decades. Cigna, Blue Cross, Blue Shield, AETNA, United Healthcare, and many other insurance companies provide reimbursement to patients for use of services by licensed acupuncturists. The level of coverage varies, largely dependent upon individual health insurance policy provisions. Licensed acupuncturists can learn more about providing coverage for their patients in the continuing education course entitled Acupuncture Insurance Billing #1. This basic introductory course covers diagnostic requirements, including ICD-10 coding, and other important procedural requirements necessary to obtain reimbursements for patient care.
 

References
1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain." Annals of Internal Medicine (2017).
2. Qaseem, et al. Annals of Internal Medicine (2017).

3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214.
4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438.
5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health.
6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. "Evidence-based evaluation of complementary health approaches for pain management in the United States." In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016.
7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
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