The public and many mainstream medical providers no longer think of manipulation and acupuncture as secondary choices in the treatment of musculoskeletal conditions. In fact, many now consider them the logical first choice of treatment. However, even practitioners of these modalities can be short sighted and rcductionistic in their approaches. It is easy for the patient and practitioner to get caught up in the "pain relief model. This mind-set may ignore underlying processes, such as infectious origins, as seen in conditions such as Reiter's Syndrome; or may fail to address other causative factors, such as metabolic dysfunction or stress and the emotional profiles. It is often difficult to recognize these patterns; and, often, unfamiliarity with how to approach these factors causes the practitioner to utilize a more mechanistic approach, since it will yield faster amelioration. The use of various holistic modalities can assist in bridging these mechanical and esoteric factors. Stressors The body does not care if the origin of one's condition is due to emotional, physical or metabolic factors; it simply responds to compensate. Cyriax stated,".. .the body responds to negative input and does not distinguish between trauma or infection." A condition may often start as a simple injury, such as a back strain, but the time lost from work will soon have an emotional impact on the patient and, if this continues, the patient's metabolic hormone balance and immune system will soon be altered. Hans Seyle described a GAS (general adaptation syndrome) response; and it has been recognizxd that, if stress is prolonged, there will be metabolic alteration, with eventual dysfunction and atrophy of various organs and systems. Thus, cortisol dysrcgulation occurs, ultimately affecting the sympathetic/parasympathetic systems, insulin regulation and pH of the body. Understanding that the body goes through multiple phases in the healing of an injury will assist the practitioner in properly administering adjunctive support. Whereas the body may have a similar response to stressors of different origin, the treatment of these may vary greatly. It is appropriate to administer pain relief in the form of physi- cal modalities or medicines; but adjunetive nutritional care is also necessary to address other factors, as these factors, left untreated, will predispose the individual to future similar responses. The study of the alternative medicines will better prepare the practitioner to individualize treatment, and, thus, to achieve better results. Stages of Healing Reaction Stage—Upon injury, there is an immediate response by the body. This Reaction Stage is the period characterized by redness, swelling, splinting and erythema. This stage will last 48-72 hours. Traditional treatment of RICE (Rest, Immo- bilization, Compression, Elevation) can be enhanced by the use of nutrient, herb and homeopathic modalities. Whereas the inflammation that occurs is a normal response by the body, it should be monitored to keep this at a minimum. Allopathically, anti-inflammatorics and muscle rclaxants are given; but care should be taken not to over medicate this normal reactive process. One of modem medicines faults has been providing relief too fast, which has often resulted in the patient's pushing physical limitations and becoming re-injured, due to a lack of pain as a warning signal. Practitioners now recognize the benefit of using proteolytie enzymes, along with minerals, to assist the body during this period. Calcium and magnesium arc vital for muscle spasming and systemic buffering of waste products. Bromelain and papain are utilized to minimize the inflammatory response. Topical herbal creams can provide localized therapy over the area of insult. Using a base cream of vitamin E, one can mix an herbal extract or nutraceuticals for localized topical therapeutic effect; i.e., arnica, hypericum, calendula, MSM. Other herbs that can be effective at this stage are wild yam, white willow bark, valerian, ginger, butcher's broom, witch hazel, guaiacum. Homeopathics would include arnica for deep bruising, aconite for pain and inflammation, apis or belladonna for inflammation. Emotionally, the aconite and arnica are helpful for shock. Injuries to the hands and feet may do well with hypericum. Gelscmium combats anxiousness, and ignatia worry, grief and loss. Regeneration Stage—Here the body starts to form coagulants, setting the stage for future healing to take place. This is when the body needs to remove the toxic substances that have resulted from the tissue breakdown of the injury and the resulting inflammatory response. Drainage products are useful here. Additionally, isodes of lactic acid will assist in the mobilization and excretion of this metabolic by-product. Physical modalities of iontophoresis and light massage, mobilization and acupuncture will yield beneficial results. Nerve rein-nervation occurs, and liypersensitivity may result from over-innervation, due to excessive fibroblastic infiltration to the area. There may be a continued need for anti-inflammatories in the individual. Allopathic anti-inflammatorics yield the best results (up to 6-8 weeks). Herbal anti-inflammatories, such as boswellia, ginger and rehmannia, take a while to reach full effectiveness. They Staaes of Healing STAGES CHARACTERISTICS DURATIO Reaction • Redness 48-72 hours Stage • Swelling • Splinting • Erythema Regeneration • Formation of coagulants 6-8 weeks Stage • Body needs to remove toxic substances from tissue breakdown • Nerve Reinnervation • Scarring of the tissue Remodeling • Regain mobility, Up to a year Stage flexibility & pliability are often more beneficial after the 6-8 weeks of use. Passive range of motion is essential at this point, with little weight or stress placed on the parts. The period of time this stage lasts is 6-8 weeks after injury. Advising the patient of his/her limitations is vital, so as not to prolong this period and complicate the healing response. Scarring of the tissues will occur during this stage, and must be kept to a minimum. Water exercises can be of benefit because of their non-weight bearing and resistance qualities. Proper administration of fatty acids and other nutritional factors, such as chondroitin sulfate, vitamin C and bioflavonoids, will assist in minimizing the inflammation response, and provide nutrition needed for ground substance integrity. Tendinous and ligamentous structures heal during this stage, so manganese and other trace elements are needed. Topical capsaicin can be effective in controlling the pain, as reinnervated areas will become active and there may be a nerve/pain response in the form of ache, spasm or parasthesia. Also, providing glu-cosamine sulfate can assist the repair of dense cartilaginous tissues. Herbs, such as capsaicin, ginger and bupleurum will be of assistance. Homeopathics will facilitate functionality and direct the healing responses. Ones to consider are Rhus tox., for injuries in which movement helps; bryonia, when rest helps; ruta, when too much movement causes pain, but complete immobilization is also uncomfortable. In the case of broken bones, Symphytum and silicea may be of assistance. Cartilaginous tears may be aided by the use of Ledum or staphysagria. Remodeling Stage—After the Regeneration Stage, the Remodeling Stage or "Reabsorption Stage" attempts to regain mobility, flexibility and pliability. This stage usually lasts up to a year after the injury. Deeper and more aggressive physical modalities are required here. Providing much of the nutritional, herbal and homeopathics mentioned during the remodeling stage is appropriate here also. Cetyl myristoleate. MSM and adaptogens, such as Schizandra and ashwaghanda. can be of benefit during this period. Individualized nutritional attention during this period is suggested, as it addresses the patient's underlying predispositions and nutritional deficits that will hinder proper healing. Active exercise, flexibility and resistance training are now vital. Attention to any residual factors must be addressed. Emotional concerns can range from loss of income to lack of self-worth and availability of family and friend support. Counseling is appropriate at this time; many patients develop dependency on their practitioners. Nutrition and diet will be helpful for proper brain and nerve transmitter function. There are sources of natural serotonin and 5-HTP to address depression issues. Herbals, such as kava, St. John's Wort, chamomile, valerian and passiflora can be beneficial for sleep, depression, pain and stress tolerance. Homeopathics should be administered toward the patient's constitution or by specific formulations for issues that need to be addressed. Other Factors—Environmental toxicity and disease-causing microorganisms are other components to be assessed in the treatment of musculoskeletal problems. Structural abnormality will create compensation, mechanically, and all these factors will cause compensation by the body, which will eventually show up in the nervous and structural systems. Environmental tox- ins, mineral imbalances and pathogens can all cause abnormal CSF flow and evidence themselves in dural tension, which can result in subtle or not-so-subtle eye disturbance, headaches, vertigo and fatigue. Cranial therapy will be of assistance in these cases, as well as the use of sarcodes, nosodes, isodes and xenobiotics. Conditions such as Reiter's Syndrome can have so many components that may be symptomatic at varying intervals, it becomes difficult to obtain an accurate diagnosis. This syndrome can be accompanied by conjunctivitis, GI inflammation and painful nodules on the soles of the feet. Only an astute practitioner may recognize the pattern. The use of homeopathic nosodes is vital to the body's immune system recognition of a pathogen. There are many other examples, such as the Lyme's and Epstein Barr organisms to consider. In closing, combining traditional chiropractic, acupuncture and allopathic treatments with the use of herbal, homeopathic and nutritional therapies will assist the practitioner better handle many difficult cases; however, the practitioner must learn to look beyond and be willing to recognize and reckon with these complicating factors. Dr. Stuart Wm. Russell attended' Pepperdine University in Malibu, CA, and Heidelberg, Germany. He earned his Bachelor of Science degree from Los Angeles College of Chiropractic in 1980, and was in private practice in Springfield/Eugene, OR, for 15 years before relocating to Northern California.. Dr. Russell has written articles for various magazines and has been a guest speaker on national health-related radio programs. He taught homeopathy at the IET institute in Northern California, and is the originator of the RET (Reflex Emotional Therapy) technique. He can be reached at 916-683-2233 or e-mail DrnaWwdCcbhotmail. com. m
