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Katia Twyford Osteopath Louise Godfrey Yoga Therapist Dr Suzanne Grant, Chinese Herbalist & Acupuncturist Post Doctoral Research Fellow, UWS.

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Presentation on theme: "Katia Twyford Osteopath Louise Godfrey Yoga Therapist Dr Suzanne Grant, Chinese Herbalist & Acupuncturist Post Doctoral Research Fellow, UWS."— Presentation transcript:

1 Katia Twyford Osteopath Louise Godfrey Yoga Therapist Dr Suzanne Grant, Chinese Herbalist & Acupuncturist Post Doctoral Research Fellow, UWS

2 LBP is the most common condition for which people use CAM 1 1. Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, December 2008.

3 What is integrative health care Why we might treat using an integrative health care protocol Commence with a case study How would we construct IHC protocol for LBP Create a patient profile Create a treatment plan Assess progress Chinese medicine treatment for LBP Osteopathic treatment for LBP Yoga therapy for LBP

4 “An inter-disciplinary, non-hierarchical blending of both CAM and conventional medicine that provides a seamless continuum of decision-making and patient-centred care and support. It employs a collaborative team approach guided by consensus building, mutual respect and a shared vision of health care that permits each practitioner and the patient to contribute…to treat the whole person, to assist the innate healing properties of each person..” Boon et al Integrative healthcare: arriving at a working definition Altern Ther Health Med 2004; 10:48-56

5 Patients are increasingly using integrative health care to manage their health and prevent illness. Chronic disease is not being adequately treated by single modalities Some patients are seeking alternatives to pharmacological treatment that have unpleasant side effects Patients perceive CAM combined with biomedicine is better than either alone

6 Chris, 46 yr old male, outdoors enthusiast, who injured his back 2 years ago while doing martial arts. He is suffering from intermittent but ongoing lower back pain. He reluctantly takes pain killers from time to time. He was diagnosed with a disc herniation at L4 and L5.

7 He admits to getting cold easily and his muscles cramp. His stools were loose, and he often had to get up at night to urinate. He drinks coffee and cold fruit juice and little else for breakfast, and is always “on the go”. He craves sweet foods. New symptoms include poor sleep and depression.

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9 Patient wants to see GP Who is the gatekeeper ? Commence individual treatment with specific practitioner Create a patient profile [2] Consider referring back to the IHC process where appropriate Not suited for IHC Yes – patient suited to IHC and chooses this path Patient wants to see CAM therapist Patient has a lower back pain & does not know who to see Patient referred to therapist or GP for known health condition Patient has ‘symptoms’ but not health condition unclear

10 Health history (description of pain, response to previous treatments, comorbidities and medications) Examination (vitals, orthopedic exam) Imaging (x-ray, ultrasound if warranted) Psychosocial measures Preferences Expectations of improvement with each modality (5 point scale) Previous experience of other treatments

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12 Patient wants to see GP Who is the gatekeeper ? Commence individual treatment with specific practitioner Create a patient profile [2] Patient-Practitioner(s) decide on a treatment plan Consider referring back to the IHC process where appropriate Not suited for IHC Yes – patient suited to IHC and chooses this path Patient wants to see CAM therapist Patient has a lower back pain & does not know who to see Patient referred to therapist or GP for known health condition Patient has ‘symptoms’ but not health condition unclear Eg. LBP. What are the comorbidities? If overweight, consider nutritionist involvement; if depressed consider assessment of severity, consider osteopathic appraisal for the level of musculoskeletal involvement. Some improvement No improvement How is this assessed? What happens here? Review treatment plan. Decision making session with patient bringing in evidence, cost and time, the patient’s preferences, expectations and values 1. Patient assessed by nominated therapists and initial treatment 2. Case conference (via , phone or in person) with patient 3. Treatment Plan: with an agreed revision date. For example, 3 months osteopathy & one course of acupuncture, commence yoga classes and consider some other mind body therapy Review with appropriate validated instruments at agreed timeframe for review

13 Recommendations for treatment based on evidence-informed practice model: Clinical presentation Expressed values and expectations Best available scientific evidence Team’s clinical experience

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16 Patient feels better! Assessment tools can be administered in the waiting room after the consult, they can be administered by the practitioner or therapist Consider utilising measurement tools at baseline eg MYMOP and Roland Morris questionnaire

17 Available at

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19 So one protocol may be a course of acupuncture, combined with an therapeutic exercise such as yoga or tai chi and some Chinese herbs….

20 Diagnosis of the dominant pattern(s): Aetiology: The depleting behaviours of coffee, cold juices, repeated outdoor exposure have depleted his qi and yang, and allowed cold and damp to penetrate his back. Yang typically depletes as we age. Diagnosis: Yang deficiency is associated with back pain, cold hands and feet, night-time urination, needing coffee There are also some elements of Qi deficiency too – loose stools, muscle cramping, craving sweets

21 Diet: Stop coffee, fruit juice Eat warm cooked foods to build qi and yang. Herbs: Shen Tong Zhu Yu Tang for meridian circulation then Shen Ling Bai Zhu San for the qi Acupuncture: Ashi points, selected huataojiaoji points (.5 cun lateral to the lower border of the spinous processes of T1-L5) Bilateral SJ5 waiguan, GB41 zulingqi, UB 22 pishu, BL23 shenshu and Ki3 taixi

22 A way to deal with stress other than coffee and being “on the go” all the time Self care for prevention This may come in the form of: A concurrent exercise therapy to prevent recurrence Further dietary advice and planning from a nutritionist ???

23 Osteopathic "lecture notes# 2 Igor A. Litvinov

24 YOGA 24

25 YOGA THERAPY 25

26 HOW YOGA IS USEFUL IN THE MANAGEMENT OF PAIN PAIN IMPACTS YOGA’S RESPONSE PHYSICAL IMMOBILITY ENERGY LOW MIND AGITATED ATTITUDE DESTRUCTIVE EMOTIONS UNSTABLE SLEEP DISTURBED MOBILITY BALANCED CALM CONSTRUCTIVE STABLE CONTINUOUS DEEP SLEEP 26

27 APPROACH INDIVIDUALIZED MULTI-DIMENSIONAL SELF-EMPOWERING INTEGRATIVE 27

28 CASE STUDY 1 September year old female Retired school teacher Married/no children Health History Nervous breakdown 1995 Depression since 1995 Scoliosis of the spine since childhood Cancer melanoma/right leg Migraines Debilitating back pain from 1985 car accident 28

29 CASE STUDY 1 September 2009 Current Health Frequent chest infections Depression Chronic lower back pain Left wrist/thumb arthritis Sinus/recurring Candida Family Medical History Asthma/obesity/arthritis/high BP/diabetes/cardiac/other Mother - Asthma 29

30 CASE STUDY 1 September 2009 Appetite-Good Energy levels-Moderate Sleep onset - good Sleep Continuity - disturbed, wakes for 1-2 hours Menstrual cycle – post menopausal Bowel movement – good/regular Fitness- regular walking, weekly yoga 30

31 CASE STUDY 1 September 2009 Medications Anti-depressant (Zoloft) since mg Daily Rivotrol for anxiety Valium for back pain when needed Naturopathic care for chest infections Therapies Osteopathy Weekly yoga class Goal To reduce stress and anxiety, increase movement and to “stay in the present moment” 31

32 CASE STUDY 1 Observations Very low mood Scoliosis of the spine Weakness in the back Fatigued Repeating old behavioural patterns Short term goal Reducing back pain Stabilizing emotions Strengthening respiratory system Long term goal Lifting depression Changing old patterns 32

33 Case study 1 33

34 Case study 1 Final Outcome Completely off medication for depression since November 2011 Rectified scoliosis of the spine 2011 Back pain improvement and ceased in first practice Respiratory system strengthened in


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