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Bach flower remedies

Description

Flower remedies in general are forms of vibrational or energy medicine in which the essences distilled from various flowers are used to promote mental, emotional or physical healing. Flower remedies native to Great Britain include Bach flower remedies, the most well-known, as well as Bailey essences, Findhorn flower essences, Green man tree essences, Harebell remedies and Orchid flower essences. Other cultures have their own native systems, e.g. Australian bush flower essences, Alaskan flower essences, Californian research essences, Hawaiian flower essences, Pegasus essences, Himalayan aditi flower essences, Pacific essences. This book has not included the other systems of flower essences, since they are not as commonly used as Bach, at least not in the UK, but while the precise plants used differ in other systems, the principals are similar to those for Bach remedies.

Bach flower remedies were devised by Dr Edward Bach (1886–1936), a bacteriologist and homeopath, who abandoned conventional medicine to develop a more natural, gentle form of healing based on plants, prescribed to address emotional and spiritual health. There are 38 remedies, plus the Rescue Remedy. Liquid preparations (mother tinctures) are made from the petals of the relevant plants, combined with water ethanol mixtures. They are produced either by the sun method or by the boiling method. In the sun method, the flowering heads of the plants are placed in a bowl of pure spring water and left in the sun for 3 hours, after which time the water is preserved in brandy. For the boiling method, the relevant parts of the plant or tree are boiled in pure spring water for 30 min and left to cool; the water is then diluted in brandy. The remedies are clustered according to seven emotional states: fear, uncertainty, insufficient interest in the present, loneliness, oversensitivity, despondency/despair and over-concern for others. The 38 remedies and the Rescue Remedy are detailed below.

Diagnosis is achieved by the technique of ‘peeling the onion’– finding out how a particular state of mind has been reached. For example, a state of insecurity may be caused by fear therefore the predominating emotion of fear would be diagnosed and treated. Treatment involves the selection of up to six remedies according to the individual’s condition: 2 drops of each remedy are added to a 20 mL bottle of still spring water and the person is then instructed to use four drops of this at intervals prescribed by the practitioner. It is also possible to self-prescribe, relatively easily, although for more severe psychological states, individuals should be advised to consult a qualified practitioner.

Evidence:

The only studies undertaken appear to have been those on Rescue Remedy to relieve stress and anxiety, particularly pre-examination nerves, the efficacy of which has been largely attributed to the placebo effect. Flower remedies may have a part to play in the psycho-physiological aspects of pain control, but whether this is a placebo effect or not remains to be demonstrated. One particular study concluded that the remedies do not appear to be effective in helping children with attention deficit disorder.

Safety:

Mother tinctures, from which the individual essences are produced, contain alcohol, suggesting caution if the patient is a recovering alcoholic, taking specific drugs to assist alcohol dependence or metronidazole or who has a moral or religious objection to alcohol. There is no evidence of toxicity and remedies appear to be safe for children and during pregnancy, despite the recommendations to curb antenatal alcohol consumption. The tendency of the remedies to reveal underlying emotions, through the ‘onion peeling’ effect mean that the practitioner should possess adequate listening and counselling skills and be able to recognize when it is appropriate to stop treatment and refer to a specialist counsellor.

Ernst E. ‘Flower remedies’: a systematic review of the clinical evidence. Wiener klinische Wochenschrift. 2002;114(23–24):963-966.

Howard J. Do Bach flower remedies have a role to play in pain control? A critical analysis investigating therapeutic value beyond the placebo effect and the potential of Bach flower remedies as a psychological method of pain relief. Complementary Therapies in Clinical Practice. 2007;13(3):174-183.

Pintov S, Hochman M, Livne A, et al. Bach flower remedies used for attention deficit hyperactivity disorder in children – a prospective double blind controlled study. European Journal of Paediatric Neurology. 2005;9(6):395-398.

Walach H, Rilling C, Engelke U. Efficacy of Bach-flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover. Journal of Anxiety Disorders. 2001;15(4):359-366.

Dr Edward Bach Centre, Wallingford, Oxon OX10 0PZ: www.bachcentre.com

The 38 Bach flower remedies

Agrimony:

for distress caused by hidden fears, worries and unhappiness.

Aspen:

for fear of unknown origin.

Beech:

for people who are intolerant and overcritical of others.

Centaury:

to promote inner strength and re-balance those who are weak-willed or subservient, enabling them to stand up for themselves.

Cerato:

to reduce indecision and promote confidence in own judgement.

Cherry plum:

to reduce frightening thoughts and ideas, fear of loss of control and to promote clear rational thoughts.

Chestnut bud:

for those who are unable to learn from past experience and constantly repeat the same mistakes.

Chicory:

for over-possessiveness, manipulation and control of other people, particularly family; promotes a more balanced, undemanding love.

Clematis:

to reduce day dreaming and absentmindedness and promote more awareness and sharpen focus on the ‘here and now’.

Crab apple:

is a cleansing remedy for those who feel their body or mind is somehow ‘dirty’ and has been contaminated, leading to obsessive thoughts or rituals.

Elm:

for temporary lack of confidence and discouragement in normally confident and capable people.

Gentian:

to dispel feelings of despondency and discouragement, usually resulting from disappointment.

Gorse:

for feelings of hopelessness and despair, often for no reason.

Heather:

to re-balance traits of self absorption and obsession with own illnesses or worries with a lack of awareness of other people or their needs leading to them being avoided and becoming lonely.

Holly:

to counter feelings of jealousy, envy, spitefulness or suspicion.

Honeysuckle:

for feelings of excessive homesickness, nostalgia, regrets, dwelling in the past.

Hornbeam:

for lethargy, lack of enthusiasm, the ‘Monday morning feeling’.

Impatiens:

to help people who are quick in thought and action and whose desire for immediate results makes them impatient and quick tempered with others.

Larch:

for lack of confidence and belief in own abilities.

Mimulus:

to help the type of person who is very shy or nervous particularly to help a known fear or anxiety.

Mustard:

to alleviate depression of unknown cause.

Oak:

to help stoic committed individuals whose determination is undermined by overwork or illness and who refuse to seek help or rest, causing despondency or despair.

Olive:

for tiredness and exhaustion due to either mental or physical overwork.

Pine:

to counter feelings of guilt.

Red chestnut:

for those who are over-concerned for the safety and well-being of others.

Rescue Remedy:

a composite remedy consisting of Star of Bethlehem, Rock Rose, Impatiens, Cherry Plum and Clematis, used as a treatment for shock, panic and general reaction to emergencies or as part of a broader, composite remedy with other remedies. It is also available as a cream or spray.

Rock rose:

used to combat feelings of terror and panic.

Rock water:

for those who are rigid and self disciplined leading to narrowness of mind.

Scleranthus:

to help those who are indecisive, mentally distressed at having to make even the smallest decision.

Star of Bethlehem:

used as a remedy for severe shock.

Sweet chestnut:

to ease deep depression and despair caused by emotional pain.

Vervain:

to temper overenthusiasm for causes which leave the patient stressed, angry and frustrated.

Vine:

for the over-domineering, inflexible individual.

Walnut:

to facilitate change when adjustment is difficult; protects against external influences which might make choices or adjustments difficult.

Water violet:

to ease the isolation which can occur if people are too reserved, proud or aloof, resulting in them becoming cut off from enjoying the help or company of others.

White chestnut:

for mental arguments or unwanted thoughts which interfere with the person’s peace of mind.

Wild oat:

to help people who are undecided in their path in life.

Wild rose:

for lack of motivation and apathy.

Willow:

for self pity, resentfulness and bitterness.

Biochemic (biochemical) tissue salts

Description

This therapy was developed by William Schussler (1821–1898), a German physician, biochemist and homeopath. There are 12 biochemical tissue salts in the original range, used to re-balance and correct the body’s own mineral salts, assumed to be essential to health at a cellular level. Deficiency of one or more of these mineral salts affects functioning of the others, leading to ill-health, but tissue salts can only be used to treat relative deficiencies, not absolute ones. Tissue salts are prepared according to homeopathic principles, using dynamized preparations in a low potency, usually 6× and are prescribed according to the presenting symptoms rather than being individualized to the person. They can be taken singly or in combination depending on the condition. Changes in diet and lifestyle may lead to the addition of new tissue salts to the original range in the near future, e.g. copper, manganese and zinc.

Evidence:

No clinical evidence for the use of these salts in the treatment of any specific condition could be found.

Safety:

No information regarding safety or evidence of specific contraindications was found.

No professional literature specifically

No professional literature specifically on the complementary therapy concept of biochemic tissue salts could be found. Literature searches for the individual tissue salts identified research on the individual minerals, but not on the homeopathically prepared tissue salts..

The tissue salts

Calcium fluoride:

builds elastic tissue of the body, muscles and blood vessels and is present in teeth and on bone surfaces. It is prescribed for: muscle weakness, dental decay, poor circulation, damaged muscles and bones, skin conditions and bleeding gums.

Calcium phosphate:

is present in bone and aids the formation of new blood vessels and digestion. It is prescribed for bone weakness, indigestion, poor circulation, fatigue and general debility and is thought to be good for convalescence.

Calcium sulphate:

purifies the blood and is an hepatic stimulant. It is prescribed for skin problems, mouth ulcers, slow healing wounds, neuralgia and catarrh.

Ferrum phosphate:

carries oxygen around the body and strengthens blood vessel walls. It is prescribed for respiratory problems, bleeding, anaemia, menorrhagia, throbbing headaches, pyrexia, inflammation, rheumatism. This tissue salt is often referred to as the ‘first aid salt’ when applied to wounds and is said to stem bleeding.

Kalium muriaticum:

is a blood conditioner prescribed for respiratory problems such as coughs, colds, bronchitis, swollen glands, childhood eczema and for digestive disorders.

Kalium phosphate:

is a nerve nutrient, present in brain cells and nerve tissue. It is used for physical and mental neurological system conditions, insomnia, mental and physical exhaustion, poor memory and concentration.

Kalium sulphate:

oxygenates the tissues and cells of the body and is used for skin, hair and scalp and nail problems, as well as catarrh, hot flushes and chills.

Magnesium phosphate:

is an antispasmodic which ensures smooth muscle movement and is prescribed for cramps, spasms, relief from sharp pains, flatulence, hiccups, headaches with shooting pains, low energy and neuralgia.

Natrum muriaticum:

aids water metabolism, moisturizes the tissues and assists glandular function and digestion. It is used for dryness or excessive moisture in any part of the body, watery colds and sneezing, dry lips, dry itchy skin and eyes, hay fever, loss of taste or smell, headaches with constipation, thirst with craving for salty foods, sleep disturbance, fatigue and feelings of helplessness.

Natrum phosphate:

neutralizes acid and aids assimilation of fatty acids. It helps to regulate hepatic and biliary function and is used for acidity, stomach upsets, heartburn, colic, indigestion, rheumatic pain and stiffness, swollen joints, jaundice and nausea.

Natrum sulphate:

eliminates excess water and helps to maintain hepatic and biliary health. It is used for water retention, influenza, liver and gall bladder conditions, including jaundice, hepatitis, digestive upset, nausea and rheumatism.

Silica:

is a cleanser and detoxifier, present in blood, skin, nails, hair bones and connective tissue. It is prescribed for spots, boils, styes, abscesses and other purulent skin conditions, cracked, brittle or split nails, glandular disorders, involuntary twitching of eyes or face muscles, stress and rheumatic pain.

Bodywork therapies

Description

‘Bodywork’ is a generic term used to describe manual, postural and touch therapies which are part of the healing tradition of ‘laying on of hands’ and which subscribe to the basic tenets of symmetry, posture, coordinated movement and gravity, aiming towards bodily re-alignment, balance and efficient function. Some manual therapies, such as Chinese tuina and Japanese shiatsu, may also be referred to as energy medicine and are included in other relevant sections of this book.

Alexander technique

Description

Alexander technique is a system of physical re-education to correct postural defects and habitual patterns of movement and bearing. It was devised by Frederick Alexander, an actor, who developed the system, following his own voice production problems, which he recognized as being due to defective posture and breathing associated with anxiety and ‘stage nerves’. Treatment involves one-to-one lessons with practitioners who act as ‘teachers’ rather than therapists. Emphasis is on balance, breathing, posture, coordination and recognition of bodily tensions which have previously gone unnoticed and treatment aims to teach ways of moving, sitting, standing and walking to reduce strain on the bones, joints and muscles. It can be used occasionally to attend to acute problems, but is more generally viewed as a complete way of life which requires a degree of commitment from the individual.

Evidence:

Some clinical trials indicate the value of the technique for coordination problems such as Parkinson’s disease and for musculoskeletal problems, including those occurring during pregnancy.

Safety:

No information regarding safety, contraindications and precautions was found.

Cacciatore TW, Horak FB, Henry SM. Improvement in automatic postural coordination following Alexander technique lessons in a person with low back pain. Physical Therapy. 2005;85(6):565-578.

Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forschende Komplementärmedizin und Klassische Naturheilkunde. 2003;10(6):325-329.

Jain S, Janssen K, DeCelle S. Alexander technique and Feldenkrais method: a critical review. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):811-825.

Mehling WE, DiBlasi Z, Hecht F. Bias control in trials of bodywork: a review of methodological issues. Journal of Alternative and Complementary Medicine. 2005;11(2):333-342.

Schlinger M. Feldenkrais method, Alexander technique and yoga – body awareness therapy in the performing arts. Physical Medicine and Rehabilitation Clinics of North America. 2006;17(4):865-875.

Stallibrass C, Hampson M. The Alexander technique: its application in midwifery and the results of preliminary research into Parkinson’s. Complementary Therapies in Nursing and Midwifery. 2001;7(1):13-18.

Stallibrass C, Frank C, Wentworth K. Retention of skills learnt in Alexander technique lessons: 28 people with idiopathic Parkinson’s disease. Journal of Bodywork and Movement Therapies. 2005;9:150-157.

Society et al., Society of Teachers of the Alexander Technique: www.stat.org.uk

Aston-patterning

Description

This is an integrative therapy of movement education (neurokinetics), ergonomics (identifying environmental aspects), bodywork (Aston massage, mykinetics, arthrokinetics) and fitness training (self massage, stretching, toning and cardiovascular fitness), based on the premise that all body movement consists of weight transfer, rocking across the hip and leg hinge joints, with matching flexion and extension of the spine, arms and legs. It incorporates reduction of the inherent tension of three-dimensional spiral patterns of movement and the aim is to develop a self awareness in order to achieve the required movement with minimal stress and maximum efficiency.

Evidence:

No evidence in the form of clinical trials or case reports on the efficacy of Aston-patterning could be found, although case reports on its use with children with cerebral palsy have previously been published.

Safety:

No information regarding safety, contraindications or precautions was found.

Hannon J. A review of Aston-patterning. Journal of Bodywork Movement Therapy. 2005;9(4):260-269.

Liptak GS. Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews. 2005;11(2):156-163.

Bowen technique

Description

This is a very gentle technique developed by Tom Bowen (1916–1982), an Australian healer in the 1950s. It is a manual therapy which incorporates a movement involving rolling of the fingers and thumb in order to manipulate soft tissues, thus stimulating energy flow and initiating self healing. The pressure applied by the fingers and thumb is no more than could be tolerated by applying pressure on an eyeball. Treatment sessions involve frequent breaks to facilitate the body to absorb the healing interventions from the therapist.

Evidence:

There is some evidence to suggest that this technique may help with musculoskeletal conditions including frozen shoulder.

Safety:

No specific information regarding safety, contraindications or precautions could be found in the literature.

Carter B. A pilot study to evaluate the effectiveness of Bowen technique in the management of clients with frozen shoulder. Complementary Therapies in Medicine. 2001;9(4):208-215.

Carter B. Clients’ experiences of frozen shoulder and its treatment with Bowen technique. Complementary Therapies in Nursing and Midwifery. 2002;8(4):204-210.

Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complementary Therapies in Medicine. 2001;9(3):178-185.

Potter R. Evidence points to effectiveness of Bowen for frozen shoulder. Physiotherapy Frontline. 2002;8(7):16.

Bowen Association UK: www.bowen-technique.co.uk

Chiropractic

Description

Chiropractic, an offshoot of osteopathy, is a manipulative therapy developed during the 19th century by Daniel Palmer (1845–1913), the term originating from the Greek cheir (hands) and praktikos (practice). Palmer believed that most medical problems result from misalignments of the musculoskeletal system, notably the vertebrae or from subluxation, altered alignment, impaired movement integrity and/or physiological dysfunction, which leads to nerve entrapment and disruption of nerve transmissions.

Specific techniques used in chiropractic include: high velocity– low amplitude (HVLA) thrusts over segments or groups of segments of the body; leverage in which a thrust is performed with counter-stabilization to prevent loss of force; impulse-movement using a short quick thrust; and recoil, in which the force of the practitioner’s arms, chest and hands facilitates the thrust, followed by recoil of the hands from the patient’s vertebrae. Techniques for specific conditions include: the Cox/flexion-distraction, a traction/mobilization technique, particularly useful for intervertebral disc pathology; the Pierce–Stillwagon technique for pelvic and cervical spine dysfunctions; the Thompson technique to correct pelvic dysfunction, particularly if there is a discrepancy in leg length; the Logan basic, in which sacral dysfunctions are treated by using fascial release techniques; and the Webster technique for converting a breech-presenting fetus to cephalic. Another technique, chiroenergetics, aids release of muscular tension associated with suppressed psychological traumas.

There are various types of chiropractic. The Gonstead technique uses high velocity–low amplitude thrusts directly on the locus of impeded movement. McTimoney chiropractic, a particularly gentle form suitable for babies and the elderly, developed by John McTimoney in the 1950s, uses a technique called the toggle-recoil to change the tension surrounding a joint with a rapid thrust followed by immediate release. In the Meric method it is believed that the third thoracic vertebra is the primary centre of subluxation, for which high velocity–low amplitude thrusts are applied.

Evidence:

Chiropractic is most commonly used for musculoskeletal problems notably back and neck pain and there is a fair amount of clinical evidence, at least in the form of case studies and single case cohorts. The therapy has also been found to be effective for the treatment of soft tissue conditions triggered or exacerbated by musculoskeletal misalignment, e.g. duodenal ulcer.

Safety:

Chiropractors are statutorily regulated by the General Chiropractic Council and, as such, must adhere to a code of practice which requires them to remain up-to-date in their knowledge and skills, therefore practitioners should be aware of relevant contraindications and precautions to treatment. Chiropractic is not suitable for people with osteoporosis, advanced degenerative joint disease or bone metastases. Initial adverse reactions include temporary dizziness, local discomfort or numbness or radiating pain. Some reports of very rare complications include stroke and neurological damage.

Beattie PF, Nelson RM, Michener LA, et al. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study. Archives of Physical Medicine and Rehabilitation. 2008;89(2):269-274.

Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008;33(Suppl):S176-S183.

Jonas W, Levin S. Essentials of complementary alternative medicine. Baltimore: Lippincott; 1999.

Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. British Journal of Ophthalmology. 2008;92(1):153-155.

Livdans-Forret AB, Harvey PJ, Larkin-Thier SM. Menorrhagia: a synopsis of management focusing on herbal and nutritional supplements and chiropractic. Journal of the Canadian Chiropractic Association. 2007;51(4):235-246.

Maiers MJ, Hartvigsen J, Schulz C, et al. Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials. BMC Musculoskeletal Disorders. 2007;8:94.

McHardy A, Hoskins W, Pollard H, et al. Chiropractic treatment of upper extremity conditions: a systematic review. Journal of Manipulative and Physiological Therapeutics. 2008;31(2):146-159.

Myers SS, Phillips RS, Davis RB, et al. Patient expectations as predictors of outcome in patients with acute low back pain. Journal of General Internal Medicine. 2008;23(2):148-153.

Pistolese RA. The Webster technique: a chiropractic technique with obstetric implications. Journal of Manipulative and Physiological Therapeutics. 2002;25(6):E1-E9.

Rasmussen HR, Terndrup PG, Myburgh C, et al. Pain perception in patients with intermittent low back pain. Journal of Manipulative and Physiological Therapeutics. 2008;31(2):127-129.

Rubinstein SM, Leboeuf-Yde C, Knol DL, et al. Predictors of adverse events following chiropractic care for patients with neck pain. Journal of Manipulative and Physiological Therapeutics. 2008;31(2):94-103.

Ruiz-Sáez M, Fernández-de-las-Peñas C, Blanco CR, et al. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. Journal of Manipulative and Physiological Therapeutics. 2007;30(8):578-583.

Theberge N. The integration of chiropractors into healthcare teams: a case study from sport medicine. Sociology of Health and Illness. 2008;30(1):19-34.

British Chiropractic Council: www.chiropractic-uk.co.uk

Chiropractic Patients Association: www.chiropatients.org.uk

General Chiropractic Council: www.gcc-uk.org

McTimoney Chiropractic Association: www.mctimoney-chiropractic.org

Feldenkrais

Description

Feldenkrais was developed by Moshe Feldenkrais and offers a process of body re-education which aims to make clients aware of the body in motion, to improve flexibility and to enhance well-being through touch and gentle manipulation. This is achieved either on a one-to-one basis (during which individually tailored touch and manipulation are referred to as ‘functional integration’) or in group sessions (in which exercises are performed to develop body awareness and flexibility, i.e. ‘awareness through movement’).

Evidence:

There is some suggestion for the use of this technique for chronic pain. It may also have a place in the treatment of people with cerebral palsy, possibly facilitating improved movement.

Safety:

No information regarding safety, contraindications or precautions was found.

Buchanan PA, Ulrich BD. The Feldenkrais Method: a dynamic approach to changing motor behavior. Research Questions Exercise Sport. 2001;72(4):315-323.

Gard G. Body awareness therapy for patients with fibromyalgia and chronic pain. Disability Rehabilitation. 2005;27(12):725-728.

Ives JC. Comments on ‘the Feldenkrais Method: a dynamic approach to changing motor behavior’. Research Quarterly for Exercise and Sport. 2003;74(2):116-123. discussion 124–126

Jain S, Janssen K, DeCelle S. Alexander technique and Feldenkrais method: a critical overview. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):811-825.

Liptak GS. Complementary and alternative therapies for cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews. 2005;11(2):156-163.

Maher CG. Effective physical treatment for chronic low back pain. Orthopedic Clinics of North America. 2004;35(1):57-64.

Mehling WE, DiBlasi Z, Hecht F. Bias control in trials of bodywork: a review of methodological issues. Journal of Alternative and Complementary Medicine. 2005;11(2):333-342.

Schlinger M. Feldenkrais Method, Alexander Technique and yoga – body awareness therapy in the performing arts. Physical Medical Rehabilitation Clinics North America. 2006;17(4):865-875.

Feldenkrais Guild UK: www.feldenkrais.co.uk

Heller work

Description

Heller work was developed by Joseph Heller in the 1970s and is based on the concepts of deep tissue massage which unblocks the body; verbal dialogue to assess emotional holding patterns; and movement re-education to correct postural misalignment. It is believed that memory is seated not only in the brain but also in the muscles and tissues of the body, so that adjusting the body at the physical level can also produce an emotional effect, while conversely, addressing emotional issues assists in the amelioration of physical conditions. The therapy follows a rigid structure of 11 sessions with follow-up advice and exercises.

Evidence:

No studies relating to the efficacy or safety of Heller work could be found.

Safety:

No information regarding safety, contraindications or precautions was found.

Moran D S, Pandolf K B, Heled Y et al; US Army Research Institute of Environmental Medicine; Natick, Massachusetts 01760-5007, USA 2003 Combined environmental stress and physiological strain indices for physical training guidelines. Journal of Basic and Clinical Physiology and Pharmacology 14(1):17–30

Heller work Heller work: www.hellerwork-europe.com

Massage

Description

The concept of massage has evolved into a number of interventions and techniques, ranging from gentle soothing movements to deep massage techniques. The most commonly used, movements include: effleurage, a deep or superficial stroking using the palmar surface of the hand to aid relaxation and circulation; pétrissage, a circular kneading movement with fingers and thumbs to stimulate muscles, improve lymphatic drainage and circulation and to break up adhesions; stimulating movements such as friction and percussion (brisk hacking or tapping with the fingertips); tapotement, in which rapid, repeated taps with the palms, sides or cupped hands are used to stimulate and revive; and vibration, the use of small superficial rapid movements of the fingertips or palms. Massage is incorporated into many traditional systems of medicine, including Japanese anma, Chinese tuina, Swedish massage, Indian head massage, Thai yoga massage and Hawaiian lomi lomi. It is also the foundation for many other bodywork therapies, as detailed in this section.

Evidence:

Massage has been shown to aid relaxation, ease pain and discomfort and improve well-being. Several studies with preterm babies demonstrate its effectiveness in improving weight gain, intellectual ability and overall prognosis; it is also of value in treating children with attention deficit hyperactivity disorder (ADHD) and depressed adolescents. In pregnancy, massage enhances fetal well-being and improves labour outcomes. In adults, it is beneficial in reducing blood pressure, stimulating excretory processes and for general relaxation.

Safety:

The deep relaxation induced by massage means that it should only be used with extreme caution in epileptics, especially those in whom a fit may be triggered by sedation as opposed to stimulation. This factor also suggests that massage, particularly that which specifically induces relaxation, may be contraindicated for people with psychosis or hallucinations, although it may be of benefit during a non-active period of illness. Direct massage over areas of thrombosis, varicosities, fracture or tumour should be avoided but generalized massage is acceptable for people with these conditions, with caution. As massage has a warming effect, it should not be performed during a febrile episode. During the first trimester of pregnancy, brisk massage of the heels is probably best avoided, as this area corresponds to the reflexology zone for the pelvis; abdominal massage should be avoided if the placenta is situated on the anterior wall of the uterus or if there is any history of antepartum bleeding; and breast massage may be uncomfortable or rejected due to leakage of colostrum.

Beider S, Mahrer NE, Gold JI. Pediatric massage therapy: an overview for clinicians. Pediatric Clinics of North America. 2007;54(6):1025-1041.

Cambron JA, Dexheimer J, Coe P, et al. Side-effects of massage therapy: a cross-sectional study of 100 clients. Journal of Alternative and Complementary Medicine. 2007;13(8):793-796.

Coelho HF, Boddy K, Ernst E. Massage therapy for the treatment of depression: a systematic review. International Journal of Clinical Practice. 2008;62(2):325-333.

Ejindu A. The effects of foot and facial massage on sleep induction, blood pressure, pulse and respiratory rate: crossover pilot study. Complementary Therapies in Clinical Practice. 2007;13(4):266-275.

Frey Law LA, Evans S, Knudtson J, et al. Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. Journal of Pain. 2008;9(8):714-721.

Hughes D, Ladas E, Rooney D, et al. Massage therapy as a supportive care intervention for children with cancer. Oncology Nursing Forum. 2008;35(3):431-442.

Imamura M, Furlan AD, Dryden T, et al. Evidence-informed management of chronic low back pain with massage. Spine Journal. 2008;8(1):121-133.

Jabr F. Massive pulmonary embolism after leg massage. American Journal of Physical Medicine and Rehabilitation. 2007;86(8):691.

Kaye AD, Kaye AJ, Swinford J, et al. The effect of deep-tissue massage therapy on blood pressure and heart rate. Journal of Alternative and Complementary Medicine. 2008;14(2):125-128.

Mitchinson AR, Kim HM, Rosenberg JM, et al. Acute postoperative pain management using massage as an adjuvant therapy: a randomized trial. Archives of Surgery. 2007;142(12):1158-1167.

O’Higgins M, St James Roberts I, Glover V. Postnatal depression and mother and infant outcomes after infant massage. Journal of Affective Disorders. 2007;109(1–2):189-192.

Robershawe P. Massage improves sleep in infants with low birth weight. Journal of Australian Traditional Medicine Society. 2007;13(1):33.

Robershawe P. Regular massage in late pregnancy decreases pain in labour. Journal of Australian Traditional Medicine Society. 2007;13(1):7.

Russell NC, Sumler SS, Beinhorn CM, et al. Role of massage therapy in cancer care. Journal of Alternative and Complementary Medicine. 2008;14(2):209-214.

Stringer J, Swindell R, Dennis M. Massage in patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Psychooncology. 26, 2008. Feb

General Council for Massage Therapy: www.gcmt-uk.org

Metamorphic technique

Description

Metamorphic technique has its origins in reflexology and was developed by Robert St John (1912–1996), a British naturopath and reflexologist. The technique involves a light touch to the reflex points in the foot, hands and head which relate to the spinal column in order to bring about transformations in the energy patterns. Metamorphic technique was originally called ‘prenatal therapy’ the aim of which was to remove energy blockages, thought to have occurred while the person was still in utero, by activating reflexology points relating to the spinal column which are also said to correspond to the various stages of fetal life. These energy blocks are thought to have manifested themselves as patterns of behaviour and the aim of therapy was to release them. Subsequently, another therapist, Gaston Saint-Pierre, suggested that treatment should aim to dissolve rather than unblock the energy blockages.

Evidence:

No contemporary clinical research on safety or efficacy could be found; some early accounts reported the apparent success of Metamorphic technique in aiding socialization and improving physical interactions of children with autism, but these have not been included here since no more recent reports have been found.

Safety:

No information regarding safety, contraindications or precautions was found.

No recent professional literature was found

No recent professional literature was found..

Metamorphic Association: www.metamorphicassociation.org

Osteopathy

Description

Osteopathy is a manipulative therapy founded by Dr Andrew Taylor Still, based on the principle that the foundation of good health lies in correct alignment of the musculoskeletal system. Misalignment of the musculoskeletal system, due to injury, trauma, disease or genetic factors, places stress and tension on the body, leading to further disease and disorder in related organs or systems. Techniques used include gentle passive movements, such as strain and counterstrain to treat muscle spasm, myofascial soft tissue release and lymphatic drainage, in which movements similar to effleurage are directed towards the heart to increase lymphatic return. Other techniques include high velocity–low amplitude movements, using short quick thrusts (high velocity) over short distances (low amplitude) against resistance; and muscle energy technique, involving the tensing and releasing of certain muscles to induce relaxation.

An off-shoot of osteopathy is cranial osteopathy, developed by William Sutherland and based on his assertion that the cerebrospinal fluid pulses rhythmically at 12–15 beats/min: disturbance of this pulsation can lead to imbalances within the body. Treatment involves tiny manipulations of the skull, spinal column and sacrum and manipulation of the soft tissues, fluid and membrane of the craniosacral system. Cranial osteopaths are always qualified osteopaths, whereas those who practise a similar technique called cranio-sacral therapy, a further development of Sutherland’s work brought to the UK by the American osteopath Dr J. Upledger, may be either osteopaths or physiotherapists or lay practitioners.

Evidence:

Several trials demonstrate the effectiveness of osteopathy primarily in the treatment of musculoskeletal disorders, disability and chronic pain, specifically back pain. There is some evidence that craniosacral therapy can be useful for treating colic in babies and that it may have a role in the treatment of dementia in the elderly. However, systematic reviews have shown variable results, with osteopathy being viewed positively, but highlighting that there is insufficient evidence to support the use of craniosacral therapy.

Safety:

Osteopaths are statutorily regulated by the General Osteopathic Council and, as such, must adhere to a code of practice which requires them to remain up-to-date in their knowledge and skills, therefore, practitioners should be aware of relevant contraindications and precautions to treatment. Osteopathy is not suitable for people with osteoporosis, advanced degenerative joint disease or bone metastases. Initial adverse reactions include temporary dizziness, local discomfort or numbness or radiating pain. Some reports of very rare complications include stroke and neurological damage.

De-Angelo N, Gordin V. Treatment of patients with arthritis related pain. Journal of the American Osteopathic Association. 2004;104(11 Suppl 8):s2-s5.

Downey PA, Barbano T, Kapur-Wadhwa R, et al. Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement. Journal of Orthopaedic and Sports Physical Therapy. 2006;36(11):845-853.

Duncan B, Barton L, Edmonds D, et al. The somatic connection. Osteopathic manipulative treatment and acupuncture proved therapeutic benefit to children with spastic cerebral palsy. Journal of the American Osteopathic Association. 2006;106(7):381.

Eisenhart A, Gaeta T, Yens D. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. Journal of the American Osteopathic Association. 2003;103(9):417-421.

Gerdner LA, Hart LK, Zimmerman MB. Craniosacral still point technique: exploring its effects in individuals with dementia. Journal of Gerontological Nursing. 2008;34(3):36-45.

Gillespie BR. Case study in pediatric asthma: the corrective aspect of craniosacral fascial therapy. Explore (NY). 2008;4(1):48-51.

Green C, Martin CW, Bassett K, et al. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complementary Therapies in Medicine. 1999;7(4):201-207.

Harvey E, Burton A, Moffett J, et al. Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations. Manual Therapies. 2003;8(1):46-51.

Licciardone J. The unique role of osteopathic physicians in treating patients with low back pain. Journal of the American Osteopathic Association. 2004;104(Suppl):s13-s18.

Licciardone J. Responding to the challenge of clinically relevant osteopathic research: efficacy and beyond. International Journal of Osteopathic Medicine. 2007;10(1):3-7.

Licciardone J, Stoll S, Fulda K, et al. Osteopathic manipulative treatment for chronic low back pain: a randomised controlled trial. Spine. 2003;28(13):1355-1362.

McManus V, Gliksten M. The use of craniosacral therapy in a physically impaired population in a disability service in southern Ireland. Journal of Alternative and Complementary Medicine. 2007;13(9):929-930.

Nourbakhsh MR, Fearon FJ. The effect of oscillating-energy manual therapy on lateral epicondylitis: a randomized, placebo-control, double-blinded study. Journal of Hand Therapy. 2008;21(1):4-13.

Potter L, McCarthy C, Oldham J. Physiological effects of spinal manipulation: a review of proposed theories. Physical Therapy Review. 2005;10(3):163-170.

Tsao JC, Meldrum M, Kim SC, et al. Treatment preferences for CAM in children with chronic pain. Evidence-Based Complementary and Alternative Medicine. 2007;4(3):367-374.

Weng-Lim K. Infantile colic: a critical appraisal of the literature from an osteopathic perspective. International Journal of Osteopathy. 2006;9(3):94-102.

General Osteopathic Council: www.goc.org www.osteopathy.org.uk

Chartered Society of Physiotherapists: www.csp.org.uk

National Back Pain Association: www.backpain.org

Reflexology

Description

Reflexology is a generic term referring to the use of one small part of the body which is said to represent a map of the whole. It is thought to have been used by the Chinese over 5000 years ago and has been recorded in Assyria, India and Egypt. Generally, reflexology is delivered via the feet, but the hands, face, ear, back and tongue can also be used. Although the treatment is relaxing – and can be used for relaxation, relief of stress, tension and anxiety – it is not simply a massage, but utilizes precise pressure points which are thought to reflect back to the organs they represent, possibly via neural pathways, although contemporary theories focus more on the meridian approach similar to Oriental medicine. There are various maps and charts in use; contemporary academics aim to explore the variations between these different charts. Reflexology can be used to restore and maintain homeostasis and is commonly given as a general relaxing session, but in clinical reflexology, specific conditions can also be treated.

There are various styles of reflexology. Reflex zone therapy, developed by Hanne Marquardt from the zone therapy work by William Fitzgerald, an American ear, nose and throat surgeon, works on the principle of both longitudinal and horizontal zones on the feet, corresponding to different sections of the body; treatment intends to focus on the causes of disease, rather than just the symptoms. Reflex zone therapy takes a more reductionist, clinical approach to treatment than generalized reflexology, some forms of which have a more esoteric approach based on the principles of energy medicine. Chi reflexology and Five Element reflexology focus more specifically on the meridians of Chinese medicine; upright reflexology utilizes the dorsal surfaces of the feet with the client in the upright position; Vacuflex™ reflexology involves the use of a special inflatable ‘boot’ via which pressure can be applied to the reflex zones in the feet.

Evidence:

Reflexology has been shown to ease pain, perhaps via the gate control theory, although some have questioned this, believing it to be a placebo effect. Other studies have favourably compared reflexology to standard pharmacological treatments for conditions such as headache, labour pain and backache. Symptoms of multiple sclerosis, irritable bowel syndrome, constipation and premenstrual syndrome have also responded well to reflexology. The claim by reflexologists that they can identify changing physiology and potential pathology has not been confirmed in formal studies, which suggests that practitioners tend to ‘over-diagnose’ identifying conditions which do not actually exist.

Safety:

There are several contraindications and precautions to reflexology treatment. Care should be taken when treating diabetics, as over-stimulation of the foot zone relating to the pancreas may theoretically trigger a hypoglycaemic attack. Treatment is completely contraindicated in epileptics, as the deep relaxation from treatment could trigger a fit. Those with deep vein thrombosis should not receive foot reflexology, although hand or ear treatment is possible; caution should be used when treating clients with varicose veins. Reflexology should also be used with caution in individuals who have foreign bodies in situ, as there is a theoretical possibility that these could be moved out of position, for example, a pacemaker, intrauterine contraceptive device or even abnormal pathology such as renal calculi or gallstones. Treatment is warming and should therefore not be used on patients with hyper-pyrexia. During pregnancy, treatment should generally only be given by practitioners who are either midwives or who have undertaken specialist preparation to treat pregnant clients. It is safe for children. Cancer patients should be treated with caution and may only be able to tolerate sessions of short duration.

Bishop E, McKinnon E, Weir E, et al. Reflexology in the management of encopresis and chronic constipation. Paediatric Nursing. 2003;15(3):20-21.

Brendstrup E, Launso L, Eriksen L. Headaches and reflexological treatment, 4th edn. London: Association of Reflexologists’ Research Reports; 1997.

Brown CA, Lido C. Reflexology treatment for patients with lower limb amputations and phantom limb pain. An exploratory pilot study. Complementary Therapies in Clinical Practice. 2008;14(2):124-131.

Deborah M. Reflexology and integrative imagery: promoting healing in patients, families and practitioners. Beginnings. 2007;27(4):6-7.

Hodgson N, Andersen S. The clinical efficacy of reflexology in nursing home residents with dementia. Journal of Alternative and Complementary Medicine. 2008;14(3):269-275.

Kim YS, Kim MZ, Jeong IS. The effect of self-foot reflexology on the relief of premenstrual syndrome and dysmenorrhea in high school girls. Taehan Kanho Hakhoe Chi. 2004;34(5):801-808.

Mackereth P, Tiran D, editors. Clinical reflexology: a guide for health professionals. London: Elsevier, 2002.

Mollart L. Single-blind trial addressing the differential effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy. Complementary Therapies in Nursing and Midwifery. 2003;9(4):203-208.

Mur E, Schmidseder J, Egger I, et al. Influence of reflex zone therapy of the feet on intestinal blood flow measured by color Doppler sonography. Forschende Komplementärmedizin und Klassische Naturheilkunde. 2001;8(2):86-89.

Quinn F, Hughes CM, Baxter GD. Reflexology in the management of low back pain: a pilot randomised controlled trial. Complementary Therapies in Medicine. 2008;16(1):3-8.

Tiran D, Chummun H. The physiological basis of reflexology and its use as a diagnostic tool. Complementary Therapies in Clinical Practice. 2005;11(1):58-64.

Tovey P. A single-blind trial of reflexology for irritable bowel syndrome. British Journal of General Practice. 2002;52(474):19-23.

White AR, Williamson J, Hart A, et al. A blinded investigation into the accuracy of reflexology charts. Complementary Therapies in Medicine. 2000;8(3):166-172.

Williamson J, White A, Hart A, et al. Randomised controlled trial of reflexology for menopausal symptoms. British Journal of Obstetrics and Gynaecology. 2002;109(9):1050-1055.

Association of Reflexologists: www.aor.org.uk

Reflexology Forum: www.reflexologyforum.org

Rolfing

Description

Rolfing (also called structural re-integration therapy) involves the use of deep massage techniques to loosen and relax the fascia and muscles, together with re-education of the client to help him/her correct body misalignment and maladaptive movement patterns. It was developed by Ida Rolf (1896–1979), a biochemist who studied a range of complementary therapies when treatment of her own medical condition fell short of her expectations. A key concept is the relationship between the client and the gravitational force acting upon them – a state of equilibrium should be attained so that potential energy (form) is in direct proportion to kinetic energy (function), the balance being equivalent to the amount of available energy in the body. If the person has poor posture, more energy is needed to perform the necessary functions. The system is influenced by three key principles: the osteopathic belief that structure determines function; the homeopathic emphasis on the integration of a person’s mental, emotional and physical factors; and the yogic focus on lengthening and strengthening positions to achieve a balanced body. Treatment involves 10 sessions during which the connective tissue system is lengthened using a series of myofascial release techniques. As treatment progresses, emotional components may be manifest and the unblocking of emotional processes is seen as an integral part of the treatment.

Evidence:

No clinical evidence was found.

Safety:

No information regarding safety, contraindications or precautions was found.

Mehling WE, DiBlasi Z, Hecht F. Bias control in trials of bodywork: a review of methodological issues. Journal of Alternative and Complementary Medicine. 2005;11(2):333-342.

Rolf Institute: www.rolf.org

Trigger point therapy

Description

Trigger point therapy (also called deep tissue therapy, myotherapy or manual ischaemic compression therapy) is a manual therapy based on the principle that, following injury, damaged tissue leads to the development of trigger points, areas of localized hypersensitivity which are tender when compressed. This gives rise to stiffness, restricted movement, fatigue and referred pain. The trigger points can be activated if the muscle is over-used or there is excess emotional or physical stress, resulting in spasm, deep muscular ache or sharp disabling pain leading to a spasm/pain/spasm cycle. Treatment involves deactivation of the trigger point and myomassage to relieve the spasm.

Evidence:

Recent evidence supports the use of this technique for headache and myofascial pain.

Safety:

No information was available regarding safety. No evidence of any contraindications was found.

Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Practice Research Clinical Rheumatology. 2007;21(2):367-387.

Fernández-de-las-Peñas C, Cleland JA, Cuadrado ML, et al. Predictor variables for identifying patients with chronic tension-type headache who are likely to achieve short-term success with muscle trigger point therapy. Cephalalgia. 2008;28(3):264-275.

Ga H, Koh HJ, Choi JH, et al. Intramuscular and nerve root stimulation vs lidocaine injection to trigger points in myofascial pain syndrome. Journal of Rehabilitation Medicine. 2007;39(5):374-378.

Itoh K, Hirota S, Katsumi Y, et al. Trigger point acupuncture for treatment of knee osteoarthritis – a preliminary RCT for a pragmatic trial. Acupuncture in Medicine. 2008;26(1):17-26.

Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiology Clinics. 2007;25(4):841-851. vii–iii

Malanga G, Wolff E. Evidence-informed management of chronic low back pain with trigger point injections. Spine Journal. 2008;8(1):243-252.

Breathwork therapies

Description

Breathwork is a collective term for several therapies which aim to heal through the medium of breathing exercises and techniques, with breath control, to maximize the body’s physical potential and to clear and clarify the mind.

Buteyko

Description

This therapy was devised by Dr Konstantin Buteyko in Moscow and aims primarily to alleviate asthma symptoms, but has also been used for allergies, hyperventilation, emphysema and chronic obstructive pulmonary disease. The system aims to teach the person to breathe very shallowly, avoiding deep inspirations, both at the onset of and during an asthma attack thus raising alveolar carbon dioxide levels.

Evidence:

Results from some clinical trials indicate a reduction in inhaler use in asthmatics but the technique is generally not supported by the Cochrane Review team.

Safety:

No information was found regarding safety, contraindications or precautions. However, conventional healthcare professionals should advise patients that this therapy should not be used as a substitute for orthodox medical treatment in life-threatening situations.

Al-Delaimy W, Hay S, Gain K, et al. The effects of carbon dioxide on exercise induced asthma: an unlikely explanation for the effects of Buteyko breathing training. Medical Journal of Australia. 2001;174(2):72-77.

Bowler S, Green A, Mitchell C. Buteyko breathing techniques in asthma: a blinded randomised trial. Medical Journal of Australia. 1998;169(11–12):575-578.

Bruton A, Lewith G. The Buteyko breathing technique for asthma: a review. Complementary Therapies in Medicine. 2005;13(1):41-46.

Courtney R, Cohen M. Investigating the claims of Konstantin Buteyko, MD, PhD: the relationship of breath holding time to end tidal CO₂ and other proposed measures of dysfunctional breathing. Journal of Alternative and Complementary Medicine. 2008;14(2):115-123.

Cowie RL, Conley DP, Underwood MF, et al. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respiratory Medicine. 2008;102(5):726-732.

Holloway E, Ram F. Breathing exercises for asthma. Cochrane Database of Systematic Reviews. (3):2000. CD001277

Kuiper D. Dysfunctional breathing and asthma. Trial shows benefits of Buteyko breathing techniques. British Medical Journal. 2001;323(7313):631-632.

McHugh P, Duncan B, Houghton F. Buteyko breathing technique and asthma in children: a case series. New Zealand Medical Journal. 2006;119(1234):U1988.

McHugh P, Aitcheson F, Duncan B, et al. Buteyko: an effective complementary therapy. New Zealand Medical Journal. 2004;117(1189):U781.

Opat AJ, Cohen MM, Bailey MJ, et al. A clinical trial of the Buteyko breathing technique in asthma as taught by a video. Journal of Asthma. 2000;37(7):557-564.

Shaw A, Thompson EA, Sharp D. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study. BMC Health Services Research. 2006;6:76.

Thomas S. Buteyko: a useful tool in the management of asthma? International Journal of Therapeutic Rehabilitation. 2004;11(10):476-480.

White A. The Buteyko explanation of asthma does not gain strong support. Focus on Alternative and Complementary Therapies. 2001;6(2):132-133.

Buteyko, Buteyko: www.buteyko.co.uk

Rebirthing

Description

This modality was instigated by Leonard Orr in the 1960s when he noticed that hot water and relaxation induced a sense of being ‘somewhere else’. He developed a system to harness this feeling, using connected breathing, which apparently leads to a complete rebirthing experience, enabling people to address childhood issues of self esteem or lack of assertiveness. Later he decided that hot baths were not necessary for the process and that the key to success was in the breathing technique. Contemporary rebirthing requires 10 sessions with a rebirther and thereafter, people can rebirth themselves.

Evidence:

No evidence from clinical trials was found, but surveys of attitudes to complementary medicine and its use among the general public occasionally mention rebirthing as a popular therapy.

Safety:

No information regarding safety, efficacy, contraindications and precautions was found.

Begg D. A guide to rebirthing. Connections. 2001;39:30-32.

Malassiotis A, Margulies A, Fernandez-Ortega P, et al. Complementary and alternative medicine use in patients with haematological malignancies in Europe. Complementary Therapies in Clinical Practice. 2005;11(2):105-110.

British Rebirth Society: www.rebirthingbreathwork.co.uk

Vivation

Description

Vivation claims to teach the client how to be happy – happiness being regarded as a skill which can be learned – and involves the integration of negative experiences in order that they may become positive, through circular breathing to re-energize the energy patterns. Complete relaxation as an aid to reducing resistance; awareness in detail through interpretation of the feelings experienced; and integration into ecstasy – changing the context of the feeling and transforming it to a positive experience. This aims to focus on the person’s willingness to experience the integration.

Evidence:

Safety:

No information regarding efficacy, safety, contraindications or precautions was found.

No professional literature was found

No professional literature was found..

Vivation Vivation: www.vivation-uk.com

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A-Z of Complementary and Alternative Medicine A guide for health