REFLEXOLOGY FOR BACK PAIN Why is it important for reflexologists to have in-depth knowledge about back pain? 1. A few facts: - According to the American Pain Foundation, back pain is the - main cause of disability among Americans under the age of 45. - According to the World Health Organization, low back pain is a - leading cause of disability in the world. - Americans spend $86 billion per year trying to find solutions to - their aching backs. - These $86 billion have not helped to reduce the amount of - people suffering from back pain. - The incidence of back pain among teenagers in industrialized - countries is increasing. A study on 14,400 schoolchildren aged - 13 to 15, published in 2003 in the journal of the International - Association for the Study of Pain - Pain (103:259-268) - and - carried out by the Kovacs Foundation (www.kovacs.org), - showed that 50% of the boys and 70% of the girls had already - suffered back pain at some point.

In other words, a high percentage of your patients do or will have back pain, whether it is their primary reason for seeking your help or not. As such, no reflexologist can afford to remain in the dark about this principal cause of disability.

"Complementary" is not the same as "alternative". Alternative means that one course of treatment can be substituted by another. On the other hand, a complementary therapy is a therapy practiced in conjunction with conventional Western medicine for the benefit of the patient (faster healing, pain relief, well-being enhancement, etc.). Reflexology qualifies as a complementary therapy and this requires us to work in cooperation with the medical world - again, for the benefit of our patients. As a matter of fact, all codes of ethics of the profession stipulate clearly that we must refer our clients to the appropriate health care provider if we suspect they suffer from an untreated condition.

However, our relationship with the medical world can go further and the truth is that the world is changing. The health care world is evolving towards something called integrated medicine. The integrated approach to medicine combines traditional Western medicine with complementary therapies but is overseen by doctors, doctors trained in the integrative approach to sickness. This is an evolution that is already well under way in certain countries. For instance, the Hadassah hospital in Israel (www.hadassah.org.il) has a complementary medicine clinic offering the best of traditional and complementary medicines to its patients. They started with oncology patients and then moved on to orthopaedics, neurology, gynecology, and pain treatment with extremely positive results. Other examples are Denmark or the UK. This is our future. This is very exciting news for our profession BUT - and this is no small "but" - if we want to be a part of this new integrated medical world, if we want to speed up this evolution for the benefit of patients, if we want doctors to respect us and to respect our profession, to be willing and enthusiastic to work with us seriously, we need to speak their language, we need to talk the talk. This is why, faced with today's pandemic of back pain, it is so important for reflexologists to distinguish between the scientific facts regarding back pain - which have been proven beyond a doubt by hundreds of reliable studies - and the totally unsubstantiated or obsolete popular beliefs.

What every reflexologist should know about back pain:

1. Essential facts about the back proven by medical research

- A back fulfills a number of very important functions (standing upright, flexibility of movement, and balance) for which it needs to remain strong and flexible. - The absolute nemesis to maintaining one’s back limber for comfortable movement is NOT age but lack of movement. - A back that doesn't exercise becomes weak and adopts bad postures. - A back was designed for a life of physical activity and not for sitting all day long. It is our modern way of life which tempts us to sit so much (work, transport, tv, computer, etc.). For the WEAK BACK, SITTING is one of the most STRENUOUS positions.

- A back is a very strong and resistant structure by nature. Treating one's back like a delicate and breakable object is the wrong attitude, even when it hurts. It only contributes to making it weaker and therefore leads to more pain.

2. The difference between specific and non-specific back pain

Specific back pain is the pain resulting from a serious injury, illness, or acute structural degeneration or deformation of the spine (such as scoliosis, facet joint degeneration, spinal stenosis, disc herniation, etc). Only 10 to 15 % of back pain cases are specific back pain cases.

The rest, known as non-specific back pain, is what 85 to 90% of the population suffering from back pain experiences. It is NOT caused by an injury, an illness, or structural problems of the spine. For many years it was the "unexplainable bad back", the one you had to learn to live with, hence the name. Times have changed. Nowadays, back pain specialists know what's causing it and how to fix it (see point 4).

3. If you're presented with a case of acute isolated back pain

If a patient mentions an acute episode of back pain (with or without incident prior to the pain) partially or totally immobilizing them, keeping them awake at night, you need to refer them to a doctor immediately, if only to be sure nothing is seriously wrong. You can treat them with reflexology to reduce the pain and stimulate the healing process while sending them to the doctor, of course. Be very gentle with all techniques causing the hips to move - such as metatarsal kneading - if the pain is located in the lower back. If there is nerve impingement or disc herniation, any joint movement in the area could cause even more pressure on the nerves and certainly unnecessary pain to the patient. Instruct your patient to let you know immediately if anything you do exacerbates their back pain. You may apply strong pressure on the feet in your treatment - in fact, this is the only way some of the nerves in the foot which are directly connected to the back can be contacted -, just be aware of hip movement.

4. Cases of chronic and recurrent back pain (85 to 90 % of all back pains)

In most cases, back pain is either chronic (daily) or recurrent (comes and goes in episodes which can last for days, weeks, or months) whether it is specific or non-specific. And chances are that most of your patients with back pain will tell you about their bad back "which has been bad for years".

Chronic or recurrent non-specific back pain (= 85 to 90% of all back pain cases) occurs when muscles in the back are weak forcing the adoption of repeated or prolonged bad postures. There is no such thing as unexplainable back pain! The mechanisms of this pain are the following: lack of physical activity combined with an abundance of sitting leads back muscles to become weak. Weak muscles easily overload and force the subject to adopt bad postures, especially in the strenuous sitting position. When muscles overload, they spasm, and in doing so, compress on the surrounding pain nerves. When one part of the back hurts, the person tries to find a position that allows them to stop feeling the pain but in fact, what they are doing is overloading a new set of muscles which are also going to spasm, compress, and activate the surrounding pain nerves. Moreover, the activation of pain nerves in the back causes in itself more contraction of the back muscles. More contraction of the back muscles activates even more the pain nerves. It's a vicious circle which, when prolonged, can be very hard to break. The magnitude of the pain is not proportional to the magnitude of the problem. A simple thing like muscular weakness can cause immense chronic pain.

Research has proven that in these cases the only way out in the long term is: returning to PHYSICAL ACTIVITY and STRENGTHENING THE BACK MUSCLES. Resting and overprotecting one's back is counter-productive and has been shown to worsen the patient's condition.

So what is the role of the reflexologist in these cases? A very important one. Most of these patients are in so much pain that they refuse to return to physical activity. The role of the reflexologist is therefore to reduce the pain or eliminate it so that the patient feels comfortable enough to return to physical activity. The best solution is to refer them to a physical therapist who will give them a specific strengthening program after the pain subsides. The role of the reflexologist is also to explain all these facts about back pain to the patient and letting them know that these facts are the result of extensive clinical research. Many people who suffer from back pain believe there has to be something very wrong with their back because it hurts so much. Now you can reassure your patients that if specialists haven't been able to find a specific cause to their pain, it is very likely that there is nothing seriously wrong with their back, that what they suffer from is non-specific back pain (in other words, weakness of the back muscles combined with a lack of physical activity). Make it clear to them that this is very good news.

When presented with a case of non-specific chronic or recurrent back pain, you need to work on the direct reflexes, the Central Nervous System, all the affected plexuses, the Solar Plexus, and all the stress-related reflex areas. Be aware that chronic or recurrent back pain in combination with overprotective behavior and inactivity can lead to pain spreading throughout the back, going into the neck and causing headaches, going to the shoulders and arms, going to the ribs, going into the buttocks, hips, legs, knees, ankles, and even feet.

If you have a patient whose chronic or recurrent back pain is specific and caused by a structural problem such as scoliosis or disk degeneration, part of the solution is also to reduce the pain through reflexology and then STRENGTHEN THE BACK MUSCLES, since this will slow down - even possibly prevent - further damage. In these cases, preventing further damage is a high priority.

I have seen with my own eyes the metamorphosis that adapted and adequate strengthening exercises can bring about in people of all ages who start out in an appalling state and believe wholeheartedly that all hope is lost for them.

5. Obsolete beliefs

Some back pains are unexplainable: OBSOLETE
Whether specific or non-specific, all back pains are now well understood by specialists. The common back pain is no longer a mystery and can be solved by strengthening the back muscles.

Some people just have bad backs and are doomed to have pain the rest of their lives: OBSOLETE
Absolute nonsense! Some people do have weaker backs than others. No one is doomed. No one. Many injuries can be prevented by strengthening the back and remaining active. Most pains also disappear when strengthening the back muscles.

Young people don't suffer from back pain: OBSOLETE
Unfortunately, yes they do. More and more as a matter of fact. Children under 12 rarely have back pain but at 13 the problems seem to develop. Too much inactivity, not enough sport, too much sitting at desks of the wrong height, and heavy backpacks are some of the contributing factors. Children and adolescents need to be active and do sports to have a strong back. Young people who develop chronic back pain have a very high chance of becoming adults with chronic back pain.

Back pain sufferers should rest as often as possible: OBSOLETE
Back pain sufferers should keep their normal routine as much as possible. The more they rest, the weaker the muscles become. A back sufferer can rest for a few days or a week when he or she is in a lot of pain. This is not the same as "resting as a lifestyle" to overprotect one's back. This will only lead to the muscles in the back becoming very weak and overloading very easily. The only way to reverse this vicious circle is to start strengthening the back muscles.

Back pain sufferers cannot exercise because they need to be careful with their back: OBSOLETE Nonsense! Quite the contrary. Back pain sufferers need to exercise and become active again to reduce or eliminate completely their back pain. With the help of a (sports) physical therapist they can get a strengthening program tailored to their needs. Swimming and pilates also produce excellent results.

There is an age limit to start strengthening the back muscles: OBSOLETE
Simple exercises exist for everyone no matter how bad in shape they are, no matter what their age.

This article was written by Florence Cohen - The medical data and conclusions used in this article are not the personal opinion of the author but reliable medical conclusions obtained from hundreds of clinical studies compiled and assessed for their validity by some of the most renowned back pain specialists in Europe. For more information on back pain, reflexology for back pain, or to access the medical references used for this article we recommend that you browse through the various sections of our website.

Copyright 2009 Florence Cohen - You may not copy this article without authorization.