The Importance of Bodywork
We've been exploring the importance of the basics of self-care
during the summer months, to maximize the benefits to your health.
If you remember our last few columns, the primary focus has been
on qi, the body's vital energy, and how to cultivate more of it
from the food we eat and drink and our daily lifestyle. You already
know the body uses vital energy for all its physiologic processes,
such as endocrine functions, cellular function, and especially
the healing process.
The importance of bodywork as a part of general maintenance cannot
be overstated, and the topic is so vast I almost don't know where
to begin. First, let's clarify what I mean by bodywork: chiropractic,
therapeutic massage, acupuncture and oriental massage, bioenergetics,
feldenkrais, and yoga therapy are just the tip of the body-work
iceberg and play an important role in both the healing process
and general preventive maintenance.
In the beginning
One of the basic tenets in traditional Chinese medicine (TCM)
is the adage "Where there is blockage, there is pain."
We learned it on our first day of graduate school, and continued
to hear it throughout. From the standpoint of TCM, whenever the
free-flowing nature of qi is blocked or moved from its natural
course, it will accumulate and cause pain or internal disease.
To keep things simple, we will discuss a few basic reasons for
this: excess, deficiency and stasis/stagnation.
You may find it helpful to keep in mind the idea of a streambed
for this principle. Picture, if you will, a mountain stream with
ample water running through it so that the water moves freely,
and is clean, clear; it stays within its natural boundaries, and
it is fresh - nourishing to what surrounds it. This is a good
metaphor for the movement of qi through the body in the absence
of disease. Now a river at the end of the summer or during times
of drought has less volume moving in the creek bed; it pools up
in places because there is not enough water to push through the
rocks, due to a deficiency. When water pools, it becomes stagnant
(with all the bugs and scum floating on the top).
Now translate this principle into the human body: when there
is a deficiency of qi so that there is not enough to flow through
its natural course, it will pool and stagnate. If left unattended,
it will accumulate to cause pain or disease (maybe that is our
layer of scum at the top of the pool
Similarly, a creek bed in the springtime after the snowmelt will
often overflow the banks, with water flooding outside the normal
course. This is due to too much water flowing through the riverbed,
causing flooding and damage to the surrounding area. This also
results in stagnation - only this time due to an excess, which
also will cause pain or disease if left unattended.
The purpose of regular bodywork is to ensure that the body's
vital energy moves in its proper direction, that there is enough
of it so that things do not pool up and become stagnant, or overflow
and cause 'flooding.' How much and what type of bodywork to get
may seem confusing, but there are some general concepts to keep
in mind that may be helpful when exploring this for the first
Fans of Star Trek (my favorite analogy) will have heard about
'structural integrity' in terms of the ship staying in one piece.
Our physical body is similar to the Enterprise - it is the vessel
for our travels though time and space. In this case, I define
structural problems as musculoskeletal (and joints). The large
muscle groups support the alignment of the body: the quadriceps,
periformis, psoas, and hamstrings support the alignment of the
pelvis, the erector spinae on either side of the spinal column
help maintain the spine in its proper curvature, shoulder and
cervical muscles connect in the neck region. While it may be obvious
that sprain/strain, insufficient exercise, injury and trauma will
cause these muscle groups to move out of balance (resulting in
inflammation and pain), you may not understand that it also takes
qi or vital energy to hold bones and muscles in their proper alignment,
not just strength and flexibility. It is how someone with a TCM
diagnosis of kidney deficiency may have mild low back pain as
a symptom. The vital energy of the kidneys (separate from Kidney
organ function) help to strengthen that area of the body. It is
also why someone with an excess of liver qi may experience sharp
pain down the sides of the legs - the energetics of this organ
influence this region of the body. Because a long-term deficiency
or excess can result in a structural problem even in the absence
of an injury, regular bodywork is essential to maintaining structural
In my private practice, I use acupuncture and oriental medicine
to regulate qi flow, since it is wonderful for relieving the pain
of stagnation whether it caused by excess or deficiency (usually
things are a mixture of both). We build up the body when there
is not enough "water" moving through the stream, and
drain areas when there is too much. Generally, my patients with
chronic back pain often require a structural adjustment from a
chiropractor followed by deep tissue massage or acupuncture to
breakup the scar tissue or muscle tension that moved the vertebrae
out to begin with. The muscles of the body have memory - and it
takes time and physical manipulation to coax them back into proper
alignment, and relieve the pain of inflammation.
How quickly someone responds to treatment is a mixture of things:
- How long have you had the condition?
- How severe is the problem?
- How healthy were you to begin with? Do you have an underlying
internal condition that hampers your recovery?
- Are you willing to take supportive measures such as yoga and
strength training to prevent recurrences?
For patients who are particularly deficient from chronic endocrine
disorder such as hypothyroid or diabetes, immuno-compromised,
or undergoing multiple drug regimens, it will take longer to experience
physical relief because the body is often too weak to hold itself
together properly for any length of time. It is why you may feel
really good for a day or two after a treatment, only to find the
body returning to the old pattern a few days later. Rest assured
it is a good sign - your body is responding to treatment. The
muscles have just not healed enough to stay in their proper position.
A good rule of thumb is to allow one month of regular treatment
(regular meaning 2x per week) for every month you have had the
condition. Multiple modalities, such as massage with acupuncture
and chiropractic will generally yield faster results that are
more complete, because you are addressing several aspects at the
same time - bones (chiropractic), muscles (deep tissue massage),
pain/ inflammation/ weakness and atrophy (acupuncture and oriental
A Word about Stress
Stress has become a dirty word outside both inside and out of
the medical community, and seems to be considered largely a mental
phenomenon by both physicians and lay-persons alike. Stress is
usually associated with negative experiences such as job, the
daily commute, the loss of a family member, etc., culminating
in acts of violence at the post-office. To add insult to injury,
western medicine lists as a mental-emotional disorder, which implies
psychosomatic or all-in-your-head type symptoms. For most, the
association is not a pleasant one.
Stress, however, is not just a mental experience and is not related
to whether you enjoy an experience or not - it is a physiological
process that happens at the cellular level that affects endocrine
balance and cellular chemistry (remember hormones such as adrenaline,
epinephrine, nor-epinephrine? 1 There are dozens). And if you
have been following this series of articles (and reading all the
footnotes!) then you have started to figure out my basic theme:
all these processes (sleep, diet, nutrition, endocrinology, bodywork,
etc.) are inter-connected - they affect each other and they affect
the amount of vital energy available to the body.
Let's start with the basic premise that if you live on planet
earth, then stress is part of the package. Even if you are healthy,
pain-free, and love everything about your life, you will still
experience levels of physiological (e.g. cellular) stress that
can, over time, have a large impact on your health. 2 If you have
a chronic disease or suffer from chronic pain, be aware that you
will be even more susceptible physiologically to stress than the
average person. I repeatedly treat high-powered businessmen and
women who are very successful, love what they do, and who insist
that they don't have stress. (Meanwhile, their eyes are bugging
out of their heads, and their bodies have broken down to the point
of excruciating pain - but they don't have stress).
The reason I bring up the topic of stress is because many people
think of massage and acupuncture as a 'feel good' tool to promote
relaxation and alleviate stress. As luck would have it, stress
reduction seems to be one area where medical doctors are actually
willing to refer for acupuncture. Don't discount the impact that
daily stress will have on the physical body, even in the absence
of a serious illness.
Poly-pharmacy is not the way
I find it disheartening that many of my patients with pain issues
have consulted with their primary care physicians (PCPs), only
to be sent home with a potent mixture of medications - usually
some combination of Vicodin, Percocet, and Flexeril. Not only
does it usually leave them too medicated for daily living, but
it does virtually nothing to treat the cause of the condition.
Please be advised that many MDs do this with the best of intentions
- they have been trained that most conditions, if left well enough
alone, will spontaneously resolve themselves within 2 years. (We
were taught that in our curriculum as well). In addition, individuals
who are motivated to seek additional care are strongly discouraged
by their PCPs about the 'dangers' of alternative therapies. This
is extremely unfortunate. In my clinical experience, most people
with structural problems do NOT recover spontaneously, and, in
fact, get worse when untreated.
Rest assured, there is care available for structural problems
- no one need live in pain all the time, and quality care from
a qualified licensed professional will often dramatically speed
the healing process. I don't know anyone who has 2 years to hang
around and wait.
It is up to you as the health care consumer to develop a bold
attitude toward your health care and your body: become your own
scientist and begin to explore all the possibilities available!
Alternative medicine is not the mysterious place it used to be
- there are thousands of qualified licensed professionals who
are available to render aid. If you don't like the first practitioner
or modality you try, try again. Ask friends and family for practitioners
with whom they have experienced true healing; discuss you concerns
with your provider. Be aware that many medical doctors have not
learned the art of self-care themselves - they often take extremely
poor care of themselves, so they may not be able to advise you
in this area. There are good, mediocre, and poor practitioners
in every profession, and it sometimes takes a little effort to
find the right person to work with. But for the thousand of people
in this country who have been given their lives back by acupuncture,
chiropractic, massage therapy et al., the search has been well
Feel free to contact me directly at firstname.lastname@example.org.
of the Endocrine System
2. A good example of this can be seen when looking at the statistics
for female skydivers. Professionals who average hundreds of jumps
have a 50% greater chance of becoming hypothyroid in their lifetime.
The exact reason for this remains unclear, but basic endocrinology
tells us that even if you love the experience of jumping out of
an airplane, it violates our basic preservation instinct, and
the body regularly dumping high amounts of adrenaline into the
system (hence the rush). Adrenal burnout is seen as one of the
causative factors in clinical hypothyroidism.