On the following pages we take a tour of the body’s major trouble spots, in each case looking at how pain most commonly arises there and suggesting appropriate therapies and strategies described more fully in earlier chapters.
Headaches are common, and usually not life-threatening. However, it is wise to get medical advice if a headache is out of the ordinary (for example, accompanied by visual disturbances, high temperature, very stiff neck or throbbing; or if the pain comes on after a sudden head movement or blow to the head). There are three main types of headache.
• A tension headache is characterized by aching (seldom throbbing) and a feeling of tightness in the temples (or the top or back of the head), as well as discomfort in the neck and/or shoulders.
• The classic migraine is usually one-sided, with severe pain (throbbing, pounding or piercing) lasting for many hours or days. Migraines may be heralded by an aura of flashing lights, or by nausea or extreme sensitivity to light. Their cause remains unclear – they may be triggered by weather changes, or bright or flickering lights, or stressful episodes or particular foods. If attacks coincide with menstruation, hormonal irregularities may be the cause.
• Like migraines, cluster headaches are usually one-sided, but, unlike most migraines, they start without warning. Typically lasting about an hour, they involve severe pain in the eye, temple, face and neck, and sometimes the teeth and shoulders. Cluster headaches are more common in men and are often accompanied by sweating and a running nose or eyes, suggesting a food intolerance or allergy background.
Some treatments are appropriate for all three types of headache. These include relaxation and visualization methods, especially autogenic training and biofeedback – but they only work for migraines if you apply them at the first sign of the headache. Certain aromatherapy oils – particularly lavender and chamomile – can assist the relaxation process, as can soothing herbal teas, such as chamomile, rosemary, lavender and ginger. Acupressure and acupuncture can also be effective, although for migraines you will usually need to follow a full course of acupuncture rather than expecting a single treatment to work.
Certain therapies work particularly well for tension headaches. For example, many tension headaches derive from trigger-point activity, and so may benefit from manual treatment of the muscles housing the triggers. Hydrotherapy can often help – particularly the alternating of hot and cold applications to the back of the neck, or a “warming” compress to the forehead or back of the neck combined with a hot foot bath. At the simplest level, you should keep warm and rest, eat only light foods and avoid alcohol.
Rest is also important for migraines, but keep cool rather than warm. Other strategies include massage and manipulation – especially of the upper-neck area – using osteopathic, chiropractic or craniosacral methods. Studies have shown that these techniques can prevent migraines (in some cases permanently), and may also help to abort attacks that are already underway. Pressing on trigger points on the temple, base of the skull or lower neck may be effective, especially if the pressure initially increases or reproduces your symptoms.
TOP TIP Over-the-counter painkillers and prescribed migraine drugs can help to ease headaches. However, most carry the risk of side-effects, such as nausea and drowsiness. Regular use of such medication also seems to increase the frequency of attacks.
HOW TO AVERT A TENSION HEADACHE
If applied before the headache is well established, this method can ward off tension headaches, but not migraines or cluster headaches.
• Place 2 gallons (9 litres) of hot water (not scalding) into a bowl large enough to accommodate both feet. Stir 1 to 2 teaspoons of mustard powder into the bowl and immerse your feet, up to the ankles.
• Wrap a large bag of frozen peas in a towel and place this behind your neck. (If you sit on an upright chair against a wall, you can lean back onto the towel containing the peas.)
• Spend at least 10 minutes in this position and then lie down and rest.
Herbal feverfew tablets (or eating one feverfew leaf daily) reduce the frequency and intensity of migraines for some people, but are of no help once a migraine has started. Studies have shown the herb butterbur to offer relief from migraine headaches, and to prevent recurrence in many cases. Migraines were shown to have been prevented in over 60 percent of chronic sufferers who used the nutritional supplement CoEnzyme Q10 (CoQ10).1
Advocates of homeopathy claim good results with migraines – but you should seek expert advice, rather than embarking on a course of self-prescribed treatment.
Certain foods appear to provoke migraines, so record in your pain journal everything you ate in the 12 hours before an attack. Key suspects include: coffee (or other caffeine drinks); alcohol; tyramine-rich foods (such as mature cheese, chocolate and some nuts); nitrite-rich foods (including most cured or preserved meats); foods rich in monosodium glutamate (MSG); and artificial sweeteners. An oligoantigenic diet may help you to identify the culprits.
Low-blood sugar episodes (hypoglycemia) seem to provoke migraines in some people, suggesting that you should not skip meals, and that you should follow a balanced diet that excludes high-sugar items. Deficiencies in specific minerals and vitamins may also be a factor. However, you should consult a qualified nutritionist rather than prescribing supplements for yourself.
Pain in, or deriving from, the jaw (temporomandibular joint, or TMJ) can be severe. TMJ syndrome may involve difficulty in opening the mouth fully and in chewing, as well as noisy cracking and grating in the joint. There may also be active trigger points in the jaw muscles, which can be treated manually using neuromuscular massage, pain-killing injections or acupuncture.
The causes of TMJ pain can include dental imbalances (malocclusion), which can be corrected by certain dental practitioners, especially those who offer craniosacral therapy. Postural habits that stress the neck and head – for example, sitting with rounded shoulders and your head forward – may also be to blame. If this is the case, you should consult a chiropractor, specialist osteopath, physiotherapist or an expert in postural retraining, such as an Alexander Technique or Pilates teacher. Excessive use of chewing gum, as well as habitual tooth grinding (bruxism), which is often linked with anxiety, are other potential factors. Bruxism can be countered by wearing a plastic mouthguard, especially at night. Relaxation, autogenic training and visualization practices will help to ease the psychological stress that can be the root cause of many TMJ problems.
Pressing the acupuncture points in the webbing between the thumb and index finger of each hand, closer to the finger than the thumb, can relieve toothache, headache and TMJ pain. Press firmly with your other thumb for up to a minute at a time. (Do not press areas of inflammation, broken skin or varicose veins.)
This three-stage routine for alleviating TMJ pain is easy to carry out yourself – try it three times a day. Although the effects vary from person to person, you could expect to notice a reduction in your jaw pain after about a week.
1 Sit with one elbow on a table, and your clenched fist supporting your jaw. Rest (don’t press) the tip of your tongue against the middle of your lower front teeth – this ensures your jaw opens and closes symmetrically. Try to open your mouth against the resistance of your fist, which should slow the opening but not stop it altogether. Open and close your mouth five times, slowly, against resistance; and then open and close it five more times, slowly, without the hand resistance. Make sure the lower teeth stay behind the upper teeth on closing, with the tongue held as described above throughout.
2 Relax, then slowly open your mouth as far as you can without pain to stretch the muscles controlling the jaw. Hold for 5–10 seconds. Repeat this stretch once more.
3 Sitting up straight, place the tip of your tongue as far back on the top of your mouth as you can. While the tongue is in this position, slowly and gently open and close your mouth a few times as widely as you can without causing pain. This activates particular muscles (the retrusive group) and helps to reduce tension in them.
TOP TIP Try these first aids for toothache: wash your mouth frequently with half a teaspoon of salt (or five drops of myrrh tincture) dissolved in a glass of warm water; or apply clove oil or brandy to the painful area using a cotton-tipped applicator. TENS and acupuncture can also help in the short term.
Unless you have suffered a specific injury (see below), pain in the neck and shoulders usually comes from a habitual posture that puts stress on the muscles in this area. The most common culprit is a round-shouldered, head-forward posture, which not only strains the muscles supporting and moving the neck, but also crowds the upper chest, causing breathing imbalances. As muscles gradually become excessively tense they also develop trigger points, which can refer pain into distant tissues. Avoid seated and lying postures that aggravate the problem by choosing appropriately designed furniture, and by using pillows to support the neck in a non-stressful sleeping position. Treatment should aim to stretch the tightened muscles, deactivate trigger points, tone up weakened muscles and improve posture (see opposite). Physiotherapists, chiropractors, specialist osteopaths and neuromuscular massage therapists can all help.
Another source of neck and shoulder pain is “whiplash” injury, often caused by a car accident. Usually these injuries heal within a few months, but damage to delicate nerve structures, disks and joints may lead to long-term pain and restricted mobility. In a few cases, small muscles at the base of the skull are so severely affected that they atrophy, giving rise to fibromyalgia. Consult an expert if you have a whiplash injury that is still uncomfortable. Methods that may aid your recovery include: acupuncture and TENS; anti-inflammatory nutritional and hydrotherapy measures; manual and exercise (such as Pilates) therapy; and self-applied relaxation and visualization exercises.
TOP TIP Many kinds of neck pain, including whiplash injuries, may involve activated trigger points. Try using positional release technique (see pages 101–102) to treat these trigger points.
Many of us spend long periods of our working day at a desk, hunched over paperwork or a computer keyboard. These, among other activities, can lead to an unbalanced, round-shouldered posture that pushes your head forward. The following exercise should help to ease the muscles in the neck and shoulders that are stressed as a result of such a posture. Do it hourly during the time you spend working at a desk.
1 Perch on the edge of a chair or stool, with your feet flat on the floor, slightly wider apart than your hips, toes pointing slightly outward.
2 Tucking your chin in slightly, allow your arms to hang straight down with your palms facing forward.
3 As you breathe in, turn your arms so that your thumbs face backward, and stretch out your fingers. At the same time, lift your breast bone slightly forward and up, and very slightly arch the lower back. As you slowly breathe out, relax and let your hands return to the starting position. Repeat five times.
Upper-chest breathers automatically overuse and stress the scalene muscles between the shoulders and the neck. Trigger points are likely to develop here, referring pain to the neck and head. Learning slow, diaphragmatic breathing will relieve these overworked muscles (see pages 66–74).
The arms and hands are particularly susceptible to repetitive strain injuries, which include tenosynovitis (“tennis elbow”) and carpal tunnel syndrome (affecting the hand and wrist).
This exercise uses muscle energy technique (see pages 104–106) to relieve the inner elbow pain of “tennis elbow”. (This can be caused by any activity that leads to overuse of the elbow joint – not just playing tennis.) If you do the exercise no more than once a day, you should feel benefit after about a week.
1 Sitting with your painful elbow on a table, forearm upright, palm facing forward, gently bend your wrist back with your other hand, so that your fingers point toward your face. Bend only as far as you can without it hurting. With your wrist in this bent position, use your other hand to resist an attempt to bring the wrist back to its neutral position. Maintain this light isometric contraction of the flexor muscles in your forearm for 7–10 seconds.
2 Relax, and then press lightly on the palm of the hand being treated to bend it back further than was possible in Step 1. Stretch the flexor muscles in this way for at least 20 seconds.
3 Repeat Steps 1 and 2 at least once more.
4 Then to stretch the back of your forearm, place your elbow on the table, forearm upright, palm toward your face. Bend your wrist back as before and repeat the method described above.
If you work at a desk, you can take steps to minimize your chances of developing such conditions:
• Avoid typing for more than four hours a day.
• Stretch gently (without producing pain) for three minutes every half hour.
• Pay attention to your posture, the height of your desk and the position of equipment such as your computer.
• Undertake general, regular exercise.
• Monitor your stress levels.
If you do develop an “overuse” problem, it can be treated with rest (and sometimes splinting of the wrist), physiotherapy or even surgery (for example, to release trapped nerves). If the area is inflamed, reduce swelling through diet and hydrotherapy (especially an ice pack). Any trigger points giving rise to the pain should be deactivated, for example using neuromuscular massage or acupuncture.
If the condition is severe, cortisone injections may be an appropriate option. However, repeated application can weaken tissues. Before resorting to cortisone, you should try conservative methods, such as ergonomic and postural re-education, TENS, acupuncture and bodywork – under expert supervision.
No pain provokes more visits to the doctor than backache, although – even without treatment – it usually gets better within a few weeks. However, if pain persists for more than two to three weeks you must seek professional advice, as the list of potential causes is so varied. This can include disk problems; trapped nerves; irritated, restricted or inflamed joints; muscular irritation or spasm; or trigger-point activity. Occasionally, persistent back pain can be caused by other internal problems, such as kidney disease or a gall-bladder condition.
Advice for backache will depend on its cause. However, there are some general principles. Above all, do not do anything that aggravates the pain. It is important to work out the difference between “hurt” and “harm”. Gentle back stretches (see opposite) may hurt a little, but as long as they do not aggravate your existing back pain, they are unlikely to be doing harm – and may well help.
Avoid complete rest or using a back rest for more than a few hours at a time, unless this is advised by an expert or pain is extremely acute. Unused muscles rapidly lose mass and strength, which will slow down your recovery. Rehabilitation from chronic back pain almost always demands the strengthening of spinal and abdominal stabilizing muscles, requiring advice and instruction from an expert, such as a specialist osteopath, a physiotherapist or a chiropractor, ideally working in collaboration with a Pilates instructor.
There are various measures for all kinds of back pain, such as deactivation of trigger points – consult a neuromuscular or massage therapist. A licensed massage therapist can help alleviate your back pain, particularly by targeting specific trigger points. Acupuncture and TENS can also ease chronic back pain, if only temporarily.
If your pain features tight muscles either side of your spine, try lying on two tennis balls in a sock (tied off to stop them escaping), so that one is on each side of your spine. By slowly moving around on the balls, you can get pressure right into the tight, sore spots that need to relax. Use this technique as often as you feel it helpful, always following up with a gentle stretch for the painful area.
TOP TIP Looked at in profile, the spine is curved in an “S” shape. When you stand up straight (when your earlobe is directly over your instep), the natural curves of your spine are properly supported by your back muscles.
Stretching may ease your back pain if the problem appears to be muscular. This exercise is a simple example of the kind of stretch that is often effective. However, if you find that it aggravates the pain, do not proceed any further. If, on the other hand, the exercise does seem to help ease your back pain, perform it two to three times each day. To prepare for the exercise, apply an ice pack to the painful area for 5 minutes, or use an ice spray (available from any pharmacist) for 5–10 seconds.
1 Lie on your back, with a folded towel under your head, your knees bent, your feet flat on the floor and a hand on each knee. Breathe in, then as you exhale lightly draw your stomach down toward your spine. At the same time, pull your knees toward your shoulders (not your chest) until you feel a slight stretch (not pain) in your back. Hold, breathing normally, with your lower abdomen lightly pulled in toward your spine, for four to five breathing cycles (in and out).
2 As you exhale, draw your knees a little further toward your shoulders. Hold for up to 3 minutes, then relax with knees bent and feet flat on the floor.
Alternative: If this stretching exercise aggravates the pain, try standing as tall as you can and arching your back a little, with both hands at waist level to support you. If this makes your back feel better, do this backward stretch two to three times a day, for a minute or two at a time. It can also be easily performed lying face down on the floor or bed.
Hydrotherapy can ease back pain in several ways: ice and “warming” compresses relax tense muscles; alternate hot and cold applications improve circulation; and periodic ice applications reduce inflammation. Avoid hot packs, unless you follow up with massage or a cold application, as heat alone, even though it may feel good at the time, will usually lead to local congestion.
If your pain is being worsened by inflammation, try anti-inflammatory dietary strategies. If stress and anxiety are affecting you, relaxation methods, such as autogenic training, biofeedback and visualization may be helpful, too.
Associated as it often is with heart conditions, chest pain can be worrying. However, pain in the chest is more likely to relate to the muscles between the ribs (the intercostal muscles), or to rib restrictions, than to the heart. If we do not breathe properly (see pages 66–74), your intercostal muscles can develop trigger points and become highly stressed, and the ribs can become limited in their range of movement. When we correct our breathing the intercostal or rib pain should ease. Angina pain (which usually manifests first in the left arm) tends to remain unaltered, even when we breathe properly. So, if you are concerned about the cause of your chest pain, inhale and exhale fully a few times – if the pain changes, your heart is probably not to blame. If you are in any doubt, consult a doctor.
TOP TIP If you have a painful cough, try putting two drops of hyssop (or Olbas) oil into a bowl of hot water. With a towel covering your head and the bowl, place your face over the rising steam, and breathe slowly for 10 minutes.
Chest pain that worsens when you are resting may be caused by a digestive problem or inflammation, and you should seek medical advice. If you have chest pain without obvious cause, and you are an asthmatic, or have had a recent bout of coughing, then you can reduce your pain through a combination of massage and other bodywork; self-applied positional release methods (see pages 101–102); and stretching. Chest pain may also derive from spinal problems – these should be checked for by an appropriate practitioner.
Methods that often ease pain in tense chest muscles include TENS, acupuncture, a “warming” compress and all relaxation methods.
BLADDER, PROSTATE AND ABDOMINAL PAIN
If you feel a burning pain on urination you may have a bladder infection. Ultimately, you should seek advice from your doctor, who may prescribe antibiotics, but in the meantime increase your fluid intake, especially water, to not less than 4 pints (2 litres) a day and take capsules of cranberry extract or drink cranberry juice (unsugared). Cranberry contains natural chemicals that help in the elimination of bacteria from the bladder. Various herbal teas, including buchu and parsley, may also be helpful.
An enlarged prostate may lead to difficulty in urinating, as well as aching or burning pain on urination. Seek medical advice if you are suffering from these symptoms. Taking zinc supplements, extracts of saw palmetto berries, Pygeum africanum or nettle root over a period of several months may bring long-term benefit. You can derive more immediate, though temporary, relief from a prostatic massage (performed by a trained healthcare provider).
TOP TIP Hydrotherapy provides an excellent remedy for bladder, kidney and prostate problems. Try spending between 20 and 40 minutes in a “neutral” bath (see page 90), or consult an expert practitioner.
Abdominal pain can arise from so many different conditions that only general comments are possible here. These first-aid approaches should not replace responsible medical advice.
Much abdominal pain can be traced back to psychological roots. Emotional stress tends to lead to rapid, upper-chest breathing. This, in turn, means that you swallow more air, which results in bloating and sometimes the aggravation of existing abdominal pain caused by such problems as hiatus hernia. Many relaxation methods, such as progressive muscular relaxation, meditation, visualization and slow, deep (diaphragmatic) breathing can help enormously.
Many types of abdominal pain respond well to herbal remedies. For example, the antispasmodic properties of peppermint may relieve stomach cramps. This can be taken in the form of tea, drops or capsules. Try taking ginger, chamomile, aloe vera or slippery elm (as teas, extracts or powders) to treat digestive upsets. Mastic powder (derived from a resin that is produced by the shrub Pistacia lentiscus) is more efficient at deactivating the bacteria that cause gastric ulcers than most antibiotics. You can ease pain relating to a spastic colon by taking aloe vera juice, slippery-elm powder (mixed into a paste with water) or charcoal capsules.
A “warming” compress around the abdomen and lower chest can help to soothe stomach ache and abdominal pains in general. Or you could ask your partner or a friend to massage your back or abdomen using lavender or diluted chamomile essential oil. However, ensure that you do not massage directly over any inflamed tissues or organs.
GYNECOLOGICAL AND CHILDBIRTH PAIN
For safety, most gynecological pain requires medical investigation and attention, but here is a brief look at some interim, self-help measures you can try.
To ease pelvic pain and cramps, try physical and mental relaxation methods (for example, autogenic training and visualization), as well as massage, or sustained thumb or tennis-ball pressure to the lower back. Hydrotherapy methods, such as a “warming” compress on the waist, can also help, while herbal aids include black haw and cramp bark taken as tinctures (seek advice from a qualified medical herbalist) and ginger-root tea.
Chronic pelvic pain is often caused by trigger points in the lower abdominal and upper thigh muscles, as well as internally. Deactivating these points, using methods such as muscle energy technique (see pages 104–107), can often eradicate symptoms. In the USA, a group of more than 100 women with chronic pelvic pain underwent trigger-point treatment. This removed all pelvic pain from 90 percent of the women, with most pain free a year later.
If you are suffering from vaginal irritation, or pain resulting from yeast infection (thrush), try using vaginal suppositories infused with tea-tree oil or calendula; or you could mix acidophilus (a “friendly” micro-organism, available as a powder or capsule from health stores) into live yogurt and apply this mixture on a tampon. You may find that dietary strategies and supplementation (such as probiotics) help, particularly if a low-sugar diet is also followed. Consult a qualified nutritionist or naturopath for advice.
TOP TIP Taking raspberry-leaf tea, an ancient folk remedy, for some days before and during delivery eases labour pain without interfering with the strength of your contractions.
Many non-pharmaceutical measures can reduce childbirth pain: giving birth in a water tub; acupuncture; breathing techniques (especially calming breathing, see page 72); and relaxation and visualization. Visiting an osteopath once a month in the last trimester will ease the discomfort of advanced pregnancy and help prepare your pelvis and back for childbirth. A good source of relaxation and pain relief is a “neutral” bath of no less than 20 minutes.
Your birth partner can help to ease pain during your labour by applying direct thumb pressure to tender areas of your sacrum (at the base of the spine), as well as to your back just below the lowest rib, close to the spine. You can also apply acupressure yourself. Once contractions start, try pressing firmly the tender area about one hand’s width above the inner ankle bone (Spleen 6 in Chinese medicine), for up to five minutes every half hour (this point should not be stimulated before the 38th week of pregnancy). The acupressure exercise on page 152 may also help. If you are giving birth in a medical setting, such “alternative” methods will need to be discussed in advance.
Bodywide conditions demand bodywide attention – constitutional, whole-person strategies. Methods that have a calming effect on the body as a whole, such as acupuncture, relaxation massage, biofeedback, mindfulness meditation, autogenic training and breathing retraining, can alleviate – even if only temporarily – any of the conditions discussed here.
The causes of the chronic muscular-pain condition fibromyalgia are complex, often originating in a genetic predisposition and aggravated by one or more factors, such as trauma, a biochemical disturbance (for example, thyroid hormone imbalance) or a severe emotional upset. Central sensitization will have evolved, and strategies will be needed to avoid aggravating this further, while attempting to reduce the pain inputs from peripherally sensitized areas that feed into the sensitization process.
Treatment has to be very gentle indeed, to avoid placing new demands on already overloaded body systems. Strategies need to address the causes of fibromyalgia, as well as relieve the constant pain and fatigue that typify the condition. Apart from the general therapies mentioned above, you could try: thyroid hormone rebalancing (if appropriate, and under medical supervision); noninvasive manipulation methods, such as positional release technique (see pages 101–102); gentle and closely monitored progressive aerobic exercise; and sleep-enhancement methods.
Similar to fibromyalgia, myofascial pain syndrome is the result of multiple active trigger points. These can usually be deactivated by neuromuscular massage, acupuncture or dry needling methods. However, the causes of the trigger point activity also need addressing – and this usually involves paying attention to lifestyle, posture, breathing, diet and stress-related issues.
The burning, tingling or aching sensations associated with chronic nerve pain may derive from inflammation (neuritis), irritation or entrapment (neuralgia), or a disease of the central nervous system, such as multiple sclerosis. Other causes include infection, as in shingles, and diseases such as diabetes, cancer and arthritis. You may be able to ease nerve pain by taking supplements of vitamin B-complex, or herbs such as passiflora, valerian or Jamaican dogwood (but only in consultation with a medical herbalist).
A strategy known as counter-irritation may also help to treat nerve pain. Try rubbing an extract of cayenne pepper onto a chronically painful area – although the skin will redden, pain usually recedes noticeably. In the case of the painful scars left over after shingles, rub in an extract of red chilli peppers. Be patient, as it may take a day or two for you to feel the benefits.
TOP TIP Wearing a copper bracelet can ease the pain of rheumatoid arthritis. The copper, which is absorbed through your skin, helps to protect the joint membranes and joint-lubrication fluids that are damaged by the disease.
Osteoarthritis is caused by wear and tear of the joints. In the early stages of the condition, you can do much to maintain good function through appropriate bodywork – stretching and movement – taking care not to irritate the joints. If you are overweight, you should lose weight, as this may be placing extra stress on your joints. You can also derive benefit from hydrotherapy (for example, compresses and Epsom-salts baths) and nutritional measures, including: reducing animal-fat intake; taking supplements of eicosapentenoic acid (EPA), glucosamine sulphate and chondroitin sulphate; and ingesting herbs such as devil’s claw (in the form of dried, powdered root or as a tincture) and feverfew (eat one leaf a day).
The joint inflammation that characterizes rheumatoid arthritis can be eased by following a diet low in protein and sugar, but high in EPA (see pages 128–30). Other helpful treatments include TENS (at a high setting) and gentle exercise that maintains muscle tone without irritating inflamed joints.