New York Times
Science Tuesday
With the costs of medical
care spiraling out of control and an ever-growing shortage of doctors to treat
an aging population, it pays to know about methods of prevention and treatment
for orthopedic problems that are low-cost and rely almost entirely on self-care.
As certain methods of
alternative medicine are shown to have real value, some mainstream
doctors who “think outside the box” have begun to incorporate them into their
practices.
FASTER THAN AN OPERATION
The triangular forearm support may relieve shoulder pain in those with injured
rotator cuffs.
One of them is Loren
Fishman, a physiatrist — a specialist in physical and rehabilitative medicine
affiliated with NewYork-Presbyterian/Columbia hospital. Some in the medical
profession would consider Dr. Fishman a renegade, but to many of his patients
he’s a miracle worker who treats their various orthopedic disorders without the
drugs, surgery or endless months of
physical therapy most doctors recommend.
Many
years ago, I wrote about Dr. Fishman’s
nonsurgical treatment of piriformis syndrome, crippling pain in the
lower back or leg caused by a muscle spasm in the buttocks that entraps the
sciatic nerve. The condition is often misdiagnosed as a back problem, and
patients frequently undergo surgery or lengthy physical therapy without relief.
Dr. Fishman developed a
simple diagnostic technique for piriformis syndrome and showed that an injection
into the muscle to break up the spasm, sometimes followed by
yoga exercises or brief physical therapy, relieves the pain in an
overwhelming majority of cases.
Nowadays yoga exercises
form a centerpiece of his practice. Dr. Fishman, a lifelong devotee of yoga who
studied it for three years in India before going to medical school, uses various
yoga positions to help prevent, treat, and he says, halt and often reverse
conditions like shoulder injuries,
osteoporosis,
osteoarthritis and
scoliosis. I rarely devote this column to one doctor’s approach to
treatment, and I’m not presenting his approach as a cure-all. But I do think it
has value. And he has written several well-illustrated books that can be helpful
if used in combination with proper medical diagnosis and guidance.
For
many years, yoga teachers and enthusiasts have touted the benefits to the body
of this ancient practice, but it is the rare physician who both endorses it and
documents its value in clinical tests. Dr. Fishman has done both.
Rotator Cuff Relief
This year, Dr. Fishman
received a prize at the International Conference on Yoga for Health and Social
Transformation for a paper he presented on a surprising yoga remedy for rotator
cuff syndrome, a common shoulder injury that causes extreme pain when trying to
raise one’s arm to shoulder height and higher. He described a modified form of a
yoga headstand that does not require standing on the head and takes only 30
seconds to perform, and presented evidence that it could relieve
shoulder pain in most patients, and that adding brief physical
therapy could keep the problem from recurring.
Rotator cuff injuries are extremely common, especially among athletes, gym and
sports enthusiasts, older people, accident victims and people whose jobs involve
repeated overhead motions.
For
patients facing surgery to repair a tear in the rotator cuff and many months of
rehabilitation, the yoga maneuver can seem almost a miracle. It is especially
useful for the elderly, who are often poor candidates for surgery.
Dr.
Fishman said he successfully treated a former basketball player, who responded
immediately, and a 40-year-old magazine photographer who had torn his rotator
cuff while on assignment. The photographer, he said, had been unable to lift his
arm high enough to shake someone’s hand.
Instead of an operation that can cost as much as $12,000, followed by four
months of physical therapy, with no guarantee of success, Dr. Fishman’s
treatment, is an adaptation of a yoga headstand called the triangular forearm
support. His version can be done against a wall or using a chair as well as on
one’s head. The maneuver, in effect, trains a muscle below the shoulder blade,
the subscapularis, to take over the job of the injured muscle, the
supraspinatus, that normally raises the arm from below chest height to above the
shoulder.
The doctor discovered the
benefit of this technique quite accidentally. He had suffered a bad tear in his
left shoulder when he swerved to avoid a taxi that had pulled in front of his
car. Frustrated by an inability to practice yoga during the month he waited to
see a surgeon, one day he attempted a yoga headstand. After righting himself, he
discovered he could raise his left arm over his head without pain, even though
an
M.R.I. showed that the supraspinatus muscle was still torn.
Dr.
Fishman, who has since treated more than 700 patients with this technique, said
it has helped about 90 percent of them. “It doesn’t work on everyone — not on
string musicians, for example, whose shoulder muscles are overtrained,” he said
in an interview.
In a
report published this spring in
Topics in Geriatric Rehabilitation (an issue of the journal devoted
to therapeutic yoga), he described results in 50 patients with partial or
complete tears of the supraspinatus muscle. The initial yoga maneuver was
repeated in physical therapy for an average of five sessions and the patients
were followed for an average of two and a half years.
The
doctor and his co-authors reported that the benefits matched, and in some cases
exceeded, those following physical therapy alone or surgery and rehabilitation.
All the yoga-treated patients maintained their initial relief for as long as
they were studied, up to eight years, and none experienced new tears.
Yoga for Bone Disease
Perhaps more important from a public health standpoint is the research Dr.
Fishman is doing on yoga’s benefits to bones. Bone loss is epidemic in our
society, and the methods to prevent and treat it are far from ideal.
Weight-bearing exercise helps, but not everyone can jog, dance or walk briskly,
and repeated pounding on knees and hips can eventually cause joint
deterioration.
Strength training, in which muscles pull on bones, is perhaps even more
beneficial, and Dr. Fishman has observed that osteoporosis and resulting
fractures are rare among regular yoga practitioners.
In a
pilot study that began with 187 people with osteoporosis and 30 with
its precursor, osteopenia, he found that compliance with the yoga exercises was
poor. But the 11 patients who did 10 minutes of yoga daily for two years
increased bone density in their hips and spines while seven patients who served
as controls continued to lose bone. He noted that yoga’s benefits also decrease
the risk of falls, which can result in osteoporotic fractures.
Medical guidance here is important, especially for older people who may have
orthopedic issues that require adaptations of the yoga moves.