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Lower back pain without a known cause: What works?

Lower back pain without a known cause: What works?

By Saima Anto, M.A., R.AC, R.TCMP

Lower back pain is very common, affecting half of the population every year, and sixty to ninety percent of the adult population is at risk of developing lower back pain. Most often, tests can find no cause for the pain; this condition is termed ‘non-specific’ back pain.

Though most acute episodes will resolve within six weeks, the pain often returns, and ten to twenty percent of lower back pain sufferers go on to experience chronic lower back pain, which persists for at least three months. Non-specific lower back pain is a major cause of missed work hours.

What works for this type of back pain? That is, what measures are consistently proven to deliver better outcomes than no treatment?

When one high-quality study shows a form of treatment is effective for relieving pain and helping restore function, those findings get our attention. When repeated high-quality studies show a form of treatment works well to relieve pain and help restore function, we can be that much more confident that treatment will deliver results.

For example, one systematic review of randomized controlled trials examining the efficacy of traditional acupuncture, published in the journal Spine in 2013, showed that acupuncture consistently reduced pain and improved function, when used alone or in addition to other approaches.

As the evidence keeps adding up, treatment guidelines now recommend the use of acupuncture as a stand-alone approach, able to treat the majority of back pain cases by itself (though some cases will benefit still more from conjoint treatment, with physiotherapy or chiropractic in addition to acupuncture). The most recent guidelines for the treatment of back pain, issued to doctors by the American College of Physicians and the American Pain Society, explicitly states acupuncture has “proven benefits” for patients who don’t get better with self-care.

Some treatment approaches for back pain that are proven to work well — that is, have measurably large effects in repeated studies — include:

–    Acupuncture

–    Behavioral changes

–    Chiropractic

–    Exercise therapy

–    Individualized patient education

–    Massage

–    Physiotherapy

–    Yoga

Behavioral changes can make just as big a difference as any of these other measures in relieving pain and restoring function but are especially important in the acute stage. When back pain interferes with daily activities, it’s important to:

–     Stay active, and get back to normal activities as soon as possible

–    Avoid worry

–    Develop strategies to manage the effects of soreness on daily activities

–    Avoid strains and manage the risks of future injury

Patients who receive individualized information covering these points, in sessions lasting at least 2 hours, see better results; however, this effect is stronger for those with acute back pain. Once the pain becomes chronic, these behavioral changes make much less difference.

What can I expect when I see an acupuncturist for non-specific low back pain?  Studies show acupuncture treatment offers immediate pain relief and an overall improvement in functioning, with effects lasting as long as 3 months after treatment ends.

When you see a licensed acupuncturist for back pain, you may be asked questions that seem unrelated to your back, and the acupuncturist may take your pulse and look at your tongue, as well as asking questions. This just means the acupuncturist will be treating your back pain, not someone else’s. Because the theory underlying acupuncture is holistic and comprehensive, a seemingly random assortment of unrelated symptoms can often resolve into a clear clinical picture when seen through the lens of traditional Chinese or Japanese medical knowledge.

On the basis of traditional medical theory, the acupuncturist may even place some needles in locations that are nowhere near the area where the pain is felt; one well-known point for low back issues is actually in the crease of the knee!

Regardless of which particular points are used, you can rest assured knowing that acupuncture based in traditional theory has proven unbeaten as an effective stand-alone treatment for back pain and its related issues.

What kind of treatment makes the biggest difference?  Do something about it, instead of doing nothing. That makes the biggest difference of all.

Saima Anto, M.A., R.AC, R.TCMP is available for acupuncture treatments of low back pain and other conditions at Pacific Wellness on Tuesdays, Wednesdays, Fridays and Saturdays.  Please call 416-929-6958 to inquire about the appointment.

Why Incorporate Therapeutic Ultrasound into a Massage Treatment?

Why Incorporate Therapeutic Ultrasound into a Massage Treatment?

By Linda Chang, RMT

Registered Massage Therapist
Certified Therapeutic Ultrasound Practitioner


Therapeutic ultrasound is one of the most widely used modalities for the treatment of soft tissue injury, joint dysfunction and pain, which has been used in North America for over 40 years.  Therapeutic ultrasound is the use of sound waves to elicit therapeutic benefits to specific target tissues.

In addition to massage therapy, I also obtained professional training and certification as a certified therapeutic ultrasound practitioner.  In my practice, I integrate Swedish and deep tissue massage, Shiatsu (basic), and therapeutic ultrasound (if indicated) into one multi-faceted treatment.

According to a client’s condition, I apply the thermal and/or non-thermal effects of therapeutic ultrasound to treat specific conditions.  In the meantime, depending on the different target body parts, protein and collagen contents of the structure I am treating, it is crucial to formulate the right dosage with an articulate combination of frequency, power density, duty cycle and treatment time to achieve safe and effective results.

Incorporating therapeutic ultrasound (only if indicated, and consented by the client) into a massage treatment reinforces the relief of musculoskeletal pain and tension, joint stiffness, muscle spasm by increasing metabolic rate, blood flow, vasodilation, permeability through cell membranes, and enzymatic activities; therefore it enhances cellular functions to remove tissue debris and repair the target area.

Massage with therapeutic ultrasound can be helpful for a number of acute, subacute and chronic conditions, including musculoskeletal pain and tension, tendinitis, frozen shoulder, Sciatica, knee pain, headaches, plantar fasciitis, neurological symptoms (numbness and tingling), deep adhesion, etc.  When a short therapeutic ultrasound session is combined into a Swedish and deep tissue massage session, you may be pleasantly surprised about the next level the entire treatment can reach!


Prior to joining The Pacific Wellness Institute in November 2014, Linda practiced massage therapy at physiotherapy and chiropractic clinics respectively.  Other than helping clients de-stress, Linda has extensive clinical experiences working with clients through their journeys to recovery.  If you have any questions about a combination treatment of massage with therapeutic ultrasound (if indicated) for your specific condition, please contact Claudia at The Pacific Wellness Institute at (416) 929-6958.

Sleep Better: Pillow & Mattress Considerations

Sleep Better: Pillow & Mattress Considerations

By Dr. Sandeep Kalirah, BSc, DC

Pillow Recommendations

One of the most common questions I get in my Chiropractic office is, “What type of pillow should I be using?”  Well, whenever a patient asks me about a pillow, the only suggestion I ever make is the water pillow.  The reason I recommend the water pillow so much is because it is a custom pillow.  This means that it does not follow a “one size fits all” recipe; you decide how firm or how soft the pillow should be, based on your own comfort and needs.

Each pillow comes with a spout that allows you to fill water into the pillow.  The more water you fill into the pillow, the firmer the pillow becomes; the less water, the softer.  Then, when you lie down on top, the water moves instantly, evenly distributing to surround the weight and contours of your head and neck.

The pillows are made out of durable material, so you don’t have to worry about getting wet.  They are also completely sanitary; you don’t have to worry about changing the water.

Of course, it will take a few uncomfortable nights to decide just how much water is right for you.  But after experimenting with the water levels, I am sure each patient can achieve the perfect pillow for their needs!

I am familiar with three companies that manufacture and distribute water pillows:

1)      Mediflow/Chiroflow

2)      Obusforme

3)      EmbraceAir

You may purchase these pillows from most rehabilitation/chiropractic/physiotherapy clinics, and in some cases, your insurance may be willing to reimburse you for the costs associated; please check with your insurance provider for more information.

Mattress Considerations

When selecting a mattress, I’d like for my patients to consider two principles:

  1. Comfort
  2. Support


When selecting a mattress, it is always a good idea to practice 10 Minute Test Drive.  10 Minute Test Drive is similar to test driving a car; “Drive before you buy.”  Lie down on the mattress for approximately 10 minutes.  If you feel comfortable and don’t toss and turn too much, this mattress may be the perfect bed for you.


When you lie down on your side or back, you should feel your spine remains straight. If at any point you feel you’re sinking into the bed or that the bed is caving in around you, this mattress is not the appropriate bed.

Types of Mattresses:

Generally speaking, there are four main types of mattresses:

  1. Firm
  2. Plush
  3. Memory Foam
  4. Pillow Top

1. Firm
Firm mattresses have flat-tops with no extra padding or layers on top.  Traditionally, firm to medium-firm mattresses has always been recommended for the relief of lower back pain.  However, because firm beds are generally supportive, I recommend my patients always “Test Drive” to make sure they are also comfortable.  Finding a good balance of support and comfort is vital when selecting a firm mattress.
2. Plush
Plush mattresses are among the softest beds on the market; however, the extra foam layering above the coils provides a lot of comforts but very little support. Therefore, I generally do not recommend plush beds and ask my patients to stay away from them.  Over time, patients with plush beds do usually develop spinal pain.
3. Memory Foam
A neat fact about Memory Foam is that it was created by NASA for the space program.  It never did “take-off” but lucky for us, it ended up in mattresses instead.  Made from polyurethane, memory foam mattresses are firm in cool temperatures and soft in warm temperatures.  This is what allows the mattress to mold to the contours of a warm body, providing support.  Keep in mind, it does take approximately 10-15 minutes for the mattress to completely respond to the body’s heat.  If you toss and turn at night, this may pose a challenge when it comes to comfort.  Memory foam is also available as foam overlays or toppers, to place over a pre-existing mattress.
4. Pillow Top
Pillow top mattresses are probably the most common mattress out there, and one that I commonly recommend for comfort.  These mattresses have an extra layer of padding attached to the top, to provide additional comfort.  Support varies for a pillow-top mattress, therefore, like a firm mattress, it is very important to “Test Drive” and make sure your spine does not sink into the mattress.

Dr. Sandeep is accepting new patients at the Pacific Wellness on Mondays, Wednesdays, and Fridays. She offers 15 min. complementary consultations (Exams and Adjustments not included). Please call us at 416-929-6958 to take advantage of this exclusive offer.