Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.1 The most common symptoms of GERD are burning stomach pain, acid or bile regurgitation and dysphagia.2 When the hiatal sphincter becomes irritated, even water does not pass.
In terms of side effects, the Journal of the American Medical Association published a study in 2006 in which investigators studied the files of 145,000 patients who had taken a proton-pump inhibitor (Nexium) for more than a year. Patient risk of suffering a hip fracture was 44 percent higher than for non-users. What's more, a long-term study suggests symptoms can return even following hiatal surgery.4
To evaluate nondrug, nonsurgical options, I carried out a randomized trial.5 Sixty-five adults suffering from chronic moderate or severe GERD served as participants. This trial had three parts. In part 1, 22 patients received spinal manipulation and ischemic compression therapy using thumbtip pressure on the trigger points (TrPs) localized in the upper two quadrants of the abdomen, mainly the stomach region. These patients reported an average 66 percent symptom amelioration after 20 treatments; 73 percent reduction 30 days after the treatments; and 57 percent reduction six months later.
In part 2 of the trial, 27 patients received exclusive ischemic compression therapy on the TrPs of the upper two quadrants of the abdomen, mostly on the stomach. After 20 treatments, patients reported 65 percent symptom amelioration; 63 percent amelioration one month after completion of treatment; and 67 percent six months later.Part 3: A final group of 13 patients received dorsal spinal manipulations exclusively. After 20 treatments, average symptom amelioration was only 40 percent; 38 percent one month after treatment. Eight patients in this last group agreed to receive 20 more treatments of ischemic compressions in the upper quadrants of the abdomen, mostly on the stomach. The improvement rate rose to 71 percent.
Steele4 has hypothesized that GERD is the somatization of anxiety and depression. In my trial, many patients had noticed the appearance of their symptoms after a significant change in their life, such as a divorce, loss of work or an increase in job responsibility. My hypothesis is that these stressful events provoked trigger points in the stomach.
Most of the time, these stressful events happened years previously, but TrPs may persist indefinitely or until they are taken care of with the appropriate technique. The ischemic compressions were performed with 8-second thumbtip pressure on the two or three TrPs. In my experience, improvement is evident within six treatments.
References
- Jakson SB. Gastroesophageal reflux disease. Top Clin Chirop, 1995;2(1):24-29.
- Mittal R, Holloway R, et al. Transient lower esophageal sphincter relaxation. Gastroenterol, 1995;109:601-610.
- Lundell LR. The knife or the pill in the long-term treatment of gastroesophageal reflux disease. Yale J Biol Med, 1995;67:233-246.
- Steele GH. Cost-effective management of dyspepsia and gastroesophageal reflux disease. Gastroenterol, 1996;23:561-577.
- Hains G. Hains F. Descarreaux. Gastroesophageal reflux disease, spinal manipulation therapy and ischemic compression: a preliminary study. J Am Chirop Assoc, 2007 Jan.
Urinary Incontinence
Urinary incontinence (UI) is defined as an involuntary loss of urine. In most cases, female patients suffer from stress or urge urinary incontinence, or both. Stress UI is present when the patient laughs or while exercising; urge UI is when the urge to urinate is overwhelming. Fifteen to 20 percent of women experience UI sometime in their life.1
We surveyed 100 women between 50 and 70 years of age; 78 were suffering from UI. These women felt isolated and considered the problem as shameful. More than half of women don't consult anyone for the problem, and feel frustrated and embarrassed. It is well-known that birthing is a common cause of UI, as are bladder infections.
I performed a randomized trial in which I hypothesized that while birthing, the bladder is crushed between the baby and the pubis, especially if the baby is big or the pelvic inlet is small. In these cases, trigger points are produced in the bladder musculature and the pelvic floor muscles, thus causing urinary incontinence.2
If the trauma is accentuated, UI may present immediately after birthing. If less pronounced, UI will be felt at around 50 years of age, when normal muscle weakness presents itself.
This clinical trial aimed to find the efficacy of myofascial therapy using ischemic compressions on trigger points (TrPs) in the bladder area in 33 female patients suffering from chronic urinary incontinency. In this trial, thumbtip pressure was applied on the trigger points located in the bladder area, vertically behind the pubis in an area 6-8 centimeters wide. Generally, two or three TrPs were present, and an 8-second pressure, painful but bearable, was used.
Thirty-three female patients from 33 to 55 years old who had been suffering from UI for an average of six years participated in the trial. Twenty-four patients (experimental group) received ischemic compressions on TrPs in the bladder area; nine patients (control group) received ischemic compressions on TrPs located in the hip muscles.
Two standard questionnaires were completed by all participants to assess symptom reduction following treatment. In the experimental group, after 15 treatments, average symptom amelioration was 69 percent; 73 percent 30 days after treatment; and 60 percent six months later. By comparison, symptom reduction was only 21 percent in the control group after 15 treatments. In the experimental group, improvement was rapid, with 18 of 24 participants (75 percent) reporting an evident amelioration within six treatments.
References
- Fanti A, Kanashak Newman D, Collins D, et al. Quick Reference Guide for Clinicians. Managing Acute and Chronic Urinary Incontinence. Rockville: U.S. Department of Health and Human Services, 1996 (AHCPR Publication no. 96-0686).
- Hains G, Hains F, Descarreaux M, Bussière A. Urinary incontinence in women treated by ischemic compression over the bladder area: a pilot study. J Chiro Med, 2007;6:132-140.
Dr. Guy Hains is a Palmer graduate who practiced in Trois-Rivières, Québec, before passing away in late 2014. He had eight clinical research articles and randomized trials on myofascial trigger-points therapy published in peer-reviewed journals; and authored three books on the subject, the last of which is Myofascial Trigger Point Therapy: An Effective Method for the Elimination of Most Musculoskeletal Health Problems