The missing link: Osteopathy and BICOM in treating chronic lower back pain
Jorge Costa, Osteopath, Aerospace Physiologist
Dear colleagues,
in today’s speech, I would like to give a new and complementary perspective on how to approach those extremely difficult cases regarding CHRONIC LOWER BACK PAIN (CLBP)
Epidemiology
Lower back pain is known worldwide as a public health problem, and is one of the main reasons patients resort to primary health care. Either for the therapeutic and diagnostic resources spent, or the high rate of disability it causes to patients, lower back pain is a real challenge for family physicians, making the thorough characterization of the multidisciplinary team associated with this condition a matter of the upmost importance.
The spectrum of disease and morbidity associated with LBP is broad. For many patients, LBP episodes are self‐limited and resolved without specific treatment. For others, however, back pain is recurrent or chronic, causing significant pain that interferes with employment and quality of life. Muscle‐ligamentary and degenerative causes are the most frequent (> 85%), and often cause exhaustion to patients, services and complementary means of diagnosis. LBP is rarely a sign of serious pathology, including infection, neoplasia or other systemic disease.
According to the Global Burden of Disease (GBD) 2013 study, backache is among the top five causes of DALYs (disability‐adjusted life years), along with ischaemic heart disease, lower respiratory tract infections, cerebrovascular disease and road accidents.
It affects a large part of the working‐age population, leading to absenteeism from work and a significant drop in productivity. It is estimated that up to 80% of all adults will have LBP on at least one occasion during their life, and this is one of the most frequent complaints at the General Practice/Family Medicine consultation.
Risk Factors
The risk factors associated with back pain remain poorly understood, however the most frequently reported ones include smoking, obesity, age over 45, female gender, physical and/or psychologically vigorous occupations, sedentariness, low level education, professional dissatisfaction, and psychological factors such as anxiety, depression, and somatization.
Definition and classification
LBP can be defined as pain or discomfort located in the lumbar region between the lower costal ridge and the folds of the lower back, with or without irradiation to one or both lower limbs.
LBP can be classified according to the type of pain into acute, sub‐acute and chronic.
Acute lower back pain can be defined as pain or discomfort located in the region between the lower costal ridge and the folds of the lower back, which starts abruptly, usually after an effort and worsens with mobilization, lasting no more than four weeks, with or without irradiation to one or both lower limbs. Patients who continue to have lower back pain beyond the acute period have subacute lower back pain (lasting between 4 and 12 weeks). After this period, it is called chronic back pain.
Recurrent LBP is defined as a new episode of lumbar pain after an asymptomatic period of six months, with the exception of exacerbation of chronic lower back pain.
Depending on the etiopathogenic mechanism, lumbar pain can be classified as mechanical or non‐mechanical (Table 1). Mechanical pain contributes to 97% of cases and is therefore usually called common. Mechanics implies that the pain is the consequence of a structural anomaly, trauma or degeneration of a normal anatomical structure without a considerable inflammatory component and may be due to excessive overload/force, secondary to trauma/deformation or secondary to a degenerative change of disc or posterior interapophyseal joints.
(Table 1)
The difficulty in establishing a definitive diagnosis in most LBP cases has given rise to the term “non‐specific lombalgy”, a condition which is considered benign. More than 85% have non‐specific back pain, which is defined as back pain that is not attributed to a specific known or recognizable pathology (e.g. infection, tumor, osteoporosis, ankylosing spondylitis, fracture, inflammatory process, root syndrome or equine tail syndrome).
Prognosis
According to the World Health Organization (WHO, 1998), CLBP results from the progression of unresolved acute LBP which can be caused by inflammatory, degenerative diseases, congenital changes, muscle weakness, osteo‐articular predisposition, as well as signs of intervertebral disc degeneration, among others.
In order to avoid the evolution towards chronicity, acute LBP should be properly valued and treated. The following risk factors must be taken into account in regards to the development of chronic LBP and delayed recovery: age; duration of the initial episode; duration of stopping work; relapses; hospitalization; low educational level; low level of resources; family dysfunction; previous history/previous history of depression and anxiety; poor working conditions; low qualifications and professional dissatisfaction; precarious employment; existence of conflict following an accident at work; inappropriate use of diagnostic and therapeutic resources; tobacco, alcohol or drug abuse; history of trauma; poor cardiovascular condition.
Clinical experience
In my practice I’ve found that chronic LBP develops more frequently in individuals who present with maladjusted coping strategies, functional limitations, poor general health, presence of psychiatric comorbidities, presence of non‐organic symptoms or who are in labor litigation.
For the detection of psychological risk factors that influence the prognosis, a set of signs known in the international literature as “yellow flags” are constituted.
1. Beliefs and inappropriate attitudes towards back pain;
2. Behavior of pain with exaggerated rest;
3. Labor problems or compensation process;
4. Emotional problems (depression, anxiety, tendency to isolation).
The identification of “yellow flags” should lead to appropriate cognitive‐behavioral follow‐ups. Psychosocial evaluation is generally advised in patients presenting with one or more of these yellow flags.
CLINICAL EVALUATION IN CONSULTATION
A simple and practical classification, proposed by the Agency for Health Care Policy and Research – USA, and which has gained international recognition, divides LBP into one of three categories – the so‐called “diagnostic screening”:
Complicated backache (tumor, fracture, infection, equine tail syndrome)
Lombalgy with sciatica (herniated disc)
Non‐specific backache
This first observation (sufficient in most cases because most of our patients already tried everything in the conventional medicine and appear in the consultation in despair) should be aimed at excluding complicated back pain.
Finally, it should be noted that the clinical evaluation should also include an evaluation of psychosocial risk factors, which is predictive for the evolution to chronic complaints.
Did you know?
“According to the report “The state of health care quality 2015” by the “National Committee for Quality Assurance” (USA), approximately one quarter of patients with BP and aged between 18 and 50 have had imaging examinations for which they had no indication. It should be noted that inappropriate use of lumbar imaging can lead to irrelevant findings, unnecessary treatments and unjustifiable surgical interventions.
Joint guidelines of the American College of Physicians and the American Pain Society (2007) explicitly recommend that “Doctors should not routinely obtain images or other diagnostic tests in patients with non‐specific lower back pain…”
Osteopathy and BICOM®
Facing this reality, Osteopathy gets more and more fans because of its approach and results.
Osteopathy is a system and philosophy of health care that separated from traditional (allopathic) medical practice about a century ago. It places emphasis on the musculoskeletal system, hence the name ́Osteo ́ refers to bone and ́path ́ refers to disease. Osteopaths also believe strongly in the healing power of the body and do their best to facilitate that strength.
Pain is the chief reason patients seek musculoskeletal treatment. Pain is a symptom, not a disease by itself. Of critical importance is first to determine the cause of the pain. Cancers, brain or spinal cord disease, and many other causes may be lying beneath this symptom. Once it is clear that the pain is originating in the musculoskeletal system, treatment, that includes manipulation, is appropriate.
My experience
As an osteopath and regardless of the great importance of osteopathy in CLBP, I had a few patients who didn’t have good results or the results were not lasting and this was the main reason why I started working with this combination: Osteopathy/ BICOM® bioresonance.
What I noticed was the huge increase in the success of treatments and lasting results.
Case 1
Chronic lower back pain for the past 3 years especially when waking up and at the end of the day.
Woman, 53 y/o
Mother of 2, 2 cesarean sections, divorced 10 years ago, entrepreneur
Medical history
Several consultations carried out by a family doctor, orthopedics (Lumbar MRI, CAT without relevant data)
Medication for the past 2 years: non‐steroidal anti‐inflammatories, painkillers, muscle relaxant)
Several treatments in physiotherapy.
In my consultation
Severe lumbar hypomobility with no reference to lower limbs.
Patient refers to constipation, insomnia (difficult to maintain sleep), extreme fatigue, lack of energy.
1st treatment
Observation
I could verify that the patient is in extreme difficultly when getting up from the chair
Treatment
Maintains medication
Osteopathy
Lumbar myofascial release
Scar myofascial release
BICOM® bioresonance
Basic therapy
Support elimination organs (liver and kidneys)
3017.0 Clear deep blockages
910.3 Eliminate scar interference (BRT oil OC)
3022.0 Blood circulation, regulate (BRT oil OC)
For vertebral blockage: 197.0 (CTT kit orthopedics, ampule O056), chip
Observation
Although the patient hasn’t said anything, I could see that she moves with less difficulty.
Supplementation
Start increase of water intake, Magnesium malate (1+1+1), melatonin (8 sub‐lingual drops when already in bed).
2nd treatment (1 week after)
Patient report
Patient mentions that she felt “lighter” but still has pain, however not so strong. Can sleep better but still wakes up several times during the night.
Treatment
Osteopathy
Visceral osteopathy abdominal cavity (very painful for the patient)
Harmonic techniques lumbar spine
Traction lumbar/sacrum
BICOM® bioresonance
Basic therapy
3066.0 Lymph activation
910.3 Eliminate scar interference (BRT oil OC)
To stabilize lumbar spine: 198.0 (CTT Kit orthopedics, ampule O032)
198.0 (CTT kit hormones, ampules Dopamine HON 009 + Serotonin HON 026)
3022.0 Regulate the blood circulation (BRT oil OC)
Observation
Patient refers that she feels “great”, still has pain but happier
Supplementation
Maintain the medication and the supplementation.
3rd treatment (1 week after)
Patient report
Diarrhea
Sleeps much better, during the week only took medication for 3 days
Refers to a decrease of 60% of pain.
Treatment
Osteopathy
Visceral osteopathy abdominal cavity.
Manipulation HVLA (High Velocity Low Amplitude) L4‐L5‐S1
BICOM® bioresonance
Basic therapy
3022.0 Regulate the blood circulation (BRT oil OC)
For vertebral blockage: 197.0 (CTT kit orthopedics, ampule O056)
To stabilize ligaments: 198.0 (CTT kit orthopedics, ampule O040)
Chip on the L4/L5 region
Observation
Patient reveals she has a totally different posture regarding life. “Now I have time to think about other things than my pain”
Patient started to do yoga, pilates.
Supplementation
Reduction of Magnesium because of the diarrhea (1+0+1) if diarrhea remains reduction to 0+0+1
4th treatment (2 weeks after)
Patient report
Doesn’t take any medication
Refers to a decrease of 80% of pain, restful sleep, feels very happy with life
Treatment
Maintain Magnesium (1+0+1) and melatonin
Osteopathy
Myofascial diaphragm
Manipulation HVLA T12
BICOM® bioresonance
Basic therapy
3017.0 Clear deep blockages
To stabilize ligaments: 198.0 Test program (CTT kit orthopedics, ampule O024) (BRT oil OC)
To stabilize muscles: 198.0 (CTT kit orthopedics, ampule O039) (BRT oil OC)
Observation
No reference of pain, great lumbar mobility.
5th treatment (1 month later)
Patient report
Feels like a new person, no medication, no LBP, restful sleep, decrease of melatonin (4 drops) and has a new boyfriend.
Treatment
BICOM® bioresonance
Basic therapy
To stabilize ligaments: 198.0 (CTT kit orthopedics, ampule O024) (BRT oil OC)
951.1 Blockage in tissue
3036.0 Regulate detoxication
Observation
Every 3 months she makes a follow up treatment.
Supplementation
Maintain magnesium 1+0+1, melatonin (4 drops)
Case 2
Chronic lower back pain for the past 2 years after hernia surgery (L4/L5)
Male, 62 y/o, bank accountant, retired, married, 1 daughter
Medical history
High blood pressure (medicated)
Stopped taking medication after several attempts.
Hernia surgery 2 years ago
Pain on palpation L3‐L4‐L5 region with associated hypomoblity
Has a good quality of sleep
When he wakes up, needs to stay sat in bed before getting up because of the pain.
Pain is worse when he needs to start moving after a few minutes of being in a standing position
Small swelling in L4/L5/S1 area
1st treatment
Osteopathy
Myofascial release LB
Harmonic techniques lumbar spine
Gentle traction L4‐L5‐S1
BICOM® bioresonance
Basic therapy
Support elimination organs
For lumbar anesthesia: 197.0 (CTT kit orthopedics, ampule O055) (BRT oil OC)
3037.0 Inflammations (Input: pain area) (chip)
197.0 (CTT kit orthopedics, ampule O051) (BRT oil OC)
Chip on pain area
Observation
At this point nothing has changed except that the patient feels tired.
2nd treatment (1 week after)
Patient report
2 days of diarrhea after treatment and felt extremely tired, the pain was worse in those two days but started to improve after that and now he has no pain.
Osteopathy
Myofascial release psoas
Harmonic technics LB
BICOM® bioresonance
Basic therapy
For vertebral blockage: 197.0 (CTT kit orthopedics ampoule O056) (BRT oil OC)
3086.0 Oxygen regulation (chip)
3125.0 Cell regeneration, chronic (chip)
Solar Plexus Chakra: 970.2 Chakra therapy for 1st to 3rd chakra (3 min) + CH2 Mineral: citrine
Observation
Patient returned for follow up 6 months later with no complaints.
Case 3 (special case)
This patient has had CLBP (since forever he said). However he came to my clinic with an acute LBP for the past 2 days.
Male. 58 y/o, lawyer, divorced, 1 son
Medical history
Patient doesn’t remember when started to have LBP, acute LBP for the past 2 days during sleep.
In severe pain with every move he makes, highly depressive, dyspepsia. Takes painkillers every day, gastric protector, multivitamin for the brain.
After talking with the patient we could find a timeline to discover when the LBP started and he says that after the divorce everything got much worse. (10 years ago)
1st treatment
Osteopathy
Myofascial release diaphragm
Sacrocraneal therapy pelvic diaphragm
BICOM® bioresonance
Basic therapy
Support the elimination organs (liver, kidneys)
Solar plexus Chakra: 3,3 Hz; H 1,2; Di 7,0; 4 min (according Dr. Hennecke and Mrs. Ma‐ quinay‐Hennecke ) (BRT oil OC)
Root Chakra: 970.2 Chakra therapy for 1st to 3rd chakra (3 min) (BRT oil OC) 198.0 (CTT kit orthopedics, ampoule O045) + CH2 Tryptophan ampule (CTT kit orthomolecular substances, ampule OS048) (chip)
For shock: 197.0 (CTT kit orthopedics, ampule O053) (chip)
3017.0 Clear deep blockages + CH2 MSM ampule (CTT kit orthomolecular substances, ampule OS056)
Observation
Patient is still in severe pain however he mentioned that he feels strange, nausea, slight vertigo but able to walk by himself.
Advice
Water intake, avoid milk
2nd treatment (1 week after):
Patient report
Patient refers to hot flashes 1 day after, he kept taking painkillers and feels better. The pain he feels is the one that he has for the past 10 years, mentions that it is slightly better regarding dyspepsia
Treatment
Osteopathy
Although he says is better he still has a lot of difficulty with all movements.
Harmonic technics lumbar spine
Myofascial release sacrum area
HVLA ilium (bilateral)
HVLA L4/5
BICOM® bioresonance
Basic therapy
951.1 Blockage in tissue (BRT oil OC)
3036.0 Regulate detoxication + CH2 MSM ampule (CTT kit orthomolecular substances, ampule OS056) (BRT oil OC)
Throat Chakra: 940.1 Chakra therapy for the 5th to 7th chakra (3 min) + CH2 mineral: azurite‐chrysocolla
Solar Plexus Chakra: 970.2 Chakra therapy for 1st to 3rd chakra (3 min) + CH2 mineral: citrine
Observation
Patient refers that he feels sad but with more movement and less pain
Advice
Maintain water intake, avoid milk
3rd treatment (2 weeks after)
Appointment should take place one week after but patient cancelled and reschedule one week after.
Patient report
Refers that he cancelled because started to feel much better and wanted to try if things would keep improving without treatment. After the treatment he cried without reason (he said…). In two weeks only took painkillers 3 times.
When sitting in the chair, did it with almost no pain and very easily.
Treatment
BICOM® bioresonance
Basic therapy
3086.0 Oxygen regulation + CH2 Adrenal gland ampule (CTT kit hormones, ampule HON036) (chip)
Splenic Chakra: Mineral: fire opal, 970.2 Chakra therapy for 1st to 3rd chakra (3 min) + CH2 Dopamine ampule (CTT kit hormones, ampule HON009), Tryptophan ampule (CTT kit orthomolecular substances, OS048) (BRT oil OC)
To stabilize lumbar spine: 198.0 (CTT kit orthopedics ampoule O032)
Observation
Patient refers that he feels younger, lighter and even in court he has more energy to fight for the client.
We made an appointment for one month later for follow up but he canceled few days before. What I know is that some days later I saw him jogging just like a normal healthy person.
In conclusion
We can’t just use “one size fits all” for the same condition. Every patient is a challenge and looking beyond what they say, looking the way they move, behavior, speech, their life history, their energy, is needed for the success of the treatment.
We cannot be responsible for what they do in their lives but we are responsible to help them as best we can from “our side” and make them trust that we do our very best in our job. They need to understand every single touch, and move we make. Explaining this for them and telling them what we are doing makes the cells “understand” better.
For that we have a huge tool – the BICOM® optima.
I have to say that I presented only 3 cases. I could also present many more regarding other pathologies but these were cases that were extremely difficult because the patients were desperate and hopeless, just wishing that something could take that pain away. And here BICOM® is a success by itself and is also very powerful in conjunction with other medical specialties.
Thank you for your time.