The
Natural
EDITION 38 NO. 2 | SUMMER 2023
Therapist ISSN 1031 6965
Summer 2023
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Contents Edition 38 No. 2 | Summer 2023
From the Chair
5 Executive Officer Report 8 Branch Chair Updates 15 ANTA News 17 Round 1 Graduate Award Winners 2023
20
26
The Art of Yang Sheng: Nourishing Life the Chinese Medicine Way
Exploring Thoracic Mobility and Breathing Biomechanics
Barbara Malarski, ANTA Member, explains
Isaac Enbom, ANTA Remedial Therapy Branch
Chair, explores how dietary intervention can
Yang Sheng and Emotional Immunity and how
Chair, explains thoracic mobilty and how
help in musculoskeletal pain.
its helps her clients in practice.
natural therapists can empoly the various
35
Dietary Interventions in Musculoskeletal Pain Ananda Mahony, ANTA Naturopathy Branch
strategies to assess and improve both mobility and breathing.
39
43
47
52
An In-Depth Review of the Efficacy of Manual Therapy for Neck Pain and Headaches
The Barefoot Movement - A Goldilocks Story
Breath, Mind and Spirit - Understanding the Power of Pranayama for Wellbeing
Beyond the Conventional Weight Loss Approach
Shaun Brewster, ANTA President, tells a story of how he took up barefoot running, and using his knowledge as a clinician, changed the way
Elise Cowley, ANTA Member, takes an in-
he treated clients with injuries.
depth look at the data showing that various
Neerja Ahuja, ANTA Ayurveda Branch Chair, explains the history of Pranayama, its mind-
Danielle Svensson, ANTA Member, explains from a clinical perspective and exploring the data, why conventional weight loss efforts are failing.
body connection and its practical applications.
manual therapy interventions can drastically reduce neck pain, headaches and cervical dysfunction.
The
Natural Therapist
The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers. Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.
EDITION 38 NUMBER 2 – SUMMER 2023
ISSN 1031 6965
ANTA BRANCH CHAIRPERSONS Shaun Brewster • National President • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair • ANRANT Committee Member • Health Fund Chair Warren Maginn • National Vice-President • Director of ANTA • National Nutrition Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Ananda Mahony • National Treasurer • Director of ANTA • National Naturopathy Branch Chair Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member
Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member Tino D’Angelo • Director of ANTA • National Chinese Herbal Medicine Branch Chair Neerja Ahuja • Director of ANTA • National Ayurveda Branch Chair Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • ANRANT Chair
The
Natural Therapist
Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577 Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au
ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au
ANTA Executive Welcome Summer 2023
From the Chair It is with sincere gratitude and respect that I complete this final report as the ANTA Executive Officer. Five years ago, I took up this role at the request of the ANTA Board of Directors in September 2018. I would like to thank all staff at the National Administration Office, the ANTA Board of Directors, our revered ANTA Seminar presenters and our lifeblood, the ANTA Members for their work in Natural and Traditional Medicine services since 1955. After eighteen years as an ANTA Director, multiple terms as the ANTA President, twenty odd years as an ANTA member-therapist/ business operator, part time trainer, full time educator with a national reach, this national governance role proved to be a good fit.
Summer 2023
The fact that in 2019, the Chief Medical Officer of Australia announced 15 therapies were found to lack any evidence base including safety, quality, clinical efficacy or cost effectiveness is a false premise. Statistics demonstrate otherwise! The evidence of these metrics are based on medical records preserved by mainstream health which clearly demonstrate the safety and quality of natural and traditional medicine commensurate with the miniscule (<1%) occurrence of any adverse events recorded against clinical application and client usage of natural and traditional medicine services.
On the one hand, the Australian Government established the Australian Skills Quality Authority (ASQA) and the Tertiary Education Quality and Standards Agency (TEQSA) to approve training Over the years, the ANTA Administration Team standards, guaranteed to produce higher has transitioned through many challenging education graduates with inherent supervised times. Since 2014 adverse events impacting clinical training requirements. These standards our professions culminated in April 2019 when and criteria were established in collaboration the Australian Government removed 15 natural with the Australian Securities and Investments therapies from the private health funds list. This Commission (ASIC) Registered industry peak was a serious blow to all Natural and Traditional bodies. It cannot be said that there are no training Therapists across Australia and caused peak standards or any evidence of client safety, clinical bodies deep concern for the future of Natural efficacy, quality outcomes or cost effectiveness and Traditional Therapists nationally. One of when Australian Government agencies are the very challenging events was the removal of appointed and funded to guarantee the requisite Naturopathy and related ingestive therapies as graduate outcomes and ensure public safety. rebatable items from the health funds list. It also cannot be said there is no statutory regulation or legislated oversight regulating Naturopathic education and training are among these practices when almost all Australian States the more robust natural therapy training and Territories have now adopted the National programs offered. Its removal from the rebate lists Code of Conduct to hold all health practitioners defies the most rational level of understanding accountable under the Office of the Health about what Naturopathy is and how it has Ombudsman when their practices fall outside benefited so many Australians. Naturopathy’s the auspices of the Australian Health Practitioner education, training and practice in the current Regulation Agency (AHPRA). This means all four-year degree will not fail to deliver excellent Natural and Traditional health practices in practitioners with higher level skills and methods Australia are regulated under legislation passed to prevent many common, adverse health into law by the Australian Government. conditions. THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 5
ANTA Executive Welcome Summer 2023
On the other hand, it beggars’ belief in the democratic society in which we live that another Government agency is able to position itself to ride roughshod over Government funded, tertiary educated health workers to deprive them of health fund recognition and force up the costs of legitimate health care services to users. All this because they purported to have unseen, unknown evidence of a lack of quality and safety in natural therapies. These actions quite clearly contradict the metrics the Australian Natural and Traditional education regulators possess in relation to the index professional training programs and their governance. Further to this, within six days of the announcement to ban 15 therapies from health funds list, the Australian Health Minister announced a further review of the 2014-15 review outcomes would begin following a challenge from the Natural Therapies Professional Associations. This challenge was based on evidence the reviewers appointed by the National Health and Medical Research Council (NHMRC) failed to adhere to the standards and criteria for the review of the submissions made by the stakeholders. The second review is now nearing completion. What the ANTA Board were able to do in the face of this seemingly insurmountable barrier was demonstrate the resilience within our profession at all levels across numerous collaborative Associations and fight back against the negatives, offering as much support to our members as we could muster. One of the many positives within ANTA is the initiation of change to Guild Insurance, ANTA’s preferred insurance provider to lower costs to Members and ensure only proven costs around genuinely higher-risk practices were accepted by the ANTA Administration. The outcome resulted in better coverage for all modalities with lower premiums. This initiative also sparked a professional relationship with a genuinely supportive partner for our members’ services. Our members responded positively, and we have all benefited from this initiative. We continue to search out ways to support our members practices through our improved facilities, services and marketing.
the invasion across Australia by the COVID-19 virus. Many people contracted the virus and some passed as a result. Sadly these events will affect the health record in Australia for some time with the trailing negative effects on the Australian population. The many ways COVID-19 affected us personally may be a matter for the history books. Here we are more than three years since the first recorded infections in Australia and these infections continue with serious and long ranging effects such as COVID Organising Pneumonia and Long COVID. Natural and Traditional Medicine has consistently proven its value alongside mainstream medicine related to avoidance, prevention and recovery from the myriad after effects. I am impressed by the way ANTA Members endured the influences of the pandemic and we have emerged wiser, healthier and benefited in many ways through following our personal and professional experiences. While anti-viral medications found their place in treatment toward recovery from COVID-19, Natural and Traditional Medicine has contributed effectively in recovery for many through overcoming the after effects of the virus and even the life preserving treatments required in some cases. Now we have an opportunity to discuss evidence-based approaches from mainstream and alternative medicine protocols to aid post infection recovery. I also see an increase in enthusiasm and commitment from Members toward pre-COVID levels of clinical practice while engaging in the treatment of post-COVID and other health effects experienced by many Australians. I encourage all our members to hold their faith in their client services and treatments. By following the naturopathic edict of “first, do no harm”, our future is secure!
The continuing challenge to us all has been widely discussed and debates continue to surface about PAGE 6 | SUMMER 2023 | THE NATURAL THERAPIST VOL 38 NO. 2
Regards
Jim Olds
ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM
ANTA Executive Welcome Summer 2023
From the President
Summer 2023
A thank you to Mr Jim Olds At the end of 2023 will be the end of an era for ANTA. We will be saying farewell and happy retirement to a true champion of ANTA. James (Jim) Olds, joined ANTA in October 1996 and was elected to National Council five years later. A bachelor qualified Musculoskeletal Therapist (Myotherapist), Post Graduate certified Sports Coach, Diploma qualified Remedial Therapist, Chinese Massage Therapist and Clinical Nutritionist. Not to mention a long list of other certificates and academic awards. Outside of his substantial contribution to ANTA, Jim lectured and held senior academic positions in Higher Education and Vocational Education organisations. He was also an exemplary clinician, treating and helping countless individuals in his private practice for many many years. Jim has stood strong and represented the interests of ANTA Members fiercely, fairly and without falter for over two decades.
ANTA, its Members and the broader community. It is with heavy hearts, but the fondest of wishes, that we say good bye to our friend Jim. ANTA is far better for your contribution Jim, and those of us who had the pleasure of serving under and alongside you are better for that experience. Thanks Jim. Regards
Shaun Brewster
ANTA National President
His dedication and leadership saw him hold Chair positions for a number of different modality branches, he was also Chair of the ANTA’s Ethics Committee, Chair of ANTA’s Accreditation Board, he was Treasurer, Vice President and President. In 2018, sadly we saw the passing of our then, long serving Executive Officer and close friend of Jim’s, Mr Brian Coleman. True to his commitment to ANTA, Jim accepted the request from National Council to step into the Executive Officer role to steer ANTA forward. As Executive Officer, Jim was able to utilise his inclusive management style to lead and strengthen the team at ANTA’s National Administration Office, and also employ his vast and comprehensive knowledge of the Australian health care landscape to benefit THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 7
ANTA News Summer 2023
Branch Chair Updates
Summer 2023
Acupuncture Branch Chair Update In June 2022, the Chinese Medicine Board of Australia (CMBA) along with 11 other Australian Health Practitioner Regulation Agency (AHPRA) Boards accepted the Shared Code of Conduct. This Shared Code of Conduct sets out 11 guiding principles to ensure high standards of competency, professional conduct with clients and colleagues alike, and ethical behaviour and research. Our uptake of this and the other principles found within the Shared Code shows the next developmental step for the profession as a whole. We need to be able to speak to this, and the other principles, as healthcare professionals. The CMBA recently published their revised Guidelines on Chinese Medicine practice which includes safe Chinese Herbal Medicine practice and Infection Control for Acupuncture and Related Practices. They will come into effect 1 December 2023. The most recent Reference Group meeting with the CMBA and industry stakeholders held on 15 August 2023, highlighted this Shared Code and emphasised to the representatives around the table, what the priorities for the regulator would be over the coming year at least. Advertising Standards, Cultural Competency and Safety (for First Nations people) and the review of English Language conditions on registrations. The lack of understanding around what constitutes Cultural Safety and culturally safe practice around that table was alarming and unsurprising. I suggest all ANTA Members get proactive on educating yourselves on this issue. There is a paid CPE/D online service called Ausmed, which has a good 30 minute webinar on what it is and how to practice it. ANTA will also be running some Cultural Safety seminars in the new year. As for advertising standards, please read the Branch Chair update from Tino D’Angelo (Chinese Herbal Medicine Branch Chair) on page 11. The CMBA will be continuing to target compliance around AHPRA advertising standards, given that the
results of a 2020/21 audit they did showed 56% of practitioners were non-compliant. The main issues of concern were content on websites and social media where practitioners; claimed to be specialists or subspecialists in an area of Eastern medicine practice, provided a lack of acceptable evidence for treatable issues, and therefore provided unrealistic expectations of beneficial outcomes. The standards for advertising what we can treat, are far higher than that of evidenced-based practice, so the workarounds in business and practice advertising have to be mindful and clever. Just as well those are core strengths for all Chinese Medicine (CM) practitioners. Another telling statistic from that same 2020/21 audit, indicated that the average length of time a CM practitioner stays within the profession is 15 years post-graduation. When you consider that many in the mainstream and public healthcare industry work within the industry for their whole working life, 15 years is not that long. Why are we leaving? Of course, there can be a few reasons for why this might be. It could be that many come to CM practice at an older age so there is the attrition of retirement, or that once women (and 75% of practitioners are women) have children and raise families, other priorities take over. Maybe it is after 15 years of hard graft, isolated working conditions, the endless juggling of commercial considerations over clinical ones, and an increasing conservatism within the healthcare landscape, the work and reward ratio for many seems to diminish into unsustainability? The ANTA Chinese Medicine (Acupuncture and Chinese Herbal Medicine) Chairs would love to hear from Members about what their experiences within their work environment are like and we will be looking to create a poll or survey for Members soon.
PAGE 8 | SUMMER 2023 | THE NATURAL THERAPIST VOL 38 NO. 2
ANTA News Summer 2023
If you get to the ANTA National Seminars (held around the country each year), Tino and I are always open to hearing from Members, and you can always reach out to us via email.
what the future of the medicine and the profession looks like in Australia. Students and more specifically new graduates are the lifeblood of the profession into the future.
On other news, another issue gaining currency both within the Reference Group stakeholders and more broadly, and which is illustrating a level of structural disadvantage, is the categorisation of CM practice.
The CMBA is heartily insisting that the rate of current students enrolled in CM is strong and increasing, (another insight from their 2020/21 audit), which on the face of it is good news.
Is it Allied Health (as many want), Complementary or Alterative? How interesting what is in a name and a term… identity politics at its best.
Getting some traction on the professional issues that are frustrating our community would go even further to ensuring those young practitioners are joining our ranks. Let us watch this space!
Federally we are recognised as Allied Health, but our profession’s lack of membership in the Allied Health Professionals Association (AHPA) and the deafness of State health authorities is hampering effects to get State based recognition progressed.
Regards
Kaitlin Edin
ANTA Acupuncture Branch Chair
ANTA will continue to advocate and represent on the issues where we can and continue to put pressure on the main points of these matters where it is appropriate to do so. Where we can work with other Associations for the benefit of the industry, we will. While we are clear that the role of the CMBA is to protect the public, the current Chair of the CMBA Board, Dr Danform Lim has been more proactive in his response to lobbying by the Associations than his predecessor. Lim with his Board have accepted how it is possible within the Board’s scope, to develop a public awareness campaign, advocating for the industry by raising the consciousness of CM practice within the Australian mainstream, and emphasising the benefits of seeing a registered CM practitioner. So, it would seem the CMBA is stepping up to assist the profession where it can within its scope. This campaign was meant to have been rolled out in early August this year and due to technical issues within the CMBA has now been set for early next year. Our understanding is that it will include advertising on a range of platforms. It would have been useful if this campaign had gone through some industry testing first, but that it is happening at all is a sign of the times. Most of you will have heard about the cancelling (and teach out) of the undergraduate CM course at RMIT. Many have been up in arms about it, but undergraduate CM and Acupuncture courses are still being taught within a range of (mostly private colleges) educational settings. As we all understand student enrolment and engagement is one of the canaries in the coalmine. It gives us a snapshot of THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 9
ANTA News Summer 2023
Ayurveda Branch Chair Update I am taking this opportunity to reconnect with you. As part of the ANTA team, I am committed to network with you and forward awareness of Ayurveda in Australia as a holistic health modality that deserves a top place in the preventative and primary health care system. I hope this message finds you in the best of health and spirits. As we come together as members of ANTA, I am filled with a great sense of purpose. It is a privilege to serve as your Branch Chair and to have the opportunity to connect with each of you in our shared journey of working with and promoting Ayurveda in Australia. I know we need to do a lot more, but journey of a thousand miles starts with a single step. And we just need to keep working. As you know, Ayurveda, the “Science of Life”, has a profound history that dates back to thousands of years. It encompasses not just a system of medicine, but a holistic way of life that looks to harmonise the mind, body and Spirit. Our ayurvedic ancestors and lineage gave this timeless wisdom to us, and it is our responsibility to safeguard, nurture and spread it. In these current times, the world is increasingly recognising the value of holistic healing approaches like Ayurveda. People are looking for and pursuing natural, sustainable solutions to their health concerns, and Ayurveda offers a signal of hope. ANTA plays a major role in advancing this cause of natural health, and our membership holds the key to its success. Let us remind ourselves that unity is our greatest strength. Together, we can strengthen our voices and advocate for the acceptance and integration of Ayurveda into mainstream healthcare. We can collectively advance and share knowledge and enhance our skills to provide the best care to our patients. By being part of ANTA, we join hands not only with each other but also with all those people who stand to benefit from Ayurveda’s wisdom.
access to workshops, seminars and resources that keep us updated with what is going on, not just in Ayurveda in Australia but also other natural health modalities, enabling us to provide the best care to our patients. Please use the resources provided on the ANTA website and Member Portal. • Community and Support: Being part of an Association means you are never alone in your journey. You have a community of like-minded individuals who understand your challenges and can offer support and guidance. • Promotion of Ayurveda: By being a part of an Association and having a Branch Chair on the ANTA Board of Directors, you are contributing to the greater cause of promoting Ayurveda. Your membership helps in bringing initiatives that spread awareness and knowledge about natural health and Ayurveda. Let us stand together, inspired by the timeless wisdom of Ayurveda, to serve humanity and make a meaningful impact on the world of healthcare. Your active participation and commitment are vital in realising the full potential of our Association and all of us. Once again, I invite you to join me in this incredible journey of brining awareness, wellness and growth. Let us rekindle the flame of Ayurveda’s wisdom and light the path for those who are looking for healing and balance. Together, we can make a difference not only in the lives of individuals but also in the future of Ayurveda itself. Thank you for your dedication and passion for Ayurveda. I look forward to our collective efforts in the days to come.
As we reflect on the journey ahead, I encourage you to embrace the potential that lies within our ANTA membership: • Knowledge Exchange: Our ANTA community serves as a platform for sharing experiences, research and case studies. • Advocacy: Together, we can lobby for policies that promote Ayurveda, and natural health, ensuring its rightful place in the healthcare landscape in Australia. • Continued Education: As Members, we have PAGE 10 | SUMMER 2023 | THE NATURAL THERAPIST VOL 38 NO. 2
Regards
Neerja Ahuja
ANTA Ayurveda Branch Chair
ANTA News Summer 2023
Chinese Herbal Medicine Branch Chair Update Australian Health Practitioner Regulation Agency Friendly Advertising Guidelines: A General Overview: Kaitlin Edin (Acupuncture Branch Chair) and I represented ANTA at the most recent Reference Group meeting with the Chinese Medicine Board of Australia (CMBA) and industry stakeholders held on the 15 August 2023 in Sydney. One of the many topics highlighted was the issue around Advertising Guidelines. According to an audit that the CMBA had conducted in 2020/21, the results (only recently reported) found 56% of practitioners were non-compliant with the Australian Health Practitioner Regulation Agency (AHPRA) advertising standards. The audit found that the main issues of concern were materials or content where practitioners claimed to be specialists or subspecialists in an area of Eastern medicine practice; provided a lack of acceptable evidence for treatable issues, and therefore provided unrealistic expectations of beneficial outcomes. It is both unsurprising and concerning. As we know most practitioners are also small business owners. Websites and social media are the lifeblood of many small business owners. When faced with commercial considerations, the lack of structural supports, and a plethora of material out there on the web about competing practices, we seek to distinguish ourselves as educated and professionals. The standards for advertising what we can treat, are far higher than that of evidenced-based practice, so the workarounds have to be mindful. We both thought its a timely reminder, to provide an overview of AHPRA’s Advertising Guidelines and to help make some of the key points clearer to our registered Chinese Medicine and Acupuncture Members.
Understanding Australian Health Practitioner Regulation Agency:
AHPRA is the national organisation responsible for implementing the National Registration and Accreditation Scheme (the National Scheme) across Australia. It works in partnership with each of the 15 national boards, CMBA (the Board) being one of them, to ensure public safety within the healthcare sector.
The CMBA does NOT advocate for our profession directly. This is the role of ANTA (and other Associations). However, in making sure that the general public receives the highest standard of care when it comes to Chinese Medicine and Acupuncture treatment, it advocates for professionalism and industry accepted standards. In so doing it could be argued that it indirectly advocates for Chinese Medicine practice in Australia Advertising is an important way health practitioners and providers of regulated health services promote their services to the public, but the National Law establishes requirements for advertising a regulated health service. These requirements are important for public protection and help to ensure the public receives accurate and honest information about healthcare services. Advertising can influence a consumer’s decisionmaking about their health care needs. It is important then that consumers have access to information that is accurate, not misleading, and is supported by acceptable evidence. Unlawful advertising may compromise the healthcare choices of the public. The Advertising Guidelines state if you are advertising a regulated health service, your advertising must not: • Be false, misleading or deceptive, or likely to be misleading or deceptive. • Offer a gift, discount or other inducement, unless the terms and conditions of the offer are also stated. • Use testimonials or purported testimonials about the service or business. • Create an unreasonable expectation of beneficial treatment. • Directly or indirectly encourage the indiscriminate or unnecessary use of regulated health services. At first glance, this all may not only seem incredibly overwhelming but also very restrictive to abide by, and quite frankly for some, a change of mindset may be necessary to see it in a positive light. If we see the guidelines as aligning with the Boards purpose, which is to protect the public, and we accept that safety is the responsibility of us all, then we begin to understand that to be within the guidelines means we are lifting the representation of the industry to the general public. To see the advertising guidelines in a different light, let us take two examples: The first being the kind of practitioner that seems to
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 11
ANTA News Summer 2023
do everything and nothing very well, who promises the world but always falls short on what they deliver. The second being, the situation where a patient comes to you and they say, “I have come to you because you are the only one you can fix me”. Both are red flags as a professional. And both are really about expectations. As healthcare professionals, we do not want false or unrealistic expectations, not least because it puts us under pressure, but it highlights the vulnerability of the patient, and it makes it unsafe for us as practitioners also. It becomes an ethical issue, when we do not recalibrate our own or a patient’s expectations of our medicine and the results that can be achieved. Excellence develops when we are clear about the limits and scope of what we do as practitioners. A further examination of the restrictions within the guidelines, illustrates that they are all about ethical, honest practice. This ensures safety for the general public, but it speaks to our integrity as well. The examples below may assist in illustrating the practical use of the main aspects of the guidelines:
False, Misleading, or Deceptive Advertising –
This is where the most sense of restrictions comes in, because to be misleading is to jeopardise the reputation of not only one practitioner, but the profession as a whole. Of course, what is consided misleading to the regulator is not always considered that way by the clinicians that work with the medicine every day. There is not much we can do to completely resolve this apart from remaining truthful and realistic about our claims. It is best to not to make a claim about a treatment being beneficial for a specific condition. Current research/acceptable evidence can be difficult to source, because the standard of research required for advertising is considerably higher than clinical significance. You would do better keeping any claims quite general as in the (compliant) example below. Also be sure to check out AHPRA’s website for what is considered ‘acceptable evidence’. Non-Compliant: “Our Acupuncture and Chinese Herbal Medicine treatments will alleviate your headaches without any side effects”. Compliant: “Acupuncture and Chinese Herbal Medicine has been used in the management of headaches for many years. Please consult with our experienced practitioners to discuss the most appropriate
treatment for you”.
Gifts, Discounts, or Inducements – In general your medicine needs no inducement, however, there may be times where business is very slow and a shoutout to your clients with a small incentive may be beneficial. Existing clients are important to keep, and how you communicate with them may be different to how you engage new clients. It is important in this case that we do not advertise in a way that can make us look ‘cheap’ and shrill, and also important to ensure that what we are doing is not encouraging indiscriminate or unnecessary use (below). The most important thing to keep in mind here is that the terms and conditions of the promotion must be stated. The terms and conditions may be listed directly following your promotion statement, or you could direct the reader to where they are – and they must be easily accessible. Non-Compliant: “We are offering 20% off for existing patients during this month”. Compliant: “Existing patients may be eligible for a 20% discount when referring friends and family (please see terms and conditions below)”. “*Terms and Conditions: This offer is only for existing patients when valid referral of a new patient is confirmed. This offer may only be used once”.
Testimonials – Reviews or Feedback From Patients – Generally do not put these on your
websites and try and avoid commentary on sites like Facebook. Third party platforms like Whitecoat and Google, work on testimonials and these platforms are generally not in the regulators sights, so many businesses use them to improve their SEO and website rankings just take care if you choose to engage with reviews on a third party site. Non-Compliant: “Dr ABC is the best acupuncturist I have ever seen”. Compliant: “The atmosphere at ABC Clinic is lovely, and the staff are very friendly”.
Encouraging Indiscriminate or Unnecessary Use - This in unethical behaviour and while it does
go on, it is not usually something our profession tends to engage in. Everyone that comes to see us for treatment should be in legitimate need for our services. Have a rationale for all treatments and if you
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ANTA News Summer 2023
are audited you will not have an issue here. Non-Compliant: “Keep your bookings with us regular to maintain perfect health”. Compliant: “The length of your treatment may vary based on the type of illness”.
Claiming Specialist Titles – Beware (mentioned
this briefly earlier on), you might be very experienced and have a keen interest in a particular health condition, but do not call it a speciality. The only practitioners who can claim to be specialists are those within the mainstream medical fields. If you have additional training and qualifications by all means list those, but do not call yourself a specialist or what you do a speciality.
While advertising offers numerous benefits, it is essential for us as Chinese Medicine practitioners to adhere to the advertising requirements outlined in the National Law and follow ethical guidelines, remain truthful, and prioritise client health and wellbeing. The guidelines are part of how we develop our profession in Australia and maturity of practice. The best designed regulation assists us to create and maintain a trustworthy, capable and reliable profile, providing accurate information to the public while upholding the integrity of our profession.
Non-Compliant: “Dr ABC specialises in the treatment of gastrointestinal problems”. Compliant: “Dr ABC has over 10 years of experience in treating gastrointestinal problems”.
Regards
Tino D'Angelo
ANTA Chinese Herbal Medicine Branch Chair
Further information and examples may be found on the AHPRA website, where you will also find a PDF document called ‘Guidelines for Advertising a Regulated Health Service’.
Myotherapy Branch Chair Update This year has seen some major challenges in the Myotherapy profession. We have unfortunately seen a higher education provider wind down their bachelor in Myotherapy program. Enrolments in Advanced Diploma of Myotherapy programs at TAFE’s and private recognised training organisation’s (RTO’s) have been lower on average. Like many of the modalities in the natural therapies professions, there appears to be some post pandemic fallout that has impacted course uptake nationally. Likely a contributing factor to the current state of play in Myotherapy is the fact that there has been a delay in the release of the updated Advanced Diploma of Myotherapy training package. The new start date for the updated program is set for the start of 2025. I have had the pleasure of representing ANTA as part of the committee that has produced the updated Advanced Diploma of Myotherapy training package. The new program promises to deliver some important and highly valuable knowledge and skill updates in the areas of corrective exercise, pain science, more
thorough clinical practicum and more. With more certainty around release dates and the content of curriculum updates, we expect to see improved confidence in training providers and some positive moves for the Myotherapy profession. Communication with Myotherapy practitioners indicates that demand for their services is consistently high, with many members reporting long waiting lists. So, despite some of the challenges in the education sector, Myotherapy is still in a strong position. ANTA has continued to advocate for and represent the interests of Myotherapists nationally. We have furthered our collaboration with several other professional Associations and worked closely with health funds and other stakeholders to ensure the high standing of our Members in the broader healthcare landscape. Regards
Shaun Brewster
ANTA Myotherapy Branch Chair
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 13
ANTA News Summer 2023
Naturopathy Branch Chair Update 7th International Congress on Naturopathic Medicine Conference - Paris, France:
It was with enormous pleasure that I recently flew to Paris to attend the 7th International Congress on Naturopathic Medicine (ICNM). In my capacity as ANTA Naturopathy Branch Chair, I was able to liaise with members of ICNM and participants from many parts of the world, including a dozen or so Australian naturopaths who also attended. As part of conference, I presented findings of a literature review I had completed, “Dietary Interventions in Musculoskeletal Pain”. Also presenting were Australian naturopaths and ANTA members, Elizabeth Greenwood and Christos Miliankos. Elizabeth’s talk, “Medicinal Influences on Anti-Ageing Parameters: Balenotherapy and Longevity” outlined the impact of medicinal bathing on quality of life and ageing outcomes. Many of you may be aware that research is part of Elizabeth’s dectorate studies. In his presentation, “Harnessing Body Wisdom to Stay Young”, Christos inspired participants to recognise and utilise naturopathic tools such as iridology, nail, and tongue signs as part of a holistic health assessment. Christos is a practicing Naturopath and Bowen therapist who focuses on integrated iridology. He is the current President of the International Iridology Practitioners’ Association and has just had a book published on iridology, “People with Eyes Like These”. As a notable naturopath practicing in Australia, Dr Nirala Jocobi presented her talk, “SIBO Matrix: Understanding the Underlying Causes to SIBO”.
Statutory Registration for Naturopathy and Western Herbal Medicine:
Since the last Branch Chair Update the crossassociation Town Hall presented by ANTA, CMA and NHAA was run with significant interest across our professions - over 1000 people registered to attend. For those of you that missed the live event, the recording is now available front-facing on the ANTA website under the drop-down menu “What’s New” or available in the ANTA Member Portal. If you have any questions or comments about the Town Hall or Statutory Registration, I encourage you to get in touch.
Private Health Insurance Update:
In a recent update from the Natural Therapies Review Expert Advisory Panel (NTREAP) evidence evaluations for Naturopathy Review A - Whole Practice are currently being finalised. The outcomes prioritisation for Naturopathy Review B - Selected Nutritional Supplements is underway and due at the end of August as are the draft evidence evaluations for Western Herbal Medicine. All evidence is expected by December 2023 and the Chair report to Government is anticipated to be provided in early 2024. The purpose of this review process is to assess published scientific research for the 16 modalities excluded from private health insurance including Naturopathy and Westen Herbal Medicine. From this review process the Natural Therapies Review Expert Advisory Panel will advise if private health insruance should cover these therapies.
The ICNM mission is advancement in traditional, complemetary and intergrative medicine. Over the three days of presentation each element was explored ranging from topcis focusing on traditional and clinical approaches such as therapeutic fasting and balenotherapy to current and emerging concepts such as genomics and metabolomics. From an audience prespective I enjoyed the traditional and holistic emphasis of the presentations, although there was plenty to engage those more interested in a more biomedical perspective. For those interested in submitting an abstract or attending next year, the 8th ICNM conference will be held in Barcelona, Spain, where the themes will be immunity, inflammation and mental health.
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Regards
Ananda Mahony
ANTA Naturopathy Branch Chair
ANTA News Summer 2023
ANTA News
Summer 2023
2024 ANTA Membership Renewal Notices Issued ANTA has issued renewal notices for the majority of ANTA Members. Those Members who are not registered with AHPRA need to ensure that they pay their 2024 ANTA Membership fees before 31 December 2023. ANTA issued renewal notices in early November via email. Please check your junk/spam folders. If you cannot find your invoice, you will be able to view a copy in your ANTA Member Portal, under ‘Email Logs’, or you can contact ANTA on 1800 817 577 or admin@anta.com.au.
Continuing Professional Education Points Due Soon! Continuing Professional Education (CPE) is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care. CPE is an important part of providing professional health care services to patients and ensures practitioners regularly update their clinical skills and professional knowledge. ANTA requires Members to complete 20 CPE hours annually (January to December). CPE hours need to be lodged in your ANTA Member Portal before 31 December 2023. Please see the instructions below to help update your CPE points. 1. Once you have logged in, hover over the word Member Centre (below our logo) and click on My Member Management System. 2. Then click on CPE Activity. 3. Then click on the ‘Add a new CPE Activity’ button. 4. You can now record your CPE activity, ensuring that you complete all fields correctly. Enter the actual date you completed the activity; enter the year you completed the activity; enter the mode you completed the activity (e.g. book, webinar, seminar etc); enter a full description of the activity that includes the name of the book, webinar, etc; including the name of the author or institution (if relevant); enter the number of hours you took to undertake the activity which will be your points, i.e. 1 hour of activity = 1 point. 5. Click ‘Save & Close’ then proceed to Step 3 to enter the next activity.
ANTA Christmas Closure The ANTA Administration Office will be closed from Thursday 21 December 2023 until Monday 8 January 2024. During this time, no emails or calls will be answered. If you need assistance, please send an email to admin@anta.com.au and a response will be provided when the office reopens. All the ANTA Board of Directors and staff would like to wish all Members and their families a happy and safe Christmas. THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 15
ANTA News Summer 2023
What is CPE:
ANTA CPE Guidelines
Continuing Professional Education (CPE) is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.
Why is CPE Necessary:
CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge. ANTA requires members to complete 20 CPE hours annually (January to December). Completion of 20 CPE hours annually is a requirement for your ongoing ANTA membership. It is also a requirement for provider recognition with all health funds and WorkCover authorities (if applicable). Note: If you do not complete 20 hours of CPE annually, your ANTA membership will be suspended until you have completed the 20 hours required. If you are registered with health funds and WorkCover authorities they will terminate your provider registration.
Please note that 1 hour of CPE activity = 1 CPE point. For members registered with health funds, please note that they carry out audits of your records each year to ensure 20 hours of CPE have been completed. By the end of each calendar year ensure that you lodge details of 20 hours of CPE on your personal profile within the ANTA Member Centre. We recommend that you also keep a copy of your CPE records (e.g. attendance certificates) in the event of an audit.
Other Benefits of CPE:
• Members are kept informed and up-to-date with the latest developments • Facilitates communication and networking • Encourages further study • Enhances professional standing within the community
Required CPE Hours:
ANTA members must accumulate a minimum of 20
CPE hours annually (January to December). At least 50% of CPE hours undertaken must be related to the modalities you are accredited in by ANTA. Note: Hours in excess of 20 completed in the current year are not permitted to be carried over to subsequent years. Members registered with CMBA/AHPRA must abide by the CMBA/AHPRA CPD/CPE Guidelines for the modalities of Acupuncture and Chinese Herbal Medicine and must also submit their CPE to ANTA (http://www.ahpra.gov.au/chinese-medicine.aspx).
CPE Activities:
Members can undertake CPE hours in many ways including the following: • Attend ANTA free seminars • Research scientific information within the ANTA Member Centre on: * IMGateway * eMIMS Cloud • Participate in research projects involving, or related to, natural therapies • View seminar recordings and seminar presentations • Complete courses on ANTA eLearning Centre • Give lectures/tutorials • Give CPE seminar presentations • Undertake further study • Complete short courses • Contribute an article to the ANTA journal “The Natural Therapist” and ANTA website • Contribute an article to other relevant journals, magazines and publications • Read articles in the quarterly ANTA journal “The Natural Therapist” • Subscribe to and read other professional publications and journals • View webinars • View online DVDs or recordings on relevant topics • Listen to recordings on relevant topics • Radio/TV broadcast on relevant topics • Read and research information on topics relevant to your practice • Attend local practitioner groups/workshops • Conduct volunteer work with community groups involving natural therapies For further information or assistance contact ANTA at admin@anta.com.au or 1800 817 577.
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ANTA News Summer 2023
Round 1 Graduate Award Winners 2023 Bertrand Dupuche
Dannielle Coffey
Grace Barron
Kadi Lillis
Kate Murfet
Keeley Malcolm
Kristie Scarlett
Odette Lydford
Congratulations also to: Yang Hu
Rema Nakhle
Tara Black
Xinyi Chen
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 17
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ANTA Member Article Summer 2023
Barbara Malarski
Master of Acupuncture Diploma of Teaching Post Graduate in Teaching
The Art of Yang Sheng: Nourishing Life the Chinese Medicine Way What is Yang Sheng?
Yang Sheng is the Chinese Medicine art of self-healing. The literal translation of Yang Sheng is Yang / “to nourish”, Sheng / “life, vitality”. Simply put it means nourishing life. This ancient art has its historical roots in Daoism and Chinese Medicine: practices that are over 2,500 years old. Yang Sheng is holistic; cultivating the physical, mental, emotional, and spiritual dimensions of who we are during this human experience. Traditional cultures
understood balance and harmony and practised it in their day-to-day lives. There was an understanding of the close connection between nature, the universe and man. Yang Sheng’s wisdom is available to everyone.
Prevention is Better than Cure:
Yang Sheng is a preventative medicine. Practising it, we are developing optimal opportunities for good health before disease arises. Even if mild health symptoms develop, the practice of Yang Sheng
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ANTA Member Article Summer 2023
enhances the possibility of symptoms moving quickly through the body and retreating like the tide.
question is, how can we guide our clients to embrace it? Many of the challenges that make it difficult for people to change are due to habitual patterns that are rooted in our psyche and emotional states. Some of these patterns have become hardwired. We can be likened to a computer that has not updated its software, running an old program that no longer serves the hardware (us).
Today humans increasingly face confusion, stress, sleep issues, digital bombardment, chronic diseases, and ever-evolving health issues. An old Chinese proverb states “waiting to treat an illness after it manifests is like waiting to dig a well after one is thirsty” – Yang Sheng, offers health guidance to live long and live well.
The Role of Emotions on Our Immunity:
Practical Ways to Cultivate Yang Sheng in Your Life:
Peter Deadman, in his book ‘Live Well Live Long: Teachings from the Chinese Nourishment of Life Tradition’, talks about three main ways to cultivate the principles of Yang Sheng. They include: • Avoiding behaviour that causes harm like eating processed fast foods. Excess in any area including drinking, smoking or emotional states that are prolonged and unresolved. • Promoting a healthy lifestyle through social connection, and exercise. Working with our emotions and resolving unresolved trauma. Resting and movement according to our age and stage of life and dependent on the work we are involved with. • Internal practices such as meditation, and qigong cultivate wisdom, serenity and balance. So, as we face life events good, bad and challenging, we bring a more neutral poise to these life situations. Choosing these practices can lead to inner enquiry into the nature of who we are beyond our personality and identity, with a more internal focus while still being in the world of work, family and life responsibilities. Deadman talks about the four legs of the chair or the four pillars: mind and emotions, diet, exercise and sleep. If we only focus on one of the legs, we have an unstable chair. This guidance is practical and is common knowledge for healthcare practitioners. The
Much has been written about the Chinese Medicines’ perspective and understanding of emotions and the connection to the organs and the fiveelement system. Chinese medicine classical texts offer a rich and extensive body of knowledge of emotions and their contribution to our health and wellbeing. In the past couple of years, the global community has publicly faced numerous health concerns and with this has come a plethora of information on social media, in books, articles and webinars on immunity from multiple health perspectives. Taking a modern view alongside the traditional wisdom and art of healing from Yang Sheng, we can combine these perspectives and explore our health from a term I have developed and come to use, Emotional Immunity.
What is Emotional Immunity?
Emotional Immunity refers to a form of resilience and capacity to bring awareness to our emotional state of being. In my clinical practice as an acupuncturist, I have noticed an exponential increase in clients’ levels of anxiety, fear, and sense of hopelessness since the pandemic. This is due to a number of factors that have been impacted by • Social media and generally negative news reporting. • A social division that was created by what choices people made relating to their personal health choices during that time. • Isolation from friends and family and wider social connections. For some people, this has resulted in a sense of loss of identity, fear, anxiety, and depression.
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ANTA Member Article Summer 2023
When we develop Emotional Immunity, we become in touch with what is happening inside us. We can experience emotions but rather than being reactive, Emotional Immunity offers an opportunity to be present and centred on what is arising.
wane according to our activities and our age tends to inform us what types of foods and exercise are most appropriate. As we reach the winter of our life (late aging), we may require lighter types of foods and less vigorous exercise.
How Do We Do This and What Are the Benefits?
“The elements of our body are fashioned in the stars. Were written into nature” - BBC TV science programme.
What are the potential consequences for staying for prolonged times in states of fear, anxiety and helplessness? Emotions and trauma left unchecked including intergenerational trauma can develop into a wide range of symptoms if not expressed. Through the practice of Yang Sheng and developing Emotional Immunity, we can impact our biological immunity in a positive way. Caroline Myss a well-known medical intuitive and writer once said, “our biography becomes our biology”. Teaching Emotional Immunity may well be the best health tool we can give our clients in an ever changing and unpredictable world.
The Health Benefits of Connecting with The Environment: Nature has its rhythms and cycles and so does our life. Depending on our age and stage, we wax and
There is an increasing recognition now from Western science, of the connection between the individual and the universe. New fields of study including in the areas of Quantum Physics, String Theory, Epigenetics and Neuroplasticity are closing the gap between traditional medicine knowledge; a 3000-year history of man’s connection with nature. Yang Sheng has a place in our modern culture as we recognise the significance of nature and the environment to enhance our health and state of wellbeing. Japanese people have embraced this with the practice of shinrin-yoku (forest bathing) a term coined in the 1980s and adopted by the Japanese Government as a physiological and psychological exercise to increase health and wellbeing contributing to balance and harmony within the individual.
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ANTA Member Article Summer 2023
The practice of Yang Sheng offers balance in all areas of our lives; what we eat, how we eat and when we eat. Emotions are recognised and validated. Through exercise, movement and breath our very life force is expressed. It invites us to protect and preserve the essence of our being, including our blood, qi, yin and yang, which is the foundation of Chinese Medicine. To find out more about Emotional Immunity and Yang Sheng and how to apply it in your life check out Barbara’s website www.schoolofgreenmedicine.com In March 2024 Barbara will be launching her 8-module course Discover the Chinese Healing Art of Yang Sheng; 8 Steps to Health and True Immunity, with CPE points available for ANTA Members.
The article was written by Barbara Malarski (M.Ac (Acupuncture), Dip Teaching, PostGrad in Teaching). Barbara Malarski is an acupuncturist and the Founder of the School of Green Medicine, a new paradigm of medicine. She has been in clinical practice for 25 years. Barbara has a teaching background establishing a Natural Therapies program at Cairns Tropical North Institute of TAFE and trained over 700 students in Remedial Massage and Oriental Health Medicine. Barbara has been an accredited assessor for the Chinese medicine accreditation committee for over a decade.
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 23
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THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 25
ANTA Member Article Summer 2023
Isaac Enbom
ANTA Remedial Therapy Branch Chair Diploma of Remedial Massage Advanced Diploma of Myotherapy
Exploring Thoracic Mobility and Breathing Biomechanics Introduction:
Thoracic mobility, the ability of the ribcage to move and expand plays a pivotal role in the mechanics of breathing. The thorax serves as the protective housing for vital organs while accommodating the intricate interplay between the respiratory and musculoskeletal systems. In this article, we delve into the profound relationship between thoracic mobility and breathing biomechanics, highlighting its significance for Natural Therapists. Breathing biomechanics refer to the physiological and mechanical processes involved in the act of breathing, which is essential for providing oxygen to the body’s cells and removing carbon dioxide. Breathing involves the coordination of multiple anatomical structures and muscles, and understanding the biomechanics is crucial in order to identify dysfunctional breathing patterns and to develop specific treatment interventions.
Breathing involves two main phases: inhalation (inspiration) and exhalation (expiration). Inhalation (Inspiration): During inhalation, the diaphragm and external intercostal muscles contract. The diaphragm moves downward, increasing the volume of the thoracic cavity. The external intercostal muscles between the ribs also contract, lifting the ribcage upward and outward. These actions collectively expand the thoracic cavity, causing a decrease in intra-thoracic pressure. This decrease in pressure relative to the atmospheric pressure causes air to rush into the lungs. Exhalation (Expiration): Exhalation can be passive or active. In passive exhalation, the diaphragm and intercostal muscles relax, and the elastic recoil of the lung tissue, along with the relaxation of the ribcage, decreases the volume of the thoracic cavity. This results in an increase in intra-thoracic pressure, causing air to flow out of the lungs. In active exhalation, such as during exercise, the internal
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ANTA Member Article Summer 2023
intercostal muscles and abdominal muscles can also contract to actively push air out. The primary muscles involved in breathing are: • Diaphragm: A dome-shaped muscle that separates the chest cavity (thoracic cavity) from the abdominal cavity. Contraction and relaxation of the diaphragm control the volume of the thoracic cavity. • Intercostal Muscles: These are muscles located between the ribs. The external intercostal muscles aid in inhalation by lifting the ribcage, while the internal intercostal muscles assist in active exhalation. • Accessory Muscles: These muscles, including the sternocleidomastoid, scalenes, pectoralis minor and certain muscles of the back, can become more active during heavy breathing or in conditions of increased respiratory demand. The lungs themselves have elastic properties due to the presence of elastin fibers and the surface tension of the fluid lining the alveoli (tiny air sacs in the lungs). The elastic recoil of the lungs plays a crucial role in passive exhalation. Surfactant, a substance secreted in the alveoli, reduces surface tension and prevents the collapse of alveoli during exhalation.
Thoracic Mobility and Breathing:
Adequate thoracic mobility is essential for efficient ventilation. Physical restrictions in the thoracic spine or ribcage can hinder the diaphragm’s movement and limit the ribcage’s expansion, leading to lack of diaphragmatic involvement and upper respiratory compensation. Different activities and situations can lead to varied breathing patterns. For example, during rest, breathing tends to be slow and shallow. During exercise or physical exertion, the body requires more oxygen, leading to faster and deeper breaths, which in turn provides the mobility and endurance required to maintain good breathing mechanics. Emotions, stress, and certain medical conditions can also influence breathing patterns. These can manifest into altered breathing mechanics and over time cause pain and discomfort associated with cervical spine conditions. Psychological trauma, prolonged anxiety and stress or an overactive sympathetic nervous system can result in these conditions becoming apparent. Pain may also contribute to dysfunctional beathing. High levels of pain, movement avoidance or movement that causes pain may force the patient to
adapt their breathing patterns. Limited thoracic mobility may force the body to rely more on accessory muscles for breathing, which can result in increased strain and fatigue. Over time, this can contribute to musculoskeletal imbalances and discomfort. The pattern built up over time represents a vicious cycle. Often patients will seek treatment to the painful area which can provide temporary relief. However, treating the symptoms may not resolve the condition and leaving patients seeking unnecessary ongoing treatment.
Assessment and Interventions:
Natural Therapists can employ various strategies to assess and improve thoracic mobility and breathing. Palpation and range-of-motion tests can provide valuable insights if breathing dysfunction is suspected. Patients with breathing dysfunction may present with hypertonicity within the accessory musculature of inhalation which is typically the primary location of their presenting symptoms. However, there is a direct correlation to the range of motion of the thoracic spine and ribcage and utilisation of the lower thorax in breathing. Assessing thoracic mobility involves observing the range of motion, symmetry and ability to move all parts of the thoracic spine. Assessment of the ribcage movement during breathing, assessing joint mobility, and identifying asymmetries also forms part of a comprehensive assessment strategy.
Treatment Strategies:
Addressing breathing dysfunction requires a comprehensive and individualised approach, often involving collaboration among various health professionals. An evidence-based model that addresses the underlying condition and involves the patient in the decision-making process as much as possible should be used. Below are a number of different treatment approaches that may be used for patients that exhibit breathing dysfunction.
Education, Mindfulness and Biofeedback:
Education can be one of the most powerful treatment interventions. Patients must be informed of the importance of proper breathing techniques and how breathing dysfunction can impact their overall health. A step-by-step approach to breathing focussing on the lower thoracic and diaphragmatic movements can have a profound effect. Explaining the connection between stress, anxiety, and breathing patterns and teaching relaxation techniques, mindfulness, and stress management strategies are an integral part of
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ANTA Member Article Summer 2023
the overall treatment strategy. Breathing exercises should encourage slower, diaphragmatic breathing instead of shallow chest breathing. This can be achieved by the patient placing one hand on their belly and the other hand on their chest and observing which hand rises first or is dominant. This biofeedback strategy can be progressed to using a book or other moderately heavy object on the patient’s belly. The focus should be on diaphragmatic breathing which should move or press into the hand (or book) which is further validated visually. Breathing apps and wearable devices can also provide real-time feedback to encourage proper breathing techniques.
Lifestyle, Occupational and/or Behavioural Modifications:
Once the patient is able to master diaphragmatic breathing, it should be incorporated into activities of daily living, exercise or specific mobility techniques to further consolidate the pattern. For patients with breathing dysfunction related to anxiety or panic disorders, Cognitive Behavioural Therapy can help address underlying psychological factors and modify maladaptive thought patterns. Further, the importance should be emphasised on the ability of the patient to recognise their breathing patterns and identify when sub-optimal biomechanics are utilised.
when implemented gradually with deep breathing awareness. Treatment strategies should be tailored to the individual patient’s needs, underlying conditions, and contributing factors. A holistic approach that combines education, retraining, psychological support, and medical interventions often yields the best outcomes for addressing breathing dysfunction.
Conclusion:
The intricate relationship between thoracic mobility and breathing biomechanics underscores its importance in maintaining optimal health and functionality. Health professionals, armed with a comprehensive understanding of this connection, can employ targeted interventions to enhance thoracic mobility, thereby positively impacting breathing mechanics and overall wellbeing. Through a holistic approach that combines assessment, exercise, and education, health professionals can empower their patients to achieve better respiratory function and a higher quality of life. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
Patients should also be advised to quit smoking, maintain a healthy weight, and engage in regular moderate to high intensity physical activity to improve overall respiratory health.
Mobility and Preventative Training:
Mobility exercises should encompass thoracic extension, rotation, lateral flexion, and ribcage expansion. Techniques such as thoracic spine mobilisation, foam rolling, and dynamic stretches can be effective. Incorporating breathing exercises that encourage deep diaphragmatic breathing can aid in improving thoracic mobility. Some examples include an ‘Open Book’ exercise with deep breathing or a ‘Quadruped Reach’ or ‘Thread the Needle’ exercise. These are all beneficial
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THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 29
ANTA Member Article Summer 2023
Tiffany Mackenzie
BHSc (Complementary Medicine)
Camilla Brinkworth BHSc (Naturopathy)
Buglossoides arvensis Seed Oil - The Sustainable Omega Solution?
Financial disclosure: Camilla is Chief Executive Officer and Co-Founder of PhytoLove, a company with exclusive distribution rights for human and canine supplements of Ahiflower (refined Buglossoides arvensis seed oil) in Australia and New Zealand.
Abstract:
Over 80 percent of Australians lack adequate, appropriately balanced omega intake - driving inflammation and significant systemic health implications. Marine-derived omega options have significant deleterious environmental and ecological consequences. Furthermore, recent compoundspecific isotype analysis reveals no retro-conversion from long-chain omegas, and consequently, marine and algae supplementation lack critical omega-3 metabolites. Though academic focus has centred on eicosapentaenoic acid and docosahexaenoic acid, emerging science shows unique, overlooked benefits associated with other omega metabolites - such as alpha-linolenic acid, stearidonic acid, eicosatetraenoic acid and gamma-linolenic acid not found significantly in fish or algae. Shorter-chain plant-based omega sources lack efficacy in supplying long-chain omegas
in most people, due to delta-6-desaturase enzyme competition. New to the Australian market, a novel, regeneratively grown, plant-based omega oil, refined Buglossoides arvensis seed oil boasts a unique lipid composition that provides the body with an exceptionally high stearidonic acid content. Through bypassing the delta-6-desaturase enzyme, refined Buglossoides arvensis seed oil provides the most diverse array of oxylipin precursors from complementary omega-3 and omega-6 pathways and recognised anti-inflammatory substrates. Refined Buglossoides arvensis seed oil can provide the body with alpha-linolenic acid, stearidonic acid, eicosatetraenoic acid, eicosapentaenoic acid, docosapentaenoic acid, gamma-linolenic acid, dihomo-gamma-linolenic acid, and bio-synthesised docosahexaenoic acid.
Omegas are Critical for Health:
sufficient dietary intake. Additionally, the standard Western diet contains approximately 20-40 times more omega-6 than omega-3 whilst the biological
Whilst every human requires both omega-3 and omega-6, research indicates that less than 20% obtain
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ANTA Member Article Summer 2023
optimum is between 1:1 and 3:11. Approximately 90% of people eating a Western diet are therefore deficient in omega-3 and eating an excess of pro-inflammatory omega-6 oils2. Omega-3 and omega-6 oils are essential to ingest and play critical roles in joint health, central nervous system (CNS), immune system and brain development. They also assist in inflammation management, hair and skin health and hormonal regulation.
Current Omega Choices in Australia:
A range of omega supplement options exist for commercial supply in Australia, though current options have various drawbacks. Popular plant-based options including flax, hemp and algae have risen in popularity, whilst marine oil remains the most common selection. As shown in Figure 1, the short-chain omega-3 and omega-6 metabolites, linoleic acid (LA) and alphalinolenic acid (ALA), both rely on and compete to use a rate-limiting enzyme delta-6-desaturase (D-6-D). Due to this shared enzyme, despite adequate omega-3 intake, excess dietary LA prevents much of the conversion of ALA to longer-chain metabolites, stearidonic acid (SDA), eicosatetraenoic acid (ETA) and eicosapentaenoic acid (EPA) and increases the amount of LA that converts to pro-inflammatory arachidonic acid (AA)3. Conversion efficacy is additionally impacted by genetic determinants, biological age and gender. Whilst flax oil has a favourable omega 3:6 ratio, it contains no SDA and hence its conversion to longerchain metabolites is entirely reliant upon D-6-D enzymatic activity.
Though hemp seeds contain relatively low SDA levels which bypass the D-6-D conversion step, their omega 3:6 ratio is heavily slanted to omega-6, which does not beneficially contribute to the shift needed away from excess omega-6. Long-chain omegas EPA and docosahexaenoic acid (DHA) can be acquired from both algae and marine oils. Most of the omega research focus has been on these longer-chain metabolites, perhaps due to financial interest. However, research suggests both the importance of other metabolites that are not enriched by either algae or marine oils, and a disruption of natural metabolism when preformed long-chain omega DHA is ingested. Importantly, there are significant and growing concerns about the depletion of our oceans by fishing and the subsequent climatic consequences. Whilst EPA and DHA are undeniably crucial metabolites, the significance of other metabolites has been widely overlooked. Notably, a 2017 study showed circulating ALA, SDA and eicosatrienoic acid (ETE) levels to be mediators of fluid intelligence, total grey matter, and frontal neocortex brain integrity in healthy seniors, rather than EPA or DHA4. Further, a 2021 National Health and Nutrition Examination Survey (NHANES) epidemiological work corroborates the importance of other metabolites, showing that higher levels of serum LA, ALA, EPA and DHA all showed robust inverse correlations with all-cause mortality risk, but that only ALA correlated to lower cancer death risk (not LA, EPA or DHA), and that only higher serum EPA (not DHA) correlated to lower cardiovascular death risk5.
Figure 1: Metabolism of Omega-3 and Omega-6 Fatty Acids.
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A double-blind, placebo-controlled trial found algaederived DHA supplementation to have deleterious effects on cognition compared to placebo, at odds with the widely-held assumption that its supplementation would enhance cognition6. A further study tested EPA versus DHA supplementation and found that whilst the EPA cohort improved overall cognitive performance, the DHA group actually declined and performed worse than placebo7. It might be concluded from this study that for fluid intelligence, EPA may be more important in relation to DHA than previously believed. When supplemented, long-chain omegas may disrupt the natural metabolic flow of essential fatty acids. Long-chain omega DHA supplementation appears to block the conversion of short-chain omegas; notably, those who do not consume long-chain fatty acids (FA) have a comparatively up-regulated conversion of short-chain to long-chain FA by epigenetic control of converting enzymes3. In a study of over 14,000 people, researchers remarked “…the precursorproduct ratio from plant-derived ALA to circulating long-chain omega-3 polyunsaturated fatty acids (PUFAs) was significantly greater in non-fish eaters than in those who ate fish… results suggest that the best conversion rates are by individuals that do not consume (preformed) DHA”. Compound-specific isotope analysis has recently established that despite previously held belief, there is minimal retro-conversion of DHA. Researchers showed that the increase in plasma EPA following DHA supplementation in humans does not occur via retro-conversion, but from a slowed metabolism and/or accumulation of
plasma EPA. Additionally, substantial amounts of supplemental EPA can be converted into DHA8. This implies that metabolism is engineered to move in a singular direction from short-chain fatty acids (SCFA) omega-3 to the long-chain fatty acids (LCFA) omega-3 metabolites – with the body autonomously converting what is needed within its tissues. When considering marine sources of EPA and DHA, there are significant sustainability concerns with fishing. Some experts predict that we can expect virtually empty oceans by 2048, unless there is drastic intervention9. Additionally, fish presents concerns for human health, commonly containing microplastics, dioxins, polychlorinated biphenyls (PCBs), and heavy metals10,11,12. The European Food Safety Authority concluded that wild marine fish and fish oil have the highest PCB contamination of all foods. Another study postulated that fish oil may increase prostate cancer risk13.
A Better Choice?
Refined Buglossoides arvensis seed oil is regeneratively grown, with a unique lipid composition that delivers the most diverse array of oxylipin precursors. With high combined ALA plus SDA levels, providing up to ten times more SDA than hemp, and with a 4:1 omega 3:6 ratio, it shows up to 400% better conversion to EPA than flax in humans14,15,16. Compared to a pure marine source, it has shown up 90% conversion to DHA in mammal models. Professor Adam Metherel from the University of Toronto15 states that “the unique omega-3 PUFA composition (high SDA) of refined Buglossoides arvensis seed oil may provide DHA to blood and tissues at a rate similar to DHA and faster than flaxseed oil despite no differences in DHA levels”. Research has also demonstrated fascinating comparable anti-inflammatory actions between SDA and DHA. In 2017 Sung et al. showed that both SDA and DHA comparably inhibited nitric oxide produced from inducible nitric oxide synthase (iNOS) protein in macrophages, lipopolysaccharides (LPS)-stimulated nuclear factor-ĸB (NFĸB) expression in macrophages and mitogen-activated protein kinase (MAPK) phosphorylation. In light of these three anti-inflammatory molecular activities, in which the cells treated with SDA did not accrue any DHA, the researchers asserted “that SDA... may be [used] as an alternative to the fish-based fatty acids for preventing inflammatory diseases” and that SDA is “as effective as DHA against inflammatory response in LPSstimulated macrophages” 17.
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ETA is another typically overlooked metabolite with emerging anti-inflammatory properties. Refined Buglossoides arvensis seed oil due to its SDA content thereby uniquely enriches cells with ETA. Since there is no significant retro conversion of longchain omegas, neither fish, nor algae enrich cells with ETA, whilst conversion from flax is stunted by its dependence on (rate limited) D-6-D activity. In addition, novel anti-inflammatory metabolites biosynthesised by the enzyme 5-lipoxygenase (5-LO), 8‐hydroxy‐9,11,14,17-eicosatetraenoic acid (Δ17-8HETE) and 8,15-dihydroxy- 9,11,13,17-eicosatetraenoic acid (Δ17-8,15-diHETE), have also been identified18. In simulated whole blood trials, refined Buglossoides arvensis seed oil has demonstrated anti-inflammatory actions by a 45% increase in interleukin 10 (IL-10). IL-10 is an anti-inflammatory cytokine, produced mainly by immunosuppressive alternatively activated macrophages (M2)-like monocytes/macrophages, which strongly inversely correlates with severity of several human inflammatory diseases19. Compared to flax, fish or algae, another unique property of refined Buglossoides arvensis seed oil is the presence of gamma-linolenic acid (GLA), which exists in levels comparable to evening primrose oil. Additionally, studies with refined Buglossoides arvensis seed oil showed an increase in dihomoY-linolenic acid (DGLA) levels of 17% following consumption, whilst flax oil consumption actually decreased DGLA by 16%14,19. Botanical sources of GLA combined with omega-3 PUFAs, ALA and SDA have been shown to “markedly increase circulating levels of DGLA and have little impact on circulating AA levels... suggest[ing] that botanical omega-3 18 carbon polyunsaturated fatty acids (18C-PUFAs) not only enhance the conversion of dietary GLA to DGLA but also inhibit further conversion of that DGLA to AA.” Among the effects noted is that elevated DGLA levels in neutrophils caused a dramatic reduction in leukotriene B4 (LTB4) generation which augments and prolongs tissue inflammation20.
survival in the small intestine22. Mice studies showed decreased interleukin-6 (IL-6) to IL-10 ratios in mice and both increased hepatic insulin receptor abundance and hepatic insulin receptor substrate 223. It was hypothesised that a specific cytokine microenvironment may underlie the unique antiinflammatory and immunity-enhancing phenotype that was observed in mice fed refined Buglossoides arvensis seed oil through Total Parenteral Nutrition (TPN). Critically, refined Buglossoides arvensis seed oil delivers the most rich and varied range of oxylipin precursors from any commercially available omega-3 or omega-6 source. The NHANES research findings, which concluded the vital importance of a wide variety of omega metabolites, stated that “in consideration of associations between serum SDA and long-chain omega-3 PUFAs together with lower intake of marinederived fish and environmental chemical pollutants, SDA-rich oil may safely and expediently increase the concentration of serum EPA or other long-chain omega-3 PUFAs to play their beneficial roles”5. In closing, the Global Organisation of Omega-3s for EPA and DHA asserted in 2022 that “the stakes are high. The ocean cannot provide even the most conservative daily dose of EPA plus DHA for each human being”. Could refined Buglossoides arvensis seed oil be the sustainable omega solution?
Correlations between red blood cell levels of all omega-6 fatty acids and mortality ten years later in a cohort of over 3000 subjects who had presented clinically with chest pain or myocardial ischemia between 1997 and 2000, showed an inverse correlation of omega-6 LA and GLA levels with allcause mortality, and most strongly with GLA levels21. Whilst research is underway to confirm cardiometabolic benefits in humans, researched benefits include, when combined in a duo-cap delivery form, up to two times increase in probiotic
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 33
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PAGE 34 | SUMMER 2023 | THE NATURAL THERAPIST VOL 38 NO. 2
ANTA Member Article Summer 2023
Ananda Mahony
ANTA Naturopathy Branch Chair BHSc (Naturopathy) Graduate Certificate (Human Nutrition) Master of Medicine (Pain Management)
Dietary Interventions in Musculoskeletal Pain
Persistent pain is a leading cause of disability worldwide with a huge personal and economic cost. It is associated with increased risks of co-morbid health conditions, increased body mass and poorer diet quality and patterns. As a modifiable risk factor, dietary intake and nutritional interventions have the potential to positively influence individual experiences of pain and improve quality of life. Further, such approaches may provide valid solutions to help resolve chronic pain. Unfortunately, the relationship between chronic pain and dietary influences is not clear cut. Poor nutrition is known to contribute to system inflammation and oxidative stress, both of which can play a role in pain persistence. While most studies examining diet and musculoskeletal pain focus on interventions that promote weight loss or reduce inflammation and oxidative stress there is still much that remains unexamined. It is currently unclear whether individual dietary components are causal, increase risk or are sustaining factors in persistent pain. In addition, many of the studies investigating the effect of targeted dietary interventions have limitations. From a clinical practice perspective uncertainty about best practice approaches for clients in persistent pain even within subpopulations with the same pain condition persists. In addition, lack of clinical certainty can lead to unnecessary dietary
restriction, lack of effect and even risk of nutritional insufficiency. This article examines different dietary patterns and targeted dietary interventions for chronic musculoskeletal pain. Recent research is explored and dietary interventions that have the potential to reduce pain severity, improve quality of life and minimise the risk of co-morbid conditions are discussed. It is clear in the literature that a western dietary pattern (WDP) is associated with advancement of osteoarthritis and other musculoskeletal pain. Abundant in saturated fat, the WDP promotes expansion of white adipose tissue and dysfunctional adipose cellular responses. It is also high in energy and refined carbohydrate intake, which promotes inflammatory signalling and gene expression and increased systemic inflammation overall. Poor nutrition and unhealthy dietary patterns associated with the WDP contribute to oxidative stress, which along with inflammation plays a role in pain persistence1,2. The WDP is also associated with greater Dietary Inflammatory Index (DII) scores which correlate with increased weight gain, obesity risk, greater pain severity and osteoarthritis prevalence3. The
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association between with DII and symptomatic osteoarthritis is not entirely accounted for by increased joint loading to weight. Studies have shown reductions in joint pain where the affected joint is non-weight bearing suggesting that biomechanical loading is only one potential factor involved1. The gut microbiome may also be a contributing factor, with correlations seen between low grade inflammation caused by gut microbial disturbance and the severity of knee osteoarthritis, rheumatoid arthritis, generalised musculoskeletal pain and fibromyalgia4. While there is a strong correlation with WDP and the development and progression of musculoskeletal pain, there is growing evidence of a positive role for nutrition in the management of chronic musculoskeletal pain. An overview of recent research is provided below. The DII was developed to measure the potential impact of a diet on the inflammatory status of an individual; a high score reflects pro-inflammatory potential of the diet, whereas a low score reflects the anti-inflammatory potential of the diet. A study by Strath et al. (2022)5 assessed the relationship between the DII and movement evoked-pain severity in people with chronic lower back pain (CLBP). The results suggest that diet-induced inflammation does indeed impact movement evoked pain in CLBP but to greater degree for females than males. This sex bias is consistent with research in fibromyalgia. A regression analysis by Toopchizadeh et al. (2020)6 assessed if DII is associated with knee osteoarthritis related pain, poorer physical function and emotional wellbeing. The highest DII index was associated with increased severe pain regardless of sex. The Mediterranean diet is considered an antiinflammatory dietary approach. There are a limited number of intervention studies using the Mediterranean diet in chronic pain, some of which are limited by poor adherence to the dietary guidelines7,8. However, the results overall suggest a trend towards a lower risk of pain and in the case of knee osteoarthritis, a lower prevalence9. Suggested mechanisms by which the Mediterranean diet benefits osteoarthritis include: • Lower inflammatory scores leading to less pain. It has been well established that inflammation plays a role in cartilage damage10. • Lower oxidative stress and advanced glycation end products allowing for enhanced collagen type II and aggrecan expression levels. • Higher fibre and nutrient intake, which have been shown to have a preventative effect on knee osteoarthritis.
• Supports the extracellular matrix, which may help promote repair9. Associations with overall diet quality have also been assessed in back, neck and hip pain, with researchers showing that despite similar total calories, those with chronic spinal pain had significantly poorer diet quality overall11. Those with spinal pain reported less protein, fruit, whole grains and dairy intake and consumption of more sodium, saturated fat and added sugar. The type of sugar consumed was significant. Fruit sugar consumption was associated with a 2530% lower likelihood of chronic spinal pain. Higher added sugar was associated with more spinal pain. It is unclear if poor diet quality leads to an increased risk of developing chronic spinal pain or if chronic spinal pain leads to individuals eating a poorer quality diet or both. Either scenario, however, has negative implications for health because lower diet quality has significant impacts on mortality and morbidity. This research is consistent with diet quality research in migraines, osteoarthritis and rheumatoid arthritis. Lack of clarity around total fat intake is evident in the research with low and high fat intakes being studied. Diets low in saturated fat such as vegan, vegetarian and specific low-fat diets have been in most studies in the context of chronic pain, with positive benefit seen in fibromyalgia, rheumatoid arthritis and general musculoskeletal pain1. By contrast a recent study by Field et al. (2022)7 looked at the effects of a higher fat, well formulated keto diet (WFKD) as compared to a whole food diet (WFD) in overweight participants with spinal pain or fibromyalgia. Both intervention groups reported improved quality of life and reduced pain using a visual analogue scale. The WFKD group additionally demonstrated significant improvements in pain interference, weight, depression and anxiety. Despite positive outcomes, there were a number of barriers to a WFKD including food enjoyment, quality of social life and consideration of vulnerable populations where the diet is inappropriate. What is missing in research looking at total fat intakes is that fatty acid ratios are not considered. Part of the benefit reported from the WFKD is that it focussed on unsaturated fats over saturated fats, which have been shown to contribute to inflammation1. The focus, and likely part of the benefit of the Mediterranean diet is that it has a significant intake of monounsaturated fats from olive oil and a lower saturated fat intake than a WDP. More recent research has also shown that a higher intake of omega-6 to omega-3 dietary ratio is associated with greater pain intensity for orofacial pain, headache, low back pain, and bodily pain12.
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A previously untried approach in chronic pain is immunoglobulin G4 (IgG4) antibody exclusion. A study by Casini et al. (2022)13 tested individualised IgG4 antibody exclusion in 54 participants with various types of chronic pain including neuropathy, diffuse pain, back pain and headache. Unrelated to age and sex, IgG4 were found at medium/high levels in 87% of subjects, where more than five different food types had to be excluded. A one-month exclusion diet of individual food intolerances lead to visual analogue scale (VAS) pain score decreases of more than 50% along with improvement in mood and quality of life scales. Another target for nutritional intervention is to change focus from a disease type or specific pain presentation to include factors that sustain pain perception and amplification in the brain and central nervous system. Central nervous system sensitisation is a process that frequently occurs in chronic pain leading to amplified pain responses. It involves immune driven neuroinflammation within the brain and spinal cord leading an increased responsiveness of nociceptors. Along with neuroinflammation and persistent glia activation, neuronal excitability outside of normal range is implicated in the transition from acute to chronic pain. When present, people experience hypersensitivity to painful sensations, to non-noxious input and the pain spreads. Preliminary studies suggest that high fat and/or high sugar intake are positively associated with pain intensity and pain threshold, and this is thought to be through the dietary induction of central sensitisation. The mechanisms linking diet, neuroinflammation and central nervous system (CNS) sensitisation in chronic pain include: • Vagal afferent neuron activation which informs the brain about dietary intake, nutritional status, and peripheral inflammation. • Gut dysbiosis and intestinal permeability. Changes in gut microbiota can directly and indirectly affect
neuroinflammation in the onset and progression of pain. • Induction of oxidative stress leads to activation of Toll-like receptors. All these factors can prime glia to further insult or injury or sustain glial activation, which contributes to central sensitisation. Reviewing the body of research in dietary interventions/patterns and chronic pain no single dietary strategy was found to be significantly more effective, suggesting that a range of dietary changes may be helpful in improving chronic pain presentations14. Whole food diets likely share common attributes such as improved diet quality, increased nutrient density, weight loss, and alterations of the gut biome, which are all part of the complexity that extends beyond a single diet. Considering the lack of specific outcomes with dietary interventions and the complexity of chronic pain, development of individual dietary strategies is a sound clinical strategy. As a clinical framework, the following approach may be useful: • For all chronic pain types aim to reduce persistent low-grade inflammation (neuroinflammation), a primary contributor to maladaptive nervous system responses and amplified pain perception, by reducing high sugar and high saturated fat intake. • Shift fatty acid ratios towards unsaturated fats (mono and polyunsaturated) over saturated fats and omega-3 fatty acids over omega-6. • Reduce ultra-processed food intake overall. • Avoid known allergens and food intolerances. • Consider patient preference with long term dietary patterns as all the following have been shown to have benefit: vegan, vegetarian, pescatarian, Mediterranean, well formulated keto diet (based on unsaturated fats). For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 37
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ANTA Member Article Summer 2023
Elise Cowley
ANTA Member BHSc (Nutritional Medicine) Diploma of Remedial Massage
An In-Depth Review of the Efficacy of Manual Therapy for Neck Pain and Headaches
Introduction:
Neck pain and headaches can be incredibly debilitating, with many sufferers seeking all manner of interventions to alleviate pain and discomfort. As remedial massage therapists and myotherapists, headaches are among some of the most common complaints our patients present with, in clinic. We know firsthand how patients can benefit from tailored manual therapy protocols for cervicogenic pain. So does the current scientific research support the empirical evidence among practitioners? It turns out there’s plenty of data showing that various manual therapy interventions can drastically reduce neck pain, headaches and cervical dysfunction among patients. In this article, we will look in-depth at the efficacy of spinal manipulative therapies, trigger point therapy, stretching and vertebral mobilisation techniques for relieving neck pain and headaches. The
bottom line is that manual therapy, in many forms, is a great solution for headache patients that provides targeted benefits with demonstrable efficacy.
The Burden of Cervicogenic Neck Pain and Headaches:
As defined in the International Classification of Headache Disorders by Olsen (2018)1, a cervicogenic headache is a ‘secondary headache arising from a disorder in the cervical spine and its periarticular components, often accompanied by neck pain. The majority of cervicogenic pain is due to dysfunction or sensitisation in the upper neck and spinal segments of C1, C2 and C3’. Recent reports suggest that headaches affect 2.2%-4.1% of the general population, with a higher occurrence in women than in men by a factor of four2. There can be a range of reasons why people sustain cervicogenic headaches, from direct trauma
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and injuries such as whiplash, chronic poor posture, cervical musculature weakness and other neurological conditions. These headaches are commonly caused by the convergence of sensory branches from the trigeminal and superior cervical spinal nerves in the trigeminalcervical caudalis nucleus3. This may explain why both cervical and trigeminal regions (head, neck and jaw) are a classic presentation that many patients present with. In most cases, imaging or clinical examination must be performed to confirm a lesion or disorder in the neck or local soft tissues known to cause headaches. To determine a cause-and-effect relationship, practitioners also need to see at least two of the following: the headache began around the same time as the cervical disorder or lesion appeared, the headache improved as the cervical disorder or lesion improved, moving the neck worsens the headache and reduces the range of neck movement, or the headache goes away after blocking a nerve or structure in the neck4. Because cervicogenic headaches and related neck dysfunction have complex causes, multidisciplinary interventions are typically the most beneficial.
Which Manual Therapies Are The Most Helpful?
this may not address the root cause of the issue and could result in dependency and other metabolic disturbances. Treatments such as anaesthetic and corticosteroid blocks of the occipital or cervical nerves, pulsed radiofrequency, and cold therapy are also commonly proposed methods to temporarily alleviate pain from an allopathic standpoint. Currently, healthcare professionals opt for more conservative interventions, such as manual therapy that can effectively resolve symptoms in the long run. Non-invasive techniques like dry needling, stretching, mobilisations and exercise prescription are the primary components of such treatments. There is great potential for some manual therapies to resolve cervicogenic headaches, but the types that are the most indicated will vary for each patient. A systematic review published by Borrella-Andrés et al. (2021)5 investigated the effectiveness of manual therapy techniques on cervical radiculopathy. This review, consisting of 17 studies, found that manual therapy protocols had a positive impact on pain indices and cervical disability outcomes, irrespective of the therapy applied. While there was no statistically significant difference between each intervention, the most effective results were due to cervical mobilisations which encouraged intervertebral foramen opening. This technique increased the intervertebral space using transverse mobilisations on the spinal segments of the neck.
Historically, the standard medical approach typically involves medication as a first-line therapy. However,
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A 2022 systematic review published in the journal Headache (2022)6 included 14 clinical trials that evaluated the efficacy of spinal manipulative therapy, Mulligan’s Sustained Natural Apophyseal Glides (SNAGs), muscle energy techniques (METs), trigger point therapy, suboccipital muscle relaxation, positional release techniques and translatory vertebral mobilisation techniques. Every intervention listed had success in reducing headache intensity across all the studies evaluated. While all the interventions managed to reduce the intensity of headaches, the quality of improvements found in this comprehensive review is as follows: • The best short-term improvements were the positional release and ischaemic pressure (trigger point) techniques. • The best longer-term improvements were seen in translatory vertebral mobilisation, spinal manipulative therapy and SNAGs in combination with massage techniques as above. • The most beneficial pattern of treatment involved one to two sessions per week for six weeks.
What Makes Them So Effective?
The reduction in headaches and neck pain brought about by these interventions is due to some potent physiological events. The initial improvements are likely due to the mechanical activation of the nociceptive inhibitory systems, which confer instant ‘hypoalgesic effects’. Specifically, soft tissue techniques and spinal mobilisation techniques both act by modulating local blood flow, improving hypoxic tissue states and increasing endorphins and endogenous opioids. Finally, manual techniques that involve pressure changes enable the fascia and any focal adhesions to reorganise, facilitating a healthy homeostatic balance in the tissue.
Is There a Gold Standard Therapy for Neck Pain and Headaches? As most of us know, an ideal approach is to treat the patient, not the condition. With this in mind, establishing a treatment plan that takes into account the complexities of each patient is paramount. Aside from this, the clinical features of cervicogenic headaches are readily identifiable among manual therapists and as discussed, we have a wealth of
non-invasive, highly effective treatment options at our fingertips. So is there anything we can add to deliver a ‘gold standard’ approach to cervicogenic headaches and neck pain? The missing piece, according to the research, is rehabilitation and strengthening. An article from The International Journal of Sports Physical Therapy (2011)7 says that most patients with cervicogenic headaches have weak deep neck flexors, compared to patients with other headache types. Together with manual therapies, correcting postural imbalances, and strengthening cervical spine musculature can serve as a more well-rounded approach to cervicogenic headaches. By building better neuromuscular control from targeted training, patients experience a higher reduction in pain frequency and intensity across all demographics. This approach should help guarantee long-term, sustained recovery for patients with this cervicogenic pain, headaches and related conditions8.
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
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ANTA Member Article Summer 2023
Shaun Brewster
ANTA National President BHSc (Musculoskeletal Therapy) Graduate Diploma (Exercise Science)
The Barefoot Movement - A Goldilocks Story If you are someone who has committed themselves to understanding the body and finding ways to help optimise it, then you would no doubt have stumbled upon the barefoot movement at some point in your career. The idea of freeing the feet and allowing them to develop the strength and functionality that they were designed to have, would sound like a logical and even credible concept. There are experts and proponents of barefoot activity all over the world, each one giving their version of how and why spending more time barefoot is going to be the solution to any number of functional problems or ailments. For about a decade I was one of those people and often referred to as “the barefoot guy”. As part of my Exercise Science post graduate training, I conducted a major literature review of the research on the topic, through this and through my own experimentation and application through ultra-distance running, I found myself in the position of being the person others came to for advice or guidance on the topic.
I wrote countless articles on barefoot running for running magazines and blogs, I was a brand ambassador for a barefoot shoe company, I was interviewed on podcasts, I even wrote a short book and filmed instructional videos on how to transition from traditional to barefoot style shoes. During this time I watched as so many people fell into this movement, but ended up injured and ultimately went back to wearing whatever they had been wearing all along. So how can something that appears to make sense with regard to biomechanics, neuromuscular function, and that is supported by the research be the cause for countless injuries? Goldilocks will likely have the answer… In 2009 a book titled Born to Run was published, written by an American author by the name of Christopher McDougall.
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This book was perhaps the catalyst for much of my dedication to barefoot movement, and it no doubt inspired hoards of others to make a change out of their Nike Airs or Asics Kayanos and into a pare of shoes that at the time likely resembled a sock with a rubber sole. This book told the true story of a tribe of native Mexicans who have existed in the Canyons of Mexico for hundreds of years, essentially unaffected by the modern world. The author sought out these tribes and spent time observing their behaviour. To his surprise he discovered them to be incredibly gifted runners, with running being a central part of their culture. And yes, they were barefoot. The author’s further investigations into the topic led him to read more about evolutionary biology which he outlines in his book, describing the various unique anatomical features that the human body has which possibly make it a more efficient running machine than any other animal alive. Key amongst these are the biomechanical advantages found in the foot and ankle complex, the ability of our tendons to store and release energy and of our ability to sweat and breath at a rate we can control. After reading this book and purchasing my first pair of barefoot shoes, I boldly set off on a run for about 30 minutes to allow my body to experience the freedom and function improving benefits of this type of movement. I was disappointed to find that it was in fact much more difficult than I had expected. Shortly after the run, I felt tension building in my lower legs, which was followed by uncontrollable and painful cramping in my calves. This went on for about two days.
necessary punishment of running without any cushioning or structure in my shoes. It may be useful at this point to describe what a “barefoot shoe” actually is. The definition has changed over time, but essentially it is a shoe build on a minimal last (sole), that is ideally a flat platform (no raise at the heel), though less than a 2cm heel to toe drop is now considered a minimalist shoe. The sole of the shoe is generally very flexible, no arch support at all, no motion control foam or rubber, a wide toe box to allow the toes to spread and the upper part of the shoe should not limit the foot’s movement in any way. All in all, it has a rubber sole to stop you cutting your feet on something sharp, and the rest of shoe is just there to keep your foot on the sole. With such a stripped down and unsupportive shoe design, it is little wonder why so many people who take up barefoot running or just the wearing of barefoot style shoes end up in pain. As human beings we have engineered shoes over the past 70 years or so that have progressively gotten more and more complex and structured. Gel cushioning, inflatable air pockets, high tech rubber compounds, arch supports, curved soles and any number of other advancements have led to us being
Not to be dissuaded, I pushed on. I kept reading the research (limited as it was at the time), I studied those who had somehow found a way to be comfortable running barefoot, and I continued to try to condition my legs and feet to withstand the seemingly
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able to rely on the shoe rather than our own body to protect us from force and load. Through the invention of modern footwear we deengineered the need for our bodies to absorb shock and dissipate those forces safely.
Those who forced their feet to adapt to not having the support they were accustomed to, without an appropriate period of adaptation, ended up injured. Those who relied wholly on foam and rubber to take away any and all impact forces also ended up with their own set of injuries.
So, we should not be surprised that if we suddenly do away with all that support that our body may protest a little… or a lot.
Goldilocks had to try the porridge that was too hot and too cold before she realised that the sensible option was somewhere in the middle.
It was my experience, with persistence, gaining a better understanding of lower limb biomechanics, experimenting with technique and ultimately using myself as the crash test dummy, that I found barefoot shoes to be a positive and useful concept.
The truth is that swinging the pendulum too far in any direction is problematic.
Over time I found that my feet and legs did in fact adapt to their new way of moving. I also found that foot pain, which I had experienced regularly throughout my life, was now a thing of the past. Additionally, my running efficiency improved and the number of running injuries I experienced decreased. Could it be that I was just becoming a better runner? I had considered that, so decided to spend some time running in other more traditional running shoes, only to realise that many of the problems I had overcome would simply return after changing back to “normal” running shoes. Likewise, when I had to wear dress shoes for work or other non-minimalist shoes on occasion, I would get back pain or I just felt awkward when walking. The answer it seemed was that like most things, there needed to be a period of adaptation to the change to barefoot. So where does Goldilocks come into this story? As the barefoot “cult” hit its peak about 10 years ago, many of the major shoe companies were introducing a minimalist offering, yet some went the other way, creating a maximalist design with overly thick soles to dampen any forces experienced underfoot. Conversations in the running community and beyond had you picking a side of the fence to live on. You were either a barefoot guy/girl, or you were not. As a clinician, I paid close attention to what people wore on their feet and the types and rates of injuries they were experiencing. What I saw led me to realise that anyone who allowed their pendulum to swing too far too quickly in either direction, opened themselves up to injury and pain.
Attempting to go from traditional cushioned, structured shoes to minimalist shoes without applying an appropriate period of tissue conditioning and allowing for adaptations in movement strategies is foolish. Likewise, moving to excessive cushioning and support and thus unloading your soft tissues, joints and reducing your ability to perceive and manage impact forces, is also a recipe for deconditioning and a reduction of neuromuscular control. So, after a decade and half of experimenting, studying and examining the pros and cons of living with less shoe under our feet, my personal and clinical impression is that it is generally a good idea. From an evolutionary and biomechanical perspective, allowing the feet to move as they were designed, to absorb force and to adapt to those same forces, and to be a dynamic and responsive functional unit, to me seems like good common sense. However, if your lifestyle does not involve the need to manage high or repetitive loads through your feet (running, long walks, other sporting activities etc.), and you do not currently experience foot pain, or pain in other areas such as knees, hips, back, which may be attributed to what your feet and ankles are doing, then the old saying of “if it ain’t broke, don’t fix it” may be relevant here. Though, if you ever get to the end of the day and look forward to taking your shoes off, this may be a sign that those shoes are not serving you as best they might. Be warned though! If you do decide to reduce the support, cushioning and control that your current shoes may be providing you, then do so progressively. The human body is an adaptation machine. It can withstand incredible change, but only if given the time and opportunity to do so.
THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 45
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ANTA Member Article Summer 2023
Neerja Ahuja
ANTA Ayurveda Branch Chair Ayurveda Awareness Centre
Breath, Mind and Spirit Understanding the Power of Pranayama for Wellbeing
Introduction:
Yoga, an ancient science, is all about connecting your mind and body, and helping your Spirit grow. One of its important skill or “limb” is something simple but powerful: your breath. The word Pranayama comes from two separate words: Prana and Ayama. Prana means life force, or life essence or breath, and Ayama has many different meanings including expansion, length, and rising. Pranayama, is the art of controlling, lengthening, or expanding your breath. Yoga and Ayurveda are sister sciences with the same fundamental principles and both work with breath for bringing health.
The Historical Context of Pranayama:
Around 200BC, Patanjali, an Indian sage, physician, philosopher and grammarian, wrote the Yoga Sutras. He is considered the founding father of modern Yoga and had a whole section dedicated to Pranayama. In the 15th century, another book was written, the Hatha Yoga Pradipika, or light on Hatha Yoga, by Svatmarama. This book dives even deeper into the techniques and benefits of Pranayama. It expands on the foundational principles given in the Yoga Sutras and provides detailed instructions on breath control practices.
The heart of Pranayama is about understanding two crucial things: Prana Shakti (life force) and Chitta Shakti (mental force or consciousness). These are like the power sources for our body and mind. Prana, the vital breath or life force energy, is the essence of life itself. It is the subtle energy that flows through every atom and cell of our being. Prana is responsible for the functions of our physical body and influences our mental and emotional states. • Prana Shakti is like the invisible energy that keeps your heart beating, your lungs breathing, and your body going. It is responsible for your physical health and affects your thoughts and emotions. • Chitta Shakti is your mental force. Chitta influences every aspect of our existence. It shapes our perceptions, beliefs, and reactions to the world around us. It is the source of creativity, intuition, and self-awareness. It is where your thoughts, feelings, and memories live. It is like the canvas for your mental and emotional experiences. These two forces are linked. Prana gives Chitta the energy to do its thing, and Chitta can also affect how Prana flows in your body. When these two are in balance, life is good, and we experience a harmonious
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and fulfilling life.
The Mind-Body Connection:
The mind-body connection is a central theme in both Yoga and Ayurveda. Pranayama is a bridge between these two worlds of body and mind, providing a tangible means to harmonise physical and mental wellbeing. Your breath, something we usually do not pay much attention to, becomes a powerful tool. It helps you tap into your inner self, explore higher consciousness, and unleash your full potential.
Science of Pranayama:
Pranayama is not just ancient wisdom; it is backed by modern science too. Studies show that different Pranayama techniques can have some incredible effects on heart rate, blood pressure, and stress hormone levels. 1. For example, one study in the Annals of the New York Academy of Sciences by Brown & Gerbarg (2009), found that yogic breathing can positively impact heart rate variability and reduce symptoms of anxiety and depression. 2. Many scientific studies have studied the effects of Pranayama on stress reduction. These studies have shown that practicing Pranayama techniques, such as deep breathing or slow-paced breathing, can activate the parasympathetic nervous system, promoting relaxation and reducing the effects of stress on the body. 3. There are specific research studies, which show how Pranayama helps lower cortisol levels (the stress hormone), decrease heart rate, and promote a sense of calmness. 4. Research has shown that slow-paced breathing techniques like Bhramari Pranayama, can enhance cognitive function. By increasing the supply of oxygen to the brain and improving cerebral blood flow, Pranayama can improve attention, memory, and information processing. It is then like a mental workout. 5. Pranayama techniques, like Kapalabhati and Anulom Vilom, focus on deep and controlled breathing. These practices help strengthen the respiratory muscles, increase lung capacity, and improve overall respiratory function. Such Pranayama can be beneficial for individuals with respiratory conditions such as asthma. 6. Scientific studies have found how practicing Pranayama can modulate the activity in the amygdala, the part of the brain responsible for processing emotions. This can result in improved emotional stability, reduced reactivity to emotional triggers, and better control over impulsive reactions.
Pranayama is an important part of mind-body practices like Yoga, Ayurveda and Meditation. Engaging in mind-body practices, including Pranayama, leads to positive changes in gene expression related to immune function, stress response, and inflammation. This highlights the complex connection between our breath, mind, and physical wellbeing. It can activate your “rest and relax” mode, making you feel calm. Plus, it can lower your stress hormone levels and heart rate. So, Pranayama is like a natural stressbuster. It can calm down the part of your brain that deals with emotions, making you more emotionally stable and less impulsive. Stress, anxiety and depression can play a role in the onset and progression of many other illnesses. Pranayama helps in prevention of those other diseases by helping reduce stress levels, anxiety, and depression, and enhancing wellbeing and bringing peace of mind. By activating the vagus nerve through deep and slow breathing, other than exercise and meditation practices, one can overcome anxiety and depression bringing long term improvement in wellbeing.
Physiology of Breath:
Let us look into how breathing works. It is something we do automatically, but it plays an important role in Pranayama and its effects on the mind and Spirit. Breathing involves the rhythmic expansion and contraction of the diaphragm, the primary muscle responsible for inhalation and exhalation. It expands when you breathe in, pulling air into your lungs, and relaxes when you breathe out, letting air flow out. Chest breathing or shallow breathing indicates stress to the brain. Deep abdominal breathing not only brings a rich supply of oxygen but also gives a message to the brain that all is well. Converse is also true. When you are feeling stressed or angry, try some deep and slow breathing! The mood will change very quickly. So, breathing or Pranayama is a simple and effective way of changing the mental state. The autonomic nervous system (ANS) is the body’s automatic regulatory system, responsible for functions such as heart rate, digestion, and respiratory rate. It is divided into two branches: the sympathetic nervous system (SNS), responsible for the “fight or flight” response, and the parasympathetic nervous system (PNS), responsible for the “rest and digest” response. Pranayama plays a significant role in modulating the ANS. Slow, deep breathing techniques activate the PNS, promoting relaxation and reducing stress. Fast and shallow breathing triggers the SNS, bringing
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heightened alertness and arousal. Understanding this connection is crucial in harnessing the power of Pranayama for mental and spiritual growth.
Some Common Pranayama Techniques:
Pranayama is a collection of different kinds of techniques. The breath can be slow and steady, or strong and forceful. A few popular ones are: • Anulom Vilom (Alternate Nostril Breathing), used for balancing your energy and calming your mind. • Kapalabhati (Breath of Fire, or Skull Shining Breath), cleanses your mind and energises you. • Bhramari (Bumble Bee Breath), soothes your nerves and reduces stress. • Ujjayi (Victorious Breath), enhances concentration and calms and yet invigorates your mind. There are many more techniques which can be used to generate heat, cool down the body, increase focus and concentration, calm the mind or cleanse, and balance the energy pathways. We must learn these practices from a teacher as there can be fine tuning required and some of the Pranayama techniques may have undesirable effects if not done properly.
Mind-Body Connection - Relationship Between Mind and Breath, Pranayama, and Emotional Stability:
The profound relationship between breath and mental wellbeing is at the heart of Pranayama practice. While breath is an automatic and continuous process, conscious manipulation of the breath can have a real impact on the mind.
Pranayama practice is effective for correcting the hormonal imbalance conditions and other disorders like hypertension, anxiety, and depression. The calming effect of the Bhramari Pranayama helps in overcoming drug dependency. Pranayama is not just ancient wisdom; now science backs it up that it reduces anxiety and depression, improves emotional regulation, helps you sleep better, and eases the effects of post-traumatic stress disorder (PTSD). So, it is not just breathing; it is a mental health tool.
Pranic Body and Pancha Kosha – Pranamaya Kosha, and Pancha Prana:
According to Yoga and Ayurveda, the body is made up of five sheaths or layers: • Annamaya Kosha (Food Sheath). • Pranamaya Kosha (Vital Sheath). • Manomaya Kosha (Mental Sheath). • Vijnanamaya Kosha (Intellect/Intuitive Sheath). • Anandamaya Kossa (Bliss Sheath). The Pranamaya Kosha, is the vital sheath or energy sheath that fuels your physical, mental, and even Spiritual self. It is the link between your body and the deeper aspects of your being. Pranamaya Kosha is fueled by the Prana or life force absorbed through the breath, through food, and from the cosmic universal life force that surrounds and permeates us. The practice of Pranayama helps to keep this energy flowing freely. This affects the health of the physical body as well.
Pranayama taps into the PNS, making you feel calm and reducing stress. It is like a shield against today’s stress-filled world. The slow, deliberate breathing techniques soothe the nervous system, helping to ease the physical and mental manifestations of stress, including muscle tension, anxiety, and racing thoughts. Pranayama helps you concentrate better, which is very useful when distractions are everywhere. Different types of Pranayama produce specific physiological responses and it greatly depends on type and duration of the practice. In Pranayama, you can control the diaphragm to affect your mental and physical state, bringing calm and balance. It has been reported for example that Bhramari
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Your physical body, the Annamaya Kosha and Pranamaya Kosha work together to keep you healthy. The Pranamaya Kosha connects the dots between your physical self and your deeper inner world. The ancient science of Yoga covers a profound exploration of the mind-body connection and Spiritual growth. At its heart lies this fundamental element that serves as a bridge between the physical and the metaphysical - your breath. Pranayama, the yogic science of breath, is a foundation of this practice, offering a pathway to unlock the profound potential of the human Spirit. “Prana” is the five primary life forces, collectively known as “Prana Vayus.” It is responsible for the breath, the movement of energy, and the functioning of the mind. Prana’s balanced flow throughout the body is vital for maintaining health, and its disruption can lead to various ailments. Five Prana or the five vital energies, govern various functions within the body. These energies are called Prana, Apana, Vyana, Samana, and Udana. Each has a distinct role and impact on our physical and mental health according to Ayurveda. Prana’s role is in inhalation, Aana’s role is in elimination, Vyana’s role is in circulation, Samana’s role is in digestion, and Udana’s role is in speech and expression. Pranayama plays a vital role in cleansing and purifying the Pranic body or Pranamaya Kosha. Specific Pranayama techniques can help remove blockages and imbalances in the flow of Prana, restoring harmony and vitality. An imbalance in any of these Pranas can manifest as physical or mental disorders. Pranayama offers a powerful means to regulate and harmonise Pancha Prana.
Breath Awareness in Everyday Life – Some Tips, and Benefits of Conscious Breathing:
1. Pranayama in Yoga Practice: Pranayama serves as a valuable complement to physical Yoga asanas (postures). By integrating breath control with movement, practitioners can deepen their Yoga experience, improving flexibility, balance, and focus. 2.Pranayama in Meditation: Meditation and Pranayama are inseparable companions on the path to self-realisation. Controlled breathing in Pranayama enhances meditative experiences, calming the mind and helping in concentration. 3.Pranayama in Daily Life: Other than formal practice sessions, you can cultivate breath awareness throughout your daily life. This mindfulness brings a sense of presence and wellbeing, reducing stress and promoting emotional resilience. Conscious breathing can be used in any situations, e.g. during
work, exercise, or moments of stress to ease a situation. 4. Pranayama for Holistic Health: For those with specific health concerns, specific Pranayama practices can be used. Whether you are looking for respiratory relief, cardiovascular support, or stress management, you can tailor Pranayama techniques to your needs. Pranayama contributes to holistic health by addressing physical, mental, emotional, and Spiritual dimensions.
The Lifelong Journey:
Pranayama is not a destination but a lifelong journey. Whether you are a beginner or an experienced practitioner, the path of Pranayama continues to unfold, offering deeper layers of self-awareness and Spiritual growth.
Practical Application of Pranayama:
Some of the practical applications of Pranayama: • Stress management and relaxation • Enhancing mental clarity and focus • Emotional resilience and wellbeing • Physical health and vitality • Spiritual growth and self-realisation • Ease body’s response to stress and anxiety • Help improve immunity In summary, we can say the ancient practice of Pranayama brings together age-old wisdom with modern scientific support, making it a valuable tool for enhancing our overall wellbeing. This practice, rooted in history and backed by research, offers a practical means to reduce stress in our fast-paced world. Its impact on the connection between our mind and body, as evidenced by reduced stress levels, improved emotional control, and heightened cognitive function, makes it as an essential mental health resource. Pranayama’s holistic advantages, including balancing vital energies and strengthening immunity, provide a comprehensive approach to health. As we integrate Pranayama into our daily lives, it becomes a lifelong journey, guiding us toward self-discovery, equilibrium, and the realisation of our untapped potential — aligning perfectly with our pursuit of wellbeing and fulfillment.
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
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THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 51
ANTA Member Article Summer 2023
Danielle Svensson
ANTA Member BHSc (Nutritional Medicine)
Beyond the Conventional Weight Loss Approach
Entering just two words “how to” into your Google search bar, reveals “how to lose weight fast” as one of the top searched questions.
In a nation where weight loss industry services are worth close to $500 million in 2023, and two in three adults are overweight or obese, it asks a different question – why are conventional weight loss efforts failing? Being one of the greatest public health issues to date, excessive unhealthy weight gain has markedly increased in many parts of the world and has been attributed to the explosion and availability of ultraprocessed, inexpensive, and energy-dense foods, alongside a lack of daily physical activity1. We might simply correlate this with the age-old ‘calories-in-vscalories-out’ equation when it comes to weight loss.
The abundance of competitors that make up the weight loss sector, including dietary meal provision companies, diet shakes and meal replacements and online weight loss programs, have created an overwhelming landscape of solutions to essentially the same problem across the last few decades. Whilst there is no question that the environment that informs the energy in vs energy out equation for an individual is a critical factor in their weight loss and weight maintenance journey, there are many other factors influencing body weight that must be considered. These include infection, epigenetics, endocrine disruptors, sleep debt, pharmaceutical iatrogenesis2 as well as other key biological factors including resting energy expenditure (REE), body composition, meal-induced thermogenesis, appetite control and
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satiety, adipocyte metabolism, nutrient partitioning, gastrointestinal signalling and emotional state and stress1. From a clinical perspective, other presenting factors that may also influence weight gain include gut dysbiosis, insulin resistance, endocrine hormone dysfunction, chronic inflammation, loss of muscle/ sarcopenia and genetic predisposition. A simple model highlighting the factors determining body weight and composition (as shown in Figure 1), include key metabolic and physiological factors such as NEAT (Non-Exercise Activity Thermogenesis) and behavioural factors such as macronutrient composition and eating frequency1. In essence, it is the complexity and interaction of an array of factors that more closely explain daily energy expenditure and intake, which can be highly variable from one person to the next. Conventional weight loss efforts are also failing because they do not more closely consider the physiological adaptations that occur within the body to counteract a reduction in energy intake. Dietinduced weight loss may trigger mechanisms such as a
decrease in energy expenditure, increases in appetite, craving and orexigenic hormone (such as, ghrelin) levels, decreases in fat oxidation and anorexigenic hormone (such as, leptin) levels, and potentially promote weight regain2. Furthermore, many weight loss approaches do not consider maintenance of weight loss, which is considerably the most important step of all. Research has shown that at the end of prolonged continuous (12-14 week) energy restriction, as little as 60% of the expected change in body weight and fat mass is elicited through an intentional energy deficit1. In contrast, the MATADOR (Minimising Adaptive Thermogenesis And Deactivating Obesity Rebound) study successfully demonstrates that intermittent energy restriction, in comparison to continuous energy restriction, produced greater weight and fat loss in a controlled cohort. The prescribed intermittent energy restriction was delivered as alternating two-week blocks of energy restriction and energy balance, for a 16-week period. This approach resulted in greater fat loss without greater loss of fat-free mass, a lessening in the reduction of resting energy expenditure, and superior weight loss retention after six months, compared with an equivalent
Figure 1: Determinants of Body Weight and Body Composition.
AEE = Activity Energy Expenditure; DIT = Dietary Induced Thermogenesis; ExEE = Exercise Energy Expenditure; NEAT = Non-Exercise Activity Thermogenesis; Other = Factors Such as Non-Shivering Thermogenesis; REE = Resting Energy Expenditure; TEE = Total Energy Expenditure. Adapted from Bryne & Hills (2013)1. THE NATURAL THERAPIST VOL 38 NO. 2 | SUMMER 2023 | PAGE 53
ANTA Member Article Summer 2023
‘dose’ of continuous energy restriction across the same period3. This study is just one example of an approach that goes beyond traditional weight-loss diets and provides a strategy that may support better compliance and metabolic outcomes across the long term. Once we have addressed some of the key foundations to optimal metabolic health, such as eating for stable blood sugar, daily exercise, optimising sleep and circadian rhythm and minimising stress, if weight loss is to be achieved it must be founded on addressing core behavioural and biological factors, adapting to inevitable metabolic changes, ensuring dietary and lifestyle flexibility, and of course adopting an individualised approach. This approach is the antithesis of the quick fix of conventional diets: however, as holistic-focused clinicians it is one that empowers and educates clients to see weight loss beyond the number on a scale, and as a critical step in achieving optimal health and wellbeing. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
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