ANTA TNT Autumn 2022 Vol37 No.1

The

Natural

Therapist

EDITION 37 NO. 1 | AUTUMN 2022

ISSN 1031 6965

Autumn 2022

The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION

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Contents Edition 37 No. 1

|

Autumn 2022

5

Executive Officer Report

8

Branch Chair Updates

28

18

23

Ayurveda and Yoga Therapy for Heart Disease

Bomb Proofing Your Clinical Practice

Neerja Ahuja, ANTA Ayurvedic Branch Chair,

explains the benefits of changing with the

explores heart disease and how Ayurveda and

times to ensure your clinic can be the most

Yoga can help those that suffer.

successful.

38

42

47

Healthy Recipes Rachel Knight, qualified Chef and Nutritionist,

Sex Differences in Chronic Pain

lists some delicious recipes for you to try out!

Ananda Mahony, ANTA Naturopathy Branch

Simple Strategies for Distance Running Injury Prevention

Chair, explains the sex differences in chronic

Isaac Enbom, ANTA Remedial Therapy Branch

pain and key considerations for both women

Chair, writes about the simple strategies that

and men.

can prevent injury for runners.

ANTA News

From the Chair

7 ANTA News 49 Notable Naturopaths with Ananda Mahony

Does Acupuncture Alleviate Low Back Pain in Adults Aged 18-70 Years More Effectively Than Standard Medical Care?

Shaun Brewster, ANTA National President,

Lisa Potocnik, ANTA Member, explores the literature to see if Acupuncture can help alleviate low back pain.

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 37 NUMBER 1 – AUTUMN 2022

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 Ayurvedic 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

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Join the Metagenics Practitioner Facebook Group for the latest Congress Updates.

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ANTA Executive Welcome Autumn 2022

From the Chair It suffices to acknowledge the last two years have been particularly challenging for everyone in many ways, ANTA is no different.

The quality of the people we work with makes the difference. The National Administration Office at ANTA are outstanding in the way they assist Members with their inquiries, the quality of the advice they give out is consistent with our values and professional standing. This has contributed to the steady growth in new Members we have attracted to ANTA and maintained our position in the top order of professional Associations in Australia. The challenges for ANTA Staff have been to stay informed about the latest changes from State to State and disseminate accurate and relevant information to ANTA Members when it matters. All Staff at the National Administration Office have executed their engagement with Members with balance and understanding along with their significant contributions to our Members’ administration.

Your ANTA National Council has been active as always behind the scenes, feeding information forward from around Australia to keep us abreast of events nationally. We are indeed fortunate to have a group of dedicated, knowledgeable, committed Directors and Branch Chairs to steer our direction consistent with your needs. I am grateful to be supported by this vibrant group of practitioners willing to give their time and expertise to further your cause and ANTA’s standing within the Australian community.

The challenges for all of us as an Association are related to what we do next. It has become clear to operate an Association at the highest level requires quality systems to support the quality Staff. ANTA has entered a cycle of renewal to upgrade its Member Management System to match the Client Relationship Management platform we have developed over the last two

Autumn 2022

years. Coming up to complement these vital systems is our planned “Find a Practitioner” service to Members, directly related to ANTA Members and their modalities of practice. This service is being developed to provide an integral system open to the public that will provide modality and contact details to people looking for the high quality and effective services ANTA practitioners are known for.

Whatever you practice, from anywhere in Australia, you will be found by potential clients through the ANTA website at no extra cost to you. Our industry partner Media Heroes are adding the finishing touches to this feature of your membership so stay tuned for the release date.

Renewing and updating our website has also been a complementary process and a pleasure to offer our Members an improved and highly functional website, which you will have been using now for some time. This new website with its public facing pages will ease the effort required to locate and browse whatever articles or information you are looking for.

The introduction to our new operating platform is next, this will accelerate and select your topic with speeds we once dreamed of. Another of our industry partners, 1ICT has joined in our aim to provide the best services to our Members to benefit and build their businesses as we come out of three or four challenging years. We have been monitoring events that challenge our Members since 2018 and are aware how sections of Members are affected by natural and other events. For example, floods, fires and government reviews to remove Health Fund rebates from Members’ services. Of course, COVID-19 topped all of these as the pandemic developed across the country and the world.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 5

ANTA Executive Welcome Autumn 2022

What we do next is the most important part of our recovery, we are monitoring trends to judge the shortest distance to recovery. Everything we have done over the last two years is aimed at rebuilding our engagement and commitment to Members, Students, and the public. We are renewing efforts to restore what has been lost to our Members including relationships so valuable to our Member services. We are looking forward to resuming our delivery of Continuing Professional Education (CPE) Seminars in person, beginning with Brisbane in March, Perth in May, Sydney in August and Melbourne in November.

I look forward to renewing our friendships once more as we travel Australia to bring you the best presenters available and maintain your skills and knowledge in clinical practice. In closing, I also

acknowledge the support from another of our industry partners, Guild Insurance for assisting us with the delivery of our Member services on so many levels. I am particularly grateful for their support of the Student Bursary Awards that assist our future practitioners start-up through their significant material support, thank you.

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

Vale Judy Jacka Vale Judith Mary Jacka, GradDipHRE, BHSc, ND 1 August 1938 - 1 March 2022 It is with much sadness that ANTA has to announce the passing of past ANTA Director, Foundation ANTA Member, Founder of the Jacka Foundation for Natural Therapies, and pioneer of natural medicine in Australia, Judy Jacka.

Judy passed away in the early hours of March 1, 2022. ANTA expresses on our heartfelt condolences to Judy’s family and all those that met and worked with Judy.

It is impossible to encapsulate the magnitude of almost 60 years of Judy’s commitment to natural therapies in Australia. Her career culminated in a decade of philanthropy with the establishment of the Jacka Foundation in 2010 and included service on the Board as Vice-Chair until her retirement in 2021.

After studying at the then Southern School of Naturopathy in 1971, Judy was appointed as a lecturer and later as principal of the school between 1974 to 1985 and Chair of the Southern School Council until 1999.

The commitment, dedication and achievements Judy demonstrated throughout her career led to the granting of numerous awards, including: • 1999 - Life Membership of the Australian Natural Therapists Association granted for contributions to the profession, education and industry.

• 2012 - Complementary Health Care Council of Australia award in appreciation of ongoing support for the council.

• 2016 - Honorary Fellowship, Western Sydney University, in recognition of philanthropic work and contributions to education and practice.

• 2017 - Lady Cilento Award, Complementary Medicines Australia for lifelong dedication to complementary medicine.

PAGE 6 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA News Autumn 2022

ANTA News ANTA National Seminars are Back Face-to-Face!

Autumn 2022

ANTA Guidelines for Myofascial Dry Needling Courses Numerous Dry Needling courses are being promoted and not all are of a suitable standard or content. In recent time several issues have been identified resulting in complaints against practitioners using Dry Needling and significant claims for compensation lodged with insurers by clients.

The “ANTA Guidelines for Myofascial Dry Needling” has been developed with advice and input from ANTA and our insurer to assist ANTA Members who are considering undertaking a course in Myofascial Dry Needling so they can practice Dry Needling safely and obtain insurance cover for Dry Needling.

ANTA is pleased to announce that our faceto-face Seminars are back in 2022.

It has been a long couple of years of virtual webinars and ANTA National Council is excited to travel the country and catch up with all our Members.

This year, our Seminars will be held on a Sunday and start mid-morning! Like always, the Seminars will be recorded and placed into the ANTA Member Centre for those that cannot attend.

Note: Myofasical Dry Needling courses are not sent to ANTA for assessment by course providers and these guidelines are provided to assist Members to select the appropriate course.

The Seminars this year are: Brisbane - March 13th Perth - May 22nd Sydney - August 14th Melbourne - November 20th

Log into the ANTA Member Centre and download the guidelines today!

Mobile Clinic Services Please note that if you wish to provide mobile clinic services to your clients in their home, you must register your home address as a clinic (mobile clinic) and have facilities that will allow you to see clients in your home. Refer to each Health Fund’s requirements for registered providers on their websites.

Health Funds that DO allow mobile services for rebates: ϐ Australian Unity ϐ CBHS ϐ NIB ϐ GU Health ϐ Peoplecare Mobile Clinic Services Guidelines can be downloaded from the ANTA Member Centre.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 7

Branch Chair Updates Autumn 2022

Branch Chair Updates

Autumn 2022

Acupuncture & Chinese Herbal Medicine Branch Chair Update Well, 2021 seemed to slip by in a stressful haze of lockdowns, mandates and escalating business requirements. It seems that everything and nothing happened in the year that was. Here are some of the ways Tino and I have been representing Members in the last 12 months.

In late 2020, the Chinese Medicine Board of Australia (CMBA) sought initial feedback on draft revisions of the Board’s Guidelines on safe Chinese Herbal Medicine practice and guidelines on infection prevention and control for Acupuncture and related practices. As one of many key stakeholders, ANTA provided feedback on those guidelines in early 2021.

In late September 2021, ANTA representatives attended the CMBA/AHPRA meeting with the Professional Associations (PAs). The CMBA directive and scope is the protection of the public. The PAs is to protect and further Member interests and agency. This annual meeting is the intersection of these two groups and is as fascinating as watching paint dry. Regulatory issues were the key theme, with clarifications around the ongoing COVID-19 restrictions on Chinese Medicine practitioners, the challenges to Continuing Professional Education and First Aid noted, and some flexibility in approach by the regulator applied. AHPRA registration fees were fixed and did not increase. The CMBA has several committees handling issues of policy, planning, notifications and registration, and these were briefly reported on.

Tino and I, together with the other Directors on the ANTA National Council and the National Administration Office, spent hours updating Members as soon as clear advice became available.

All these contests have come with an ever-increasing digitisation of processes and data to facilitate modern life. It’s not only Big Pharma we need to be mindful of but the tyranny of Big Data too. To that end, neither Tino or I will be seeing you on Meta! And if you really want to be educated on the topic, read Yuval Harari’s 21 Lessons for the 21st Century.

While we hope that 2022 will bring less rhetoric than previous years, Tino and I urge you to stay with us – because together in respectful diversity we are stronger. How we continue to stand our ground and lean into the cyclones of transformation will determine the new days for us all. As we know, an ocean is made up of many drops.

And despite the many distances between us, whether they be philosophical or geographical, may the space between us be blessed.

The ongoing issues around certain herbs on the Poisons Schedule were discussed, as well as how access may be managed through an endorsement (within registration) process. Moving forward, further discussions among the peer Associations and societies would be required, and the CMBA may assist PAs in an advisory capacity. We’ll keep you posted on this as discussions emerge.

Throughout the year, the adage the only constant is change got a workout when the Chief Health Officers of each State and Territory updated or changed the Emergency Acts and Public Health Orders. The ink never dried on one set of amendments before another was handed down.

PAGE 8 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

Kaitlin Edin

Acupuncture Branch Chair

Tino D’Angleo Chinese Medicine Branch Chair

Branch Chair Updates Autumn 2022

Ayurvedic Branch Chair Update I am introducing myself as the new Ayurvedic Branch Chair on the ANTA National Council. My name is Neerja Ahuja (Adv. Dip. in Ayu., certified Yoga Teacher, Yoga Therapist, Dip. in Human Values). I am the Principal Consultant at Ayurveda Awareness Centre (AAC) and started the first Ayurveda Registered Training Organisation in Australia in 2003, offering qualifications up to the Advanced Diploma in Ayurveda.

As your Ayurvedic Branch Chair, I am committed to networking with you to create awareness of Ayurveda in Australia as a holistic health modality that deserves a top place of the preventative and primary health care system. I will do whatever I can to work with the ANTA National Council as well as Government and regulatory bodies to promote Ayurveda and support our Members.

I have been conducting Ayurvedic training, workshops, seminars and offering Ayurvedic consultation and detoxification and de-stressing treatment since 2003.

I recently became a certified Yoga Teacher and Yoga Therapist. I regularly publish articles in professional health journals to align with my passion to promote Ayurveda in the wider community. My online courses have been taken up by students in 135 countries.

Neerja Ahuja

Ayurvedic Branch Chair

Multi-Modality Branch Chair Update Happy New Year and welcome to 2022 (the year of the Tiger). It is my sincere hope that 2022 will align more closely with practice norms seen prior to 2020.

The World Health Symposium occurred exclusively online in early 2021. Attended by over 300 delegates online over three days, this event provided a substantial amount of Continuing Professional Education (CPE) points across ANTA disciplines. The event had Australian and international authorities who were all keen to share their knowledge via a presentation followed by live question and answer sessions. As a Director who championed this event, aided towards its manifestation, and attended throughout, I very much look forward to seeing how this event continues to unfold in the future. I and the Board believe that giving all our Members access to high quality CPE at a low entry cost is essential as an organisation.

During the year, ANTA Directors Tino, Kaitlin and I attended and advocated for our Chinese Medicine Members at the Australian Health Practitioner Regulation Agency (AHPRA) Chinese Medicine Board of Australia (CMBA) meetings. During these online meetings, we provided feedback to the CMBA. We applauded the recognition of all AHPRA accredited Chinese Medicine professions under the ‘allied health’ banner of the Australian healthcare system. This re-categorisation immediately permitted our Chinese Medicine Members to continue practicing in many Australian jurisdictions. This re-categorisation will also aid the ANTA Board of Directors in our continued communications with Private Health Funds, Medicare,

and the Department of Veteran Affairs.

Lead by Shaun Brewster (ANTA National President), the ANTA National Council and in collaboration with other professional practice bodies, ANTA has continued to provide leadership and direction to Members with information and advice during these difficult times. Information about a variety of mandates were typically announced without any discussion or consultation. Premiers, Chief Health Officers (CHOs) and State Health Minsters often made spontaneous decisions without any consultation.

The ANTA National Council in collaboration with the National Administration Office offered modalitybased updates for the benefit of Members within 24 hours of these annoucements. This involved ANTA representatives speaking with and clarifiying the imposed decisions with each State Health Department to ensure that ANTA Members had the most up to date information. I want to ensure all our Members that ANTA continues to advocate for all our modalities, and better two-way communication with these government agencies.

Mark Shoring Multi-Modality Branch Chair

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 9

Branch Chair Updates Autumn 2022

Myotherapy Branch Chair Update Reflecting on 2021, it is clear that the past year was a challenging one in many ways. As ANTA’s Myotherapy Branch Chair, it has been my absolute pleasure representing the Myotherapy profession and working toward the promotion, strengthening and development of our profession.

In 2021, Myotherapy (along with most of our natural therapy colleagues) was hit hard in many parts of Australia with lockdowns and restrictions on practice.

It was devastating to see so many practitioners struggling to keep their businesses afloat, and yet heartening to see so many bounce back and return even stronger than before.

My role has been a very active one, including representation on the re-development committee for the Cert IV and Diploma of Massage, plus as the Chair of the Steering Committee for the Advanced Diploma of Myotherapy. The updates to the Advanced Diploma of Myotherapy are still underway and we expect to have that completed in the next few months.

In addition to this, I have worked alongside counterparts in four other national industry Associations to ensure we are obtaining, deciphering and providing to our Members the best and most accurate information we can about COVID-19 matters, industry updates, etc.

The future of Myotherapy is bright, with education standards improving, an employment sector that has a demand higher than can currently be met, and an ever-growing regard for our profession within the wider health community.

As a career Myotherapist myself, it has and continues to be an honour to represent Myotherapy on the ANTA Board of Directors. It was also a great honour to be elected ANTA National President at the end of 2021. I look forward to working closely with the rest of National Council, with the support of ANTA’s Executive Officer and the National Administration Office to support and represent ANTA Members in their practices and more broadly in their professions.

To our Myotherapy Members I’d like to say, thank you for your resilience and your determination to weather the storm of the past two years. Now more than ever, we have to be agile in the way we work and to push forward with more tenacity than ever before.

If you ever have any questions, concerns or comments, please feel free to send them to the National Administration Office and they will be passed on to me for response.

The Myotherapy Working Group was formed back in 2020 to foster growth and recognition of Myotherapy. This group involves representatives from several training institutions, Associations and private practice. I have greatly enjoyed contributing to and participating in this group, and look forward to continuing to do so into 2022.

PAGE 10 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

Shaun Brewster Myotherapy Branch Chair

Branch Chair Updates Autumn 2022

Naturopathy Branch Chair Update As a relatively new Member to the ANTA National Council, I would like to introduce myself briefly. I am a naturopath of 20 years with experience in clinical practice and lecturing in nutrition and naturopathy, both at Endeavour College and Torrens University in Brisbane. I have a special interest in working with people in chronic pain and have completed a Master of Science in Medicine (Pain Management); chronic pain is the focus of my presentations at ANTA Seminars.

As part of the overview, the Natural Therapies Working Committee have decided to only include core modalities as taught in Tertiary Education Quality and Standards Agency approved curriculums.

As such it was outlined that the Naturopathy executive summary will not include yoga, iridology or homeopathy. This decision means the Naturopathy protocol is one step closer to being releseased for public review.

Apart from my want to give back to my profession, one of the key reasons I joined the ANTA National Council was to advance interprofessional communication between naturopaths and other health care professionals. Joining the Board during the pandemic has meant many other issues have taken precedence but watch this space, and please, if you have a common interest in this topic, I would love to hear from you.

Further progress will be noted in the branch chair report as it becomes available.

I recently noted in an email to our Naturopathic Members that I believe our profession is strong and resilient. Thank you again for your commitment to the profession. As the Naturopathy Branch Chair, I will do what I can to work for you within ANTA National Council and more widely and please get in touch if you have questions or concerns.

Private Health Insurance Update With the aim of having private health insurance reinstated for Naturopathy, ANTA continued with participation in the most recent stakeholder meeting of NTREAP (Natural Therapies Review Expert Advisory Panel). Unfortunately, a further delay was advised due to the pandemic with an extended time frame for the Review, now late 2022.

Master of Naturopathy – Launching 2022 Working with Southern Cross University (SCU), ANTA recently reviewed and now recognises the soon to be available Master of Naturopathic Medicine. With the aim of preparing students for clinical practice as a Naturopathic practitioner, the course has a strong focus on naturopathic philosophy, herbal and nutritional medicine, integrative health, and evidencebased practice. This course is suited to graduates of the Bachelor of Health Science (Health and Lifestyle) from SCU (four years full time including the Bachelor and Masters) or for graduates with a degree in a health-related field who want to become naturopaths (two years full time).

Ananda Mahony Naturopathy Branch Chair

While the delay is far from ideal, it was noted that the Review process was more rigorous than in 2015, now including many checks and balances and opportunities for stakeholder and expert input.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 11

Branch Chair Updates Autumn 2022

Nutrition Branch Chair Update Over the past two years, Australian Natural Medicine practitioners, along with the rest of the world, have certainly faced new challenges. Some of those challenges have brought confusion and uncertainty, or disruptions to previously normal ways of interacting with friends and loved ones, as well as patients.

Just as our patients are individuals and need a personalised approach, ANTA has sought to honour the differences between practitioners and their various differing preferred approaches to practice (within the bounds of regulations, codes of conduct, and scope of practice).

However, the resilience demonstrated by many, including ANTA’s Members, has allowed this period of contraction to also be a time of learning, growth and expansion.

As an example, for those looking to connect with isolated individuals at this time, please see the ‘Virtual Consultation Guidelines’ policy document located within the ANTA Member Centre, which has been developed specifically to support practitioners to appropriately and effectively deliver online consultations.

The ANTA Board of Directors and National Administration Staff have been working hard to help support practitioners to cut through the confusion and find a means of adapting to the changing conditions so that they can provide the support that their communities and patients need now more than ever.

The world’s focus on health has put practitioners of all stripes into the limelight, each with their own contributions to deliver. From acute healthcare management priorities, to long term preventative or chronic health recovery strategies, the need for the services of qualified health practitioners, who are able to use well-evidenced scientific rationale to develop appropriate, effective, and personalised support strategies, is significant and growing.

Clinical Nutritionists have a particularly key role to play in addressing the need for clinically sound information regarding certain nutrients relevant to immunity, as well as diet and lifestyle modifications that can manage existing chronic health conditions that may increase adverse risks, or those that may stem from the changes to a more sedentary at-home life.

These activities are one of the primary ways that ANTA seeks to ensure natural medicine practitioners can continue to bring their unique knowledge and experience to the Australian healthcare landscape.

If early indications are correct, 2022 may bring some further clearing of confusion, and easing of restrictions to our previous norms, however it is unlikely that the importance of health will fade from the forefront of our community’s minds any time soon. In fact, the work may only just be beginning for a world looking to be even healthier than before.

To your best in 2022.

ANTA has been championing this role of Nutrition and Clinical Nutritionists within it’s discussions with Government Departments and various other bodies, to secure rights to practice, protections of title, maintenance of Health Fund coverage, and the ongoing pursuit of practitioner registration.

PAGE 12 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

Warren Maginn Nutrition Branch Chair

Branch Chair Updates Autumn 2022

Remedial Therapy Branch Chair Update Between all the Covid tests, lockdowns, and changes in restrictions, 2021 was actually an eventful year as far as Remedial Therapy goes. Here are some of the highlights ANTA as seen and been working on this year.

A time for change – Associations work together to improve the standards of Remedial Therapy In 2021, five major Associations united with a joint application process for training organisations. Not a lot of Members know that ANTA will only recognise some training providers. These training providers otherwise known as colleges, TAFE’s and RTO’s will need to apply to see their courses recognised by ANTA or any other professional Association. The initiative saw a change to a single application to all five Associations which streamlined the process for training providers, as well as providing the industry with a level of consistency. Ultimately, with more Associations speaking the same language and agreeing on acceptable standards, we will continue to develop the profession and ensure the next wave of remedial therapists meet the continuing need of the industry.

New Remedial Course to be Released in 2022 Another major change this year was the formation of a new Diploma of Remedial Massage. Before you panic, this is a normal process and no, you won’t need to go and get re-accredited. The national training package updates around every five years and we will see a new course published in 2022.

ANTA’s Remedial and Myotherapy Branch Chairs have followed this closely, contributing significantly to the development of the new course. We are confident that the update will bring with it some noteworthy improvements such as increased knowledge of pain science and the biopsychosocial model, understanding research and evidence-based practice. The new course also sets firmer standards around clinical experience which will allow students to develop better skills and knowledge while practising on real external clients with genuine musculoskeletal complaints.

2021 - the Year of Adaptation With a year of so much negativity, there has been some encouraging signs – our Members ability to adapt and soldier on. In fact, ANTA’s Remedial Therapy Membership numbers have increased in 2021 despite the numerous lockdowns and challenges.

More humbling is the way our Members got on with the job. While some Remedial Therapists were throwing their hands in the air giving up and others relying on Government handouts, many ANTA Members chose to think outside the box. Remote selfrelease sessions, group mobility training via zoom and exercise programming are just some of the successes we have heard about this year. This way of thinking and the courage to ‘have a go’ has led to some innovative ways to not only keep the business afloat, but also service our clients who were in desperate need of our services. I believe many of these strategies will stick and continue to evolve as alternative streams of revenue and additional value we can offer in improving the health and wellbeing of our clients.

To wrap the year up, I’d just like to say thank you to all our Members who have provided constructive and positive feedback to the National Administration Office over the last 12 months. I look forward to a prosperous 2022 and wish you and your practice all the very best.

Isaac Enbom

Remedial Therapy Branch Chair

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 13

The Business Platform for Organic Growth Naturally Good Returns to Sydney June 2022

Since launching in 2015, Naturally Good has built itself as a pivotal business platform for all things natural, organic, and healthy.

With personal health and wellness at an all-time high, the natural and organic space is growing rapidly and Naturally Good plays an important role in connecting businesses together to discover opportunity and meet the growing demands of consumers.

Live Trade Exhibition

The Naturally Good Trade Exhibition is a once-a-year opportunity for the industry to reconnect faceto-face and explore the latest in the natural, organic and health industry. Run over two-days, the exhibition connects hundreds of brands with thousands of visitors ranging from buyers, distributors, and suppliers.

After a disruptive two years, excitement is rapidly mounting for this year’s upcoming exhibition which will return to Sydney this 6-7 June 2022. Exhibitors will showcase their products across a wide variety of sectors including food, beverage, beauty, personal care, health, home and lifestyle sectors.

Alongside the two-day exhibition, the free seminar program will be available for all attendees.

Industry experts, game changers and thought leaders will share their insights, knowledge and hottest tips and tricks.

This year the Pitch Fest will once again be held on the exhibition floor, allowing all trade buyers to sit in on the industry’s most enthusiastic product pitches alongside expert judges. The Pitch Fest provides a live platform for brands to put their business or product in the spotlight that offers real feedback on market opportunity, packaging, viability and the pitch itself.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 15

Business Summit

The Naturally Good Business Summit is a one-day event targeted towards manufacturers, brands and distributors who are looking for insights and knowledge to level up their business growth.

This year the Summit will be held on Friday 3 June 2022, two days before the exhibition opens. Led by industry experts, this unique event will explore the depths of the hottest trends and topics taking over the natural and organic sector, as well as business advice that is second-to-none.

This platform also provides an opportunity to network and connect with like-minded industry professionals.

Naturally Good Awards – New in 2022!

Launching for the first time this year, Naturally Good Awards will be an evening to honour and recognise the brands and products that are pioneering and shaping this ever-growing industry.

Judged by industry professionals, 10 prestigious awards are up for grabs from across categories such as food and beauty, to best marketing campaign and more.

The inaugural event will be held on Friday 3 June 2022, for a true celebration of what the industry has on offer.

Year-Round Business Platform

Naturally Good is more than just face-to-face events. Hosting an online digital directory for all things natural, organic and healthy, the directory offers an online marketplace for brands to put their products into the hands of key buyers all year round.

Get Involved in 2022

With only a few months to go, the Naturally Good trade exhibition is gearing up for another successful event.

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Stand bookings are selling fast and visitor registration is now open. For more information head to naturallygood.com.au PAGE 16 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

Neerja Ahuja

ANTA Ayurvedic Branch Chair Advanced Diploma in Ayurveda Principle Consultant at Ayurveda Awareness Centre

Ayurveda and Yoga Therapy for Heart Disease Introduction

Heart disease or cardiovascular disease (CVD) is a phrase used for a variety of conditions that affect the heart’s structure and function. There are several diseases under the heart disease umbrella which include: • Coronary heart disease (CHD) – is caused by the build-up of plaque in the heart’s arteries. It is also ischemic heart disease (IHD) or Atherosclerosis or coronary artery disease (CAD). This is a hardening of the arteries • Heart attack (myocardial infarction) • Heart failure • Arrhythmias – abnormal heart rhythm • Aneurysm – a bulge caused by weakening of the heart muscle or arteries • Rheumatic heart disease – caused by rheumatic fever, and mainly affecting the heart valves • Congenital heart disease – defects or malformations in the heart or blood vessels that occur before birth • Cardiomyopathy – this condition causes the heart’s muscles to harden or become weak • Myocarditis – inflammation and infiltration of

myocardium with necrosis and degeneration • Pericarditis – inflammation of the pericardium • Valvular diseases – related to valves of the heart According to the World Health Organisation, CVDs are the leading cause of death globally, taking an estimated 17.9 million lives each year1.

Heart Research Australia (2022)2 also confirms that heart disease is Australia’s leading single cause of death, with 18,590 deaths attributed to heart disease in Australia during 2017. Heart disease kills one Australian every 28 minutes.

To support these statistics, the United States of America, Centre for Disease Control and Prevention (CDC), a trusted source, says that approximately every 40 seconds an American will have a heart attack. In the United States, one in every four deaths is the result of a heart disease.

Causes and Risk Factors

According to the World Health Organisation, the most important behavioural risk factors of heart disease and

PAGE 18 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol1. Most cardiovascular diseases can be prevented by addressing above mentioned behavioural risk factors.

In this context, Yoga, Ayurveda and Natural Therapies can play an important role in preventing as well as management of CVDs.

Yoga and Ayurveda

Yoga and Ayurveda are two inter-related branches of the same tradition. Together, Ayurveda and Yoga form a complete approach for optimal health, vitality and higher awareness.

Each of them has its unique place and function, but each overlaps into the other on many levels.

This combination of Yoga and Ayurveda also provides the basis for a real dialogue with modern medicine addressing not only specific therapies but also the real causes of disease and how to maintain health and wellbeing in society3.

Ayurveda in the Modern Context

From the last few decades, there is a global concern on raising trends of chronic and non-communicable disease (NCD), an epidemic of lifestyle related diseases like diabetes, obesity, heart diseases, typically a result of stress, improper diet and irregular or sedentary lifestyle.

Ayurvedic lifestyle supports physical, mental as well as social health. These lead to improvement in disease process, disease symptoms and improvement in the quality of life, helping in the prevention and management of diseases.

Pursuing the healthy living style mentioned in Ayurveda is in the form of daily, seasonal routines, good food habits and appropriate physical exercise as mentioned in the ayurvedic texts is the best way for prevention of any disease.

There has been plenty of research done now indicating the value of Ayurveda and lifestyle management for heart disease, including for reducing stress and hypertension which are major contributors for any disease.

Yoga Therapy in the Modern Context

There has been plenty of research done now indicating the value of Yoga and lifestyle therapies for heart disease, including for reducing stress and hypertension which are major contributors for any disease4,5.

Yoga also improves heart health by increasing circulation and blood flow. Practicing Yoga and Ayurveda appropriately can help lower blood pressure, cholesterol, and blood glucose levels, as well as the heart rate. They can all add up to a lower risk of hypertension, stroke, and heart disease6,7.

Emotional Heart

The heart has always been the symbol of life and love, of joy and happiness, of courage and faith. In ancient writings, the heart is considered as the seat of sensations and consciousness. It is important the seat of emotions.

Reducing burden of emotional stress, bringing some joy and peace in the heart are important considerations for anyone, including for patients with heart disease.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 19

ANTA Member Article Autumn 2022

What Are They Saying?

Hugh Calkins, M.D., Director of the Cardiac Arrhythmia Service at Johns Hopkins Medicine, says “A large number of studies show that yoga benefits many aspects of cardiovascular health. There’s been a major shift in the last five years or so in the number of cardiologists and other professionals recognising that these benefits are real”8.

Dr. Gloria Yeh, an Associate Professor of Medicine at Harvard Medical School, says “Yoga is unique because it incorporates physical activity, breathing, and meditation,” 9. As she explains, each of these elements positively affects cardiovascular risk factors, so combining them was bound to show a benefit.

Chanting or contemplation or even listening of the sacred sound of AUM helps a heart patient recover.

Chanting of Anahat Chakra beej mantra, or mental recitation of mantra “Yam” can also be used for people with heart disease.

Asanas, Bandhas and Pranayama

In general, any asanas that don’t bring strain or discomfort can be done and have some benefit for the heart, with understanding of some underlying principles.

We need to take care that there is no forcing or straining, related breath, focused yet calm mind and attitude at the time of yoga practice.

What Ayurveda and Yoga Offers for Heat Disease?

Being overenthusiastic and rushing or doing strong yoga postures may potentially lead to injury.

Relaxation, Meditation and Yoga Nidra

In general, the postures that extend the spine and expand the chest benefits the patients with heart disease.

Stress by itself can cause heart disease and is one of the important risk factors for many health conditions, including heart disease. Looking after emotional heart and reducing stress is an important consideration in any Yoga therapy protocol10.

In that context, including Shavasana, Yoga Nidra and meditation are key parts of the protocol.

It is well known that many heart attacks occur when a person is bending forward which compresses the chest, forcing the abdomen and diaphragm against it, decreasing the space for the heart and lungs,

Mantra Chanting

Some studies aim to show that three factors are significantly associated with the use of chanting in health and wellness: a. Stimulated quality of life, b. Enhanced mood, c. General wellbeing.

They have shown that mantra chanting has measurable and positive physiological and psychological outcomes that support health and wellness11. There is plenty of research that indicates the value of mantra chanting including AUM chanting.

At another level, Yoga and Ayurveda talk about Soul (atma), which is more subtle than the mind and so cannot be fully comprehended by the mind. In that sense, any research cannot fully explain the benefits of chanting, but it has been found very valuable in physical, emotional, and Spiritual growth and wellbeing.

PAGE 20 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

restricting their movement, reducing blood flow and oxygenation to heart and lungs both, which can precipitate a heart attack if heart is already weak, or the person is obese.

Contra Indications

Inverted poses are generally contraindicated for people with high blood pressure (BP) and some other disease.

Some modified variations may be done gently with use of props depending on the conditions of the patient.

• Surya namaskar, sarwangasana, halasana, shirshasana & its variations • Fast breathing, right nostril breathing, agnisar dhauti, bhastrika pranayama, any pranayama with kumbhaka • Vaman dhauti, shankha prakshalana (Laghoo / Purna) cleansing practices.

These are all contraindicated for people with heart disease12.

Jal neti or Trataka can be done. The shatkarmas can be good and useful for prevention but contra indicated if someone has heart disease.

1. Simple and gentle supine postures with gentle breathing, no forcing, or straining, with some hamstring stretches kind of postures can help loosen and warm the muscles in lower extremities, hips and lower spine while improving circulation.

2.Abdominal postures or prone position postures can also create abdominal pressure, on chest and heart, they also require caution and gentleness. It is better to be conservative and do them gently, and without holding breath, especially people who have had heart surgery, have high BP or any condition with weakened heart.

3.Standing poses can be sometimes hard, especially for older people who have heart disease if they have poor balance. They need to be introduced gently, depending on patient’s condition and age and comorbidities, etc.

4. Practicing pranayama is limited to only gentle inhalation and exhalation exercises for heart patients. Left nostril breathing, anulom vilom, deep breathing, ujjayi pranayama without kumbhaka, bhramari pranayama without kumbhaka are good pranayamas for people with heart disease.

5.Some useful Asanas: Tadagasana, Vajrasana series, Pavanmuktasana, Ardha Chakrasana, Anantasana, Bhujangasana, Dhunurasana, Katichakrasana, Tadasana – Tiryaka Tadasana.

6. Bandhas and breath retention are contraindicated because bandhas and breath retention boost

BP and so are not good for the heart. For heart patients only deep breathing is suggested.

Ayurvedic Herbs and Treatments

1. Ayurvedic Snehana Massage – with hrud basti and shirodhara treatments can be very useful in destressing 2.Hrud Basti – especially with arjuna oil or ashwagandha oil can be very useful in strengthening the physical heart 3.Ayurvedic Herb – Arjuna is very useful typically for a patient with heart disease. Another good herb can be ashwagandha. These or other herbs need to be taken only after consulting a practitioner.

Mudras

Hridaya mudra (heart gesture) or apana vayu mudra is a good mudra for people with heart disease.

Foods

1. Foods to Favour – Normal food with less fats & carbohydrates and with high fibres. In general, a sattvic diet will be recommended. Another word to consider is “mitahara” – moderation in food intake, typically plant bases, low fat diet.

2.Foods to Avoid – Non-vegetarian food, milk & milk products, oily & spicy food, refined and processed foods, fast food, preserved food, too much salt.

Conclusion

From this we can see that Ayurveda, Yoga and Natural Therapies can play an important role in preventing as well as management of cardiovascular disease.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 21

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PAGE 22 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

Shaun Brewster

ANTA Myotherapy Branch Chair ANTA National President

Bomb Proofing Your Clinical Practice

There is no disputing the fact that our natural therapy professions have been hit hard over the course of this pandemic.

Almost all of us have been shut down at one time or another, and in some cases many times and for months at a time. While not every state or region was impacted to the same degree, we have all felt the sting of hesitant communities, reduced movement and a lack of confidence to mix with others and utilise services such as ours.

Two questions bubble to the top at this time…

1) Why were we impacted the way we are?

2) How can we avoid it happening again?

Let’s start with the WHY

My role in the early part of the pandemic evolved into a COVID-19 response liaison of sorts for ANTA. I was responsible for collecting and deciphering information from Government, for seeking clarity and for pushing back when their rulings made no sense. I worked

closely with other peak bodies and we coordinated our efforts for the benefit of our respective Members.

It was a relentless and frustrating function to fill, but it certainly gave me insight into how Government arrives at the conclusions that it does.

I should point out first of all that at no time was our industry consulted or included in any decision-making processes. This was not for our lack of trying, however Government needed to move quickly and decisions were made without the involvement of those who would inadvertently be the most impacted.

This, of course, led to widespread frustration and disenchantment of our profession. How could they (Government) decide that we were NOT essential to our community, yet other professions were? Our patients rely on us, we keep them healthy, moving and well.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 23

ANTA Member Article Autumn 2022

During these periods ANTA was very vocal with all levels of Government in the various departments involved in these decisions. It quickly became very obvious that the overarching goal behind the limitations on our practices was driven by a need to reduce and limit human movement in the community, and thus limit the speed of transmission until such time that other measures could be put in place.

With only certain health professions able to operate, and only very high need patients able to access these services, reduced community movement was achieved but our businesses were hit hard.

Was it necessary to do this?

Was it the appropriate and best option?

We may never know, as the landscape has changed dramatically since that time, as has the virus itself.

While much of Australia was plunged into lockdowns and the many restrictions, we were also one of the very few fortunate countries where we could receive financial assistance to soften the blow.

Many of our businesses were negatively impacted in a big way, and some were unfortunately unsalvageable by the time we came out of those periods. Conversely, some were quick to adjust and found a way to not only stay afloat, but to bounce back strong.

Every one of us has our own story, with the chapters telling a different tale during the challenging times of 2020, 2021 and now into 2022.

A common theme of discussion on social media and in other forums was the fact that many of our natural therapies are not Australian Health Practitioner Regulation Agency (AHPRA) registered, and that is the reason we were left out in the cold.

four year bachelor degree qualification for the vast majority of practitioners in a given profession, along with the modality / profession posing a high enough risk to the community that it warrants oversight / registration. These and several other factors are why our applications for registration have been refused to date.

Our professions (with the exception of Chinese Medicine / Acupuncture) have not been deemed appropriate in light of the standards set by AHPRA. It has not been through lack of trying and we will continue look for opportunities for this to happen as time goes by.

Ultimately, AHPRA registration would not have been the silver bullet that many thought it would have been during the height of the pandemic. Our Chinese Medicine and Acupuncture practitioners, while AHPRA registered were still negatively impacted by the restrictions, as were many of our colleagues in other Allied Health professions.

While it may seem that those in public health coasted through unscathed, they too had to deal with a reduced workforce size, greater strain on working conditions and the inability to service much of the community that needed their care.

With all this in mind, it seems that if we are to bomb proof our careers and our clinical practices against future pandemics or similar, we have two options…

Play by the current rules, go back to school, complete a qualification in something that meets AHPRA registration and hope that the next pandemic doesn’t have the same impact.

OR

There were cries for Associations to “try harder” or to “pull their fingers out” on this point, and to push our way through the iron AHPRA gates. Only then, would we be taken seriously and our ability to practice at those times be reinstated.

Play a different game altogether.

The reality is that ANTA is a strong supporter of registration, and that we have submitted on more than one occasion to AHPRA to have our many professions registered under their umbrella.

Zooming right out and looking at the past two years for what they were, observing those who struggled and those who thrived, considering the actions and inactions that led to the many outcomes for each and every one of us; it seems that there are some things we can all do to “bomb proof” ourselves against situations like this and many others.

AHPRA however, has a strict set of criteria that must be met to gain membership and the registration of a title. Amongst those criteria are a minimum

If you choose to play a different game, that brings us to point number two.

How do we avoid it happening again?

PAGE 24 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

Firstly, waiting to see what happens appears to be a flawed concept.

Many of us did this. New restrictions landed, we went home from work and sat by the TV waiting for instructions. Others however decided that waiting was not an option and they quickly chose to find other ways forward.

Telehealth, online classes, click and collect pick up of physical products, social media groups, digital products, and the list goes on.

I hear you say “But my services rely solely on me being face to face with my clients...”. That may be true, but with enough creativity there may in fact be other ways that you can help people.

So many of us were pushed outside our comfort zones with regard to technology, only to discover that many of these tools that seem daunting at first were in fact quite simple to use and incredibly powerful.

Utilising technology in business is a smart move, no matter which way you look at it. It gives us options, greater reach and greater versatility with our ability to impact people in multiple ways.

Traditionally, us natural therapists are known for our longer face to face consultations. It is one of the reasons people choose to see us. They know they will get quality time and opportunity to receive the care they need. However, this reliance on face-to-face consultations became a weakness for a lot of us over the past two years. At times where in-clinic care was not permitted or when there were limitations placed on who we could see in person, so many therapists found themselves with no other option but to close down completely.

Don’t get me wrong, I would never suggest abandoning face-to-face consultations. I am a huge advocate for that quality time with the patient. What I am suggesting though, it is a good idea to have several strings to your bow. Operating a business with a number of streams of service, and therefore a number of streams of income is a fantastic way to prevent restrictions forcing you out the door.

Even without a pandemic happening, this business model creates more of a solid foundation that can see you through a range of different challenges over time.

It is much like becoming reliant on patients with private health fund rebates. If your patients stop coming to see you when their health fund rebates run out, this presents a major weakness in your operating model. Far better to build a practice that attracts people seeking a quality service rather than a convenient and cheap service.

This may be easier said than done, but it is a challenge worth facing.

How about your service as a product?

Identify some of the great things that you do, the things that your clients love about you… Can you turn some of that into a digital product perhaps? Could you record instructional videos?

Maybe you could develop a physical product that you could sell? Depending on your modality of specialisation, I’m sure there are a number of things you could make / develop / manufacture that could become a secondary stream of income.

Not all of the things I’ve suggested here need to be adopted to fortify your practice moving forward, but perhaps there is one thing you could add to the way you work so that it starts to build a little more certainty for you.

Every string you add to that bow gives you options and more of an ability to adjust at times that require it.

As we march on into 2022, I wish you all the very best in your practices and your lives, and I look forward to witnessing the amazing contributions to our community that each one of you provide.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 25

PAGE 26 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

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ANTA Member Article Autumn 2022

Lisa Potocnik

Dynamic Acupuncture BHSc Acupuncture; Dip Remedial Massage ANTA; AACMA; AHPRA Member

Does Acupuncture Alleviate Low Back Pain in Adults Aged 18-70 Years More Effectively Than Standard Medical Care?

Introduction

Low back pain is a prevalent condition with a high incidence both locally and globally1. Multiple structures are affected in low back pain including the musculature, vertebrae, discs, joints, nerves and connective tissues. Low back pain can arise from numerous aetiologies such as injury, poor posture, age associated, genetics, being overweight and occupation related2. Pain occurs in acute and chronic forms and is categorised into Specific low back pain from: trauma, malignancy, fracture, infection and inflammatory conditions; and Non-Specific or Mechanical low back pain and where tenderness occur due to an unknown cause2. There are many forms of treatment for low back pain in both standard medical

care and complementary therapies. This review examines current literature to ask the question, does Acupuncture alleviate low back pain in adults aged 1870 years more effectively than standard medical care?

Western Medicine Diagnosis and Treatment

Diagnosis of low back pain (LBP) is usually done by a General Practitioner (GP) involving patient history, questioning, palpation of local and adjacent structures as well as range of movement (ROM), joint and neurological testing2. To rule out any red flags and make the diagnosis, imaging studies such as X-ray, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) can be ordered and further referrals to Specialists may follow2.

PAGE 28 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

Differential Diagnosis

There are many differential diagnosis (DD) for LBP, these include but are not limited to: muscular strain, trauma, disc herniation, disc and/or facet joint degeneration, spinal stenosis, spondylolisthesis or spondylolysis, infections, neoplasia, autoimmune or inflammatory conditions and referral pain from renal or pelvic organ diseases2.

Treatment

Treatment for LBP in standardised care involves pharmaceutical intervention such as non-steroidal anti-inflammatories (NSAIDs), analgesics and opioid analgesics. In Australia, recent updates to the Clinical Practice Guidelines have discouraged the use of pharmacotherapy as the first choice of treatment for LBP and has advised prescribing only if necessary, at the lowest dosage for the shortest amount of time possible2. Other treatments include referrals to manual therapists: physiotherapy, chiropractic, remedial massage, exercise therapy: exercise physiologists, clinical pilates, hydrotherapy; and lifestyle interventions: weight reduction, dietary and general exercise. Surgical intervention is considered a last resort for serious cases which have not responded to any other form of treatment2.

Strengths and Weaknesses

The strength of the treatments available in Western Medicine (WM) is some of the costs are covered

by Medicare, so treatment is available to all. Its weaknesses include: providing only symptomatic relief and medications can cause numerous side effects, serious drug interactions and some are highly addictive2.

Chinese Medicine Diagnosis and Treatment

In Chinese Medicine (CM), diagnosis of LBP is made by four diagnostic methods of Observation: looking for any asymmetry, patients movements or gait, surgical scars and looking at the patient’s tongue; Inquiring about the relevant pain related questions plus the 10 CM questions; Listening for short breaths or noises due to pain; and Palpation of the local and adjacent areas for pain, tension and differences in the tissues or channels, testing ROM, joint and neurological involvement and taking a patients CM pulse diagnosis3. Recommendation for imaging studies is advised if any red flags are uncovered in consultation.

Differential Diagnosis

In CM, the DD fall under two categories, External and Internal pathologies. External pathogenic factors (EPF) include trauma, Wind-Cold-Damp (WCD) or less commonly a Damp-Heat invasion3. Internal disorders

include Kidney Yin/Yang or Essence deficiency, Liver Qi stagnation and Cold-Damp or Damp-Heat accumulation which can be acute or chronic and are usually referrals from abdominal or pelvic visceral disease or disorders3,4.

Treatment

Treatment in CM is performed based on each individuals presentation and pattern diagnosis.

Treatment techniques include Acupuncture at local (BL23, 25, 28, 54. GV3, 4. Hwatojiaji’s, extra Yaoyan and Shiqizhuixia), distal (BL40, 58, 59, 62. SI3. KD3 and extra Yaotong) and Ashi (painful) points3,4. Tuina or massage before or after Acupuncture is helpful in the local and adjacent areas to move Qi and Blood3.

Moxibustion for cold and deficient conditions warms and tonifies the channels and local area3. Herbal liniments or patches can be used on the local area for warming or cooling purposes3. Herbal medicine formulas can also be prescribed for the patients’ diagnosed pattern3,4 and exercise therapy such as Qigong or Taichi help to move Qi and Blood through the body and channels with slow and controlled movements3. There is no standardised number of Acupuncture treatments to resolve LBP, this is carried out on a case-by-case basis.

Strengths and Weaknesses

The strengths of treatment for LBP in CM are that it is individualised to each patients’ presentation, any underlying or concurrent issues can be addressed at the same time and minimal side effects may be experienced4.

The weaknesses of CM treatments are the costs involved for the patient and the lack of knowledge by the general public that they can in fact utilise CM for LBP.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 29

ANTA Member Article Autumn 2022

Table Summary of Research Methodology, Results and Quality of Papers Table 1: Summary of Selected Literature Cherkin et al. (2009)5

Inoue et al. (2009)6

Bahrami-Taghanaki et al. (2014)7

Design

Four-armed RCT

RCT

RCT

Subjects

638

26

60

Age Range (Years)

18-70

Mean 70.8 ± 9.3

19-80

Intervention

TCM Acupuncture

Acupuncture

TCM Acupuncture with Time-method Confluent Points

Frequency

10 in 7 weeks: 2x p/week for 3 weeks then 1x p/week for 4 weeks

4 in 4 weeks: 1 p/week

3x p/week until patients felt better Mean: 9.1 ± 2.2 treatments

Comparator

Standardised Acupuncture, Injection Therapy - anaesthesia Simulated Acupuncture & Usual Care

TCM Acupuncture

Outcome Measures

Roland Disability Index & Symptom Bothersomeness Scale

VAS

Primary: Pain VAS Secondary: Number of sessions; days absent from work; pain relapses

Results

8 weeks: All ACU improved 4+ pts U/Care improved 2.1 pts (p<0.001)

VAS: (p<0.01) Acupuncture showed greater results than Injection Therapy

VAS:

1 year: All ACU dysfunction improvements 59%-65% In general, no significant difference in results between the 3 ACU groups

First treatment: (p<0.05) Last treatment: (p<0.01)

Intervention group: Decreased 69.6 ± 7.9 to 11.8 ± 4.9 Control Group: Decreased 69.2 ± 8.0 to 15.7 ± 10.0 (p=0.001)

2 week follow up: (p<0.01) 4 week follow up: (p<0.05)

Adverse Reactions/ Harms

11/477 Acupuncture participants: None Short term pain (8), pain longer than 1 month (1), dizziness (1), back spasm (1)

Not reported

Quality: CONSORT

17.5/25

14/25

18.5/25

STRICTA

15/17

14/17

15/17

CASP

10/11

9/11

9/11

PAGE 30 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

ANTA Member Article Autumn 2022

Weib et al. (2013)8

Zaringhalam et al. (2010)9

Li et al. (2014)10

RCT

RCT

Case-Control

143

80 males

28

25-75

50-60

Mean 38.1 ± 6.4

TCM Acupuncture + 21-day standardised inpatient rehabilitation program

Acupuncture (AC); Baclofen 30mg (BA); Acupuncture + Baclofen (AC+BA)

Acupuncture

6 treatments: 2x p/week for 21 days

10 treatments: 2x p/week for 5 weeks

12 treatments: 3x p/week for 4 weeks

21-day standardised inpatient rehabilitation program - Germany

No treatment

Healthy subjects / no treatment

SF-36 Acceptance Questionnaire (self-made)

VAS Roland Disability Index

VAS rsfMRI data on DMN

Intervention group: Greater overall results

VAS:

VAS:

Statistically significant:

BA+AC reduction (p<0.001)

Pain: Sit/stand (p<0.01) Loads ≥ 10kg (p=0.02)

AC reduction (p=0.04)

Before treatment mean 6.

After treatment mean 1 (p<0.001)

Prickling (p=0.04) Physical functioning (p=0.02)

BA reduction 1st 2 weeks only RDQ:

AC reduction (p=0.001)

After treatment increased in DLPFC, MPFC, ACG & precuneus; Voxels mean 1998 (p<0.01)

BA reduction (p=0.04)

Healthy subjects voxels mean 2047

Minor adverse events: Nausea 2.7% Dizziness 13.5% Urgency 20.3% Pain at puncture site 36.5%

Not reported

Not reported

18/25

18/25

12/17

15/17

14/17

9/11

9/11

10.5/11

General health (p=0.02) Vitality (p<0.01) Emotional role (p=0.05)

BA+AC reduction (p=0.001)

DMN connectivities: Before treatment reduced in DLPFC, MPFC, ACG & precuneus; Voxels mean 1739

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 31

ANTA Member Article Autumn 2022

Literature Review Methodology and Results

The literature was obtained by searching the Medical Subject Headings (MeSH) Neurological and Mechanical and the search terms: Acupuncture, Acupuncture therapy/treatment, low/er back pain and lumbar pain. The inclusion criteria comprised of: scholarly, peer-reviewed, full text articles published between 2009-2020 and Randomised Control Trial (RCT)/ Case-Control studies in the English language. Articles were excluded if they were non-human or pilot studies, the LBP was caused by pregnancy and if laser Acupuncture was used. The databases utilised with results were: EBSCO Discovery (3402), Proquest Health (333) and PubMed (72). The summary of the six articles selected for review can be seen below in Table 1.

Critical Analysis of Research

Of the six articles selected for this review, five were RCTs and one was a Case-Control study10.

The smallest sample size was 26 participants6 with the largest having 638 participants5. All studies included both genders except for Zaringhalam et al.

(2010)9, which comprised of only male participants.

The interventions ranged from Traditional Chinese Medicine (TCM) Acupuncture, Confluent points timemethod Acupuncture, standardised Acupuncture and Acupuncture on pain points. Two studies8,9 used Acupuncture as well as standard care. The interventions were measured against comparators of Injection Therapy6, a German standardised 21-day inpatient rehabilitation program8, no treatment10,9,

TCM Acupuncture7 and a study which utilised standardised Acupuncture, simulated Acupuncture and usual care as its comparators5. The number of treatments varied from a minimum of four sessions6 to a maximum of 12 sessions10. Bahrami-Taghanaki et al.

(2014)7 allowed their patients three sessions per week until the patient reported their LBP had improved, the mean number of sessions was 9.1 ± 2.2. Four studies utilised the Visual Analogue Scale (VAS) as an outcome measure and one of these studies used VAS as their only outcome measure6. The Roland-Morris Disability Questionnaire (RDQ) was included in two studies5,9 and there were single uses of the Symptom Bothersomeness Scale, Short Form 36 Physical Functioning Scale (SF-36), a self-made Acceptance Questionnaire8 and resting-state functional MRI (rsfMRI) data on brain default mode networks (DMN)10. Bahrami-Taghanaki et al. (2014)7 was the only study to include secondary outcome measures which were: number of Acupuncture sessions, number of days absent from work and number of LBP relapses. Only three of the six studies reported the adverse events or harms which occurred during their trials. No harms were experienced in the Inoue et al.

(2009)6 study. The Cherkin et al. (2009)5 study had 477 receiving Acupuncture, 11 of these participants reported: short term pain (eight), pain which lasted longer than one month (one), dizziness (one) and back spasm (one). Weib et al. (2013)8 reported minor adverse events of nausea (2.7%), dizziness (13.5%), urgency (20.3%) and pain at the puncture site (36.5%).

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ANTA Member Article Autumn 2022

Evaluation of each study was assessed via the checklists: Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) 2010, Critical Appraisal Skills Programme (CASP) for RCT/ Case-Control study and Consolidated Standards of Reporting Trials (CONSORT) 2010, tabled results can be seen in Appendices A-D, located within the ANTA Member Centre. The six studies did not meet all criteria for any checklist. The CONSORT 2010 results of the five RCTs shows some lack of clarification for (section five), Intervention replication and no study specified why the trial ended or was stopped (Appendix A, section 14b). The STRICTA 2010 results applied to all six studies. Five of the six provided the majority of the information required. Weib et al.

(2013)8 did not state many of the details of needling information (Appendix 2, Item Two), possibly due to the fact that they were performing individualised TCM Acupuncture. CASP for RCT was used for the five RCTs, no study scored below a nine out of 11. Appendix 3, Section B question eight regarding confidence intervals was the most unanswered question with only Cherkin et al. (2009)5 providing this information.

The CASP for Case-Control studies was used for Li et al. (2014)10 also scored highly, however question six (b) answer “can’t tell” was due to the author of this papers’ uncertainty.

Cherkin et al. (2009)5 scored highly for both STRICTA 2010 and CASP with moderate scores for CONSORT 2010. This was the longest study with final followup at 52 weeks, they had the largest sample size of 638 patients and three comparators, standardised Acupuncture, simulated Acupuncture and usual care.

Certain aspects of the trial are not replicable as this information was not disclosed. The results found Acupuncture to be superior in effect than Usual Care however they also noted that they found no statistical significance in effects between Individualised or Standardised Acupuncture and in Acupuncture versus Simulation Acupuncture.

Scoring for the study by Innoue et al. (2009)6 was low for CONSORT 2010, and moderate for both STRICTA 2010 and CASP for RCT. Inadequate information was revealed to be able to replicate this study and no allocation, concealment mechanisms or blinding was used. This study stated they had no adverse events occur and found that Acupuncture was more effective than local Injection Therapy of anaesthesia.

Bahrami-Taghanaki et al. (2014)7 scored moderately across all three checklists. Again, certain aspects of this study were not specific enough to be able to replicate and in my research, I was unable to locate information on Time-Method Confluent Point Acupuncture. This study found that adding the TimeMethod Confluent points into TCM treatments gave enhanced and more sustained effects than just TCM Acupuncture alone.

The German inpatient study by Weib et al. (2013)8 had moderate scorings in both CONSORT 2010 and CASP for RCT but scored low in STRICTA 2010 due to not specifying certain details about the needling performed. No blinding was done in this study and the results were labelled as exploratory due to multiple outcome measures which were taken from the SF36. The study found that Acupuncture added to the standard 21-day inpatient rehabilitation program returned greater results than the program alone.

Zaringhalam et al. (2010)9 scored moderately on all three checklists. The study did not disclose the depth of needle insertion or any specific details about the Acupuncturist. The results found the greatest and sustained improvements in patients in the Baclofen + Acupuncture group.

Li et al. (2014)10 performed a Case-Control study using fMRI to detect if the abnormal brain default mode networks (DMN) which occur in chronic LBP are reversed after a course of Acupuncture treatments.

The study scored highly in CASP for Case-Control and moderately for STRICTA 2010, CONSORT 2010 was

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 33

ANTA Member Article Autumn 2022

not used as this was not an RCT. The results revealed statistically significant improvements after the course of Acupuncture treatments in the chronic LBP group with fMRI imaging showing their DMNs almost matching those of the healthy subjects brain scans.

Discussion

Monash University (2018)1 stated that LBP is the leading cause of global disability with over 540 million people affected at any one time, these numbers have doubled in the last 25 years with figures expected to rise due to an increase in sedentary population and obesity. In Australia, back pain is the second leading cause of Disease Burden2. During the year 201718, the Australian Institute of Health and Welfare (2019)2 recorded one in six people or 16 percent of the population had reported having back issues with 38 percent stating that the pain moderately interfered with daily activities. For ages 45-64, LBP is the most common condition keeping people out of the workforce1. Annually, back pain costs Australia over $4.8 billion in management and reduces the Gross Domestic Product (GDP) by over $3.2 billion1.

Researchers Moritz et al. (2011)11 wanted to ascertain whether patients in Calgary, Canada who used Acupuncture for LBP utilised fewer publicly funded healthcare services post treatment compared to those who used conventional care. After exclusions, 201 patients were selected from the Alberta health insurance registry after being identified as having had Acupuncture for LBP in the year 2000. The comparison group consisted of 804 patients who were age and gender matched to the Acupuncture group. The mean number of Acupuncture sessions was 6.8 which ranged from 2-45. Patients’ physician visits 12 months post Acupuncture treatment decreased 37% compared to the comparator group of 1% reduction suggesting that patients who utilise Acupuncture for LBP are less likely to visit a physician for LBP after treatment therefore reducing the load and cost on publicly funded healthcare systems.

Lim, Ma, Berger and Litscher (2018)12 compiled a comprehensive review of literature which included the physiology of pain and the neural processes which occur during Acupuncture. The nociceptor (pain receptor) was discovered by physiologist Sir Charles Sherrington in 1906 and this knowledge of the central nervous system (CNS) gave rise to a multitude of research into pain physiology, pain management and modalities which reduce pain such as Acupuncture12.

Studies into Acupuncture stimulation both manual and electroacupuncture, has shown involvement of nerve fibres A-delta (Aδ, myelinated thermal and mechanical nociceptors) and C fibres (unmyelinated sensory or afferent fibres) which produce an endogenous analgesic effect12. Many neurotransmitters are involved in the pain and inflammatory response: substance P, glutamate, histamine, endorphins, bradykinin, prostaglandins, serotonin, adenosine triphosphate (ATP) and calcitonin to name a few.

These substances begin a cascade of reactions at the damaged tissue site activating the nociceptors causing localised inflammation and pain12. Research has suggested that the Acupuncture points, especially distal points, are small areas where there is a higher concentration of sympathetic and sensory nerve fibres which elicit a stronger autonomic response when needled12 and manipulation of the points causes microinjury by altering the structure of fibroblasts through deformation of the connective tissues which releases ATP. ATP is broken down into purines and adenosine which are anti-nociceptive agents and block pain signalling12. A fMRI study showed increased blood flow to the Acupuncture points where deqi was obtained12.

These imaging studies are important to show that Acupuncture does have an effect physiologically and biochemically. The future of Acupuncture research should see more high-quality studies with large sample sizes which will optimistically see Acupuncture working alongside WM here in Australia to help ease the load off an already burdened healthcare system and provide patients with choices in their healthcare.

Conclusion

Low back pain is a highly prevalent condition which occurs in all ages to both males and females, to date Western Medicine has only been able to treat symptomatically with the use of pharmaceuticals however these come with many side effects. Chinese Medicine is a safe and effective therapy to treat low back pain with numerous studies showing its clinical efficacy and acceptance by patients.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles PAGE 34 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

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Healthy Recipes Autumn 2022

Healthy Recipes Rachel Knight is a Chef and Nutritionist based in Melbourne. Her passion for seasonal and locally sourced produce has led her to a career in educating the importance of good nutrition and how to maintain a healthy, balanced diet. She currently works as a Head Chef, Editor and Food Stylist for Natvia and as a freelance Recipe Developer.

Orange and Chai Spiced Rice Pudding Categories: • • • • •

Vegan Dairy-Free Gluten-Free Breakfast Hot Bakes

Recipe Data: Serves

8

Prep

10 minutes

Cook

50 minutes

Nutrition: Carbohydrates

Protein

Fats

Energy (KJ)

Calories

Serving Size

17.5g

3.2g

10.5g

754 KJ

180

343g

Ingredients: • • • • • • • • • • • •

175g Basmati Rice, rinsed under cold water 375ml Water 400ml Coconut Milk 250ml Almond Milk 1 tsp Vanilla 3cm piece Ginger, peeled 5cm piece of Orange Peel 1 Star Anise 1 Cinnamon Quill 3 Cardamom Pods, lightly crushed 2 tbsp Coconut Sugar or sweetener of choice Pistachios, roughly chopped to serve

Method: 1. In a large pot, combine the rice and water.

Bring to the boil, cover and simmer until most

2.

3.

4.

5.

of the water has evaporated (about 15-20 minutes).

Add the remaining ingredients except the pistachios and stir to combine.

Cover and simmer for 30 minutes or until the rice is soft, stirring occasionally to prevent it sticking to the bottom.

Once the rice has cooked, remove the cinnamon, star anise, cardamom, ginger and orange peel.

Serve warm, topped with chopped pistachios.

Nutritional Information Tips/Tricks: • For added spice, finely grate the ginger into the pudding.

PAGE 38 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

Healthy Recipes Autumn 2022

Macadamia Chicken Laksa

Categories: • • • • •

Vegan Option Dairy-Free Gluten-Free Low-Carbohydrate-High-Fat Low Carbohydrate

Recipe Data: Serves

2

Prep

30 minutes

Cook

20 minutes

Nutrition: Carbohydrates

Protein

Fats

Energy (KJ)

Calories

Serving Size

10g

33.8g

49.3g

2640 KJ

631

653g

Ingredients:

Laksa Paste • 1 Long Red Chilli, seeds removed and roughly chopped • 60ml Water • 1 stalk of Lemongrass, roughly chopped • 5cm piece Ginger, peeled and roughly chopped • ½ tsp Tumeric • 1 Onion, roughly chopped • 8 Garlic Cloves, peeled • 10 Macadamia Nuts • 2 tbsp Ground Coriander • 1 tsp Coconut Sugar or sweetener of choice • ½ tsp Salt Laksa • 1 Chicken Breast, sliced • 260g Konjac Noodles, rinsed under cold water • 1 tbsp Coconut Oil • 5 tbsp Laksa Paste • 500ml Chicken Stock (2 cups) • 400ml Coconut Milk • 1 tbsp Lime Juice • ½ tsp Salt • ½ tsp Coconut Sugar or sweetener of choice To serve (optional) • Fresh Coriander • Bean Sprouts • Lime Cheeks

• Red Capsicum, sliced • Fresh Chilli, sliced

Method: 1. Place all of the ingredients for the laksa paste in a high-speed blender. Blend for 30 seconds or until smooth and creamy.

2. In a wok over a high heat, add the coconut oil and fry the sliced chicken until cooked.

Remove the chicken and set aside.

3. Add 5 tablespoons of the Laksa Paste to the wok and sauté for 2-3 minutes.

4. Add the chicken stock and bring to a simmer.

Return the chicken to the wok with the coconut milk, lime and salt and coconut sugar.

Simmer for 5 minutes.

5. Divide the konjac noodles between 2 bowls and pour over the laksa. Top with sliced capsicum, bean sprouts, chilli, coriander and lime cheeks.

Nutritional Information Tips/Tricks: • The laksa paste can be stored in a jar, in the fridge for up to a week.

• For a vegan alternative substitute the chicken with tofu and use vegetable stock for the base.

• Use the remaining paste to marinade fish, chicken or tofu.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 39

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ANTA Member Article Autumn 2022

Ananda Mahony

ANTA Naturopathy Branch Chair B.App.Sc (Naturopathy) MScM (Pain Management)

Sex Differences Sex differences in pain responses are significant with different risk factors for women and men and outcomes in prevalence, presentation, and response to treatment. This article takes a brief look at research highlighting some of the differences between women and men in chronic pain, and how these differences might impact treatment approaches in a clinical setting. Before exploring further, it is important to note that research exploring the differences in biology and psychology between women and men in pain is in its infancy, and there is much work to be done to understand these differences and what impact they could have on an individual basis.

From their teen years onwards, women experience more pain than men across their lives. Almost all chronic pain conditions are experienced by women more than men, some because they are unique to women but also conditions that both sexes experience such as rheumatoid arthritis, migraines, temporomandibular joint pain, fibromyalgia, and irritable bowel syndrome. This also holds true for musculoskeletal related pain, particularly with age. For example, the Framingham Study reported that nearly

two-thirds of women compared to half of men, aged 72 and older had musculoskeletal related issues. In both men and women, pain was associated with fair or poor self-rated health, history of back pain before age 65, and disability, however, there were also unique factors associated with pain only in women, which included body mass index, systolic blood pressure, and depressive symptoms1. These additional factors show greater potential for worse quality of life issues and comorbidity.

Even though women frequently report pain of greater frequency, greater severity and of longer duration, women generally receive less treatment. Their reports of pain and concerns are taken less seriously by health care professionals, and they often must wait longer for analgesic or other pain-relieving medication2.

Unfortunately, women’s reports of pain are more likely to be dismissed as “emotional, psychogenic, hysterical or oversensitive” and therefore “not real”3. The outcome is more frequent mental health diagnoses and referral to a psychologist, rather than pain management.

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ANTA Member Article Autumn 2022

s in Chronic Pain

There are numerous reasons why women aren’t getting the necessary treatment options they need.

Largely, and even in first world countries including Australia, doctors and healthcare providers don’t receive adequate training in pain conditions that predominantly impact women. Additionally, the mechanisms that contribute to pain conditions generally aren’t well understood. As a result, many health professionals are left without adequate knowledge to appropriately diagnose and treat these chronic pain conditions. Issues of misdiagnosis, onward referrals, inappropriate treatment, a lack of answers and ongoing suffering are frequently the result2.

Notwithstanding a female predominance in chronic pain presentations, up until recently most of the preclinical work has been performed on male animals and there is a fundamental omission of data in female neuroscience research4. Chronic pain research, particularly that focused on pain conditions affecting women, is still significantly underfunded. There is hope in some areas. In 2018, funding in Australia was allocated to endometriosis and this year the Royal

Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) released newly developed guidelines for the management of this painful condition. Additionally, in the last six years there has been a gradual shift towards sex inclusive research however, there is still a significant way to go.

Despite the lack of funding and inequality women face, men and women have a comparable profile with respect to the overall burden of chronic pain5.

This is a critically important point - talking about the health inequality for women doesn’t take away the experience of pain and suffering men experience. It does however highlight a bias against women when it comes to diagnosis and treatment.

Sex Differences in Pain

Exploring the biological differences contributing to the different experiences of pain in women and men needs to be kept in context because addressing these factors alone is unlikely to resolve chronic pain. A whole person approach needs to be kept forefront even when considering the detail. The biology of pain is never straightforward and only forms part of

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 43

ANTA Member Article Autumn 2022

By comparison a higher baseline testosterone in males promotes a more dominant Th2 immune population.

Th2 T cells may have an analgesic role, potentially inhibiting pain by releasing anti-inflammatory cytokines such as IL-10. In addition, testosterone also increases the macrophage production of antiinflammatory cytokines8. the chronic pain story. Pain is modulated by many factors from across somatic, psychological, and social domains; and the longer pain persists, the less predictable the correlation between the state of tissues and the pain experienced becomes6. So it might be that sex differences in chronic pain are only a small part of overall differences between individual experiences of pain, and indeed, suffering.

Sex, Pain, and the Immune System

The broad context of this discussion is based on the understanding that many chronic pain conditions feature inflammatory or neuropathic components.

Looking at some of the differences within the immune system, the term ‘female’ and ‘male’ will be used to denote a biological categorisation as opposed to ‘woman’ or ‘man’ which is a whole human person.

The immune system plays a key role in chronic pain persistence. Compared to males, females have a more rigorous adaptive immune system and have a Th1-dominant immune population driven by higher baseline estrogen and progesterone levels.

Females also tend to have a higher predisposition to inflammatory disorders and produce a stronger pro-inflammatory immune response to tissue damage7,8. A chronic inflammatory response can lead to sensitisation of peripheral nociceptor neurons and have upstream central nervous system and brain effects, resulting in a maintenance of inflammatory pain. Women also have a higher incidence of autoimmune conditions.

A growing body of literature suggests that T cells have a role in the transition from acute to chronic pain with varying effects depending on the type of pain. In nerve pain the effect is more likely to be detrimental whereas in inflammatory pain there is some evidence of protection with Th1 cells promoting pain and Th2 and Treg cells more likely to be protective9.

Given the above discussion, it is possible that females simply develop a stronger inflammatory response, which could directly result in more pain? Similarly, regarding their higher incidence of autoimmune conditions, does this contribute to the higher incidence of neuropathic pain in females compared to males?

Microglia, Pain, and Inflammation

Residing in the central nervous system (CNS), microglia are macrophage-like immune cells capable of promoting an inflammatory response. Microglial activation is seen in both acute and chronic pain and is thought to contribute to pain sensitisation. Activated microglia release pro-inflammatory cytokines and escalate other inflammatory mediators such as prostaglandins, factors that have the potential to induce pain and increase pain hypersensitivity10.

Interestingly, research indicates that microglia in the spinal cord appear to be required for pain hypersensitivity following either nerve injury or inflammation in male but not female mice, in a testosterone-dependent manner10. Developing evidence suggests that female mice may be using infiltrating T cells to perform the same neuroimmune signalling functions. In female mice, the infiltrating

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ANTA Member Article Autumn 2022

cells were predominantly Th1 cells. As noted above, T cells can release a host of other pro-inflammatory mediates that might enhance neuronal activity.

The Role of Hormones

Sex differences in pain have commonly been attributed to oestrogen. Here it becomes complex as oestrogen can either exacerbate or dull pain depending on its concentration and location. Certainly, research and clinical observation suggest hormonal contributions to pain conditions more broadly. Sex hormones influence CNS pathways involved in pain perception – opioid, dopaminergic and serotonergic activity with observed changes in symptom severity across the menstrual cycle e.g., migraines, fibromyalgia, irritable bowel syndrome (IBS)11.

Despite reports of pain being greater at certain times of the month, the relationship between oestrogen and inflammation is complex and not clear cut and likely depends on the interaction between hormones and the extent of fluctuation rather than absolute hormone levels12. Clearly more research is needed in this area. And, in the case of microglia and pain hypersensitivity, testosterone is currently the strongest candidate as the control switch for pain pathways10.

Treatment Considerations

Key considerations for both women & men • Reduce inflammation including neuroinflammation • Reduce microglial activation within the CNS and brain aiming to shift from a pro-inflammatory microglial phenotype to an anti-inflammatory phenotype. Strategies could include: » Medical Fasting to promote microglial autophagy and promote a net anti-inflammatory phenotype13,14 • Decrease peripheral activators of glial activity for example peripheral inflammation, viral load, allergies etc.

• Reduce dietary fat and sugar as they are both positively associated with pain intensity and pain threshold15 • Dietary Strategies: » Sustained anti-inflammatory approaches focusing on diet, with appropriate supplements » Lower fat generally, specifically low saturated fat » Avoid consuming coconut oil due to saturated fat content » Focus on olive oil and healthy omega 3 and 6 oils » Avoid keto or other diets high in animal fats and cholesterol • Strengthen endogenous mechanisms to reduce inflammation.

Treatment Approaches to Consider for Women in Pain

• Address any specific hormonal contributors that may be contributing to pain • The potential for therapeutic intervention lies in the tendence for females to produce a stronger proinflammatory immune response • Address immune contributors to pain. Reduce the impact of pain promoting Th1 and Th17 cells to a phenotype that encourages resolution of pain and inflammation such as Treg or Th2 cells » Switch Th1 and Th17 phenotypes to promote inflammation resolution » Encourage Treg cells to promote tolerance.

With any individual treatment approach, the map is not the territory. Not all the above approaches will suit all individuals in chronic pain, so address the individual context as well.

This article reflects a fragment of wider contributors to the complexity of chronic pain, and indeed as discussed above, immune drivers in chronic pain are a small part of a big picture, which also includes social and psychosocial factors. At this stage it is uncertain that significantly different approaches in clinical treatment strategies for women and men will eventuate. The factors that may account for the different experiences of pain, and how this might impact clinical approaches, are often nuanced and overlapping. While it may never be clear cut, this topic is certainly worthy of consideration in individual cases of persistent pain, as is due consideration and attention to women reporting and experiencing chronic pain.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 45

ANTA Member Article Autumn 2022

Isaac Enbom

ANTA Remedial Therapy Branch Chair

Simple Strategies for Distance Running Injury Prevention

It’s that time of year again, when a lot of our patients pound the pavement in an attempt to return to normality or to achieve a new year’s goal. Often the increase or change in running habits results in injury.

This article attempts to provide manual therapists with some simple strategies to keep your patients running injury free.

Most running related injuries are a result of musculoskeletal overload which is commonly caused by poor training habits. It’s important that runners understand appropriate training volumes and good recovery strategies. However, this is difficult to achieve without a running coach or a professionally tailored running program. Most distance runners will measure their training progress by distance (kilometres), duration (minutes) and / or speed (minutes per kilometre). All of these are now very easy to measure with the use of technology such as smart watches or apps for example. These metrics can become an obsession with runners which can lead to over-training, cumulative stress and ultimately, a running related injury.

So, what is an appropriate amount of training volume and what sort of training principles should runners take into consideration?

Historically, runners have considered distance, duration, or speed to be the measure of success.

Relying on these metrics alone can significantly underestimate the total training stress that is applied, especially if it is applied repetitively over time.

Focussing solely on these ‘External Training Loads’ fails to take into consideration how runners ‘feel’ during a given training session, which is not only influenced by distance or duration but also by the runner’s state of recovery and daily stress (e.g. sleep, illness, relationships etc.)1.

Clinical commentary by Paquette et al. (2020)1 describes training loads in two categories: • External Training Load – the mechanical load such as distance or duration, and • Internal Training Load – the physiological and psychological responses to the external load such as rate of perceived exertion, heart rate and blood lactate levels.

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 47

ANTA Member Article Autumn 2022

External Training Load is easy to quantify but Internal Training Load is more difficult without the use of sophisticated equipment. The easiest way to measure Internal Training Load is to use a session Rating of Perceived Exertion (sRPE) on a numerical scale of 1-10, similar to that of the Visual Analogue Scale (VAS) commonly used to assess pain. The sRPE has been found to correlate well with blood lactate threshold which further validates its use2.

This weekly load value can then be monitored over time with attention to any major or progressive increases beyond a couple of weeks. This simple method of monitoring the training load could be a useful predictor of injury. However, running related injuries are multi-factorial. Other training factors such as frequency, surface, type (i.e., track, hills etc.) and recovery strategies should be considered in how they can contribute to injury.

Manual therapists should encourage runners to be mindful of their total training loads. A study by Napier et al. (2020)3 examined a combination of External and Internal Training Loads to determine individual training responses. The study found this method provided a more accurate representation of total training load as well as a more individualised estimate of week-to-week changes in training stress. This can have significant implications for monitoring training adaptations, resulting performance and possibly injury prevention.

As manual therapists, we have a responsibility to investigate and implement injury prevention strategies with our clients where possible. The simple act of runners paying attention to their Internal Training Loads and monitoring their total weekly training load over time using these methods could be a useful predictor of injury. In addition, it can be an easy method to help runners self-quantify and adjust their optimal weekly training volume.

The methods should be practiced over time taking into consideration the individual goals and training tolerances. The crucial step is for runners to think outside distance or duration and to be more mindful of how their body is feeling and adapting to training.

Thinking about the total training strategy can lead to more efficient training, less cumulative stress and reduce the risk of injury.

The method combined session running duration (minutes) multiplied by the sRPE (1-10) which resulted in the session training load. This value is then monitored and compared to previous session loads over time. For example, during a typical training week, a runner might document the following: Run 1: Duration: 60 mins sRPE: 3/10 (relatively easy) Training load = 60 x 3 = 180

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

Run 2: Duration: 70 mins sRPE: 5/10 (moderate exertion) Training load = 70 x 5 = 350 Run 3 Duration: 45 mins sRPE: 7/10 (difficult) Training load = 45 x 7 = 315 Total weekly training load = 180 + 350 + 315 = 845

PAGE 48 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

Notable Naturopaths Autumn 2022

Notable Naturopaths with Ananda Mahony

In this edition of Notable Naturopaths, Ananda Mahony, ANTA Naturopathy Branch Chair, sat down with Sophia Gerontakos. Since becoming a qualified Naturopath, Sophia has been supporting people in many different areas including digestive health, fatigue, menstural irregularities, skin complaints, headaches, endocrine disruption, nutritional support, general health, wellbeing and healthy living. Sophia also spends time educating her patients about the important role of food as medicine and harnessing our lifestyle to live well and feel well, with the goal of reaching a place where we can maintain good health without any prescription or supplement.

1. What is your area of interest within naturopathy?

an important role, I don’t see it as a long-term solution to the fundamental issue.

I’ve always had a special interest in mental health and have always ended up with patients in need of mental health support, so I naturally ended up with a bit of a focus there. I also have a bit of a journey with endometriosis so that and women’s health is an area I care deeply about. However, my predominant interest right now is in issues of equity regarding access to healthcare and I have been investigating ways both in clinical practice and in research on how we as naturopaths can reach more of our community, break out of the “middle-class medicine” mould, and make naturopathy more accessible to all. This started out with me starting up a free naturopathic community clinic in Brisbane and has evolved into a new area of research for me which I’m pursuing through a PhD at Southern Cross University.

2. What inspired your interest in this area?

I noticed in clinical practice that we were seeing a fairly narrow demographic of patients in clinic and that some people who would manage to come in for one or two visits could not continue despite needing continuity of care. I think the barriers could be a combination of financial and social and cultural, but predominantly financial. So, I started thinking about how to make our services more accessible to more people and I started up a free community clinic for a couple of hours a week on a particular day where anyone could come in without an appointment at no cost and see a naturopath (me). This enabled me to help people who otherwise wouldn’t have been able to see a naturopath but also came at the cost of my own time and income obviously, so although it plays

3. How has it changed your practice or focus within the profession?

In searching for other solutions to the accessibility issue this led me to what is now the focus of my PhD research at Southern Cross University investigating and designing a naturopathic group consultation structure and program and testing the feasibility of this model as an alternative to a one-on-one consultation model. Once we have tested the program out in a pilot study, I hope to publish the manual as a how-to for naturopaths who would like to run group consultations and programs.

4. What is upcoming for you?

Upcoming for me is rolling out my new program of naturopathic group consultations for people with endometriosis. I have some great naturopaths on board to test out the program in clinical practice and we are just beginning recruitment of patients with endometriosis to participate. If any readers know anyone with endometriosis who might like to participate in a 12-week naturopathic program (six visits, one visit per fortnight) or would like to participate themselves there is more info available at the link below and an option to register interest, or I can be contacted by email Sophia.gerontakos@scu.edu.au Link for more info: https://scuau.qualtrics.com/jfe/ form/SV_a32nMCHgKYrzDZs

THE NATURAL THERAPIST VOL 37 NO. 1 | AUTUMN 2022 | PAGE 49

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PAGE 50 | AUTUMN 2022 | THE NATURAL THERAPIST VOL 37 NO. 1

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