Complementary and alternative treatment for neck pain: chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais.

Of the multitude of treatment options for the management of neck pain, no obvious single treatment modality has been shown to be most efficacious. As such, the clinician should consider alternative treatment modalities if a modality is engaging, available, financially feasible, potentially efficacious, and is low risk for the patient. As evidence-based medicine for neck pain develops, the clinician is faced with the challenge of which treatments to encourage patients to pursue. Treatment modalities explored in this article, including chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais, represent reasonable complementary and alternative medicine methods for patients with neck pain.

Yoga and pilates in the management of low back pain.

Many interventions for the management of low back pain exist, however most have modest efficacy at best, and there are few with clearly demonstrated benefits once pain becomes chronic. Therapeutic exercise, on the other hand, does appear to have significant benefits for managing patients with chronic low back pain (CLBP) in terms of decreasing pain and improving function. In addition, because chronic pain is complex and does not fit a simple model, there have also been numerous trials investigating and demonstrating the efficacy of multidisciplinary pain programs for CLBP. It follows that interventions that treat more than one aspect of LBP would have significant benefits for this patient population. Yoga and Pilates which have, both been gaining in popularity over the last decade are two mind-body exercise interventions that address both the physical and mental aspects of pain with core strengthening, flexibility, and relaxation. There has been a slow evolution of these nontraditional exercise regimens into treatment paradigms for LBP, although few studies examining their effects have been published. The following article will focus on the scientific and theoretical basis of using yoga and Pilates in the management of CLBP.

Acute flaccid paralysis associated with West Nile virus: motor and functional improvement in 4 patients.

OBJECTIVE: To describe motor and functional recovery in 4 patients with acute flaccid paralysis associated with West Nile virus (WNV) infection. DESIGN: A case series describing patient clinical features at admission to rehabilitation through 6-month follow-up. SETTING: Academic acute free-standing inpatient rehabilitation hospital. PARTICIPANTS: The patients (3 men, 1 woman; age range, 29-72 y) with central nervous system WNV infection presented on rehabilitation admission, 18 to 112 days after onset of symptoms, with severe flaccid asymmetric weakness without sensory loss, and decreased functional independence. Electrodiagnostic studies demonstrated a severe diffuse motor axonopathy consistent with an anterior myelitis. INTERVENTION: Acute inpatient rehabilitation program over a period of 35 to 106 days. MAIN OUTCOME MEASURES: Motor and FIM instrument scores at admission to rehabilitation, discharge, and 6-month follow-up. RESULTS: All patients showed modest improvements in strength and function; no patient made full recovery of strength or became ambulatory by 6-month follow-up. CONCLUSIONS: Little is known about recovery in patients with WNV-associated anterior myelitis. It will be important to document any further improvements in strength and function in such patients over a longer follow-up period.