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Michael Cheikin, MD, has been called the "physiatrist you see after you've seen all the other physiatrists."
As founder of the Center for Optimal Health in Plymouth Meeting, PA, Dr. Cheikin takes all comers-the chronic and the desperate, the hurting and the hopeless. Many of his patients abandoned the conventional care system long ago, and had nowhere else to turn.
Although it makes for a demanding day, Dr. Cheikin thrives on the detective work, and then designing an innovative treatment regime that combines the best of traditional and alternative care.
"This center is a testament to my strong conviction in treating the whole person, not just a single symptom or disorder," says Dr. Cheikin, who designed his clinic specifically around the concepts of wellness and holistic medicine. Acupuncture, yoga, meditation, nutrition, Pilates, Rolfing, Shiatsu and massage therapy are a few of the nontraditional services offered alongside mainstream Western-based therapeutic approaches, including biofeedback, electrodiagnosis and wound care.
The center's treatment team includes a midwife, psychologist, body workers, nutritionist, yoga teacher and physical therapist. "Having everything under one roof helps with the continuum of care," he says. "We will work with a patient until we identify an approach that helps."
As Dr. Cheikin's clinic illustrates, "holistic" medical practice-a term often used interchangeably with complementary and alternative medicine (CAM)-is no longer the stuff of modern-day shamans waving crystals and evoking spirits. Credentialed holistic practitioners are making their way into established rehab hospitals and being sought by greater numbers of patients.
In May 2004, a study of 31,000 subjects by the National Center for Complementary and Alternative Medicine (NCCAM) found that 36 percent of American adults were using some form of CAM therapy. According to the survey, CAM approaches are often used to treat back pain, colds, neck pain, joint pain or stiffness, anxiety and depression.
The survey also found that 28 percent of adults used CAM because they believed conventional medical treatments wouldn't help them with their health problem. And 13 percent used CAM because they felt that conventional medicine is too expensive.
East Meets West
As CAM principles weave their way into conventional care settings, more patients are being exposed to Eastern-based therapies, even those being treated for more easily identifiable conditions such as stroke and traumatic brain injury.
Last summer, Marianjoy Rehabilitation Hospital in Wheaton, IL, opened a facility devoted to holistic therapies and alternative treatment. The Integrative Holistic Medicine Clinic offers spiritual counseling, stress management, Reiki, nutritional services, energy medicine and a host of holistic therapies to inpatients and outpatients.
"I spent 25 years as director of the stroke program here, and from the very beginning I saw that my patients would improve more dramatically when they were exposed to some level of spiritual care," says Gouri Chaudhuri, MD, medical director of the clinic and an assistant professor at Rush Medical College in Chicago. "All of them would tell me that they slept better, focused and learned tasks more effectively."
When Dr. Chaudhuri handed off her inpatient responsibilities to her successor 2 years ago, she began designing the new clinic to enhance-not replace-medical management by a patient's primary care team.
"We welcome any patient with a chronic condition that hasn't been resolved under allopathic care," says Dr. Chaudhuri, who aims to teach patients about healthy lifestyles, reduce symptom flare-ups, and empower patients to take control of their conditions.
Clearly, the public is interested in exploring holistic approaches to remedy their ills. The Mayo Clinic identifies four key pillars of CAM: prevention is the key to good health; the body holds the ability to heal itself; learning and healing go hand-in-hand; and the body and mind are connected and interdependent.
It's a mantra that rehab professionals can support, regardless of their training or medical background.
"Fifty percent of my patients are in chronic pain due to various causes," says Robert Schulman, MD, a private practice physiatrist in New York City who offers holistic therapies alongside mainstream physiatry and rehab services. Dr. Schulman began his career with an interest in human movement and whole-body healing. He explored body therapy methods, and completed training in t'ai chi, massage therapy and myofascial release before pursuing his medical degree. Like Dr. Cheikin, he settled on physiatry as the ideal medical specialty to explore his deep interest in human movement and the holistic disciplines.
"Disease rarely happens in a vacuum," says Dr. Schulman, who spends an hour with each new patient discussing all nuances of their lifestyle. The most inconsequential detail can sometimes hold the key to a given dysfunction, he says.
After discussing the reason for a visit and the history of a condition, he asks about the family dynamic. "I may inquire if their mother was an alcoholic, or if they recently lost a job or a loved one," he says. "Lifestyle factors and stressors greatly affect the clinical picture, as well as my decision processes going forward."
The Mind-Body Connection
A key tenet of holistic thought is the idea that kinesthetic awareness and body movement hold strong healing potential. While each approach is unique, yoga, Pilates, t'ai chi, Feldenkrais, the Alexander Technique and other movement therapies adhere to common principles: Become aware of your own space, balance, posture, breathing and motion. Use this knowledge to create seamless movements that are gentler, more efficient, and can be tailored for specific rehab goals such as balance and flexibility.
Regardless of the specific approach selected, movement therapies hinge on patients assuming an active role in their recovery and health. Here are a few popular methods.
The Feldenkrais method. Feldenkrais is a system of understanding human movement, in which practitioners discover and shift habitual patterns that interfere with functioning. There are two main components of the method--awareness through movement lessons lead practitioners through a series of structured movement sequences, and functional integration is a hands-on modality designed to meet the needs of individual practitioners.
Yoga. Gentle postures and stretches are coordinated with breath awareness toharmonize the autonomic nervous system, and improve the relationship of the musculoskeletal system to gravity. Preliminary studies suggest that yoga may aid treating chronic pain, coronary atherosclerotic heart disease, carpal tunnel syndrome, psychiatric disorders, impaired lung function and high blood pressure.
Pilates. With its emphasis on movement and breathing, Pilates is a versatile approach that can be tailored to specific rehab populations. The Pilates principle of core stabilization addresses posture, muscle performance and motor control-identical concepts that form the basis of most orthopedic rehab and therapy.
The Alexander technique. The Alexander technique works to change movement habits in everyday activities. The method teaches using the appropriate amount of effort for a particular activity.
"Many of these approaches can be defined as postural re-education, with an emphasis on body awareness and understanding your own movement patterns," says Jeffrey Ives, PhD, associate professor and chair of the graduate program in exercise and sport sciences at Ithaca College in Ithaca, NY. "You make changes that are both psychological and physical."
While each approach has vocal advocates, no conclusive evidence exists to claim superiority, says Dr. Ives. Research suggests that many movement-based therapies can provide some benefits, if the movement is regulated, choreographed and purposeful. The key is determining the best therapeutic fit.
Complicating the issue further, adds Dr. Ives, is that "body awareness" isn't always a good thing. Becoming hyper-aware of every nuance, process and force acting on the body can lead to somatic preoccupation and symptom magnification. For instance, when Ithaca College hosted a conference of Alexander technique practitioners in 2000, many participants felt lighter and pain-free after the sessions, while others experienced headaches and lingering neck pain.
"Clearly, some people can have startling realizations over their movement with these approaches, and this can relate to pain relief and better function. But not all do," says Dr. Ives, who has studied body movement therapies since the late 1980s and teaches students in his complementary and alternative therapy courses to examine research studies with a critical eye. His research is focused on examining the differences between "body awareness" and "movement awareness," and determining who might benefit from each.
Square Peg in a Round Hole
The headlines bombard us daily in an avalanche of information. Meditation eases rheumatoid arthritis pain. Hypnosis may soothe pain after breast cancer surgery. Acupuncture can reverse the symptoms of osteoarthritis.
Recently, high-profile studies of alternative methods have caught the public's attention and garnered widespread media coverage. While most proponents of complementary medicine view this increased attention as a good thing, others bristle at the idea of using Western research methods to analyze holistic healing systems.
This is because isolating the effects of a single intervention on a single complaint, such as acupuncture for knee osteoarthritis, defeats the spirit of holistic care, says Dr. Cheikin.
"Think of it like a Beethoven symphony," he says. "Isolate just the violins and you may hear some nice music, but you've removed its spirit. This is a lifestyle--nutrition, mental state and physical health all enter into our care decisions."
A more reasonable approach to clinical research is to use a patient as his own control, suggests Dr. Cheikin. "If a patient has experienced symptoms for a number of years, and visited a number of specialists with no improvement, we can begin to isolate those strategies that are effective," he says. Over time and with larger study groups, patterns can emerge.
Proponents of nontraditional treatments hope that these new models can give rise to worthwhile studies that convince even the most skeptical practitioners.
"There's still a pervasive lack of awareness among medical providers as to the benefits of these approaches," says Dr. Schulman, who's reviewed the literature on medical acupuncture and found 350 articles on specific applications, yet cites ongoing skepticism and apathy among his peers.
Although opinions run strong on all sides of the CAM debate, the salient lessons that holistic medicine can teach is one that all rehab professionals can get behind--personalized, one-on-one care; healing the patient, not the condition; and most importantly, giving patients the tools to take charge of their own health, says Dr. Cheikin.
"My dream is to witness a paradigm shift in medicine," he says. "I have no interest in administering cookbook treatments that place patients in a passive role. I strive to give them the tools to take charge of their health."
Jonathan Bassett is senior associate editor of ADVANCE. He can be reached at jbassett@merion.com
Ancient Practices, Modern Science
Proponents of holistic care feel that empowering patients, and getting them involved in key decisions and therapies, makes for a better outcome. Depending on a patient's specific case and complaints, here are 5 therapies frequently employed by holistic rehab practitioners.
Medical acupuncture. There are more than 11,000 certified acupuncturists in the United States. Certification generally requires between 2,000 and 3,000 hours of training and testing-less for licensed physicians. Acupuncture seeks to unblock energy flow and promote healing by inserting hair-thin needles, heat and electrical stimulation along vital energy paths called meridians. According to the Mayo Clinic, basic research suggests that acupuncture regulates the body's nervous system and promotes pain-killing endorphins and immune cells, while altering brain chemistry.
Massage therapy. More Americans are turning to hands-on massage for specific medical applications. The American Massage Therapy Association released a study that claimed 30 percent of all people who received a massage in the last 5 years did so for medical reasons. And a recently released study from the Mayo Clinic found that massage therapy decreased pain levels for patients following heart surgery.
Biofeedback. Biofeedback uses visual and auditory representations to monitor and regulate breathing, muscular activity, temperature and other variables. In addition to traditional applications such as pelvic dysfunction and neuropathy, biofeedback is often used alongside meditation and guided imagery for conditions, such as fibromyalgia, chronic pain, stress and anxiety, and for providing relaxation to enhance other therapies.
Rosen method. This method is a technique of gentle, direct touch, in which the practitionerfocuses on muscle tension and "listens" rather than manipulating. Robert Schulman, MD, a private practitioner in New York City, staffs a Rosen-trained physical therapist for patients with headaches, back pain, muscle tension, joint pain, injuries, insomnia and chronic conditions like asthma and chronic fatigue.
Guided imagery. Patients learn to use their imaginations to guide recovery. Researchers at Kent State University in Ohio grouped chronic pain patients into a control group and a group who listened to a 7-minute audio tape that helped them relax, focus on sensory images and then change those images. The guided imagery group found their chronic pain more tolerable and easier to control.
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