Alternative Therapies for Musculoskeletal Problems

Therapy	Best Evidence *	Probably Useful †	Least Evidence ‡
Herbals	Arnica ointment/gel (topical); tiger balm; white willow (salicylate); glucosamine, chondroifin	Topical agents for wound and tissue healing, pain: aescin (horse chestnut); aloe gel; angelica; calendula; comfrey; echinacea; Saint John's wort oil; tea tree; witch hazel; wintergreen oil; curcumin (anti-inflammatory)	Tissue and wound healing: cat's claw; gotu kola; aromatherapy: lavender, camphor, eucalyptus, chamomile, rosemary. Athletic performance enhancement: Asian ginseng, eleuthero; guarana.
Diet and Nutrition/Lifestyle	Stretching, conditioning, warm-up to prevent injuries; bioflavonoids: citrus 900–1800 mg/day (improves healing time of injuries); enzymes: bromelain 500 MCU q.i.d. (proteolytic, anti-inflammatory).	Calcium 800–1000 mg/day (bone, muscle injury); magnesium 300 mg t.i.d. (muscle spasm, injury); vitamin C 400–3000 mg/day (connective tissue support, muscle damage); vitamin E 400–1200 IU/day (muscle damage), topically for scars; eliminate food allergy (may worsen inflammation).	Tissue/Wound Healing: vitamin A; copper, manganese, silicon, zinc; chondroitin sulfate; glucosamine sulfate; arginine, glutamine, l-carnitine. Bursitis: vitamin B 12 1000 µg q.d. for 2–4 wk IM or subcutaneously. Fibromyalgia: vitamin B 1 10–100 mg/day; magnesium 300–600 mg/day; vitamin E 100–300 IU/day; d , l -phenylalanine 500–700 mg t.i.d. (for pain). Enhancing athletic performance: antioxidants, B complex vitamins, chromium, zinc, iron, magnesium, branched-chain amino acids, carnitine, pyruvate whey protein, leucine, inosine, ornithine, ornithine alpha-ketoglutarate, glutamine, creatine, gamma oryzanol, medium-chain triglycerides.
Mind-Body Interventions	Regular exercise, stretching; tai chi; yoga.	Biofeedback; guided imagery; hypnosis; music therapy; qi gong; relaxation therapy; spiritual interventions.
Pharmacological and Biological Treatments			Hydrotherapy (add essential oils, Epsom salts); spa therapy; DMSO topically.
Bioelectromagnetic Therapies	TENS unit.	Energy medicine; healing touch; reiki; therapeutic touch.	Hyperbaric oxygen; light therapy; magnet therapy.
Alternative Systems of Care		Acupuncture; acupressure; traditional Chinese medicine: cupping; ayurveda: massage, oil, herbal techniques.	Homeopathy: Broken bone support: arnica 30C q 15–30 min for 2 hr, then t.i.d. for 2 days; Ruta graveolens 6C t.i.d. for 2–3 days. Sprains and injuries: arnica 30C t.i.d.–q.i.d. for 2–3 days; Ruta graveolens 6C t.i.d. for 2–3 days; Ledum 30C t.i.d. for 2-3 days. Bursitis: Rhus toxicodendron 6C t.i.d.–q.i.d. for 3–4 days; Ruta graveolens 6C t.i.d. for 3–4 days; belladonna 6C t.i.d.–q.i.d. for 1–2 days.
Hands-On Healing Techniques		Craniosacral; Feldenkrais; rolfing; trager.	Chiropractic; massage; osteopathy.

^*Therapies with the highest degree of scientific support for efficacy and safety.
^†Therapies that are often helpful but that do not have the highest degree of supporting evidence for efficacy and safety.
^‡Therapies that may be useful but that have limited scientific evidence for efficacy and safety.
NOTE: C denotes the number of times that a substance is diluted at a ratio of 1:100.
SOURCE: Sierpina, VS: Integrative Health Care: Complementary and Alternative Therapies for the Whole Person, F.A. Davis, Philadelphia, 2000.