Arnica

Chapter 6 Arnica



Lori Zucker




CASE


Samantha is a 48-year-old interior decorator. She is the mother of two teenage children. Samantha fell at home on a marble floor, badly spraining her ankle and bruising her elbow. She was discharged from the emergency room with negative x-rays, a pair of crutches to be used as needed, and scripts for pain and antiinflammatory medications.



image Initial Examination


Past Medical History: Samantha’s medical history includes a bout of mononucleosis in her late teens, colitis, anaphylactic shock secondary to antiinflammatory medications, and severe abuse during childhood.


Client Report: Client complains of pain (5/10) in her right ankle radiating into her foot and up her leg. She also complains of pain (6/10) in her right upper extremity primarily around her elbow. She reports that she is limited in most of her household, social, and work-related activities since the slip and fall. She is also limited in her yoga practice.


Client Goals: (1) Decrease muscle pain and soreness; (2) Walk pain free without an assistive device; (3) Decrease swelling; (4) Return to work; (5) Pain-free use of her right arm; (6) Return to her active yoga practice


Employment: As an interior decorator, Samantha makes her own schedule with her clients, which allows her to be available to her two teenage children. Work-related activities require her to drive, walk around clients’ homes and showrooms, and carry or move moderately heavy furniture. She also has several hours of paperwork, primarily on the computer, related to her business or her household finances.


Recreational Activities: Samantha enjoys yoga, painting, knitting, reading, and visiting museums.


General Health: Samantha reports that she has been generally healthy much of her adult life. Her history of abuse includes use of electrical impulses. As such, therapeutic electrical stimulation is not an available treatment option. Client is reluctant to try ultrasound, although she may be willing to try it if absolutely necessary.


Medications: Antidepressants, vitamins


Musculoskeletal: Strength in the right upper extremity is limited by client’s complaints of pain. Client is able to move against gravity at all joints, but added resistance is not indicated at this time.


Neuromuscular: Posture is unremarkable. Strength in the left upper extremity is WNL throughout.









































LOWER EXTREMITY ROM MEASUREMENTS
Dorsiflexion Limited to neutral secondary to pain
Eversion Not measured secondary to pain
Inversion Not measured secondary to pain
Plantar flexion +20 degrees with complaints of pain
Knee flexion/extension WNL
Hip mobility WNL
Upper extremity ROM measurements
Elbow flexion 0-100 degrees
Elbow extension -15 degrees, painful and limited at end range
Shoulder mobility WFL throughout
Wrist mobility WFL throughout

WNL, Within normal limits; WFL, within functional limits; ROM, range of motion.


Palpation: Client has right upper quarter muscle spasms, swelling around the elbow, and soreness of the forearm musculature. Palpation around the right ankle elicits a painful reaction.


Function: Client is ambulating with a single crutch for partial weight bearing on the right ankle. Bilateral crutches may have been more appropriate given the severity of the sprain, but the client’s right elbow bruise precludes her from bearing weight through the right arm. Client is limited in household ADL and many of her work-related and recreational activities.



image Plan of Care


The initial plan was for the client to receive physical therapy three times a week for 3 weeks. At home, the client was advised to rest, ice her ankle and elbow, use a light compressive garment, and elevate her leg. In the clinic, interventions included the following:


1. Active and active assistive range of motion at the ankle and elbow

2. Gentle soft tissue mobilization of the right foot, ankle, lower leg, and arm to decrease swelling and muscle soreness

3. Gait training to facilitate proper heel-toe pattern

4. Balance training

5. Light resistive exercises when tolerated by the client. Client taught home exercises as appropriate at each physical therapy visit


image Incorporating CAM into the Plan of Care


The client has inquired about the use of arnica to decrease muscle soreness. The therapist reviews the literature to decide if arnica should be included in the plan of care.


This case is used to illustrate the clinical decision-making process of whether to include a homeopathic remedy in the plan of care. The client’s goal is to “get back to normal.” During the initial physical therapy visit, the client inquires if arnica may help with management of her muscle soreness. The client explains that she is exploring the use of homeopathic remedies given her past medical history of colitis and anaphylactic shock after a dose of antiinflammatory medication. The therapist will make recommendations after examination of the client and a review of the evidence to support the use of arnica for this particular client.



INVESTIGATING THE LITERATURE


To respond to the client’s inquiry about homeopathic arnica, the therapist needs to become more familiar with the practice of homeopathic medicine and the specific literature on arnica for relief of muscle soreness. While the use of arnica is being investigated, the client’s treatment would remain the same. The therapist may not always have time to do such an extensive search. Instead she may use a targeted PICO approach.




Preliminary Reading


The therapist uses a resource available on the Internet and two books2,3 to gain some general knowledge about homeopathy. She then reads about arnica.



Homeopathy


The word homeopathy, derived from the Greek words homoios, meaning “like” or “similar,” and pathos, meaning “suffering,” was first used by Dr. Samuel Hahnemann in 1796 to explain his idea of “letting likes be treated with likes.”1 Hahnemann, the founder of homeopathic medicine, was trained as an allopathic physician in Europe in the late 1700s. His experiences led him to believe that treating illness by trying to suppress symptoms was not the optimal approach. He began to believe that if a specific substance caused illness in a person, that same substance given in extremely dilute preparations could effect a cure. Hahnemann called this concept the Law of Similars. He began to explore these specific substances through a process called provings.2 Provings followed a systematic administration of a given substance to healthy individuals. During the proving period, all signs and symptoms, including changes in temperature, intellectual acuity, alertness, body irritation, pain, and emotional state, were recorded daily. Hahnemann then organized the information in order of importance.1 In 1810 Hahnemann published The Organon, a reference book that described his beliefs in the Law of Similars and identified many of the homeopathic remedies still used today.3


The American Institute of Homeopathy was founded in 1844 and by the turn of the century, the United States had approximately 22 homeopathic medical schools and 15,000 practitioners. American interest in homeopathy dwindled through the early 1900s so much that the last homeopathic hospital closed in 1938, although the practice continued to thrive in European countries.2 Today, clinicians interested in becoming homeopathic physicians are trained in schools of homeopathy outside the traditional medical establishment.


Approximately 3000 documented remedies exist in the homeopathic literature. They are derived from plants, minerals, animals, and pathogenic substances. Today, remedies are made much as they were in Hahnemann’s time. A mother tincture is prepared by maceration of the fresh substance in alcohol. This suspension is aged for a defined period of time before the suspension is filtered by compression, which yields a concentrated “mother tincture.” The mother tincture then is used to make remedies in various potencies. Common potencies available to the public are 6×, 6C, 30C, and 200C.2 To make a 6C preparation, one drop of the mother tincture would be diluted into 100 drops of solvent. Then one drop of the new solution would be further diluted into 100 drops of solvent. This procedure would occur six times to produce a 6C remedy or 30 times to make a 30C remedy. In homeopathy, the most dilute remedies are considered the most potent. Thus a 6× dosage, which actually has the most of the original “mother tincture,” is considered less potent than the more dilute 200C preparation.4


The practice of homeopathy relies heavily on individual treatment of symptoms and dosing according to individual needs. Unlike an allopathic approach, which may vary dosages of a particular medicine by weight or age, dosages of homeopathic remedies most often are determined through an interview. During the interview process, the practitioner evaluates many different factors, including physical concerns, emotional or psychological concerns, dietary and sleeping patterns, and habits.2 Table 6-1 provides a brief summary of homeopathic remedies, their sources, and their uses.3


Table 6-1 Summary of Homeopathic Remedies











































HOMEOPATHIC REMEDY SOURCE USE
Arsenicum album Arsenopyrite Digestive disorders, deep-seated insecurity
Calcium carbonicum Oyster shell Joint and bone pain, body odor
Ignatia St. Ignatius beans Bereavement, insomnia, acute grief
Phosphorus Phosphorus Circulation problems, excessive bleeding, anxiety and fear
Pulsatilla Meadow anemone Runny nose, loose cough, greenish/yellow phlegm, depression
Sepia Cuttlefish Gynecological problems, PMS, menopausal symptoms
Nux vomica Poison nut, Quaker buttons Overindulgence in foods, alcohol, coffee
Rhus toxicodendron Poison ivy or poison oak Skin complaints with burning, itchy, red, or swollen scaly skin (shingles, chicken pox), also used for osteoarthritis, musculoskeletal problems, and sciatica
Ruta graveolens Herb-of-grace or rue
Periosteal bruising and deep achy pain of rheumatism, tendon injuries, sciatica, and eye strain

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Mar 11, 2017 | Posted by in MANUAL THERAPIST | Comments Off on Arnica

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