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Ask an expert - muscles and bones - neck

18 questions

A: This is quite a difficult question to answer. All forms of impingement and entrapment can arise for a number of reasons, and these determine whether there is a realistic chance of success. If the problem arises from a displacement of the physical structure of the body, like a joint having been knocked slightly out of alignment then it may be more appropriate to see a practitioner like an osteopath or chiropractor who can manipulate the structure back into place. It is probably possible to do the same thing with acupuncture over time, but re-arranging the bones first and then using acupuncture to consolidate the change is how many of us work alongside osteopaths and chiropractors.

If the changes in structure are due to deterioration of the bones, the problem can be more intractable. We find that impingements of nerves where the spine is starting to collapse with age are often difficult to address, especially in the neck and in the lower back. This is a simple mechanical fact; if the gap between two bones closes then nothing short of surgery is going to fix it.

In some cases, however, inflammation arising from structural changes or simply inflammation can cause the entrapment, and in this case there is some evidence suggesting that acupuncture can do more than simply offer short term pain relief and can break the cycle of inflammation which is causing the discomfort.

The short answer, though, is that each case is unique and different, so it is very difficult to quote general principles about what is best. The advice we tend to give all the time  is to arrange a brief face to face consultation with a local BAcC member to see whether in their professional opinion a problem is amenable to acupuncture treatment. The majority are quite open to suggesting alternatives if they think a patient would be better suited to another form of treatment.  

A great deal depends on the reason for the entrapment. In some cases people are beginning to show deterioration of the cervical spine through age, and the compression which this can cause, with consequent nerve impingement, is not something which treatment can reverse.

However, this is to take a somewhat pessimistic view of what is happening. We tend to look at structure first. Although acupuncture can be quite effective at treating chronic neck pain, as our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

if there is a structural misalignment which is the likely cause you may be better off seeing a chiropractor or osteopath in the first instance to pop the neck back into place. After this, there may well be good reason to have acupuncture treatment because the adjustment might be resisted by muscles which have become 'set' in an abnormal state, and need some help to re-adjust to normal function. Many members work closely with osteopaths and chiropractors, referring backwards and forwards to nudge the system back into place.

A:  This, though, is to take a very western view of what is happening. From a Chinese medicine perspective the pains which are described as 'trapped nerve' or 'muscle spasm' can often be a direct expression of a blockage in the flow of energies or a more long standing systemic weakness. If this is the case, no amount of manipulation will hold changes in place, and acupuncture may treatment well be the best option.

The best advice we can give, without knowing the wider context of your problem, is to pop in to see a BAcC member local to you and seek a brief face to face assessment of what may be possible. We are confident that they will offer you advice which is geared to your specific needs, not simply book you straight in without demur.

Q:  My  mum (aged 72) has spondylosis and suffers greatly with pain in her neck and now has quite a pronounced curvature on her spine. Would acupuncture help with the pain anddiscomfort she is experiencing?

A:We actually gave a very comprehensive response to a question about pain relief and spondylosis some months ago. It said:

There are very few research papers for the treatment of spondylitis with acupuncture, and those which have become available are generally Chinese studies which are both small and often methodologically flawed. A good example is this one:

http://www.ncbi.nlm.nih.gov/pubmed/16309054

This does not mean that it has no significance. The problem is that in the West there is more focus on the 'does it work?' question rather than, until recently in China, a focus on 'what works better?'. When you are using a two-thousand year old tradition which is embedded in the culture the use of the western drug testing model, the randomised double blind control trial, is not likely to be
your model of choice. This latter test is not entirely appropriate for testing acupuncture, because reducing the variables to one is inconsistent with how good acupuncture is practised, so unsurprisingly the number of meaningful trials is limited.

That said, pain relief was one of the most heavily tested aspects of acupuncture treatment when it became more popular in the West, which is generally taken to be after Nixon's visit to China in the 1970s. The outcome measures for research purposes, the various neurotransmitters, and the patient reports of pain are easily measured, and many studies were done which showed that acupuncture does have an effect on the experience of pain. Our fact sheet on chronic pain http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html cites a number of the better known ones. The main issue with using acupuncture for pain relief is weighing up the extent and sustainability of te relief against the cost of treatment, to put it bluntly. If, for example, treatment offers 48 hours of pain free life followed by a couple of days of bearable pain, then someone with deep pockets might find
acupuncture treatment a reasonable investment. The vast majority of us, though, are not in this position, and also the greater majority of practitioners tend not to like to continue treatment indefinitely if there is no sign of a permanent reduction in the levels of pain.

The key aim with a condition like spondylitis is not a reversal of the fusing of vertebrae ultimately caused by the condition but a breaking of the cycle of inflammation which tends to sustain itself, i.e. inflamed areas press against surrounding tissue and further aggravate the inflammation. If treatment, whether by medication or acupuncture, can break this cycle there is a chance of
maintaining a level of manageable pain. The disease label covers a wide range of presentations, and you would need to see a
BAcC member local to you for a brief face to face assessment of whether treatment would be worthwhile for you. From a Chinese medicine perspective there are also a number of systemic problems which can underpin what is in effect a local problem, and a practitioner will be able to assess quite rapidly what else may be going on in the system to inform the diagnosis in Chinese
medicine terms and to give a clearer sense of the prognosis. He or she, if you do decide to have treatment, will be very clear about setting clear outcome measures to see whether the treatment is working, and regular review periods to assess whether treatment continues to be of benefit. We think that remains good advice. The fact that your mother is 72 is not in itself an issue. The problem is more to do with the level of deterioration. In the parlance of modern supermarket advertising 'when it's gone it's gone', which means that in most cases a physical deterioration of bony structures limits the extent to which change can be effected. However, the
fact that someone has spondylosis and also has pain does not mean that there is an absolute correlation between the two. We have treated patients with severe deterioration and seen changes which were thought to have been impossible. It may well be that the pain was not a direct response to the physical issue. However, this is the exception, not the rule, and since each person's condition
is going to be unique to them in Chinese medicine terms, the best advice that we can give is to visit a local BAcC member for a brief face to face assessment of what may be possible.

Q: My boyfriend had acne when he was younger and took acutane for that. While the acne went away, it left him with considerable nerve damage where he had a constant  burning sensation on his face and scalp. The western medicine doctors say that it is because the medicine has made the nerve endings extra sensitive. The only relief that they recommend is painkillers, which is not working effectively either. Can acupuncture help with this? He used the acne medication 12 years ago and has been in chronic pain since.

A: This is a difficult question to answer. A great deal depends on the physical damage to the nerve endings caused by the drug, if this is indeed the cause of the problem. Chinese medicine has its limitations, as does any system of medicine, and if something has been damaged beyond repair, the best that one can hope for is a reduction in the severity of the symptoms.

On this score there may be some cause for hope. As our factsheets on chronic pain and neuropathic pain show

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html

there is a fairly extensive body of evidence suggesting that acupuncture treatment may be helpful in reducing the severity of pain . While this is not conclusive, i.e. we can't say with certainty that treatment will help, pain management with acupuncture has been one of the most heavily researched areas since President Nixon's visit to China in the mid 70s and the remarkable photos of people having operations with needles alone. The markers for pain and pain control are easily measured, making it a very easy area to test. The main question is how much pain relief and how sustainable. If the relief is temporary and only ever reaches the same levels, then it becomes as much a financial problem as anything else - is the level of relief for the time it happens worth the expense?

However, from a Chinese medicine perspective there are other ways of understanding what is happening which may offer some hope. The theory of acupuncture is based on an understanding of the body mind and emotions as a flow of energy called 'qi', pronounced 'chee'. In very simplistic terms when the flow is deficient, excessive or blocked, pain results, and the skill of the practitioner lies in determining where best to treat to restore flow. This is particularly interesting when people present with scar tissue after operations or accidents where there is a literal break in the flow which is not always restored as the body recovers. It is just possible that the scarring which acne can cause has left some local disruption of flow as a legacy, and this might offer another avenue to explore.

The best solution, as we say on nearly every occasion, is to visit a BAcC member local to you for advice on the basis of a brief face to face assessment. Most members are more than happy to give up a little time without charge to cast an eye over a problem before committing to treatment.

Q: Good to have this blog to post questions.  My question is we have consulted a physio for neck pain and the physio instructed that it's due to trapezius muscle knot and he has given me acupuncture treatment. The neck pain has reduced but have the  trapezius muscle pain. I am worrying if its due to acupuncture treatment? What are the side effects for trapezius muscle acupuncture?

A:If we understand you correctly, the treatment for the neck involved releasing the trapezius muscle and now that the neck pain has reduced the trapezius is painful instead.

A great deal depends on how long it is since the treatment was given. Many physiotherapists use forms of what is known as 'trigger point' acupuncture. This is a western acupuncture approach which involves locating and treating tight spots in the muscle fibres which cause pain where they are and also cause muscle contraction which can then cause pain further down the line. Trigger point treatment often involves using longer and thicker needles than we would use in traditional acupuncture, and the treatment itself can sometimes leave a painful area for a few days. There is sometimes a little internal bruising after this technique, and this can also take a short while to go. You could normally expect this kind of pain to go after 48-72 hours, although if the treatment has been epecially vigorous this may be as long as a week.

If the pain persists after this the first person you should speak to is the physion himself; he will be in the best position to assess what is happening because he will know exactly what he has done, and may be able to apply further treatment and exercises to help to resolve the problem. If this does not do the trick then the next port of call is your GP. However, we strongly suspect that the problem will have gone long before you reach this stage.

The other possibility to consider is that sometimes a severe pain can overshadow another pain in the same area, and when the primary pain goes, the second one becomes more noticeable. This is very common in feedback when people have multiple problems. Here again the physio is the best person to speak to. If he has managed to reduce the neck pain, then he can probably release the trapezius pain too.

There shouldn't be any especially noticeable side effects from this treatment. Clearly if the treatment is vigorous you may feel a little bruised in the area for up to 48 hours, but if the physio recognises from your first session that you are quite sensitive to the needling he may well reduce the intensity of the treatment to make the after-effects a little less noticeable.

We hope that this reassures you.

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