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Ask an expert - muscles and bones - sports injuries

7 questions

Q:  My son has a diagnosis of CPRS due to presumed ( imaging shows no other damage) nerve damage around the left ankle area following a football tackle. 10 months on the pain has not responded to NSAIDs, gabapentin or amitriptyline and a nerve block seems to have resolved little. Mobility remains impaired despite daily physio which is limited by the pain. Any thoughts or suggestions as to potential from accupuncture. His pain team say there is little positive experience in this area and given his localised neuropathic type pain, the chances of getting near him with needles makes it probably a non starter. I wondered whether local anaesthetic prior to needle insertion is possible?

A: If we can unpick your question accurately, against a backdrop of severe chronic pain for which no visible damage can be found and which does not respond to conventional treatment, the questions are first, whether acupuncture is worth trying, i.e. what level of evidence, if any, is there that it might work, and second, would the fact that your son is now hyper-sensitised, whether anyone could actually get needles in or near the affected area.

As far as the first question is concerned, there has been a long history into the use of acupuncture for chronic pain. Our website is down at the moment, or we would have posted an up to date reference to a fact sheet which can be found on the home page by following buttons to research and beyond. This identifies many studies which have been conducted over the years. The measures both for pain and natural pain relievers in the form of neurotransmitters are easily measured, and there have been dozens of studies which show that acupuncture can have an effect on pain. The usual question is not whether but how much and how sustainable the effect.

However, this takes us down a very western-medical route. Chinese medicine understood pain as the consequence of changes in the flows of energy through an area, either through injury or blockage or through systemic weakness. Often there is an overlay, where a systemic weakness predisposes to injury, but in the case of injury it is not uncommon for us to find a weakness in the flow which has no specific correlate in conventional medicine. This is why, often as the treatment of last resort, we have successes where the problem has not even been properly identified. However, each person is unique and different, and your best option would be to take your son to a BAcC member local to you for an informal assessment of what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether treatment would be advisable or beneficial.

As far as the needles are concerned, they are minimally painful, but we have come across situations where even the gentlest insertion was too much to bear. The beauty of the Chinese medicine system is that the complex interconnections mean that we have strategies for dealing with situations just like this. Received wisdom, for example, is that you never treat a limb where lymph nodes have been stripped, and it is not uncommon to treat the opposite limb or in some cases, the opposite lower limb. This can be very handy where someone is in a cast. The different points have resonance with each other, and even in mainstream treatment there are times when one uses points far away from the actual site of the problem. Any well trained practitioner should be versatile enough to deal with this kind of problem and provide direct treatment from a

Q: Can acupuncture help and treat chondromalacia patella?

A: Buried within our fact sheet on Sports Injuries

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sports-injuries.html

is mention of a study which shows that there may be benefit from acupuncture treatment with warm needling (using moxibustion, a technique involving the burning of a herb moxa to generate heat). There is also an interesting case study from 2001 in one of the leading US acupuncture journals

http://www.acupuncturetoday.com/archives2001/oct/10gu.html

which reports some success in treating the condition with electroacupuncture, although even we thought some of the diagrams looked a little scary.

In general, though, a practitioner would first want to explore what has caused, or been thought to have caused, the problem. A great many cases involves some form of repeat stress on the knee joint, and this can have a major impact on the management of recovery as well as on understanding from a Chinese medicine perspective what is happening. The Chinese medicine understanding of the body and mind as an integrated system of flow and balance of energy (called 'qi') means that the practitioner will primarily want to establish whether the problem is local, involving some form of trauma or over-use syndrome, or systemic, where the pain in this joint is the tip of a larger iceberg of problems within the whole pattern. This will dictate in large measure what strategy is best for dealing with the problem.

Acupuncture treatment, of course, is just a treatment like any other, not magic, so if there has been physical damage to tissue where regeneration is unlikely, then the best that can be achieved is a reduction in some of the secondary symptoms of the problem, like swelling and pain. This can have a profound effect, because there are many problems where a vicious circle arises, where damage causes inflammation causes pressures causes more inflammation, and so on. Many conventional treatments, like steroid injections, operate on this principle of breaking the cycle of pain.

Our best advice is to visit a BAcC member local to you to seek a brief face to face assessment of what might be possible. Each case from a Chinese medicine perspective is unique and different, and the same named condition in twenty people might lead to twenty different treatments. There may also be a different understanding of what is going on that may encourage a practitioner to believe that he or she may be able to help.

If it is a matter of keeping a symptom like pain or swelling under control, however, it is important to be very clear about the outcomes of treatment, especially if the symptom recurs. As a form of pain relief for a condition which is destined not to change a great deal acupuncture treatment can be a costly option, and it is never a bad thing to undertake a cost/benefit analysis of continuing treatment. What we often find, though, is that some of the 'side effects' of continuing treatment, like general improvements in feelings of health and well-being, become as valued as the pain relief itself.

Q:  I'm am thinking about acupuncture for reactivating & stimulating my left leg & glute due to a sport injury from many years ago.  I have been having physio for a year with no affect will acupuncture  help?

A: As out fact sheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sports-injuries.html
 
there is a growing body of evidence that acupuncture is being used more routinely for dealing with sports injuries. Anecdotally we are aware of a number of world athletic teams who use acupuncture as a routine part of their maintenance programme, and many physiotherapists now specialise in sports medicine in which acupuncture plays a prominent role.

 

If you have been having physio for over a year with little impact, it suggests that whatever is causing the blockage or restriction in the flow of energy to your gluteus muscles and legs is not straightforward. We are assuming that you have had a full neurlogical assessment, and if you have not, then we woudl recommend that you see your GP and arrange for this to be done. If there has been nerve damage in the lower spine, then you may need to seek specialist advice on your options.

 

Assuming that this is a straightforward failure to repair, from a Chinese medicine perspective it will be a matter of exploring whether the blockage or loss of flow, which is often the case with this type of presentation, is down to a local obstruction or whether the problem overlies a more systemic weakness or difficulty which is hindering your progress. A skilled practitioner should be able to tell you very quickly what kind of problem this is and offer you advice on how best to proceed. Visiting a BAcC member local to you will give you the clearest assessment of what can be achieved.

 

One thing we need to mention is that we often find that people trying to regain fitness tend to over-exercise in pursuit of their former levels of performance. Exerting full force on muscles, even in the super-fit, can cause micro-tears which take a few days to recover. If someone starts to exercise too soon, or carries on to work through it, it will simply a low level but continuous niggle which will not improve. We would recommend that alongside your acupuncture treatment, should you decide to go ahead, you might want to seek the advice of a specialist in sports injuries to assist your recovery. Many of these are associated with or attached to professional sports teams, and it should be relatively easy to track down one who works in your area. If they are any good their reputation will go before them!       
  

Q:  Can acupuncture help severe pain and swelling due to inflamed and torn posterior tibialis tendon? This resulted after an operation to remove navicular accessory bone 5 years ago. i have always had some chronic pain but now severe swelling and pain means I cannot work.  My GP suggested normal pain killers / rest / physio / orthotics none of which gives me relief.

 

A:  This is quite a difficult question to answer without sight of the specific problem. Generally speaking tendonitis is quite often treated by both traditional and western medical acupuncturists, and to good effect. Research of good quality is not that easy to come by because it is often individuated to specific kinds of tendon problems, such as rotator cuff injuries and specific sports injuries, and the studies are often small and methodologically flawed, as our factsheet on sports injuries demonstrates please click here 
 
You can find occasional single case studies through google, such as this one
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652628/
 
which seem to show that acupuncture has a role to play in tendonitis, but our difficulty lies in being able to determine exactly what is going on in your case. We can't tell from your description whether the problem arose as a direct consequence of something done during the operation, or whether the operation as a whole then put additional strain on the tendon, causing the rupture and swelling.
 
However, one of the great strengths of Chinese medicine is that successful treatment does not depend on establishing exactly what the pattern of causation is, but in correctly identifying how the flow of the body's energies have been affected and whether this is a local problem or one which is a manfestation of a more systemic pattern. In cases of swelling and inflammation treatment often involves both the local insertion of needles and also systemic treatment to help the whole body to support the healing process.
 
The best advice that we can give you, as we do with many problems, is to visit a BAcC member local to you and seek their advice. Our main concern, given that we believe that treatment will have an effect, would be to establish how much change was effected and how sustainable it was. Many forms of treatment have an effect, often partly explained by the placebo effect of trying something new and different, but if this is always short-lived it raises questions about whether it is appropriate to carry in with treatment. We are aware that for people in extreme pain even a day's relief is a boon, but if this is so, the practitioner has to be very clear what his or her objectives are and maintain a regular review and dialogue with the patient to ensure that they carry on the work with the patient's full and informed consent.
 
 

Q. Will acupuncture help with an old football injury? I have small broken bones in my foot and arthritus, I am taking cyzpain relief but am now walking with a limp. I enjoy walking and a Munroe bagger with one mountain to finish all of them.

 

A. The adage that the longer a problem has been around, the longer it takes to shift tends to be true. It depends to a great extent on how old 'old' is. This is not simply a question of the injury itself, but of the kinds of secondary accomodations which the body has made to cope with the original problem. It is not unusual for people with a severe pain on one lower limb to start to favour the other, and the slight change in posture can then lead to lower back pain and other musculo-skeletal aggravation.

 

 

There is some evidence that acupuncture can help osteoarthritis, although clearly if a joint has badly deteriorated there is not much that treatment can offer. Reducing the inflammation may be the best that one can hope for, but relief will probably be temporary. Our factsheet here gives a good indication of the kinds of research which exist.

 

It is very likely that if the problem is quite old, you may need to consider some other kinds of help if the inflammation and pain start to reduce. Physiotherapy or osteopathy may well be a good secondary treatment for the realignment of the body's structure, and there are a substantial number of BAcC members who are dual qualified. If one works in your area it may well be worth asking their advice on what may be possible.

 

And we wish you every success in reaching the top of that last peak!

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