Sandy Williams

Sandy Williams

Thursday, 11 August 2016 14:36

Would acupuncture be good for tennis elbow?

Q:  I suffer from severe tennis elbow.  I've had 6 steroid injections and that only helps it for a few months at a  time.   I was just wondering whether I would have more success with acupuncture? 

A:  Tennis elbow is one of the more frequent conditions with which people present at our practices.

The BAcC has a factsheet which outlines some of the research which has been unertaken

although it would be fair to say that the results are not as clear as for some other conditions for which we prepare factsheets. 

Our clinical experience is that many people do benefit from having treatment but we are always very careful with conditions like this. If someone has four for five sessions without any apparent benefit we tend to draw a sharp line in the sand and look for alternative options for treatment. If treatment is likely to be successful there is usually some improvement, even if it reverts to being not so good again, and the improvements are incremental, i.e they get a little more pronounced each time. If nothing happens or there is a similar temporary burst of better times each time, then the chances are that acupuncture is not the best option.

The key thing is to set measurable targets: how far can someone turn the arm without pain or restriction, how much weight can they sensibly bear, and so on. There is often also 'homework' - it is remarkable how many people want to carry on playing golf or windsurfing while they are being treated, and the concept of 'two steps forward, one step back' is difficult to get across sometimes.

Best advice, as always, is to visit a local BAcC member for an informal assessment of what may be possible. Most BAcC members are happy to spare a few minutes without charge to see what may be possible, and this way you get to meet the practitioner and see where they work before committing to treatment.

A:  A great deal depends on the extent of the spinal injuries.

There is a long tradition in all forms of acupuncture for treating spasms and cramps in the muscles. In western acupuncture this can often involve the use of what are called trigger points, but from an eastern perspective these are seen as blockages or stagnation in a muscle and treated accordingly. Not surprisingly the points used in both traditions tend to be the same, but we all believe that the real strength of traditional acupuncture lies not just in rectifying situations like this but in looking at the overall context to see what caused them in the first place. There is almost always some form of systemic problem underlying the appearance of a local problem, and our concern is not just to address a symptom for a short while but to make sure that it doesn't come back, if we are at all able.

Spinal injuries, however, may open up a different series of challenges. Sometimes the spasms are a consequence of the injury itself and sometimes a consequence of the structural changes which occur after an accident. In the case of the former there is a good chance of reducing or removing the problem. In the case of the latter it becomes more of a matter of management. If something has changed shape, in a distortion of the spine, for example, the stress on the musculature is going to be continuous and potentially causing spasms for a very long time, especially if there is any impingement of nerves in the area as a consequence of the structural changes.

That said, each case is unique, and with so little information to go on we can only advise that your best course of action is to visit a local BAcC member for an informal chat about what acupuncture might be able to offer. This means that a practitioner can have a look at what's going on and give you a much more accurate assessment of what might be possible than we can here.

Thursday, 11 August 2016 14:30

Would acupuncture help a damaged coccyx?

Q:  I hurt my coccyx about 6 years ago by falling off a seesaw. I have had a couple of courses of ultrasound. Usually the pain is okay but at present it is really bad especially if I sit on the sofa. Would acupuncture help and how many treatments would I need? 

A:  We are sorry to hear of your injury. In our experience coccyx injuries can be a dreadful bane to anyone's life, making long term sitting for meals, movies or leisure very difficult.

There is very little research on the use of acupuncture treatment for what is called coccydynia. The causes are usually identical, falling off horses or similar where someone goes up in a seated position and comes straight down. In one case we came across someone had been sitting on a ledge and slid forward and down with the same outcome.

We have tried treating this on a number of occasions, once to great effect, but we have to be honest and say that the treatment, the insertion of needles in the area and especially at a very powerful point at the base of the coccyx is not to everyone's taste. However, such is the nature of the pain that most people are happy to forego the small amount of embarrassment that such a treatment causes.

What we would say, however, is that from or experience there are often changes to the structure of the coccyx itself. It was long believed that the rudimentary vertebrae forming the coccyx were all fused, but the modern understanding is that there can be limited movement in the inter-vertebral joints, and if these are pushed out of shape it can cause considerable pain. In osteopathic practice we understand that it is  believed that the coccyx is involved in a great deal of the fine tuning of regulatory systems, so damage to the coccyx can lead to problems with temperature control and similar. The osteopathic and chiropractic treatments can involve equally embarrassing interventions, but if that's the price of being rid of chronic pain, most people are up for it.

The best advice that we can give is for you to visit a BAcC member local to you for a brief chat about the unique features of your own pains. Acupuncture treatment can often achieve some quite remarkable structure changes by getting the muscular functions of an area to improve. In some case like yours there is also a possibility that the inflammation brought on at the time of the injury itself has become the source of the pain, and the needles might be a way of clearing the blockage. We are often able to work away from the affected area if for some reason we cannot get access to it. If the practitioner you see does think that this is a job for a chiropractor or osteopath they will undoubtedly steer you towards someone they can personally recommend.

Thursday, 11 August 2016 14:26

Pain after acupuncture and cupping

Q:  I had acupuncture with cupping about 4 months ago. The one that was placed on my left shoulder blade area caused local pain which radiated up my neck as a sudden sharp pain. I told the practitioner when he came back after about 5 minutes and he removed that one. Since then I've had pain in that area and in my neck which is getting worse by the day and at times it's agony. What could be the problem?

A:  We are at a loss to explain what might have happened here.

Cupping itself is a relatively safe procedure except for the possibility of leaving some marking or bruising on the back or shoulders when it is used. A responsible practitioner will ensure that a patient knows that this may well happen, and also offer sensible aftercare advice in the unlikely but possible event that a small burn or bruise may appear some time later.

It would be most unusual for cupping to cause a radiating pain, however. The only thing we can imagine is that you may have moved in reaction to the cupping in a way which caused a tendon to stretch and tear slightly, which unlikely as it sounds might happen if you were at all nervous about what was going on and made a sharp manoeuvre with the body already 'set'. Other than that we can think of no other way that this could have happened, especially since the problem appears to be getting worse.

The best course of action in a case like this is to see your GP and ask for an assessment of the problem and potentially a referral either to a neurologist or rheumatologist to find out exactly what is happening. This will probably show how the acupuncture may have caused or exacerbated the problem, if indeed it was the causal factor. In your case something clearly happened at the time you were having treatment, but there remains the possibility that it was a pre-existing problem which treatment brought to the surface.

We say this not to be defensive - if something happens while a treatment is taking place it is a fairly safe bet that the treatment caused it - but to avoid people getting into dispute with practitioners before either knows exactly what has happened. In our experience further investigation pretty much always identifies the cause, and if this does point to the acupuncture treatment then there are ways of seeking restitution for any detriment you have suffered under our professional indemnity insurance.


Q:  Over 7 weeks I had acupuncture treatment for chronic insomnia (one session per week). The insomnia has slightly worsened, not improved, and I am awake from 3 am most mornings. I used to get some relief from Valerian, but since the acupuncture Valerian does not work. How long is it before the effects of the acupuncture wear off?

A:  We are sorry to hear that you are experiencing increased problems with the insomnia, but we would be very surprised if the change was down to the acupuncture treatment. Traditional acupuncture, when delivered properly, is all about balancing energies and unblocking areas of stuck energy. The most that usually happens after a session is that there can be a 24-72 window during which the energetic changes can cause mild and transient reactions like a slight headache or lightheadness, and in the case of musculo-skeletal problems a slight worsening of the symptoms. After this the body tends to stay in its adjusted state unless someone is doing something which causes it to revert, like working far too hard or eating erratically.

In this very limited case, where the treatment is given against a backdrop of poor lifestyle (not that we are suggesting that you have) it might be possible for a treatment to 'wear off' but if this were to be the case then the practitioner would be particularly concerned to adjust the treatment to avoid a kind of boom-slump cycle. The practitioner might also be interested in the fact that you are awake from 3.00am. Odd as it might sound, there are a number of diagnostic patterns where this would be a significant and which might just have been made more apparent by an overall boost in the body's energies. Over the longer term, however, the pattern would revert, so it would be surprising to find that a course of treatment had caused long term adverse effects.

We are interested to read from your supplementary question that it was a drop-in session at which you had the treatment. We are not quite sure what this means. We have a number of members who operate in multi-bed settings which offer treatment at reduced rates for people who could not otherwise afford it, but we are aware that there are other settings where people offer acupuncture, often ear acupuncture, on a walk-in basis. If it is the former this would still be traditional acupuncture. If it was the latter then it might be slightly more formulaic, and there is no doubt that for some people the repeated use of a formula which was not suited to the patient might exacerbate a problem. The best person to ask would be the practitioner who offered the treatment. If it has been done in a traditional way and crafted to your individual needs, the feedback will make sense and perhaps point to ways forward. If it is/was a formula treatment, then it might simply be better to avoid further sessions, as you have.

There is no doubt that acupuncture can benefit in treating insomnia, as our factsheet shows

and you may still find that seeking advice from one of our members working locally to you is a good option if the treatment that you had was offered by someone who did not belong to our body. Most members are happy to offer a brief chat without charge to assess whether someone may be able to benefit from traditional acupuncture.

Q: I have PTSD. I know acupuncture would not treat this, but could it help with the anxiety and sleep problems I have?

A: Strangely enough there is a small but growing amount of evidence that acupuncture treatment can be effective for PTSD. We found this 2013 systematic review

which looks at all the evidence from all the existing studies, and makes some encouraging noises. The conclusions to nearly all reviews of this kind are that larger and better designed studies are needed, but what evidence there is is quite positive.

There is no doubt that acupuncture treatment has been used for some of the component parts of PTSD, notably stress and anxiety, as well as with sleep problems. We have a number of factsheets on our website

which gather the evidence together, and we have answered a great many questions on all three which you can find rather easily through typing any into the 'site search' option on our home page.

What we invariably say in nearly every case, though, is that it is important to visit a local BAcC member for an informal chat to get a view about whether treatment can help your specific problems. PTSD can manifest for all sorts of reasons, and all of us will have treated patients over the years who have been badly affected by accidents, injuries and family traumas. There are ways of interpreting some of these through the diagnostic categories of Chinese medicine which can offer direct treatment options of specific energetic changes, not just an easing of symptoms over time. Each case is unique, though, and needs to be addressed as such.

Talking to a local BAcC member (and most of us don't charge for a short chat with a prospective patient) can often give the practitioner a better idea than we can offer here of whether treatment may work, and has the added advantage that you can meet them and see where they work before committing to treatment. The nature of PTSD is that when someone tries to address the issues involved, as invariably happens during the course of treatment, the patient needs to be able to trust the practitioner as someone they can do business with. If that rapport exists it can really help things along, as much as the converse is true. It is probably better to chat to two or three people to see where the best 'fit' is than to just go to the first or nearest. We are not counsellors, but we do listen intently, and for someone to feel that they can talk openly about their problems their often needs to be a good level of basic rapport.

Q:  How long for treatments to show they are working. I've been having acupuncture for 2 times a week for about 2 months. I have stiffness in the back of my neck that reduces my ability to turn my head side to side. I still have stiffness and a clicking sound in my neck.

A:  This is always very difficult to say. A great deal depends on factors like the time which the problem has been around, the extent of the physical change which the body is trying to achieve to restore proper function, and the person's overall energy levels. If someone has a difficult problem but excellent constitutional condition they might make faster progress than someone with a relatively minor problem in a weaker system.

The crucial issue is trying to set measurable outcomes, and then to hold regular reviews of progress. With many problems it may feel as though there has been no progress at all until it has nearly been fixed, so trying to establish independent measures of progress is really important. These are often called ROM (range of movement) measurements and can involve degrees of turn. They can often demonstrate that change has taken place even where it may not feel as though this were the case.

There is always a need to review progress every four or five weeks. Otherwise it is easily possible to get locked into a kind of treatment 'habit' where both practitioner and patient start saying 'same time next week' without reflecting on the fact that five or six weeks have elapsed and change has been slight. Not every case responds to acupuncture treatment, and acupuncture treatment may not be the best option for every problem. It is very important to draw a line if there has been no real change either in the patient's condition or the diagnostic signs which a practitioner uses to determine what has happened.

The very fact that you are asking means that the time has come to sit down with your practitioner and have a serious talk about what they are finding and whether, based on their experience, they feel that they are actually making a difference. If you both feel that this isn't working then it may be time to explore other treatment options. The practitioner will almost certainly have other recommendations as fallback options.

A:  A great deal depends on the cause and extent of the nerve damage.

There is a very small amount of evidence for nerve regeneration in animals after the use of acupuncture treatment, but nothing of which we are aware from work on human beings. There will be stories on the internet of people who were diagnosed with nerve damage and who have recovered movement and sensation, but there may not always be attributable to the treatment. In general, once a nerve has been damaged with consequent loss of function or sensation, that's that.

However, there are occasions when something which causes nerve damage doesn't but does affect the flow of energy in the body in a way which reflects nerve damage. This is most common in cases of scarring where after a major operation people can often report 'dead' patches on a limb or reduced movement. Like any flow once something has been interrupted it will continue to be interrupted until something is done to reconnect it, and most of us have had the experience of treating someone as simply as a kind of 'joining  the dots' across scar tissue and seeing some quite extraordinary changes.

However, without a great deal more information to go on it would be remiss of us to start guessing at long distance. The best advice is to visit a BAcC member local to you so that they can see exactly what is going on and offer a more professional view based on what they observe. Most are happy to do this with prospective patients when we are not sure whether acupuncture is a good option, and most of us don't charge for this. This also gives you a chance to see where someone works and a chance to see whether they are someone you feel comfortable with before committing yourself to treatment

Thursday, 11 August 2016 11:40

Persistent diarrhoea after acupuncture?

Q:  My Dad is 73 and has been experiencing lower back and hip pain, the GP is currently considering whether he needs a hip replacement. I took him to my chiropractor and on the second visit 10 days ago he was given acupuncture. Sine then he's had persistent diarrhoea. We can't identify any other trigger; he's eaten the same food as the rest of us and no-one else has a bug. is this a possible side effect of acupuncture and if so, how long can he expect it to last? 

A: We might believe that this was a side effect if the diarrhoea lasted for 24-48 hours, but to have diarrhoea for this length of time suggests a bug of some kind. The only conceivable way that this could be connected with the acupuncture treatment would be if the practitioner's standards of personal and professional hygiene fell incredibly short of the standards which an acupuncture practitioner is supposed to follow. This would have to involve not washing hands properly, and also touching the shaft of the needle in such a way that bacteria were carried into the skin.

Our standards of practice preclude this ever happening, and our health and safety consultant gave an absolute assurance that if the procedures were followed precisely there could not be any cross-infection or infection. We do have some concerns about chiropractors and osteopaths adding acupuncture to their repertoire - many do not register with local authorities as required and some are not working in suitable surroundings - but such is the safety of modern treatment, with single use disposable needles applied with the help of a guide tube that it is inconceivable that someone has managed to infect a patient. The only very remote possibility is that there may have been bacteria on the surface which were carried inwards by a needle, but the chances that this caused a bout of diarrhoea rather than a skin lesion are theoretical rather than real.

We suspect that this is probably a rather unfortunate coincidence, but hope that your father has been seen by a GP. Ten days is a long time for a bout of diarrhoea, and this warrants further and immediate investigation.

Thursday, 11 August 2016 11:34

Would acupuncture help severe spondylitis ?

Q:  I have severe spondylitis-  collapse at my L5 S1. I have no disc there. I'm bone on bone. Am I a candidate for acupuncture to relieve that pain?

A:  You would certainly be a candidate for acupuncture treatment to ease pain, but it would need a very careful professional judgement about whether the relief you managed to achieve was sustainable and sufficient to warrant continued treatment.

Acupuncture treatment has a long history of being used for pain relief since the 1970s when President Nixon's visit to China showed operations being performed without anaesthetic under acupuncture treatment. There was a considerable amount of research into how and why acupuncture worked and a general conclusion that treatment seemed to have a very positive effect on the release of endorphins and enkephalins, the body's own natural painkillers.

Of course, this is all very well if there is a chance that the reduction in pain, and with it often a reduction in inflammation, can give the body a chance to heal. In the case of serious degeneration of the spine, however, there is no chance that this will happen. As such it is a pretty straightforward equation: does the cost of treatment stack up against the amount of pain relief you get. We have known people who felt that the two or three days of relief were worth the cost, especially if they could target occasions when they really did need to have a better patch, but this tends to be a long term continuing expense, and to be frank, not everyone can afford to make that commitment.

The best option is to visit a BAcC member local to you and ask their advice based on a face to face assessment of what is happening. All we can say is that you need to set very clear outcome measures to be able to determine that the treatment is having an effect, and regular review periods if you do go ahead to ensure that the effects are as good as they were when you started. 

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