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Q: I have been told I have ischial bursitis and I wanted to ask whether this was something that acupuncture could help with?
A: This is one of those conditions where the name is less important than the way that the problem manifests. Ischial bursitis used to be called 'weaver's bottom' because it was quite common in professions where someone had to sit on a hard surface for hours on end, and the bursa between the ischial tuberosity and gluteus medius muscle became quite inflamed.
However, from a Chinese medicine point of view this would be less relevant than asking the patient the full range of questions about the nature of the pain (sharp, dull, spasm, chronic), how it varies throughout the day, how it is affected by heat, cold, pressure, and so on. The system of Chinese medicine is based on a theory of energy called 'qi' and its flow and balance in the body, mind and spirit. If the flow is blocked, or becomes stagnant, or deficient, then the practitioner's task is to reinstate ordinary flow in the belief that a properly flowing system does not generate symptoms. There would also be an important judgement call about whether this was a self-contained symptom, or whether the inflammation in one area was the tip of a much larger iceberg where it was the local manifestation of a systemic problem which might appear elsewhere, or whether a general state of depletion of the system allowed this to develop where a better flowing system might have not been affected.
The difference between the Chinese medicine approach and western medicine is that from the western point of view the naming of the condition means that there will be a number of specific treatments which your GP will offer. In the Chinese medicine system, the symptom, rather than the name it is given, will be interpreted in a number of different ways depending on what is seen to be the driver (cold, stagnation, injury, etc) and also depending on the backdrop against which it has occurred. Although many cases will require similar treatment, at a more profound level the treatment each person receives will be unique to their own needs, and will usually involve restoring the overall balance of the system alongside local treatment of the problem.
We always advise prospective patients to visit a BAcC member local to them for informal advice and a brief face to face assessment before committing to treatment. In your case it is highly likely that you may need a course of exercise to help the process of recovery, and most members know of trusted colleagues in the physiotherapy profession in their area to whom they can make a referral if this proves necessary.
Although we are not great fans of medication, there is always something to be said for a short course of anti-inflammatory medication if the symptom is very painful or interfering with your life. We are not keen on seeing people suffer while the treatment begins to take effect over three to five sessions, and although medications like diclofenac have adverse energetic consequences, these are short-term and are often far outweighed by the relief they bring. They are not a long-term solution, though, and that is what we hope acupuncture may help to provide.
As far as research is concerned, there is not a great deal which addresses the specific problem which you have, but that is more a reflection of the difficulty of pinning a single diagnosis down and finding funding for something for which outcome measures are not that precise, and the difficulty of finding funding at all! However, there is sufficient anecdotal evidence to warrant considering acupuncture treatment as a part of the overall package of treatment, perhaps alongside some exercise and possibly also some adjustments to some of the practical matters like workplace and car seating to provide as muhc relief as possible from the symptoms and to stop their escalation.
Q: Some years ago I had accupuncture and was advised to lay for an hour and to avoid caffeine and nicotine also. This was to enable the treatment to work to its best ability.
My 80 old mum is now recieving accupuncture and has not been advised the same. This worries me as she is paying nearly £50 per session and i want her to have full benifit from her sessioNs. What are your thoughts ?
A: There is nothing here to be worried about. We produced a standardised aftercare sheet some years ago when the new licensing arrangements were introduced in Scotland, and in it we said:
You need to be aware that:
· drowsiness occurs after treatment in a small number of patients, and, if affected, you are advised not to drive
· minor bleeding or bruising occurs after treatment in about 3% of treatments
· pain during treatment occurs in about 1% of treatments
· existing symptoms can get worse after treatment (less than 3% of patients). You should tell your acupuncturist about this, but it is usually a good sign.
· fainting can occur in certain patients, particularly at the first treatment.
In addition, if there are particular risks that apply in your case, your practitioner will discuss these with you.
Anything more than this is a matter for professional judgement, and with a broad variety of acupuncture styles practised within the BAcC there will clearly be variations in the advice given. Some practitioners take a particularly hard line on stimulants of any kind, and give very explicit instructions to patients about what they should or should not do. Among the other things that we have regularly heard said are not to take vigorous exercise, not to eat very large meals, not to drink alcohol after treatment or the night before a first treatment, not to drive at speed in the hour after a treatment but to relax for a while, and so on. In the vast majority of cases the advice will be geared specifically to the kinds of thing a patient might do or say they are about to do, and this is why advice may differ from person to person.
In the vast majority of cases doing any of these things would not undermine the effects of the treatment, but might bring about short term adverse effects because the system is still in a state of flux after the session and takes a while to settle. If someone forgets advice on alcohol and inadvertently has a lager with a curry later in the day, there is a very small chance that they might develop a minor headache or be slightly more affected by the alcohol, but the treatment would not be compromised. Obviously if a patient does something extreme, like going on a two day binge, then that may be different, but most people want the treatment to have the best possible effect and manage their own lifestyles accordingly.
Acupuncture treatment can be very powerful in its effects, and these are not going to be derailed or diverted by the things that most ordinary people do in life. We hope that your mother enjoys a successful course of treatment.
Q: I believe some research has been done on treating hemi-crania with acupuncture. How effective is this? Are there any practitioners within a reasonable radius of SY7?
A:We are not aware of any research specifically on the treatment of hemicrania continua as a named condition. Obviously we have factsheets about migraine
Having said that, the very specific symptoms of hemicrania do possibly have significance within the systems of Chinese medicine. As you are probably aware Chinese medicine operates from an entirely different theoretical perspective, and understands the body, mind and spirit as a movement of energy, called 'qi', whose flow and balance determine the state of a person's health. Symptoms, however, what someone actually experiences, remain the same whatever system of medicine one uses, and the advantage that eastern medicine sometimes has over western medicine is that it can offer ways of understanding specific pains such as those associated with Sjaastad Syndrome and with that treatment possibilities. There are dozens of ways of classifying headaches in Chinese medicine according to location and types of pain, and repeated stabbing pains in a fixed location are often attributed to a specific kind of blockage.
The best advice we can give, however, is to go to a BAcC member local to you and seek their advice on what may be possible. There are at least 16 within a reasonable radius of where you are, and you can generate a list by using the practitioner search function on our home page. Most are only too happy to give up a little time without charge or commitment to assess whether acupuncture is the best treatment option for someone or to recommend alternatives if they think it may not be. We have heard of people using cranial osteopathy as another possible modality for treating this problem, but believe, naturally, that acupuncture is worth exploring first.
Q: I injured my shoulder windsurfing and having rested it and resorted to a a sports massage (which made the pain worse). I wondered if acupuncture might help?
A: A great deal depends on the nature of the injury. The shoulder is a very tricky joint to deal with, as your sports massage therapist may have told you. The gleno-humeral cavity, the very loose ball and socket arrangement which gives the shoulder its extreme mobility compared, say, to the hip joint, means that its stability depends on several layers of muscle and a rotator cuff. If any of these is inflamed, torn or damaged, it can throw the whole alignment of the joint out, and this can work against recovery, especially since the shoulder is a difficult joint to immobilise and continue to function as normal.
We are not surprised that treatment made the pain worse. It is often the case that correcting a joint problem after it has become 'set' for a while can make the muscles ache a great deal. However, this should be a short-term and transient effect, and if it continues to happen, then it may well be that direct treatment is simply aggravating the problem. Acupuncture practitioners occasionally find the same thing happens if they treat an inflamed area to reduce heat and swelling; it can feel rather like poking a sleeping dragon, and make attempts to treat feel very uncomfortable. The advantage of using acupuncture, however, is that the system of Chinese medicine is based on theories of flow and balance of an energy, called 'qi', and one does not need to needle directly into the place where the pain is. Often we find that treating at a distance, 'distal treatment', by using points further down the limb or occasionally on the opposite limb or even equivalent lower limb, can have profound effects. This can all seem very mysterious to someone with no experience of Chinese medicine, but we find that once we show patients some of our charts and books, it makes perfect sense.
The best advice we can give you is to visit a BAcC member local to you and seek their advice. Shoulder problems tend to be unique and different, even in western medicine, and this will determine whether they recommend acupuncture treatment for you. You will almost certainly need to be following a course of excercise and movement at the same time to regain your proper strength and co-ordination, especially since you are very likely to be back on a board as soon as you are better. It might well be worth asking a local BAcC member if they, or a colleague, have this kind of experience - our members are happy to network to make sure that someone gets the best possible outcome. It may even be worth considering going to a physiotherapist who also uses acupuncture, as many now do, to get the best of both, although, obviously, we believe that as the 'experts' in acupuncture, you would be better off initially having your acupuncture treatment from someone who uses this as their full time job rather than simply as another tool in the toolbox.
Q: My daughter is expecting a 2nd baby in Jan. Her first delivery was by 'C' section as she was so slow to dilate the baby became distressed (3cm after several hours) She is convinced that a 2nd delivery would be similar and is considering an elective 'C' section. I wonder if acupuncture before/during labour may assist dilation & help labour progress at a more reasonable pace. If this is the case, how many sessions & how close to due date. Would an acupuncturist attend the birth & would this be tolerated in an NHS hospital.
A: A growing number of our members now offer treatment around the late stages of pregnancy and during childbirth itself, and there are several sub-organisations and interest groups within the BAcC which have sprung up which network to share best practice. We cannot name individual groups because of our commitment to our members as a whole to maintain a level playing field, but a google seach of 'acupuncture', 'childbirth' and the place where you live should quickly generate a few useful leads. The advice you get from these groups will be much more specific than we can give here.
Broadly speaking, acupuncture treatment helps to ensure that the stages of delivery follow their natural pace more easily, and especially help during the transitions which occur. We have to be a little cautious in our advice because the research evidence for this is not available, not because there is no evidence but because the format of the trials which count as evidence which we could cite are not well suited to areas like childbirth. There are many confounding factors in play which make it difficult to establish that 'x causes y'. Word of mouth has meant, however, that a growing number of women now actively seek out practitioners who are ready, willing and able to assist at the birth. Most NHS hospitals and childbirth units have no objection to the presence of a practitioner, and most practitioners who undertake this kind of work know how to work around, and keep out of the way of when necessary, the staff dealing with the delivery.
The number of sessions is impossible to determine. Generally speaking, the practitioner does the least possible to achieve the most effect, and intensive treatment would be unusual. Since the treatment is aimed at ensuring the transitions between stages are as smooth as possible, there would be times during the labour when treatment might have to be more specific, but in the absence of any direct cause and effect relationship between treatment and effect (i.e. no point which directly causes dilation), the practitioner's judgement and professional skill would determine how much treatment and when.
It is very, very important that your daughter feels entirely comfortable if she chooses to have acupuncture treatment, however. If she is worried about whether she is doing the right thing when the labour kicks off, this might be counter-productive and end up in the same result as the last time. The practitioner would also have to work very closely with the midwives as well. There would have to be a point where treatment ceased and a C-section take place if the baby becomes agitated, and a trained practitioner will know when to draw a line.
On the positive side, though, many hundreds of women every year now report very good outcomes from having treatment near or at the birth, and there is every reason to hope that your daughter will be able to benefit too.