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Q:  Over the last year I have had a lot more problems with cramps. I am only 27 years old and this year.  I have had several serious cramps on my quads, hamstrings and calves simultaneously. The cramp in my quads are the worst and the latest time last for 2 and a half hours of intense cramp. Since then my legs have never recovered.  I cant really run or doing any leg movements without them tightening up and feeling like they are going into cramp. It almost feels like constant DOMS for months. I was just wondering would acupuncture be effective as the GP's and phyiso have no answer for what I can do?

A: On the face of it it would seem very likely that acupuncture treatment might well be able to help you. The theories and practice of traditional acupuncture rest on a concept of energy, called 'qi', and its flow, rhythm and balance in the body. When the flow is compromised for whatever reason the resulting blockage or stagnation will cause pain which will continue until the blockage is released. We find that there are many conditions which demonstrate this kind of pathology, notably a great many of the repetitive strain injuries, and the use of needles together with ancillary techniques like moxibustion (the use of a warming herb) and cupping can make a huge difference.

 A practitioner would be very interested to take down a great deal more case history before being certain about this as a diagnosis, however. DOMS was always thought to be a consequence of the build-up of lactic acid in the body, but more recent assessment seems to suggest that microtrauma to the muscles and tendons can be a contributory factor. The problem with microtears and the inflammatory response which they provoke is that most athletes tend to try to work through the pain, regarding this as likely to improve their overall fitness. The reality appears to be that the microtears never get a chance to settle, and simply become worse and worse. It would be essential to establish whether you had now ceased from all forms of exercise, or whether you were still training, even to a minor extent. If so, then a part of the rehabilitation programme might involve extended rest, together with other treatments.

 There is certainly a growing number of acupuncture practitioners who specialise in sports injuries, and if you manage to track one down near to you then it may be worthwhile making a slightly longer journey to someone with this kind of background even though there may be other practitioners who are nearer. Our experience is that it really does help to be able to talk the language of training and understand the specifics of an exercise programmes which may have been a contributory factor. That said, Chinese medicine has existed for 2000 years longer than the average gym, and has addressed the same problems brought on by over-work in an unkind climate effectively. All of our members will be able to offer the same level of acupuncture skill.

 Our best advice is to find a practitioner local to you and ask for a brief face to face assessment before committing to treatment. Most of our colleagues are willing to give up a little time without charge to offer a better judgement than we can make at this remove and to advise you on whether acupuncture is the best modality to pursue.

Q:  My father is 87 and suffered unstable c1c2 neck fracture 8 months ago due to falling. He has no paralysis and has refused most medical interventions (including wearing a collar which he finds too painful) as his desire to live was reduced by recent bereavement. He has severe chronic neck and head pain ever since, with little or no relief even on opiate medicines. Please could l ask if acupuncture might perhaps give him any relief or reduction of pain if it is safe for cc2 fracture?

A: There is no reason of which we are aware why acupuncture would be absolutely contra-indicated for your father's problems. However, there are degrees of relative contraindication, but these depend on the professional judgement of the practitioner and the specific circumstances of the case.

 The one caution of which we are aware is one which mainly appears in the literature of physios who perform acupuncture. We have seen them say that there are rare occasions where the muscles of the back or neck brace themselves to maintain stability, and any treatment which relaxes muscle, even unwittingly, might make the joints of the spine more mobile and thence cause pain. However, we recently put together an acupuncture safety website with the main physio and doctor acupuncture associations www.acupuncturesafety.org.uk and this was 

not thought to be significant enough to warrant mention. Indeed, the fact that your father is wandering around without a neck brace is probably an indicator that while painful the neck is not that close to giving way.

 We do publish a fact sheet on neck pain

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

which quotes a number of encouraging studies, and certainly neck pain is one of the more frequent reasons why people seek treatment. Since the greater majority of referrals are by word of mouth res ipsa loquitur, as solicitors say - we wouldn't get the referrals if it didn't work.

 The best advice, which we invariably give, is to see if your father is willing to drop in to see a local BAcC member who can assess his specific presentation. Most members are happy to give up a little time without charge, and seeing a problem first hand gives a much better idea of what may be possible. We also are very emphatic that we treat the whole person - body, mind and spirit - so it may even be that your father could derive some benefit in other ways to help him deal with what must have been a very painful bereavement for him.


Q:  Had acupuncture more than 30 years ago and STILL have pain and some numbness on the site of a wayward needle. However, I now have chronic back, hip pain with the neck and referred pain to the testicles thrown in from time to time.

A:  Without knowing exactly where the needle was placed we find ourselves a little restricted in what we can say.

 Clearly, the one possibility which you need to rule out is that there is a piece of needle still inside your body. In modern times this would be almost unheard of. The use of disposable needles has eliminated the one main cause of pieces of needle snapping off, and that was the use of autoclaves to sterilise and re-use needles. The constant heating and cooling tended to make the steel in the needles a little more brittle, and there was a risk that a small fragment could break off. Possible as this was we have no records of any such occurrence in the BAcC (formed in 1995) or in the five precursor bodies. We did hear, however, over twenty years ago about a legal case involving a claim that a piece of needle tip had broken off and 'travelled', but we suspect that the matter was settled out of court because there is no trace of it that we can find from our searches.

 The other possibility is that the needle caused physical damage. It is hard to imagine what this might be to have endured for 30 years and to be causing secondary symptoms. However, we think that the best, and perhaps only, thing that you can do is to go to your GP and ask for an X-ray of the area to determine whether there is any physical object in place, and then to discuss with him or her whether the other symptoms to which you refer could be a consequence of physical damage in the area. This might involve a referral for an MRI if there is a chance that the damage is in deeper tissues.

 It may well be the case that you have already done what we suggest; thirty years is a long time, and if you have been experiencing discomfort for this length of time it is highly likely that you have. However, the spread of symptoms needs to be investigated anyway, whatever the root cause. 

 We are sorry not to be able to offer more help or advice than this, but with the information you have sent us this is the best that we can suggest.  

Q:  I am a registered midwife with the NMC and have been personally been a patient of acupuncture for years. Recognising the benefits I am very interested in completing training in acupuncture so that I can benefit pregnant women and ideally support women trying to conceive. Are there any courses for midwives which you would recommend. I have found a few advertised but only want to gain the correct qualification

A:  This puts us in a rather difficult position. There is currently a great divide in the BAcC between those members who are suspicious and at times downright hostile to the idea of anyone learning a small number of acupuncture skills in order to be able to practise in a defined and limited area. In their view it is only possible to use TCM safely and well if the treatment is given on the basis of a full training in traditional acupuncture. At the other end of the spectrum we have an equally forceful group of members who believe that as long as people work within the scope of practice which they have learned and are aware of the contraindications from a Chinese Medicine perspective, then it is a benefit to patients who might not otherwise have been exposed to acupuncture. It also may well encourage them in the future to use acupuncture treatment in other circumstances.

 Clearly it is not for us to endorse either view; we're all for the quiet life. Suffice it to say that we are pretty sure that you will not find a traditional acupuncture training course, at least not one associated with the BAcC, which will offer a bite-sized chunk of training. However, if you switch paradigms you will almost certainly find training courses if you look at the website of the British Medical Acupuncture Society. They offer training to statutorily regulated healthcare professionals, and we seem to recall that some time ago they offered training in this particular field in partnership with UCLH. It should be a relatively simple matter to track this down.

 We are sorry we can't be more explicit than this, but as well as providing a service to the general public we also have to be aware of the kinds of issues which are inflammatory for members, and the issue of cherry-picking, as it is perceived, is a particularly vexatious one.

Q  I have no upward movement in my big toe joint following an operation to remove a lump in the base of my foot. Can acupuncture help with muscles and nerves? 

A: A great deal depends on the extent of the damage caused by the operation.

 We do not intend any criticism of your surgeon or podiatrist, but any operations to remove lumps or growths carry a small but real risk of interfering with both the nerves which supply the foot 'downstream' and also the muscles which sometimes have to be cut slightly, or may even have become fused to the lump and become collateral damage when the lump was taken out. It would only be fair to say that if the damage is permanent then acupuncture treatment will not make a difference.

 However, traditional Chinese acupuncture operates on an entirely different theoretical basis from western or conventional medicine. The basic premise is that the body, mind and emotions are all one interconnected flow of energy, which the Chinese call 'qi' and which does not translate well into English. Health, vitality and proper function all depend on a good flow, rhythm and balance of energy. When someone has an operation involving cutting through tissue there is always likely to be some break in the flow. In severe cases, especially when someone has a great deal of keloid scar tissue, the blockage this creates can cause significant trouble. In more confined areas it can result in symptoms such as you describe, loss of sensation or loss of movement.

 

Of course, if everything in life were that simple it would be an easy thing to fix; just pop into an acupuncturist's clinic, have a few needles and all should be well. In reality, some cases respond well and others don't respond at all. There are all sorts of factors which influence this, not least of which the overall balance of energies in the person in whom the problem occurs. This will mean that some people will heal faster anyway, and others will struggles. A skilled practitioner would take this into account when making an assessment.

 In any event, where the outcome is rather uncertain it is vital to set a limit to the number of treatments which someone has before drawing a conclusion about whether it is working. Having a measurable outcome makes life much easier because progress will be visible, not just based on how someone feels on the day. We tend to suggest that four or five sessions at most are a good chance to tell whether treatment will work. If there has been no change at this point it may be good to look at other options.

 The best advice, which we invariably give, is that someone visits a local BAcC member for an informal assessment of what may be possible. Actually seeing a problem is a far better basis for offering advice, and most members are happy to spare a short time without charge to see if it is something they think they could help with.

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