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Ask an expert - muscles and bones- shoulder
Acupuncture is used by practitioners of all traditions - chinese medicine, conventional medicine, physiotherapy - for the treatment of muscle tension. Obviously the way that each explains the symptoms will be very different, as will the rationale for the treatments they give. Chinese medicine talks in terms of the flow of energy, called 'qi', and its balance, flow and rhythms, whereas the western medical practitioners will speak of knots in muscle or trigger points which need to be released. In many cases the needles will be applied to roughly the same places.
As practitioners of Chinese medicine we clearly believe that the lineage which Chinese medicine represents, with the wisdom of over two thousand years of treatment behind it, offers a better chance to understand not simply the problem but the backdrop against which it is set. Chinese medicine is emphatic that the symptom is not the same as the problem, merely a sign that something has gone wrong with the overall balance. If you correct a symptom without reference to the pattern in which it appears, there there is a chance that it will recur.
In the case of muscle tensions this is a little less likely, but the practitioner will be as interested in the way that the problem appeared as in the problem alone. There is a great deal of tension in the modern world and sometimes people have a pain in the neck because they live or work with one. Seeing how the probem has developed and is sustained by the system is important.
We always recommend that someone visits a BAcC member local to them because a bried face to face assessment by a skilled practitioner will elicit much better advice than we can give here about whether your particular presentation is suited to acupuncture treatment, or whether there are other forms of intervention that may help you more effectively.
Q: I have sprained the ac ligament in my shoulder. What can acupunctute do to speed up the healing process? My shoulder does not hurt with day to day activities, it stops me doing my normal fitness and sports.
A: This is a difficult question to answer. Tears in the acromio-clavicular ligament, like all shoulder ligament tears, can cause a generalised instability in the shoulder itself, so the fact that you have recovered normal day to day use is a very positive sign that things are healing well. There is also no doubt that acupuncture is widely used, both by practitioners of chinese medicine and by phsyiotherapists and sports injury therapists in the conviction that it does seem to speed up the healing and recovery process. There is not a great deal of evidence to support this use, but most of it is anecdotal and relies on the accounts of experienced practitioners and satsfied patients. 'Anecdotal' has become a rather pejorative word in modern times, suggesting that it has no firm foundation. We take the view, however, that it is an accumulation of anecdital evidence which is often the spur to more systematic research, and is worthy of greater respect.
How does this help you, then? Well, we can say with certainty that acupuncture will not do any harm, but there is no evidence we can offer you that it will definitely speed up healing. What we can say, however, based on our own experience, is that patients who are used to training often push themselves very hard to recover, and there is certainly plenty of evidence that the kind of micro-tears which this can cause need to repair for a longer period than most allows allow. We find that many patients push themselves hard to increase their maximum loads when they may be better served by shorter sessions within their limits to enable the ligament to recover. Otherwise it can be one step forward, half a step back, and this will slow the recovery process down.
You would do well to seek the advice of a BAcC member who will be able to offer you a face to face assessment of what acupuncture treatment might achieve, but you might be equally well advised to seek out a sports injury specialist who uses acupuncture within their overall strategy. Some of our colleagues might find this a little heretical, but our concern is for your well-being, and there is no doubt in our minds that this overall treatment needs to be overseen by someone with experience of getting sports people back to full health.
My wife is prone to keloid scaring and has a keloid scar on her upper arm from her childhood vaccination. She is thinking of having acupuncture treatment for pain in her shoulders but is worried the acupuncture needles will cause keloid scaring. Is there a risk that keloid scaring could develop from the acupuncture? She has been advised to avoid tattoos and piercings for this reason and wondered whether it would be the same with acupuncture.
Oddly enough, acupuncture is sometimes offered as a treatment for keloid scarring. An article in Acupuncture in Medicine, the journal of the British Medical Acupuncture Society, has an interesting case study
Please click here:
showing a remarkable turnaround in a large scar. From a Chinese medicine perspective, the scar is often a cause of a weakening of the flow of energy in the system, and the kind of technique used in this article is often used to encourage the restoration of good flow, often with immediate results.
Based on what we have seen over the years, we think it is highly unlikely that the kinds of skin puncture caused by an acupuncture needle, at 0.18 to 0.25 mm in width, would be likely. The 'holes' close over almost immediately and there is rarely any blood loss, which can hardly be said about tattooing and piercing. If you have any doubts at all, however, we are confident that a responsible practitioner would be happy to talk to your GP and also perhaps even insert a couple of needles in a test area out of sight as an experiment to see if your wife's was a rare case in which any skin piercing caused the formation of keloid scarring.
Q: I have had chronic pain in my left shoulder, back, left hand for the last 2.5 years, following a broken elbow and resultant frozen shoulder.
I have seen a pain management specialist and after a number of diagnostic tests (including MRIs, XRays and nerve conduction studies) and a variety of treatments including physio, trigger point injections, NSAIDs, dorsal root steroid injections and pulsed radio frequency.
All the tests indicate that I have a highly sensitised nerve at C6/C7 but no entrapment. The steroid injections were really the only treatment to give me much relief - but unfortunately this only lasted about 6 weeks. After the PRF lack of success, I have really been advised to take NSAIDs and/or start SNRIs. I don't really want to take either of these medications on a long term basis and was wondering if acupuncture is likely to provide any pain relief, since this has never been mentioned as an option.
I would appreciate your views on the likelihood of success.
A: There is no doubt that acupuncture is an option for the kind of problem which you have, and many patients attend clinics throughout the UK with exactly this kind of problem. The research evidence for the success of your specific problem is not very plentiful, not because none is performed but because many studies conducted in China are methodologically unsound. However, the fact that you derived benefit from steroid injections is a positive sign. Many patients turn to acupuncture after they have exhausted the number of injections that can be safely used in an area, and quite often the acupuncture appears to reproduce the effect which the steroid has, as far as we can tell from the anecdotal evidence which we come across.
Although acupuncture can be used, and often is, in dealing with the specific named problem with which the patient presents, though, the theory of Chinese medicine is underpinned by an entirely different understanding of physiology and organ function based on the flow of energies, called 'qi', in the body. The fact that you have had such extensive pain across a wide area of the body speaks of blockage in and impairment of this flow, and the practitioner will be interested to find out whether the local manifestation of pain is its focus or whether it is as a result of blockages within the general area. From a Chinese medicine perspective, pain only arises from blockage, excesses and deficiencies, and the skill of the practitioner in identifying what needs to be done and where is critical to ensure that symptoms go away and stay away.
Your best course of action is to visit a BAcC practitioner local to you who can offer you advice, based on a short face to face conversation, of whether they think acupuncture would benefit you. We trust that they will be honest enough to say so if they feel that this is not your best option.
Frozen shoulder can be a difficult condition to treat. Our fact sheet on the website - please click here is not overly encouraging, but the main point to note here is that there haven't been a great many studies. What counts as 'frozen shoulder' can vary considerably and creating a number of groups with identical problems for trial purposes is not that straightforward.
One major problem with the shoulder joint is that it's mobility means a dependence on groups of muscles and a relatively open socket into which the head of the humerus fits. It is very easy for there to be a minor displacement or small dislocation of the joint, and equally easy for a problem with one set of muscles to cause a ripple effect throughout all of the groups holding the shoulder joint stable. There are often secondary problems which may need to be addressed.
Chinese medicine has obviously been used to treat problems like this for thousands of years, and as well as treating locally to where the problem is on the body there are a number of functional treatments which are aimed at affecting all muscles and a couple of 'empirical points', points which have been used for centuries to help with all shoulder problems. There are also points which can be used to help reduce some of the pain and inflammation which results from the muscle and tendon strains.
However, there is no doubt that it really pays to have treatment with someone who fully understands the dynamics of the joint in great detail and can make an informed and careful assessment of the precise problem. There are a considerable number of BAcC members who are also trained in osteopathy and physiotherapy, and equally a number of osteopaths and physios who use acupuncture on a regular basis, and the combination of manipulation, movement and acupuncture may be the optimum package.
It may be helpful to seek the advice of a BAcC member local to you. Most know of colleagues within their area who specialise in this kind of condition, and many also work very closely with local osteopaths and physiotherapists, and maybe able to put together a co-ordinated package of treatment to get you back to good health and mobility.