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Q: I have tennis elbow in both arms the right arm is worse than the left.ive had 4 treatments now which lasts half an hour each time. After I have a 15 min massage the massage is so rough that the pain wants to make me cry. I was told I have bad circulation and that's why the massage is rough. So then I spend 4 days in pain after getting over the experience to go back 3 days later to have it all over again. The problem is the gentleman doesn't speak much English so I find it hard to ask him questions and get answers  I'm not seeing any progress at the moment  my question is is this normal for me to still have pain and should the massage be so vigorous?

A: We are sorry to hear of your experience.  It certainly does not help that the practitioner is not able to communicate very easily. However, we have to say that you need to be aware that you are in charge in the treatment room, and that the practitioner can only work with your consent. If you decide that the massage is too rough and ask him to stop it, then stop it he must or be guilty of common assault. It is then his problem/challenge to use his skills to circumvent the problem of not being able to get the qi moving by vigorous massage. There are always ways!

Should there be progress by now? That is a very difficult question to answer. It depends a great deal on the severity of the initial problem. Our factsheet has some reasonable evidence for the benefit of acupuncture treatment

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

but there are widely different degrees of the problem, and in some cases it can take half a dozen sessions to get the energy moving and undo the stagnation of the energy.

However, that said, the treatment should not be causing pain four days later, and unless there are stunningly good clinical results to back up continuation it would seem entirely legitimate to question whether the course of treatment is really going anywhere. There has to come a point after about four or five sessions where one can say with some certainty whether it looks like the treatment will succeed, and if it doesn't then it is important to draw a line in the sand and stop.

It is not our job to talk one of our possible members out of a job, but you need to discuss this situation with him, and if the answer doesn't help you then perhaps you might need to re-consider whether he is the best practitioner for you. We have always been very insistent that a practitioner must have sufficiently good English to address a patient's concerns because we are all too well aware of the consequences of people feeling that they haven't been heard.

And the bottom line is that it's a buyer's market. If you aren't happy with the treatment there are probably a great many other practitioners close by to whom you can transfer.

Q: My son has terrible hay fever and I want to know if acupuncture is any good in illeviating this and who would be the best person to go to near to Newcastle under Lyme to treat the condition

A: There isn't a great deal of research under the heading of 'acupuncture and hay fever' on which we can draw for evidence of the success of acupuncture treatment, and what we do have on our website is a factsheet for allergic rhinitis with which there i very considerable overlap.

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/allergic-rhinitis.html

We have checked the databases, though, and while you will find occasional studies like this one

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983860/

there are not as many as you might expect. We suspect that this is because the random timing of the occurrence of the problem makes it difficult to assemble a cohort of sufferers to run the trial.

The one thing we can say with certainty, though, is that it often helps to start treating two or three months before someone would normally start their symptoms in order to achieve the best results. Once the problem has started and bedded in it can be a great deal harder to address. Treating the person rather than the symptom is central to Chinese medicine, so working in advance of seasonal symptoms is quite a normal pattern of work anyway and one which would probably strengthen the immune system. We often find that sufferers still get small traces of symptoms but nothing like the effects they have had in the past.

You haven't mentioned whether your son is a child or not. If he is, then this bodes well for treatment. Children are not simply small adults, and many members undertake postgraduate training in paediatric acupuncture to work with children. We cannot make recommendations but we ran a quick google search using key words like your home town, acupuncture and children, and quickly generated some interesting results.

Hay fever comes in all shapes and sizes, though, and it would be best for you to see if someone is prepared to take a look at your son and see what they think. Most of our colleagues are more than happy to give up a little time without charge to talk to prospective patients, and we find this works to everyone's advantage.

In our experience younger children respond very well to treatment, often requiring minimal intervention to get really significant results. If your son doesn't fancy needles, though, we cna say that Chinese Herbal medicine and classical homeopathy both see, in our view, to offer some interesting alternatives. Both have received quite bad press over the last few years, but we have seen many patients whose experience of both modalities has been very good.

Q: My partner has two slipped discs in her back. She been refused surgery due to her age and has now been refused injections.
Will acupuncture help her?

A: We have been asked surprisingly few times about slipped discs, and our answers to the questions have been relatively circumspect, as you can see from this example:

Slipped discs can take a long time to recover, even when using therapies which are known to help. Where the standard treatment in conventional medicine used to involve a great deal of bed rest, continual movement is now the order of the day to help the accumulated tissue to disperse. Our fact sheet on sciatica

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

mentions a number of studies which show some encouraging results for the kinds of secondary problems which can arise from a slipped disc.

Sight unseen it is very difficult to offer a detailed opinion, but speaking in very general terms, there is often an accident or underlying pattern of weakness which predisposes someone to have a slipped disc, and there are often ways of understanding the disease process from a Chinese medicine point of view which offer treatment possibilities. This can often be the case when someone has reached a plateau in the conventional treatment they are having.

However, it is not uncommon for people to seem to plateau and then for the condition to resolve after 3-6 months, and you may well find that you suddenly begin to make progress again. Acupuncture treatment certainly won't do you any harm, and given that the area where you have been affected will have been quite immobile and 'stagnant' for a few months it is possible that from a Chinese medicine perspective there are significant blockages whose clearance may help to speed up your recovery.

At least a part of the reason for this circumspection is the fact that herniation usually resolves after about three to six months, and it can be difficult to assess in the circumstances whether the acupuncture treatment has added to the speed of recovery. The range of problems covered by the generic term 'slipped disc' is also quite extensive, and assembling a control and test group with identical problems may present problems in the current climate of minimal funding for acupuncture research in the West. We are confident that trials will have been conducted in China but most are never translated. Where there have been good results, though, they do tend to surface quickly, and the absence of research which meets western standards probably speaks volumes.

The fact that surgery has been considered probably points to some quite serious herniation, and we would probably surmise that the best we could achieve would be to lessen some of the pain and reduce some of the symptoms. The extent to which this worked, and how sustainable the change would be, is something only treatment itself would establish.

We always believe that the best option for cases like these is to visit a local BAcC member for an informal assessment of what may be possible. Most offer a small amount of time without charge to prospective patients to get a better idea of what benefit there may be in cases where it is not clear from the 'headlines', and if someone does commit to treatment there is usually a very clear agreement to assess progress after three or four sessions to see whether the progress warrants further time and expense.

Q: I have trapped nerves in my lower back. My pain radiates down my left leg into my foot. I have now had three sessions of acupuncture. Both of my legs feel a lot worse. They ache tingle and throb. Walking is more difficult for me and I walk a lot slower. I should be having another three sessions but I am reluctant to go back.

A: We are sorry to hear that you seem to have developed slightly worse or different symptoms after your treatment.

We would be very surprised to find that the acupuncture has actually made things worse in a directly causal way. Short of sticking a needle into a nerve there isn't a great deal a practitioner can do in the lower back which would generate the symptoms of which you speak. The only time we have come across this is when someone has a trapped nerves because of changes in physical structure, and the muscles have been guarding to hold the vertebrae apart. If treatment caused these to relax, then it is just possible that this has let bony structures change position and increase the level of impingement. We do know that physios offer this as a caution when treating lower back pains and nerve impingement, but they do tend to use more vigorous techniques than we do, and this can magnify the effects.

Another, and more likely possibility, is that the treatment has started to encourage the structure of the spine into a better shape. We do sometimes find that after long periods of operating out of shape the body's musculature can start to adapt, so when improved function starts to bring the structure back into alignment some muscles relax and others tighten to accommodate the new position, both of which can generate mildly unpleasant symptoms.

Of course, the third and less palatable possibility is that something has changed or deteriorated in the back alongside rather than because of treatment, and this has created new and unpleasant symptoms such as those you now have. This can sometimes happen, and we encourage our members not to get into pointless arguments about what caused the problem but to get the person seen by their GP as quickly as possible to establish exactly is going on. This almost invariably points to causation, but crucially it makes sure that someone gets the correct attention first.

We think your best first step is to discuss the matter with your practitioner. It may simply be a matter of adapting the treatment to suit you better, perhaps by working away from the problem area or reducing the strength of treatment. If they cannot see any reason why what they have done could have caused these problems, then they will probably refer you to your GP for further examination.

We would say 'don't panic', though - we have known of very few cases where acupuncture treatment has caused serious long term adverse effects, and the majority of these have been to do with actual physical damage caused by the needles, not reactions to treatment itself. We hope you feel confident enough to talk to your practitioner about what has happened, and remind you that you are in charge in the treatment room, so if you are not happy with proceeding, then you can just draw a line straight away and stop.

Q: My mom just had acupuncture yesterday at noon as the practitioner said that she had blood deficiency (her pulse on her left wrist was too weak). Now my mom is experiencing extreme dizziness, cold sweat, fatigue, and nauseousness. Is this normal and what should we do?

A: We are sorry to hear of your mother's post-treatment episodes. However, we are confident that by the time you receive this reply everything will have settled down.

It is very rare for people to suffer serious side effects or adverse events after treatment, and the ones that do happen are invariably to do with actual physical damage caused by a needle. In the hands of a properly trained and qualified professional acupuncturist this is extremely unlikely to happen; it is only the poorly trained or inept that cause these sorts of problems.

However, it can be the case that people can 'wobble' a bit after a first session, and some of the things you mention - dizziness,  fatigue, nausea and so on  - can happen. There are a number of possible explanations for this. Sometimes it is the body starting the process of cleansing itself of energetic blockages. The Chinese believed that pathogens travelled inwards and reversing this process could often lead to a disturbance as they cleared. Some people are also energetically very sensitive, especially if they are somewhat weakened. This can be a reaction to treatment which is too powerful for them, and the practitioner will take this into account when they get feedback, and adjust the strength of treatment accordingly. This might mean fewer needles, less manipulation and so on, but all of these adjustments can make a tremendous difference if someone is a strong reactor.

Of course, there are two other more prosaic reasons. The first is that your mother may not have been warned of some of the basic housekeeping rules before treatment, as for instance making sure that you have eaten something within the last few hours rather than being treated on an empty stomach, and this can sometimes exaggerate the effects of treatment. We have seen a patient faint because she hadn't eaten for twelve hours before treatment, and then only a small bowl of cereal. The second possibility is that the symptoms are of a virus, but by coincidence have happened after treatment. With over four million treatments being given every year there are bound to be a few occasions when someone gets ill at the same time as treatment, but without any causal connection. If this is the case, then the usual steps need to be taken; bed rest, etc etc.

We strongly suspect that these are transient reactions to treatment, though, and we think they may well have subsided before you get this response. It is important to let the practitioner know, and it may well be worthwhile calling the practitioner today for advice and guidance. They will know better than we could what they have done and what your mother may need to do to help. If the symptoms have persisted for 48 hours and show no signs of relenting then it may well be worth having a word with her GP, or calling the 111 advice line, the NHS non-urgent service. We have found this to be very successful at directing people to the best help for their needs.

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