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Ask an expert - muscles and bones

335 questions

We have been asked about muscular tension in recovery after injury a few times, and a typical answer has been:

A: It certainly couldn't do any harm to try traditional acupuncture. We choose out words carefully, though; when we say traditional acupuncture we mean acupuncture based on an understanding of the principles of Chinese medicine. There is a great deal of acupuncture being offered these days by people whose focus is primarily musculo-skeletal, such as physios, osteopaths and chiropractors, and while we have no doubt that they often do very good treatment as an adjunct to their primary discipline, there are times when this kind of 'point and shoot' approach will not be enough. The problem from our perspective, of course, is that when this doesn't work people say 'acupuncture didn't work', to which we respond 'only a very reduced form of it.'
Chinese medicine looks at the body as a dynamic structure of energy, called 'qi' in Chinese thought, whose flow, rhythms and balances are integral to good health and well-being as well as to good recovery from the injuries which everyone experiences from time to time. In cases like yours this means two things. First, it is possible that there has been disruption to the flow of energy locally which, by the use of both local and distal treatment, a practitioner might be able to correct. If there is a local weakness or blockage, most treatments are only going to be partially successful in restoring function.
Second, there are often cases where an injury manifests as an acute problem on top of a more chronic weakness which has not generated any symptoms as yet, and also may manifest against a backdrop where the entire body is running below par. The problem with  acute then chronic problems is that they prevent the system as a whole from recovering and lock the problem in for a long time. 
Acupuncture treatment may be able to address both of these issues, and a visit to a BAcC member local to you for a brief face to face assessment may be able to establish very quickly whether the practitioner thought that there was something they could do to help.
As general guidance we think that this is still a good start. When applied to specifics, like an ACL reconstruction, we would want to ask a number of additional questions based on our experience over the years. This would involve asking about and looking for scar tissue, checking the geometry of the joint to see that it hadn't been minutely altered by the work done to the ACL, and also looking at any learned postural habits which have become slightly more entrenched during a recovery period. It is not uncommon, for example, for people to develop a slight rotation at the sacro-iliac joint as they favour the opposite leg during recovery, and this can have all sorts of implications for the body's flexibility even where the deviation is very small.

The advice we gave before, to visit a local BAcC member for an informal chat, is by far the best thing to do. Each case is unique and different, and it often takes a brief face to face chat and examination to give a properly informed view.

From a western/conventional medicine perspective this might well be a trapped nerve, and given the location of the sensation which you have had and are now experiencing the trapping might be anywhere from the neck down. The fact that the sensation has not been too powerful until recently suggests that the level of impingement has not been too great, and this might mean that the clinical signs are not that obvious to examination. GPs tend to be pragmatic, and since the cost of trying to establish what it is might be disproportionate to the amount of disruption the problem is causing it might be difficult to pursue much further. The one option you might want to consider from this perspective is osteopathy, since a small adjustment of the bone structure might be enough to deal with the problem.

That said, from a Chinese medicine perspective we see a great many of these undefined or ill-defined problems. We see them as disruptions in the flow of energy, and whenever these occur there will always be pain or discomfort. This can arise from a blockage in what we call 'qi', the energy of the body, or equally often from excesses or deficiencies in the flow. The skill of the practitioner lies in determining whether this is a local problem or whether it is a systemic problem and the tip of a much larger iceberg which needs addressing. We then use needles to reinstate the correct balance.It is always impossible to predict at a distance whether treatment might work. It is in the nature of the system of medicine to see each person as unique and different, and for this reason twenty people with an identical named condition might have twenty different treatments. This is not a method solely confined to complementary medicine; the great Canadian physician William Osler often said 'the good physician treats the disease, the great physician treats the patient who has the disease.' This is why we always advise prospective patients to contact a local BAcC member for an informal chat about what may be possible. Most are happy to give up a little time without charge to offer a more informed view face to face of what may be possible
We have usually taken a rather downbeat view of how successful treatment can be, as this 'nested' response last October shows. Our personal experience is that by the time people come to acupuncture treatment there is often not enough evidence to underpin a commitment to a long course of treatment which may be necessary. Hence we wrote back then:

We have to be honest and say that there is not a great deal of evidence for the effective treatment of Morton's neuroma with acupuncture. We published an answer through this same section three years ago to a question from a patient who was convinced, and with some justification, that treatment with one of our colleagues has been wholly responsible for a complete improvement in his condition. We have to say, though, that our clinical experience runs counter to this, which is why the very upbeat tone of webpages like that of this American practitioner as it is) raises a wry smile. If only...Having said that, what he describes in the formation of the tissues which cause the condition is something with which we deal elsewhere on the body, and in theory there is no reason why treatment should not be able to reduce some of the discomfort. However, we would be very surprised if this could be done without the aid of orthotics which reduce some of the pressure on the affected areas while any treatment beds in.Each case is unique and different, however, and the only real solution is to seek face to face advice from a BAcC member who can look at exactly how the problem manifests in you, and more importantly, can see the overall context in which it is occurring. One of the great strengths of Chinese medicine is that it looks at the whole system, not simply at a symptom which is regarded as merely a warning sign. Thousands of people with identical foot structures to you will walk thousands of miles without getting neuromas, and there may be systemic problems which have predisposed this to happen.The other recommendation we would make, and we are sure that you have done this already, is to find a good chiropodist or podiatrist who can work alongside any other treatments you try to help to maintain improvements. Working in partnership with other health professionals for problems like yours can often be extremely powerfulThis still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare.  There is an interesting case study about the use of therapeutic massage is useful for the background information, but nothing new involving acupuncture treatment.However, we have since heard anecdotal accounts of people committing to lengthy spells of treatment which have seen significant changes, and when you consider that surgery is probably one of the few other options available, this may not be a bad thing to try.As always in cases where the evidence base is a little thin and where the stories of success are not that frequent we advise prospective patients to set or find measurable targets for change, and also to insist on regular review periods if they do go ahead. The measurable target is essential; problems like Morton's neuroma can lead to good days and bad days, and asking how things are on either won't really help to decide whether to carry on. Walking further and with less pain is something which is more difficult to argue about, and this really helps where changes can sometimes be too small to recognise day by day.Reviews are equally essential. Where there may be a long haul it is very easy to rack up a very large bill for treatment without realising it, and it always pays to know where you are, both in terms of progress and expense. As above, an initial informal chat with a local BAcC member is a great place to start. 
As you can imagine we have been asked about sciatica on many occasions and a typical recent answer was:

As you can read from our factsheet has been a significant amount of research into the treatment of sciatica with acupuncture, and the results have been increasingly positive. The threshold for being able to make a definite claim is based on a research process for which very little acupuncture treatment except non-traditional formula work will work, but there have been dozens of Chinese studies aimed at finding what works better which seem to show that sciatica responds well to treatment. Certainly this 'expert's' experience is that sciatica seems to respond well to treatment in most cases.There is no doubt that formula treatment will work to an extent, and there are many medical acupuncturists and 'cookbook' practitioners who will use the same 'sciatica' patients on every patient. The real strength of traditional acupuncture, though, is that it addresses the problem of why sciatica occurs in this particular patient, or more properly why the system does not put right and recover from the injuries which normally cause it. Twenty different people may have the same named condition but be treated in twenty entirely different ways. What this does is not just put the problem right but try to make sure that it does not recur.There are no special treatments for sciatica, and no specialists, so any well-trained traditional acupuncturist should be able to help you. The best advice, though, since there are one or two cases which would not make us feel so optimistic, is to pop in to see a BAcC member local to you for a chat and to get a short face to face assessment of what is going on. This will not only give you more precise information but also give you a chance to meet a practitioner and see where they work before committing to treatment.This seems to us to remain the best advice we can give without actually being able to see the patient first hand. What we would say, though, is that we often work closely with osteopaths in treating problems like this. Although we work 'functionally' so to speak, encouraging the muscles and tendons to re-assert the body's correct shape and posture, there are times when a visit or two to an osteopath to make structural amendments can often speed up progress. Where acupuncture really helps structural work is that it appears to consolidate structural changes and maintain the gains which have been achieved. We are assuming, of course, that your wife has had the usual battery of tests, X-rays at least, to see if there is a change in the lower spine which may be contributing. There are cases, especially where discs have worn badly, where the possibilities for change and improvement become more long-term and gradual. Given the extent to which your wife is suffering further information from an X-ray or scan sounds like it might be a very good idea. Most sciatica can be alleviated by a change of position, and if the pain is acute and continuous it suggests more is going on than meets the eye.
As our factsheet shows is some fair evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.Our fact sheets have been around for some while, and we always research what other papers have been published since the ones we referenced there. There isn't a great deal that's new, and indeed an interesting review of treatment options

only mentions acupuncture as an adjunct to interventions like physiotherapy. There is a reference to a study from Iran looks like it has been translated word by word using a dictionary, but allowing for the rather odd language there have clearly been some good results. However, a 2012 systematic review rather downbeat about most treatment options.The great strength of Chinese medicine, however, is that it treats the person, not simply the condition. A hundred people presenting with a frozen shoulder may be treated in a hundred different ways because each person is unique in the balance of their energies, and the practitioner will be working to establish what it is about the overall balance which has impaired someone's ability to recover. Many people will damage their shoulders but be fine again within a week. When the damage takes longer to hear the obvious question, apart from the severity of the cause, is what is blocking healing. Sometimes this is outside the practitioner's control; as we said above it is a very difficult joint to immobilise in order to help recovery. Often, though, there is an underlying imbalance which means that a person is getting the best from their own system.This means it can be rather difficult to generalise, and the advice we invariably give is to visit a local BAcC member for an informal chat about what may be possible. Most members are happy to give up a little time without charge to assess whether treatment may be of benefit, and many prospective patients value this chance to meet the practitioner before committing to treatment. 
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