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Ask an expert - muscles and bones

327 questions

You will not be surprised to hear that we have been asked this question before, although not for some time. Our last answer over a year ago said:

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

(informative 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 gettinneuromas, 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 powerful

This 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

which is useful for the background information, but nothing new involving acupuncture treatment.

Our earlier advice, to visit a local BAcC member for an informal assessment of what may be possible, is still likely to be your best option. We are confident that you will get an honest opinion before committing to treatment.

We are delighted to say that there is some very good evidence  for the treatment of lower back pain with acupuncture. Indeed, until a recent reversal of policy based on what we believe was very unsound interpretation of research, NICE, the clinical guidelines body, was recommending ten sessions of acupuncture treatment as one of the basic offers for people with chronic back pain of over six months duration. You can see some of the evidence on which this decision was based on our factsheet which can be found here:

Of course, from a Chinese medicine perspective treating back pain per se is not really how we work. It isn't just empty rhetoric that we treat the person, not the symptom, and although the symptom might be identical in twenty people they may well be treated in twenty different ways. Each symptom arises against a backdrop of imbalance, and it is by treating the imbalance as well as, and sometimes instead of, the symptoms real change can both be made and sustained. There are obviously specific points which can affect the lower back, but if these are treated alone and a deeper underlying problem is not addressed the pain will return.

The fact that pain can arise in many different ways means that sometimes the obvious diagnosis doesn't really work either. Most people over the age of 50 have some deterioration of the lower spine, but although it is often declared the cause, it may not be. We have certainly treated many people with serious deterioration of the lower spine whose pains have gone.

Acupuncture can also be used for straightforward pain relief, and here the main questions which we have are not whether it works but how much and how sustainable the results may be. There has been a great deal of high quality research into the use of acupuncture to release the body's own painkillers (easily measured and easy to assemble test groups), and it is largely on this basis that most Pain Clinics offer acupuncture.

The best advice that we can ever give, since each patient is unique and different, is to visit a local BAcC member for an informal assessment. Most are only too happy to give up a little time without charge to see whether acupuncture is the best option for your specific presentation. We are confident that you will get an honest appraisal and assessment.

We are sorry to hear that you are faced with such a long wait for a specialist opinion. All we can say with certainty is that acupuncture is very probably not going to make things any worse and may well help to address the symptoms and reduce the pain.

The theory of acupuncture, as you have probably read, is about the flow of energy, which we call 'qi', and its correct balance and flow within the body. Essentially all of the theory boils down to techniques to understand how and where blockages and imbalances arise, and skills with needles and moxa to reinstate the normal flow. The simple underlying premise is that where energy flows as it should then everything should function as it is supposed to.

When people have accidents there is often inflammation and deep bruising which from a Chinese medicine perspective can mean a blockage in the flow of energy which is more than the body can correct. Sometimes this is a local problem, but at other times it may be indicative of a general weakening of the system which means that there isn't enough energy to sort out the body's more peripheral problems . The great strength of Chinese medicine is that it can look at the overall context rather than simply picking off symptoms one at a time.

Soaking your hands in ice cold water no doubt does help, mainly by providing a temporary deadening of the sensation, but we would advise any patient to be cautious about doing this for too long after an injury. It is always helpful to apply ice straight away to stop excessive swelling, but after a while the repeated cooling actually starts to work against the body, causing the stuck energy to become even more stuck. If you are going to use cold we suggest that you alternate with some heat to try to encourage flow as well. Alternating hot and cold is the option many physios will recommend to people with injuries.

The best advice that we can give is that you visit a BAcC member local to you for an informal assessment of whether acupuncture might be a good idea. Most members are happy to give up a little time without charge to see a problem in the flesh and advise on whether acupuncture treatment might help, and this is your best route. It's a pity we don't know more about the nature of your accident, whether it results from a sprain or a fall. However, the fact that the pain is referring up the arm could be indicative either of nerve impingement (from a western medicine perspective) or a blockage in the flow of energy in the channels (from a Chinese medicine perspective), both of which are more encouraging in terms of potential recovery. we certainly hope so.

We are sorry to hear that in spite of all the treatment you are receiving matters don't seem to be improving. It's a little difficult to answer this question, because as you can easily understand, our expertise lies in using traditional acupuncture so we wouldn't hold ourselves out to be experts in any other fields. However, we invariably suggest osteopaths and chiropractors as alternatives, and indeed, often work with them to achieve change. Our work on the functional aspects of the body together with their work on the structural aspects is often what is called synergistic, the two treatments having more effect than the sum of their parts.

We would want to know a great deal more before offering any other suggestions, though. As our factsheet shows

the evidence of the use of acupuncture in treating sciatica is pretty good, so the fact that you are seeing no change is unusual. It would also be helpful to know exactly how much of a problem it is/was, and how it came about, i.e. suddenly through accident or slowly through wear and tear. All of these have a bearing on what we might recommend to a patient we took on.

The one thought that we can't help have, though, is that this is quite a great deal of treatment to be having all at once. We tend to reserve more than once weekly treatment for really acute problems where the patient cannot function at all. For more chronic problems two or more treatments a week might just be a little disruptive to the healing process. Not everyone would agree, and in China, for example, acupuncture might well be routinely delivered every day for a ten day course of treatment. Many Chinese practitioners do the same in the UK, but the majority of us tend to leave a little more space between sessions to give the body time to adjust. It might just be that less is more in your case, and that letting the treatment bed in for a little longer might encourage more progress.

There are a variety of associated bodywork treatments in oriental medicine - tui na, shiatsu, etc - many of which are used within traditional practice by acupuncturists but also by people who specialise in these techniques. You might usefully see if this could be added to the mix.

More than this we really cannot say without access to more comprehensive background information, but we would encourage you to ask your practitioner about what else you might usefully do. They, after all, have access to all the information which we would need, and have undoubtedly come across similar cases in the past and know what is likely to be a good adjunct and who locally is best qualified to offer it.

We have been asked about the treatment of sciatica many times, and a recent answer was:

As you can read from our factsheet

there 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.

We are surprised that seeing an osteopath has made no difference, but the one strength of acupuncture is that it mainly deals with function, not structure. If an osteopath puts a lower spine back into shape but the surrounding musculature still retains levels of poor function, then it will revert quite quickly. Encouraging better function in the local tissue can of its own accord spring the spine back into shape, as well as balancing up the whole system which in and of itself can achieve good results. Many people come to acupuncture treatment for back and hip problems.

Of course, if the problem is pseudo-sciatica, the most likely cause of which is piriformis syndrome, then this is all the more likely to be the case. The effect of the spasm in this muscle can put pressure on the sciatic nerve which generates exactly the same symptoms as one would get from compression of the nerve root. Acupuncture treatment can be effective in helping to address this as well.

In summary you may well find that acupuncture can help your wife. The real question is how much help and how sustainable the outcomes are. We have great faith in treatment always doing something, but there are times when the effects are short lived and non-incremental, so it is very important to try to establish good measurable outcomes and also to review progress every five sessions or so to ensure that you don't build up an unintentional treatment habit where the weeks can slip by unnoticed.

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