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Ask an expert - muscles and bones

330 questions

This sounds rather like the effects of a prolapsed or bulging disc pressing on the nerves and causing these distal effects, and we have to say that acupuncture treatment has been used to good effect in treating both chronic lower back pain and in sciatica, as both of our factsheets show:

Although osteopaths focus mainly on the structure of the body, and might be able to adjust misalignments of the lower back, it can sometimes take a more functional treatment like acupuncture to achieve greater change by encouraging the musculature of the lower back to function more efficiently and hold the back in place after it has been adjusted. This is how we tend to explain the fact that back pain and its treatment remains one of the commonest reasons for referral to an acupuncture practitioner. Of course, this is to take a very conventional view of the symptoms which you have. From a Chinese medicine point of view it is a failure in the flow of energy which generates symptoms such as you are experiencing, and it is not unusual to find that patients with considerable arthritic degeneration of the lower spine can be relieved of their symptoms even where the lower back cannot possibly have changed, i.e. the 'obvious' cause of the problem isn't really the cause of the problem.What we always recommend is that you visit a local BAcC member so that they can take a look at exactly how your problem presents and see what might be possible for you. In Chinese medicine each person is unique and different, and treatment is geared not just to the symptom but to the overall balance of the person. It is not uncommon to find that some patterns of discomfort are manifestations of more complex underlying imbalances, and from our perspective the real strength of this system of medicine is that by addressing the whole person we believe that symptoms are more likely to stay gone and not to return.
Restless leg syndrome  is now egaining recognition as a diagnosable problem, with a new name(!) (Ekbom Syndrome), and there are a number of treatment options which are being explored. A review article several of these, and the one acupuncture review this in turn cites two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.We have not come across much in the way of new research, although another small study published early this year (2015) the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.We have looked at all the available research and there is nothing new to report. However, from a Chinese medicine perspective it would be unusual to treat a named symptom by itself. The whole essence of Chinese medicine is that we treat the person, not the problem, and even where a dozen people suffer from restless leg syndrome in the same way, each might be treated entirely differently depending on how the symptom was perceived to be arising from the overall patterns of imbalance. The best advice that we can give is that you visit a local BAcC member to see what might be possible for you. Seeing the overall pattern as well as hearing your individual account of how it affects you will probably help them to see what causal pathways are involved and advise you on how effective acupuncture treatment may be.

We are really sorry to hear of your son's problem. These extremely uncomfortable but largely undiagnosable problems often create what the doctors call heartsink patients, the ones for whom they do not have an immediate answer and for whom they run out of options fairly quickly.

We were asked about a similar problem some years ago and our answer then encapsulates the general response to these sorts of problems:

We wish that we were able to say with confidence that acupuncture treatment would be of benefit. However, as far as the research goes, which is the only basis on which we are able to make claims to efficacy, there is very, very little. This probably has a great deal to do with the fact that conditions like tenesmus and anismus often spontaneously reverse, and are therefore quite difficult to research because gathering a trial and control group is hard. The other problem is that most people are trying just about everything at the same time, so a clear difference between acupuncture and acupuncture plus the normal treatment is not easy. Most people simply say 'throw everything at it.'

Clearly from a Chinese medicine perspective, based as it is on the underlying belief in an energy, called 'qi', and the understanding of its balance, flow and rhythm, there are ways of looking at conditions like this which are different from a conventional western medicine understanding. These could range from a simple consideration of what is flowing in the area, i.e. which channels might be affected, to a functional concern, i.e. which part of the system maintains good function in the end of the colon and rectum, and a broader look at what might have caused the problem to begin. The ancient Chinese, for example, had a very complex understanding of the effects of heat, cold and damp on the system, and very often attributed griping and spasmodic pain to the invasion of cold into a body orifice. For a race which was largely agricultural this kind of phenomenon was seen to be based on common sense. Although it is not as common in modern life to be exposed to extremes of climate in this way we have seen several cases where people have literally been exposed to cold breezes while inadequately dressed and suffered symptoms such as these.

From the Chinese medicine perspective, however, there would also be other signs and symptoms in the patient's presentation which would guide the practitioner's strategy, and these might just as easily point to a systemic problem of which your husband's symptom was a small manifestation.

Our only advice in cases like this is to visit a BAcC member local to you and seek their advice in person. This is the sort of case where there is no effective substitute for discussing with the patient what is happening, and offering a more rounded judgement on the potential benefit of acupuncture treatment.     

We have checked again for any research trials which might have surfaced since we gave this advice, but have found none. There are occasional sites like this one,

whose provenance we cannot check and which is riddled with advertisements and referrals on which we cannot comment, but what it does do is to offer some very real interpretations in Chinese medicines for what is happening and the relevant treatments. This kind of 'named condition - Chinese medicine treatment' is not how we believe we work, although it is becoming increasingly common in China, but it has to be said that for cases of acute pain it is often an approach that will bear fruit. 

The advice we gave in the earlier response holds good, though. If your son visits a BAcC member local to him for a brief chat about what may be possible we are confident that the practitioner will be able to make some sense in Chinese medicine terms of what is going on and give a balanced view of whether acupuncture treatment may be able to help him. 

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.
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