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Ask an expert - muscles and bones

339 questions

Q:  Can acupuncture help treat ankylosing spondylitis and if so what treatment is required and which symptoms can it cure.  What is the likelihood of a successful cure and what is the likelihood of a relapse after treatment.

A : There isn't a great deal of research into the use of acupuncture for ankylosing spondylitis. There are many possible reasons for this, over and above the fact that in the west research into the use of acupuncture is very limited for want of funding. The most likely is that each presentation tends to be unique, and for the most common trial design, the randomised double blind control trial, it is essential to test like with like. The more variable the presentation, the less reliable the results are considered to be. There are more papers produced in China, most of which do not get translated, and a review published in 2016

 https://www.ncbi.nlm.nih.gov/m/pubmed/29231581/


suggests that most of these studies showed benefit, but needed to be followed up with larger and better designed trials.

From a Chinese medicine perspective where each presentation is addressed as unique, it is very difficult to say without seeing the patient what might be possible. If the inflammation is in the relatively early stages then interpreting the symptoms through the diagnostic categories of Chinese medicine might offer treatment options to reduce pain and reduce the inflammation. We have certainly heard anecdotal reports of people having their discomfort much improved, but it is very difficult to generalise from random cases. However, if the condition has progressed to the point where there is some fusion of the lower spine that will severely limit what may be achieved. Pain relief always remains an option, but the extent to which the pain can be reduced and how long the reduction can be maintained are not easy to predict.

As for the level of success and relapse that is impossible to say for much the same reason: each case is different. All that we can ask of our members is that they set measurable outcomes for patients so that there are real indicators of improvement, and regular review periods to ensure that treatment doesn't just carry on and on without looking at the value of continuing.

We are sorry that this is not as helpful as we are usually able to offer, but the condition is so variable that we would be remiss to offer someone false hope by being more positive than we can be.


 

Q. Do you treat Mortons Neuroma?

A. We have certainly tried to treat Morton's Neuroma, and not always with success as a rather downbeat answer from last year indicates:

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

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/


(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 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 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 massagehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/which 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.

We don't think that there is a great deal that we can add to this. Some cases respond well, others don't but we have never found anything with predictive value to see which is which before starting to treat. That is why we are very cautious, review regularly and make sure that a patient is happy to continue in the absence of immediate change. 'Treatment habit's can become expensive very quickly and don't play well when someone realises that nothing much has happened.

Q. I am contacting you on behalf of my mother who has experienced a loss of functionality and feeling in the lower body due to a suspected spinal cord inflammation; feeling/mobility has shown slow/small sign of returning.

Can acupuncture assist in reinvigorating nerve path ways and also address "pain"?

I would be interested in speaking to a specialist who could help discuss this and also understanding the possible help acupuncture could offer.

Thank you for your time and help with this matter.

A. We would be very reluctant to be too committal about the reinvigoration of nerve pathways. There is a small amount evidence for nerve regeneration through the use of acupuncture but this is mainly based on experiments with animals, what our colleagues sometimes refer to as 'ratpuncture' and usually only the peripheral nerves which even in western physiology can show signs of regeneration. Spinal nerves are another matter, and we suspect that a great deal depends on the extent of the impingement caused by the suspected inflammation.

The one hope would be that from a Chinese medicine perspective something has caused a blockage in the flow of energy, some of the more important channels run along the length of the spine, and that treatment might restore proper flow. It is a long shot, but that doesn't mean that it cannot work. What it does mean, though, is that if there is a blockage it will clear quickly, so we would be reluctant to see anyone commit to a long course of treatment.

When it comes to pain there are stronger grounds for believing that acupuncture might bring some relief. After Nixon's visit to China in the 1979s there was a great deal of research into acupuncture for pain relief and anaesthesia, and it was easy to demonstrate that treatment can cause the release of neurotransmitters. Many Pain Clinics now routinely offer acupuncture treatment. The main question is how much relief treatment gives and how sustainable the changes are. If the changes are short-lived then treatment may not be the answer unless it is precisely targeted at times when people need to be pain-free.

As far as specialists are concerned most traditional acupuncture practitioners are by the nature of the system of medicine generalists, and we have never heard of anyone specialising in this field. from our perspective we treat people, not conditions, and our understanding is based on looking at how the whole system functions. Your local BAcC member is perfectly well qualified to offer you a view of how much benefit your mother might derive from treatment. indeed,most of our colleagues are happy to give up a few minutes without charge to prospective patients so that they can make a properly informed choice about treatment.

Q. I have been suffering from intense heel pain in both feet now for 6 years. I've been through years of physio/insoles/MRI/surgery etc in attempts to find the cause. Research now leads me to consider peripheral neuropathy. 15 years ago I suffered an almost terminating attack of Guillain-Barré Syndrome and I wonder whether this may be involved. I live on Hampshire/Surrey border. Could I get some recommendations for expert acupucture in this area, specialising in Peripheral Neuropathy.

A. The first thing to say is that there are only a couple of areas where we take specialism seriously - paediatrics and obstetrics - and where are are eventually likely to recognise expert training. Chinese medicine is by its very nature generalist because we treat people with conditions, not the condition itself. In that sense we are all qualified to treat everything, although we have to be very careful how we say this because treat implies cure, and treating people with, for example, cancer is not about curing so much as maximising the body's balance. It's an easy misunderstanding to foster.

That said, many problems present locally against a backdrop of systemic weakness, so some protocols emerge which can be applied within the overall context which we would primarily treat. We have been asked about peripheral neuropathy on a number of occasions, and a typical answer has been



There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html


shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.
Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.
The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

From a conventional/western perspective it is quite possible that the Guillain Barre episode has resulted in nerve damage, and to that extent there may be a limit to what is achievable. We do come across cases, though, where the disruption in the flow of energy as we see it produces a pain which is assumed to arise from a broader condition someone has. Once people get a disease label it seems quite common to refer everything back to it. This is why we always recommend in cases like yours that a chat with a local BAcC member is always worthwhile. It is sometimes possible to see signs of blockage which would encourage the view that treatment may help.

We always have to be realistic, though, and after 15 years of unrelenting pain it would be a long shot for acupuncture to do the trick quickly. This does leave you open to the possibility of running up a large bill in the attempt which achieves nothing significant, so if you do decide after talking to someone to go ahead we would recommend that you try to find as objective as possible an outcome measure of progress and agree regular review periods before you start.

Good luck!

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.

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