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Ask an expert - muscles and bones

314 questions

File under muscle and bone - arm

As you might imagine, we have been asked questions about tennis elbow on a number of occasions and a typical answer has been:

Tennis elbow is one of the more frequent conditions with which people present at our practices.

 The BAcC has a factsheet which outlines some of the research which has been unertaken

 although it would be fair to say that the results are not as clear as for some other conditions for which we prepare factsheets. 

 Our clinical experience is that many people do benefit from having treatment but we are always very careful with conditions like this. If someone has four for five sessions without any apparent benefit we tend to draw a sharp line in the sand and look for alternative options for treatment. If treatment is likely to be successful there is usually some improvement, even if it reverts to being not so good again, and the improvements are incremental, i.e they get a little more pronounced each time. If nothing happens or there is a similar temporary burst of better times each time, then the chances are that acupuncture is not the best option.

 The key thing is to set measurable targets: how far can someone turn the arm without pain or restriction, how much weight can they sensibly bear, and so on. There is often also 'homework' - it is remarkable how many people want to carry on playing golf or windsurfing while they are being treated, and the concept of 'two steps forward, one step back' is difficult to get across sometimes.

 Best advice, as always, is to visit a local BAcC member for an informal assessment of what may be possible. Most BAcC members are happy to spare a few minutes without charge to see what may be possible, and this way you get to meet the practitioner and see where they work before committing to treatment.

This is still the essence of what we would say now. Further evidence keeps on being generated, as for example in this trial published last year

but the overall weight of evidence is not enough at present to make firm recommendations.

We are not quite sure what to make of your GP's suggestion. Certainly without sight of your problem we are a little in the dark. If there is strong clinical evidence suggesting that surgery is the best option then it would be wise to follow the advice you are being given. Cutting is usually only done as a last resort, and if that is what the scans and X-rays show then acupuncture may not work. However, it can certainly be said that it won't make things worse, and it might well be worth having three or four sessions to see what can be achieved to head off surgery if this is at all possible.



Q: how does acupuncture help in managing osteoarthritis. Does it only relieve pain or can it also slow down the progression of the disease

A: There is a very large and increasing body of evidence for the use of acupuncture as a treatment for osteoarthritis, as our factsheet shows

Many of the studies are quite clear that reduction in pain with acupuncture is a reasonable expectation of outcome for treatment, and many of the studies cited here speak of the reduction in physical dysfunction which acupuncture treatment seems to achieve.

However, it is a fairly large step from pain reduction and functional improvements to statements about slowing down the progression of the disease. To the extent that changes in physical movement wrought by the pain and inflammation can both make the situation worse, any reduction or change in either will stop the condition feeding off itself, i.e. the symptoms become a part of the causal pattern which causes deterioration. However, the factors which predispose someone to osteoarthritis may still be as active as they were before, be they genetic, environmental or lifestyle, so it would only be reasonable to say that unless these change then slowing down the disease progression may not as easy to achieve.

This is to look at things from a conventional medical perspective, though. The ancient Chinese were just as prone to osteoarthritis as modern people, but the whole nature of the understanding of disease in Chinese medicine is different, and from this perspective there may be something which a practitioner could reasonably hope to achieve to remove some of the causal factors. Chinese medicine is predicated on an understanding of the flow of the energies of the body, called 'qi', and its patterns of flow and balance. Factors which affect this are often described in physical terms  - heat, cold, damp, etc - as a reflection of the conditions in which most people worked on the land. The Chinese would see the joint being directly affected by these conditions and use acupuncture and herbs to reduce the impact on the body.

In doing so they would also be mindful of the unique balance of the individual and the constitutional patterns which they had inherited which made some people more prone than others to develop osteoarthritis (the Chinese called it Bi Syndrome, and classified it according to its presentations - Hot Bi, Cold Bi, Damp Bi, etc). In this sense an experienced practitioner might hope to reduce the symptoms as well as addressing some of the deeper factors which predisposed someone to suffer with OA. From this perspective it might well be possible to look at slowing down the disease progression.

No treatment for OA works in isolation, though. An integrated approach, involving not just acupuncture but physical therapy, diet and exercise, will always offer the best chance of making life more tolerable for an OA sufferer.

Q: I have struggled with my neck and shoulders for years and have recently started to get tension head aches. Massages have helped in the past but not so much anymore. My posture isn't great so I know this is the main trigger and I also work in an office so sit at a desk for 8 plus hours a day. Would acupuncture help me?   Thanks in advance

A: We often come across people who are pretty much spot on about the causes of their problems - posture, work-related stress and sedentary nature - but are not in a very good position to do much about it. This is a problem for us as acupuncturists in terms of the ''two steps forward, one and half steps backward' of a great deal of the treatment we do. We obviously believe that we can help problems like neck pain and headache, and the evidence supporting this is pretty good, as our factsheets show:

It falls a little short of an absolute recommendation but this is more to do with the vagaries of methodological requirements than the treatment itself. These remain some of the more common conditions for which people seek our help.

We suspect that the real issue here is how a practitioner might work with you to manage the causes of your problems. There are a number of exercises and self-help routines which people can use, both within acupuncture and within associated disciplines, and many of our patients find these very beneficial, although we have to be honest and say that it takes a bit of nagging on occasion. We know that employers have statutory duties to offer staff members breaks when they are machine or desk bound, but we know equally well that it is a brave employee these days who insists on this. There are a number of meditation and mindfulness programmes which can be of great help, and other people use NLP as a means of anchoring relaxed states and breaking the cycle of tension.

We think the best thing to do, though, would be to visit a local BAcC member, possibly for a chat or even for a couple of sessions to explore how much change the acupuncture treatment seems able to achieve. If this can be targeted for a time when you have some R and R ahead, like a Bank Holiday weekend or holiday, so much the better. This will give a very clear indication of the possible benefits.

Much of the problem stems from blockage and stagnation of the energy, and acupuncture treatment can be hugely effective in relaxing people. The point, though, is to stop them tensing up again while they do what they have always done.

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

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: Is there a possibility that acupuncture will help me with a bad problem of balance?

A: A great deal depends on what is actually causing the balance problems. We have, for example, a considerable body of evidence for the treatment of vertigo, as our factsheet

shows but there are literally dozens of conditions which are differentiated in western medicine - Meniere's disease, vestibular disorders, labyrinthitis, ineer ear infections and so on - which can generate balance problems. There are also cases of accidental damage, as for instance this study we found about people being researched for balance problems resulting from whiplash injuries

Essentially, there is evidence for the use of acupuncture in treating all of these problems, but the quality is variable, and we would be hard pushed without more to go on to make a positive recommendation in case the problems arise from something which cannot change.

However, as we sometimes have to remind ourselves as well as our patients, we practise traditional acupuncture which is premised on treating the person, not simply the problem they have. The theory is based on a complex flow of energy whose rhythms and balance determine good function, and whose loss of balance can generate symptoms. The skill and art of the practitioner lies not in going to the clearly defined areas which are involved in balance from this perspective but in looking at what is going on to make this symptom appear. Many symptoms are not the root of the problem but just signs that the whole system is out of balance, and without taking care of the root causes any treatment of the symptom alone may have short-lived effects.

Balance problems have been around since people stood upright so the Chinese will have addressed these issues for thousands of years. To know whether this accumulated wisdom can help you, though, the best advice that we can give is that you visit a local BAcC member for an informal chat. Most are very happy to give up a small amount of time without charge to give prospective patients a better idea of what may be possible, and it enables you to check them out before committing to treatment. We strongly suspect that they will feel confident about being able to help you but we trust them to say so if they think this is not the case.

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