Ask an expert - muscles and bones - arm

19 questions

A: As far as the condition itself is concerned, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

there is a small amount of fully researched evidence that acupuncture can provide short-term relief for the problem. The criteria for quotable research set the bar very high by employing research requirements more suitable for drug testing, the randomised double blind control trial. In daily practice tennis elbow is one of the more frequent named conditions for which people seek help from acupuncturists. Our usual recommendation to patients is to have two, three or four sessions along with trying as much as possible not to have to do the sorts of things which brought the condition on. 

We tend to look for regular reviews after four or five sessions and measurable outcomes - range of movement, weight bearing etc - to ensure that a pattern does not develop of ten or more sessions without any result. This tends to make unhappy patients, so we are very clear about drawing a line if there is no discernible change after the first few sessions.

On balance we think that the best advice we can give you is to visit a BAcC member local to you to see what they make of the problem that you have and by virtue of a face to face assessment offer you a very clear idea of what may be possible for you. 

Q:  Can acupuncture help with tennis elbow? I have this problem in both of my arms.  if so, what would the probable cost be, and who would be the best acupuncturist to contact?

As far as the condition itself is concerned, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

there is a small amount of fully researched evidence that acupuncture can provide short-term relief for the problem. The criteria for quotable research set the bar very high by employing research requirements more suitable for drug testing, the randomised double blind control trial, and in practice tennis elbow is one of the more frequent named conditions for which people seek help from acupuncturists of every persuasion, traditional, medical and physiotherapy. Our usual recommendation to patients is to have two, three or four sessions along with trying as much as possible not to have to do the sorts of things which brought the condition on. This is often a sports activity, but we have come across people in kitchens and laundries with issues from repetitive use of the joint.

The fact that you have the condition in both elbows we find a little surprising. Most examples we come across are linked to specific activities which are often one-sided, although we did come across a number of wind-surfers who over-taxed the structure on both sides. We would be minded to look at what was happening systemically to see if there was a general underlying predisposition to this kind of inflammation.

On balance we think that the best advice we can give you is to visit a BAcC member local to you to see what they make of the problem that you have and by virtue of a face to face assessment offer you a very clear idea of what may be possible. 

As far as cost is concerned, the majority of practitioners outside London tend to charge between £40 and £50 for a first consultation and then £35 to £45 for each subsequent treatment. Sessions can last between thirty minutes and and hour.

We are sorry that we cannot give individual referrals, but if you use the postcode option on our 'find a practitioner' home page facility, as we have just tried, you will find a number of members within a few miles of where you are live, all of whom uphold the high standards for which we stand. 

Q:  My coctor told me I have tennis elbow. He offered no medication  but told me to apply Ibugel  which I have continued to do.  I am still in a lot of pain could acupuncture cure this and roughly how many sessions would it take.

A:Somewhat astonishingly we have realised that no-one has asked this question in the three years during which we have been providing this service. This runs counter to our clinical experience, where this is one of the more established reasons for seeking acupuncture treatment.

We do have a factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

which makes encouraging noises about the small number of studies which appear to demonstrate that acupuncture may be an effective way to treat the condition.The problem which bedevils some of the studies, and not just in studies of tennis elbow, is that many are Chinese and start from the premise that acupuncture works and are intended to establish what works best. This means that from a western medical point of view the studies are flawed as evidence on which one could base a recommendation.

However, our clinical experience is that this is a condition which responds quickly if it is going to respond. This particular expert tends to draw a line at three or occasionally four sessionbs if there has been no sustained improvement. There can sometimes be a few good days followed by a reversion to roughly status quo, and unless the point of return starts to creep upwards, it may be better to look at alternatives. That's about as far as we would commit on the number of treatments necessary, and it is best practice for many conditions to review progress after four or five sessions to see whether there has been sustained improvement. For this extremely clear outcome measures are necessary.

The best advice we can offer, and we do for many problems, is to visit a BAcC member local to you for a brief face to face assessment. This will give you a really clear idea of what might be possible, and will enable the practitioner to have a quick look at the wider picture to see what else, if anything, may be hindering the natural process of healing.

There may be one or two activities you will be asked to avoid while the elboe recovers, though. Especially tennis!

Q: I have just had replacement shoulder surgery following a fall.  I have lots of aches and pains in my lower arm, wrist and elbow.  Would acupuncture help with the pain relief?

A: We often get enquiries in practice abotu problems such as yours. Any kind of fracture and subsequent surgical repair can lead to a number of aches and pains in the surrounding tissue and especially, as in your case, in muscles and tissues 'downstream' of the area of the injury.

We use the term 'downstream' advisedly. The theory of Chinese medicine is based on an understanding of the body as a system of energy, called 'qi', in movement through well-defined pathways. These are variously called channels or meridians, and as the names suggest, they need to be maintained and flowing for all the functions of the body to perform as they should. Where is a break, and especially where there has been surgery, there is always a chance that the flow has been disrupted, with consequent pain in the area and occasionally a disruption of organic function as the gradual weakening of the flow causes internal organs to under-perform.

This can especially be the case where there has been the formation of scar tissue, and treatment can often be quite simplistic, rather like 'joining the dots'. However, a practitioner will always be interested to see what makes one individual heal more quickly than another, and there may well be deeper underlying reasons in the whole system which have interfered with normal healing. This is one of the great strengths of Chinese medicine. In treating the person rather than the condition it can make sense of the great differences in people's rates of recovery by seeing the problems within the context of the overall pattern.

The one factor to take into account is that the shoulder is a very unstable joint. The ball and socket is not that well-defined in bone itself and the stability of the joint as a whole depends on layers of over-lapping muscles. Anything which disturbs the exact balance of these muscles can cause a large number of problems in the muscles which travel over the joint, rather like disturbing a cat's cradle in the childhood game. There may be a need for some form of massage to encourage the muscles to return to better function. Many members offer a form of Chinese massage, called tui na, alongside their acupuncture treatment, but most will know local massage therapists who may be able to help you if they feel that this is what you need.

Q: My friend has fractured his elbow and is in a lot of pain. He had a plaster cast but got it removed after a few weeks because the pain had increased. The pain he says is becoming almost unbearable. Would acupuncture help?

A: This is a tricky one. There is no doubt that acupuncture can be used for pain relief, and this was indeed one of the first uses in the West and one for which a considerable amount of research exists - researchers love precise definition, and there are a number of neurotransmitters involved in pain control by the body which can be measured very precisely to assess whether treatment with acupuncture has an effect. Our fact sheet is very clear on this:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

The main issue is how much pain relief treatment can achieve and how sustainable any relief is. If the equation works in someone's favour regular treatment can make a fracture bearable while it heals.

Fractures are as old as time, and there are a number of points used within Chinese medicine for specific bone mending purposes. Because they have always formed a part of the teachings which we have each been given when we trained most of us routinely use specific points when patients have broken bines, and nearly always receive feedback from patients that their bones are healing quickly and well, often faster than their doctors expect. However, this has not been well-researched and although there are cases studies like this

http://www.ncbi.nlm.nih.gov/pubmed/23131374

and a number of studies using animals which suggest accelerated bone healing, there are no results which are substantial enough evidence for us to be able to give an unqualified recommendation for the use of treatment.

We are a little concerned to hear that the pain continues, and we are assuming that this is something which his health team are aware of. It may well be worth trying to have the joint X-rayed again to ensure that there is good healing of the tissue, and possibly MRI'd to make sure that there is no local nerve impingement. If this is all under control, then another factor to consider and which may bring your friend into the realm of acupuncture treatment, is that from a Chinese medicine perspective the bone itself is just a part of the energetic construction of the elbow area, and the fact that this is healing does not necessarily mean that the blockages created by the injury have all resolved. This can sometimes lead to situations where on the surface everything appears to have healed, but the energy of an area can still be severely disrupted. From the Chinese medicine point of view, the equation is simple - blockage equals pain.

Another rather more contentious way of looking at this which is to be found in some forms of osteopathy is that the shock of the accident can in some ways be still 'contained' within the healed bone even though to all intents and purposes it is as good as new. Some forms of treatment are aimed at releasing this shock, although it has to be said that this is far from universally agreed within the osteopathic world.

The best advice we can give to you to pass on to your friend is that they should visit a BAcC member local to them for an informal assessment of what acupuncture treatment may be able to do. We are sure that a face to face assessment of the problem will be enough for a practitioner to offer a very clear opinion of what may be possible.

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