Ask an expert - muscles and bones - legs

26 questions

Q:  Over the last year I have had a lot more problems with cramps. I am only 27 years old and this year.  I have had several serious cramps on my quads, hamstrings and calves simultaneously. The cramp in my quads are the worst and the latest time last for 2 and a half hours of intense cramp. Since then my legs have never recovered.  I cant really run or doing any leg movements without them tightening up and feeling like they are going into cramp. It almost feels like constant DOMS for months. I was just wondering would acupuncture be effective as the GP's and phyiso have no answer for what I can do?

A: On the face of it it would seem very likely that acupuncture treatment might well be able to help you. The theories and practice of traditional acupuncture rest on a concept of energy, called 'qi', and its flow, rhythm and balance in the body. When the flow is compromised for whatever reason the resulting blockage or stagnation will cause pain which will continue until the blockage is released. We find that there are many conditions which demonstrate this kind of pathology, notably a great many of the repetitive strain injuries, and the use of needles together with ancillary techniques like moxibustion (the use of a warming herb) and cupping can make a huge difference.

 A practitioner would be very interested to take down a great deal more case history before being certain about this as a diagnosis, however. DOMS was always thought to be a consequence of the build-up of lactic acid in the body, but more recent assessment seems to suggest that microtrauma to the muscles and tendons can be a contributory factor. The problem with microtears and the inflammatory response which they provoke is that most athletes tend to try to work through the pain, regarding this as likely to improve their overall fitness. The reality appears to be that the microtears never get a chance to settle, and simply become worse and worse. It would be essential to establish whether you had now ceased from all forms of exercise, or whether you were still training, even to a minor extent. If so, then a part of the rehabilitation programme might involve extended rest, together with other treatments.

 There is certainly a growing number of acupuncture practitioners who specialise in sports injuries, and if you manage to track one down near to you then it may be worthwhile making a slightly longer journey to someone with this kind of background even though there may be other practitioners who are nearer. Our experience is that it really does help to be able to talk the language of training and understand the specifics of an exercise programmes which may have been a contributory factor. That said, Chinese medicine has existed for 2000 years longer than the average gym, and has addressed the same problems brought on by over-work in an unkind climate effectively. All of our members will be able to offer the same level of acupuncture skill.

 Our best advice is to find a practitioner local to you and ask for a brief face to face assessment before committing to treatment. Most of our colleagues are willing to give up a little time without charge to offer a better judgement than we can make at this remove and to advise you on whether acupuncture is the best modality to pursue.

Q: After neuro tests I have nerve damage to my left knee. This is causing difficulty in walking and knee pain ,there is also muscle wastage.

A:  A great deal depends on what caused the nerve damage. If this is as a result of an accident or illness which caused the initial problem then there may be rather more difficulty in restoring full function. However, the sort of muscle wastage you are experiencing is something which happens even to top flight athletes. It is not unusual for a footballer with a knee injury to be out of action for several weeks because the quads lose their tone really quickly and can take longer than the knee itself to become match fit.

The theories of Chinese medicine are all based on theories about energy, called 'qi', which is the basic constituent of all living structures. When this energy, which flows in well-established patterns and rhythms, is disrupted pain and weakness follow. The art and skill of the practitioner lies in determining the extent to which the poor flow is a local problem or a local problem which has persisted or failed to improve because of a greater underlying weakness or problem in the overall system. This marks the difference between traditional acupuncture and the more medically based versions used by conventional physicians. Sometimes if the problem is local, then it matters not what system to choose, and both will work. However, our experience is that very often there are good reasons from the Chinese medicine perspective why something is not improving as it should, and using systemic treatment alongside the local treatments can make a great deal of difference.

There is also the issue of how long after the initial problem the treatment is given. There is an interesting parallel with the treatment of muscle flaccidity or paralysis after stroke. In China this is treated almost immediately to ensure that proper flow is restored as soon as possible. The longer the disruption has been in place the more the body starts to accept this as 'normal' and the more entrenched the weakness becomes. This does not mean that improvement is impossible, just that iot may take a little longer.

We are assuming that you have been offered physiotherapy or exercise routines to help with your recovery. We would always advise someone to arrange to visit a BAcC member local to them for an informal assessment of what may be possible. It should be fairly straightforward to find at least one near to you who specialises in treating sports injuries, and they will be without doubt a valuable resource in putting together a package which will help you back to better mobility without pain.

 

A:  We always find these sorts of questions intriguing!

We are assuming that you have already consulted your doctor about this problem. If not, it is worth checking in because there are a small number of named circulatory disorders which can cause this as a symptom and you need to rule them out.

From a Chinese medicine perspective, the body is a field of energy called 'qi' which warms, nourishes and moistens the body tissues, so any symptom like coldness in a part of the body immediately alerts the practitioner to the possibility of a weakness of flow in one of the channels or flows of energy, or sometimes to a functional failure in a part of the system as a whole. Sometimes it is possible to trace specific lines of coldness which match specific channels, and on other occasions there will be a number of other issues, not necessarily seen as symptoms by a patient, which will point to a functional disturbance in one of the Organs (not that we put a capital letter in frony - the Chinese concept of an Organ is very different from the western concept.)

The practitioner will almost certainly ask a great many questions about the problem itself, trying to establish whethere the legs feel cold to touch or just feel cold on the inside, checking whether there are specific times when it feels better or worse, asking whether there are things which make them improve, like having a bath or eating, all to get a sense of what is going on. They will almost certainly them ask you about many other aspects of your health to get an overall sense of what is going on. This is the great strength of Chinese medicine practised properly, not just sticking needles where the problems are but seeing them within the overall context of someone's health.

We always advise potential patients to visit a BAcC member local to them for advice and a chance for someone to cast a professional eye over the problem. This will give you a much better sense of what might be achieved, and will also give you a chance to meet them and see where they work before committing yourself.


Q:  Can acupuncture help relieve pain in my lower leg that appears to be neurological- intense pain when resting or trying to sleep accompanied by strong feeling of coldness. Much worse after crouching or kneeling for periods- pain relieved by walking about.

A:  We are assuming that you have had all of the conventional checks that are available to you. Anything which shows a potential neurological or especially vascular (intense pain and coldness) deficit warrants proper investigation. We hope this doesn't sound alarmist, but there are a number of conditions for which symptoms like this are a diagnostic marker, and if there is an issue it needs to be addressed soon.

On the assumption that everything checks out OK from a conventional point of view, there are some interesting diagnostic pointers from a Chinese medicine perspective. Pain arises, from this perspective, because of changes in the flow of the energy upon which the system is based. This can be a local excess or deficiency, or a blockage, and this in itself might be a local problem or a local occurrence of a systemic problem.

Given the nature of the symptoms there are too many possibilities for us even to consider delineating what the possible conventional causes could be (like sciatica or peripheral neuropathy) and how well they have been shown to respond to acupuncture treatment. From a Chinese medicine perspective there is a great deal to go on, however, and we would feel fairly comfortable about offering to treat with some likelihood of success.

What does concern us is the fact that you do not mention a conventional regime of tests. We would strongly advise this as a first step if this has not already happened. After that the best thing to do is to seek the face to face opinion of a BAcC member local to you. Most of our colleagues are more than happy to give up a little time without charge to see whether treatment is a good option, and to make any other recommendations if they think there are better alternatives to address the issue, like osteopathy or chiropractic if there is nerve impingement at the spinal level, for example.

A: We would be interested to know a little more about the trapped nerve itself and what kind of pain it is causing before we could offer a view. The knee is quite a difficult place to trap a nerve, and our first thought would be that there has been some mechanical displacement of the joint which has precipitated the problem. Although acupuncture treatment might help with the body re-aligning its structure we would be more inclined to send someone to an osteopath first to see if there was a more direct approach.

This is very much in line with advice we gave a little while ago about trapped nerves in general

All forms of impingement and entrapment can arise for a number of reasons, and these determine whether there is a realistic chance of success. If the problem arises from a displacement of the physical structure of the body, like a joint having been knocked slightly out of alignment then it may be more appropriate to see a practitioner like an osteopath or chiropractor who can manipulate the structure back into place. It is probably possible to do the same thing with acupuncture over time, but re-arranging the bones first and then using acupuncture to consolidate the change is how many of us work alongside osteopaths and chiropractors.

If the changes in structure are due to deterioration of the bones, the problem can be more intractable. In some cases, however, inflammation arising from structural changes or simply inflammation can cause the entrapment, and in this case there is some evidence suggesting that acupuncture can do more than simply offer short term pain relief and can break the cycle of inflammation which is causing the discomfort.

The short answer, though, is that each case is unique and different, so it is very difficult to quote general principles about what is best. The advice we tend to give all the time  is to arrange a brief face to face consultation with a local BAcC member to see whether in their professional opinion a problem is amenable to acupuncture treatment. The majority are quite open to suggesting alternatives if they think a patient would be better suited to another form of treatment.

We think that this is probably the best that we can say.

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