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Intense pain after acupuncture after acupuncture for golfer's elbow - is this unusual?

Q:  I've been receiving acupuncture as part of my physiotherapy treatment for golfers elbows - though  I don't play golf. The needle was inserted in my inner elbow and tweaked for about 2 minutes causing immense and intense pain at the time, which I still felt the next day.. This is my gear stick arm and I cannot drive. I've never had a reaction like this before. Is this unusual?

A:  We are sorry to hear of your predicament. While not common, this sort of adverse event can happen, but you are right to say that it is unusual.

In the majority of cases like this, the problem arises because the practitioner has inserted the needle too deeply or too vigorously, and the needles has either slightly damaged a nerve or more likely caused some deep internal bruising.This small haematoma will 'saw' a nerve each time that the arm is move or the muscles tense. Given that this joint is rich in nerves and blood vessels in transit, resting the area is rarely possible,

If this is what we suspect, the effect should wear off in about 48 hours. If it does not, then it would be prudent to make an appointment with your GP to see what is going on. Permanent damage is rare; we receive very few reports in each year of adverse events which are more than transient, but it is always worthwhile placing yourself within the system early in case it doesn't clear up quickly.

We are assuming that the treatment was administered by a physio who also does acupuncture rather than a professional acupuncturist. Most physios base their work on what is termed western medical acupuncture, which has a different conceptual basis from that which we do. The treatment is usually aimed at reducing muscles knots and inflammation based on a conventional diagnosis. It would also be fair to say that the techniques used by most are a little more vigorous than most traditional acupuncturists employ. However, a needle is a needle in anyone's system, and if there is an unintentional energetic effect as we might understand it, then a dull aching sensation could be stimulated and persist for about twenty four hours.

It is much more likely, though, that there has been minor physical damage and it is well worth discussing this with the physio before any further treatment is done. They may even be able to help resolve some of the pain which you are experiencing.

Golfer's elbow, by the way, is  the generic term for problems on the inner aspect of the elbow, whereas tennis elbow is usually the generic name for problems on the outer aspect. Windsurfer's elbow is also starting to appear more frequently.

We should add that treatment is not an endurance sport. We always remind our patients that if something hurts and continues to hurt they should tell us immediately and we can either adjust the depth and vigour of insertion, or simply remove the needle. Gain through pain may be an old adage, but not to the point where the treatment hurts more than the problem. 

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