Ask an expert - muscles and bones - arthritis

34 questions

Q:  Is acupuncture  suitable to help with arthritis in the feet. Both of my feet suffer, one more than the other, to the point that they are so stiff I am unable to walk without a frame.

A:

It will come as no surprise to hear that we have answered questions on this before. One typical answer was:

Would acupuncture be of any benefit to painful feet due to arthritis?

We have produced a fact sheet on osteoarthritis

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

and as you can see, research into the treatment of arthritis in the feet is not that common. There are many hundreds, if not thousands, of studies published in Chinese every year, but only a small percentage are translated, and we are sure that there has probably been research but we are unlikely to see it.

Although acupuncture has a reasonably good record for offering relief in cases of osteoarthritis, it would be fair to say that arthritis in the feet can be much more difficult to treat. The very tight 'fit' of the foot bones means that where osteoarthritis starts to develop it can be very difficult to overcome the constant rubbing and inflammation which this causes in order to break the cycle of pain - inflammation leads to pain leads to more inflammation and more pain, and so on.

However, one of the great strengths of Chinese medicine is that it looks at symptoms as a part of a much wider pattern of energy flow in the body, and can sometimes make sense of systemic conditions which manifest in specific areas. Treatment may involve not just the affected area, but also points elsewhere on the body which can begin to put right the underlying imbalances which are the true cause of the problems. 

Arthritis has been around as long as men have walked upright, and the ancient Chinese had their own ways of differentiating the various types based on the nature of the symptoms - better with heat or cold, movement or rest, etc etc. This has led to some well-established protocols which may offer some benefit.

However, each person is as unique and different as their symptoms, and in some cases the deterioration will have gone beyond the point where treatment will be of benefit other than as short term pain relief. The best advice we can give is that you visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think might be possible. We are confident that they will give you an honest and realistic assessment of what they think acupuncture treatment might offer.

We do not think we can improve on this as an answer as far as acupuncture is concerned. What we should add, though, is that some of the more gentle manipulative therapies can often be very beneficial. Many BAcC members, for example, use tui na, a form of Chinese massage, and this can often generate a great deal more movement. However, we have also know patients to use traditional massage and often reflexology to great effect.

We still believe that it is worthwhile having a chat with a traditional acupuncturist first, though. If the stiffness in the feet is a consequence of a much more widespread systemic condition, as understood in Chinese medicine terms, where the tendons and ligaments are not being properly nourished, no amount of massage or manipulation is going to resolve the problem quickly until the deeper underlying pattern has been remedied.

A :As you may have seen from this answer about a similar rheumatoid arthritis problem which we posted some time ago:

As you can see from our factsheet for one auto-immune disorder affecting the joints, rheumatoid arthritis http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/rheumatoid-arthritis.html

the evidence for the use of acpuncture treatment is equivocal. The gold standard for evidence, the ramdomised double blind
control trial, it has to be said, is not the best method for assessing acupuncture, and there is a great deal of slightly lower grade evidence from China which is encouraging.

However, acupuncture as a system of medicine is premised on an entirely different understanding of the
human physiology as a flow of energy, called 'qi' whose flow and balance is crucial to good health. Qi is also said to make up all of nature, and so interactions between man and his world would and could have a direct bearing on health.

The best course of action with problems such as these, however, is to visit a BAcC member local to you for advice. Most
are more than willing to give up some time without charge to give someone a better assessment face to face of whether acupuncture treatment is a  good bet, and most are always willing to refer on to other forms of
treatment if they think something else would be better for the patient.

we tend to be a little cautious in our responses about RA. In our experience this can sometimes be intractable to treatment, and we do not want to excite expectation which cannot be fulfilled.

However, there is a long history of acupuncture being used for chronic pain, as another factsheet shows:

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

and when acupuncture first started to become popularised in the West after Nixon's visit to China in the 1970s, it was the mechanisms of pain which became the focus of a great deal of the research. This was largely because the outcome measures were very clear. What we tend to say to people who look for pain relief from acupuncture is that in absence of a reversal of their main condition, the equation is really one of how much relief the treatment gives, and how sustainable the change is, set against the cost of the treatment. If the equation works, i.e. it remains cost effective to have long term treatment because the freedoms conferred allow a better quality of life, all well and good. If the change is short lived, however, then it may not be such a good option unless there are specific circumstances where being pain free even for a short time would be ideal.

Our usual response when working with conditions like RA, and one which is in keeping with the tradition to which we are heirs, is to set aside the western disease labels and to examine what is happening from a Chinese medicine perspective. This can often produce far greater clarity ofintent than working with a disease label which in itself carries associations of chronic degeneration.

We have produced a fact sheet on osteoarthritis

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

and as you can see, research into the treatment of arthritis in the feet is not that common. There are many hundreds, if not thousands, of studies published in Chinese every year, but only a small percentage are translated, and we are sure that there has probably been research but we are unlikely to see it.

Although acupuncture has a reasonably good record for offering relief in cases of osteoarthritis, it would be fair to say that arthritis in the feet can be much more difficult to treat. The very tight 'fit' of the foot bones means that where osteoarthritis starts to develop it can be very difficult to overcome the constant rubbing and inflammation which this causes in order to break the cycle of pain - inflammation leads to pain leads to more inflammation and more pain, and so on.

However, one of the great strengths of Chinese medicine is that it looks at symptoms as a part of a much wider pattern of energy flow in the body, and can sometimes make sense of systemic conditions which manifest in specific areas. Treatment may involve not just the affected area, but also points elsewhere on the body which can begin to put right the underlying imbalances which are the true cause of the problems. Arthritis has been around as long as men have walked upright, and the ancient Chinese had their own ways of differentiating the various types based on the nature of the symptoms - better with heat or cold, movement or rest, etc etc. This has led to some well-established protocols which may offer some benefit.

However, each person is as unique and different as their symptoms, and in some cases the deterioration will have gone beyond the point where treatmentt will be of benefit other than as short term pain relief. The best advice we can give is that you visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think might be possible. We are confident that they will give you an honest and realistic assessment of what they think acupuncture treatment might offer.

A:  The short answer is 'yes' as long as the practitioner is not using any form of electroacupuncture. There is nothing in the use of the 'normal' tools of the trade - needles, moxa, etc - which is a cause for concern.

There are some authorities who suggest that electroacupuncture applied locally a long way from the heart and from where the device is situated is relatively safe. One such pair of studies can be found here:

http://www.ncbi.nlm.nih.gov/pubmed/18818558

http://www.ncbi.nlm.nih.gov/pubmed/21386114

However, there are one or two case reports of people whose demand pacemakers have been affected by electroacupuncture, and we do not recommend that our practitioners test the theory by using EA.

Our view is that ordinary acupuncture has been used to great effect for at least 2500 years, and there is nothing which EA offers which cannot be replicated by the use of needle which are perfectly safe for the situation you describe.

Q:  Can acupuncture help with  someone with severe arthritis in both knees? They are unable to have knee replacements due to having had surgery done on lower legs due to hardening of the arteries,  which results in poor blood flow.  If knee replacements were to be done the healing process would be impaired which could then result in amputation due to infection

A: There is every likelihood that acupuncture treatment may be of benefit to someone with osteoarthritis of the knee. As our factsheet shows

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

there is a growing body of evidence that acupuncture treatment is as effective as conventional treatment and in many cases more so. In fact, it was a source of some annoyance three years ago, including to the medical acupuncturists with whom we meet regularly, that the NICE guidelines for osteoarthritis of the knee did not include acupuncture as a preferred treatment in spite of the evidence available. Its day may well come, however.

From a Chinese medicine point of view the treatment of joint problems invariably involves not simply dealing with the local area but also the constitution, the system as a whole. It is nearly always the case that local arthritic problems are a result either of continued exposure to poor conditions or a local manifestation of a systemic problem. The most effective treatment will always combine local and systemic approaches, because local treatment alone may not buy long lasting relief.

We are a little concerned that a knee replacement has not been offered because of poor circulation. Although acupuncture treatment is extremely safe, there are some circumstances where a practitioner will take extra care and may even want a word with a patient's GP about what is going on. In treating the diabetic patient, for example, there is always a concern when needling the extremities that any minor wound may not heal quickly, and practitioners often take additional precautions to further reduce the risk. This may even involve using alternate points away from the affected areas to achieve the desired results.

Each person is unique and different, however, and the best advice we can givem, and do usually give, is to visit a BAcC member local to you and ask for a brief face to face assessment. Most members are happy to offer this kind of facility without charge, and a well-trained practitioner, as all our members are, should be able to give a very sound estimate about how much treatment may be necessary, and indeed whether treatment is likely to be beneficial.

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