Ask an expert - muscles and bones - arthritis

34 questions

Q:  ] I have osteoarthritis in my shoulders and spondylitis in my neck. Would acupuncture help with this?

A:  Generally speaking, the evidence for the treatment of osteoarthritis with acupuncture is encouraging but not conclusive. Most of that which is done tends to compare medication with medication plus acupuncture, and the latter seems to come out favourably, but as you can see from our factsheet

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

most of the evidence relates to knees and backs rather than shoulders. It would be fair to say, however, that there appears to be an anti-inflamatory reaction to acupuncture treatment, as well as a much more evidence-based reduction in the pain associated with the condition, so that visiting a BAcC member local to you for an informal face to face assessment may well be worthwhile.

From a Chinese medicine perspective, though, the term osteoarthritis is too broad to be immediately useful. Chinese medicine is based on a theory of energy, called 'qi', and its flow, rhythm and balance throughout the system. When this flow is disrupted it can point to either functional or positional disturbances which the use of needles can correct. Since the flow is well-defined in what are called channels or meridians, a practitioner will always assess whether there are local disturbances as well as functional problems to try to correct what has gone awry.

Of course, in the words of sales advertisements, when something has gone, it's gone, so if there has been serious degeneration in a joint no amount of treatment is going to make a difference. If there are osteophytic spurs causing inflammation then the best that acupuncture treatment may be able to offer is some limitation in the inflammation, and then the question will be how much limitation and how sustainable results are. If the sums work in a patient's favour the regular treatment can reduce the pain to manageable levels. If not, other forms of pain relief and inflammatory control may be more effective.

Spondylitis is another matter, however. The same cautions apply about sustainable relief, but if there has been visible and diagnosed fusion of the bones then treatment will be about pain and inflammation control, not about finding out whether the problem can be re-defined in Chinese medicine terms. In this case there is a real need to set very clear outcome measures and review periods if you decide to pursue treatment.

Q: I have a big toe arthristis and a plantar fasciitis, I wonder if laser acupuncture  could help me?

Generally speaking, acupuncture treatment for osteoarthitis has a growing body of evidence for efficacy behind it, as our factsheet shows

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

Plantar fasciitis is a different matter, however, and as we replied to a query last year

Plantar fasciitis can be a very unpleasant and debilitating problem, as you no doubt know. There is some evidence for the use of acupuncture treatment, as this paper shows,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094706

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

We don't think that we cad really add to this.

However, your question was about laser acupuncture, and we have to be honest and say that we are not really able to offer an informed view on this. Electro-acupuncture, of which laser acupuncture is one of of many forms, has become increasingly popular over the years and has been integrated into the work of many of our members. However, there is nothing to suggest that it offers benefits over acupuncture with needles and at this stage the mechanism by which it works would be something of a mystery. There are a number of 'off the skin' needle techniques used in some Japanese styles of treatment, and there may be similarities here, but we can't really comment on what falls beyond our normal scope of practice.

We are told by the members whom we know use it that laser acupuncture is very helpful for treating those who fear needles and for the frail or small. However, we can only offer advice that you should make sure that whoever offers the treatment is using properly CE-marked equipment, has undergone some form of training in its use, and is using equipment for which they are properly registered and licensed if the laser is a Class 3B laser or higher.

Q:  have been diagnosed with arthritis in my back and neck and spondulosis in my neck my arms and fingers are also painfull and stiff.  Will acupuncture help?   

A: The pains and discomfort you describe are familiar to us; a great many patients present with arthritic pain in the back and neck, and secondary problems in the arms and fingers. There is certainly a growing body of evidence that acupuncture can be very beneficial in helping with the pain and discomfort of arthritis, as our factsheet shows

 

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

 

and you are also probably aware that acupuncture is now one of the treatments recommended in NICE guidelines for back pains which have gone on for more than six months.

 

However, the mention of spondylosis adds a slightly different dimension to what we can say. If the deterioration and fusing of the vertebrae has been quite considerable this will seriously limit what acupuncture treatment can achieve. In 'straightforward' arthritis, there are a number of protocols in Chinese medicine which help to explain the swelling, heat and pain in a joint, and with the explanation come a variety of treatment options. Once there has been a physical change in a joint, however, or the fusing which is common in spondylosis, some of the treatment options are not likely to offer much relief, and pain management may become the name of the game. Acupuncture does have a deserved reputation for pain relief, but the critical question is always how much relief and how sustainable it is.

 

However, Chinese medicine operates from an entirely different theoretical basis which sees the health of the body as being dependent on a good flow of energy, and understands illness and disease as arising from an impairment in the flow. There may be ways of interpreting what is happening to you in terms of Chinese medicine which sound a little more hopeful than the picture we have painted, and the best advice we can give you is to visit a BAcC member local to you for a much more informed assessment than we can give at a distance. We are confident that they will give you an honest assessment of the possible benefit of acupuncture treatment and a number of suggestions for alternative approaches if acupuncture seemed to be not the best way forward. 

Q. Has or can acupuncture be practiced on children with juvenile arthritis? My daughter suffered terribly with her knees & had had fluid drained on many occasions & steroid injections but it never lasts for long. She's also been on very strong pain killers too.

 

A. Many children are successfully treated with acupuncture, and juvenile arthritis is one of a number of conditions for which acupuncture is mentioned in nearly all of the review papers of alternative and complementary treatments for the condition. We would like to say that this is because there is robust evidence that it works, but we're afraid that it is simply a reflection of the fact that in desperate circumstances people will try almost anything, and there are going to be times when the treatment works.

That said, traditional acupuncture is based on an entirely different way of looking at the body as a flow of energy with distinct patterns and rhythms of flow. If these are disturbed either locally where the problem occurs or systemically of which the local problem is a specific manifestation, then until the flow is properly restored the symptom will continue. This is why, from a Chinese medicine perspective, the conventional treatments will appear strange - getting rid of the fluid or reducing the swelling isn't really dealing with the problem. A skilled practitioner will need to see what else is happening in the whole system and look at how things have progressed to be able to start to address the specific manifestations.

Children are also not the same a little adults. There are a number of ways in which a child's energy and its treatment is different from that of an adult. Although we have not yet fully agreed standards for paediatric acupuncture, there are a number of specialist postgraduate courses for treating children whose graduates are specially trained to work with children. Although most of us treat the occasional child, we would also concede that people who focus their time on this group develop a very effective way of working with children which is to everyone's advantage. We cannot give specific referrals, but using google to search for 'acupuncture' 'children' and your area may well generate a number of hits for BAcC members who have undertaken specialist training . The same search methods will also quickly identify the courses, some of which list graduates by area to help search for a practitioner with the requisite skills.

Our best advice is always to try to visit a BAcC member local to you to discuss whether acupuncture treatment is suitable. Most will offer a little time without charge to establish whether acupuncture is the best treatment, and most will also know of other techniques which it may be worth investigating if they feel that the problem lies outside the limits of their scope of practice.

The $64,000 question is what we mean by 'help' in these circumstances. The first thing a practitioner would need to know was the exact nature of the accident. If there has been permanent damage to a physical structure like a bone, tendon or ligament, or if a nerve has been damaged beyond the body's ability to repair, then this severely limits what might be possible. There is a very small amount of evidence that acupuncture may be able to help nerve regeneration but this comes from the experimental end of the acupuncture world and often involves trials on animals, or 'ratpuncture' as some of our colleagues cheerfully dismiss it.

Within the limitations posed by physical damage, however, the Chinese medicine systems have an entirely different way of looking at the workings of the body as a flow of energy, called 'qi', whose balance, flow and rhythm determine the state of a person's health. Where there has been accidental damage to the body, this is seen as impairing the flow of qi in the affected area, and there may be some physical damage the effects of which might be lessened by treatment. It is not unusual, for example, for patients who have had major scarring from injury or surgery to face difficulties in the flow of energy because of the physical obstruction caused by keloid (or cheloid) tissue. Very simple procedures to reinstate the local flow can sometimes have profound effects.

There is also a different way of looking at the flaccidity of muscles. In conventional medicine this is usually viewed as a direct consequence of nerve damage and a great deal of physiotherapy treatment is applied to retain whatever function is left. From the chinese medicine point of view, the weakness and loss of bulk in muscles is seen as a weakness in the flow of qi, and needles are used to promote good flow. This is most clearly instanced in post-stroke treatment, where in China acupuncture is applied vigorously and as soon as possible to the muscles which have been affected by the stroke to try to restore the flow of qi. Reasonably good evidence suggests that this can really speed up recovery, although as always the quality and methodological soundness of Chinese studies is often in question.

However, the advice we tend to give rather frequently is to arrange a brief visit to a BAcC member local to you for them to be able to give you a face to face assessment of what acupuncture treatment may be able to achieve. Each person is regarded as unique and different in Chinese medicine, so even two people with the same presenting symptom would often be given entirely different treatment. What we can't see at this remove, and can't tell from your question, is the actual damage from the accident, and also the investigations and tests you have had to establish the limitations within which recovery is possible. With that information a practitioner should be able to give you a reasonable estimate of what acupuncture treatment may be able to achieve.

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