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Ask an expert - muscles and bones- shoulder

17 questions

Q:  I was involved in a car accident last November I had several physio sessions and I thought I was all ok and ended sessions in February, in  less than a month my shoulder and neck were playing up again.  I continue to do exercises and I've had acupuncture in Ireland a few times when I visited there in April, this seemed to help.  I was advised I would need possibly  more intensive sessions Will accupunture help me?

A:  You have the advantage over many of our 'ask the expert' correspondents insofar as you have already had acupuncture and it seemed to help. You've also had what we can't give but wish we could to, a face to face assessment of whether treatment would be beneficial in your own case. If, as seems to be the case, your practitioner thinks it would be worthwhile continuing, then this is the advice to follow.
 
Whether you return to your pre-accident state of health is another matter. It is true to say that shoulder and neck injuries are amongst the more difficult to treat because of the delicate balance of forces in the shoulder joint and the difficulty of repairing small tears in ligaments and tendons in a joint which is in relatively constant use. If you have been given a range of exercises by a physio, however, these will have been carefully designed to maximise your recovery, and together with the acupuncture treatment, there is a good chance you will recover most, if not all, of your previous function.
 
Accidents tend to have a much wider effect than the simple physical damage alone, and the paradigm of Chinese medicine in which body mind and emotions are seen as interconnected and interdependent can be particularly helpful in addressing some of the other consequences of an accident, like the shock itself. In Chinese medicine a major disruption in any part or level of the system can have repercussions across whole system, and we sometimes find this can impair someone's physical recovery. If your practitioner treats you rather than simply treating your symptoms, he or she will address all of these kinds of issue on looking at the overall picture.
 
We have just entered 'HA5' in the practitioner search function on our homepage and generated about twenty hits for people working in your area, so you should have no problem in locating a BAcC member to take over your treatment.   
 

 

Q:  I am looking for someone to help sort a problem I have with very tight muscles in my shoulder that can not be easily released with physio massage. How can i find out how long someone has been practising/qualified.

A: The only way to establish how long someone has been qualifed and/or practising is to ask them directly. We do have information about when people qualified but we do not use this on our public register yet. There are discussions, as there have been for a long time, about increasing the amount of information available to the public, and for us it is simply a matter of ensuring that we do it in a fair manner which remains comprehensible.
 
It can get quite complicated. Some members have run small but highly effective practices for years from choice, where other more recently graduated members have very large and full clinics within months of starting to practise. There is no reliable way in which one could say that 'x' is better than 'y', and faced with that conundrum we have tended not to provide large amounts of information; from our perspective all members are skilled, safe and competent, whatever their stage of practice. The same applies to knowing what styles members practise. We know where someone's initial training has been given, but over time people develop and their style changes, and it becomes very difficult to be definitive about what members do.
 
We are looking at all aspects of public infirmation to help the patient exercise a fully informed choice in looking for a practitioner, but the for the moment the only way to establish how long someone has been practising is to ask them. Our members will not be in the least bit offended at such a request.  
 

Acupuncture is used by practitioners of all traditions - chinese medicine, conventional medicine, physiotherapy - for the treatment of muscle tension. Obviously the way that each explains the symptoms will be very different, as will the rationale for the treatments they give. Chinese medicine talks in terms of the flow of energy, called 'qi', and its balance, flow and rhythms, whereas the western medical practitioners will speak of knots in muscle or trigger points which need to be released. In many cases the needles will be applied to roughly the same places.
 
As practitioners of Chinese medicine we clearly believe that the lineage which Chinese medicine represents, with the wisdom of over two thousand years of treatment behind it, offers a better chance to understand not simply the problem but the backdrop against which it is set. Chinese medicine is emphatic that the symptom is not the same as the problem, merely a sign that something has gone wrong with the overall balance. If you correct a symptom without reference to the pattern in which it appears, there there is a chance that it will recur.
 
In the case of muscle tensions this is a little less likely, but the practitioner will be as interested in the way that the problem appeared as in the problem alone. There is a great deal of tension in the modern world and sometimes people have a pain in the neck because they live or work with one. Seeing how the probem has developed and is sustained by the system is important.
 
We always recommend that someone visits a BAcC member local to them because a bried face to face assessment by a skilled practitioner will elicit much better advice than we can give here about whether your particular presentation is suited to acupuncture treatment, or whether there are other forms of intervention that may help you more effectively. 
 
 
 

Q:  I have sprained the ac ligament in my shoulder. What can acupunctute do to speed up the  healing process? My shoulder does not hurt with day to day activities, it stops me doing my normal fitness and sports.

A:  This is a difficult question to answer. Tears in the acromio-clavicular ligament, like all shoulder ligament tears, can cause a generalised instability in the shoulder itself, so the fact that you have recovered normal day to day use is a very positive sign that things are healing well. There is also no doubt that acupuncture is widely used, both by practitioners of chinese medicine and by phsyiotherapists and sports injury therapists in the conviction that it does seem to speed up the healing and recovery process. There is not a great deal of evidence to support this use, but most of it is anecdotal and relies on the accounts of experienced practitioners and satsfied patients. 'Anecdotal' has become a rather pejorative word in modern times, suggesting that it has no firm foundation. We take the view, however, that it is an accumulation of anecdital evidence which is often the spur to more systematic research, and is worthy of greater respect.
 
How does this help you, then? Well, we can say with certainty that acupuncture will not do any harm, but there is no evidence we can offer you that it will definitely speed up healing. What we can say, however, based on our own experience, is that patients who are used to training often push themselves very hard to recover, and there is certainly plenty of evidence that the kind of micro-tears which this can cause need to repair for a longer period than most allows allow. We find that many patients push themselves hard to increase their maximum loads when they may be better served by shorter sessions within their limits to enable the ligament to recover. Otherwise it can be one step forward, half a step back, and this will slow the recovery process down.
 
You would do well to seek the advice of a BAcC member who will be able to offer you a face to face assessment of what acupuncture treatment might achieve, but you might be equally well advised to seek out a sports injury specialist who uses acupuncture within their overall strategy. Some of our colleagues might find this a little heretical, but our concern is for your well-being, and there is no doubt in our minds that this overall treatment needs to be overseen by someone with experience of getting sports people back to full health.  
 

My wife is prone to keloid scaring and has a keloid scar on her upper arm from her childhood vaccination. She is thinking of having acupuncture treatment for pain in her shoulders but is worried the acupuncture needles will cause keloid scaring. Is there a risk that keloid scaring could develop from the acupuncture? She has been advised to avoid tattoos and piercings for this reason and wondered whether it would be the same with acupuncture.

 

Oddly enough, acupuncture is sometimes offered as a treatment for keloid scarring. An article in Acupuncture in Medicine, the journal of the British Medical Acupuncture Society, has an interesting case study
 
Please click here:
 
showing a remarkable turnaround in a large scar. From a Chinese medicine perspective, the scar is often a cause of a weakening of the flow of energy in the system, and the kind of technique used in this article is often used to encourage the restoration of good flow, often with immediate results.
 
Based on what we have seen over the years, we think it is highly unlikely that the kinds of skin puncture caused by an acupuncture needle, at 0.18 to 0.25 mm in width, would be likely. The 'holes' close over almost immediately and there is rarely any blood loss, which can hardly be said about tattooing and piercing. If you have any doubts at all, however, we are confident that a responsible practitioner would be happy to talk to your GP and also perhaps even insert a couple of needles in a test area out of sight as an experiment to see if your wife's was a rare case in which any skin piercing caused the formation of keloid scarring.

 

 

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