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28 questions

We have been asked about muscular tension in recovery after injury a few times, and a typical answer has been:

A: It certainly couldn't do any harm to try traditional acupuncture. We choose out words carefully, though; when we say traditional acupuncture we mean acupuncture based on an understanding of the principles of Chinese medicine. There is a great deal of acupuncture being offered these days by people whose focus is primarily musculo-skeletal, such as physios, osteopaths and chiropractors, and while we have no doubt that they often do very good treatment as an adjunct to their primary discipline, there are times when this kind of 'point and shoot' approach will not be enough. The problem from our perspective, of course, is that when this doesn't work people say 'acupuncture didn't work', to which we respond 'only a very reduced form of it.'
Chinese medicine looks at the body as a dynamic structure of energy, called 'qi' in Chinese thought, whose flow, rhythms and balances are integral to good health and well-being as well as to good recovery from the injuries which everyone experiences from time to time. In cases like yours this means two things. First, it is possible that there has been disruption to the flow of energy locally which, by the use of both local and distal treatment, a practitioner might be able to correct. If there is a local weakness or blockage, most treatments are only going to be partially successful in restoring function.
Second, there are often cases where an injury manifests as an acute problem on top of a more chronic weakness which has not generated any symptoms as yet, and also may manifest against a backdrop where the entire body is running below par. The problem with  acute then chronic problems is that they prevent the system as a whole from recovering and lock the problem in for a long time. 
Acupuncture treatment may be able to address both of these issues, and a visit to a BAcC member local to you for a brief face to face assessment may be able to establish very quickly whether the practitioner thought that there was something they could do to help.
As general guidance we think that this is still a good start. When applied to specifics, like an ACL reconstruction, we would want to ask a number of additional questions based on our experience over the years. This would involve asking about and looking for scar tissue, checking the geometry of the joint to see that it hadn't been minutely altered by the work done to the ACL, and also looking at any learned postural habits which have become slightly more entrenched during a recovery period. It is not uncommon, for example, for people to develop a slight rotation at the sacro-iliac joint as they favour the opposite leg during recovery, and this can have all sorts of implications for the body's flexibility even where the deviation is very small.

The advice we gave before, to visit a local BAcC member for an informal chat, is by far the best thing to do. Each case is unique and different, and it often takes a brief face to face chat and examination to give a properly informed view.

Restless leg syndrome  is now egaining recognition as a diagnosable problem, with a new name(!) (Ekbom Syndrome), and there are a number of treatment options which are being explored. A review article several of these, and the one acupuncture review this in turn cites two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.We have not come across much in the way of new research, although another small study published early this year (2015) the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.We have looked at all the available research and there is nothing new to report. However, from a Chinese medicine perspective it would be unusual to treat a named symptom by itself. The whole essence of Chinese medicine is that we treat the person, not the problem, and even where a dozen people suffer from restless leg syndrome in the same way, each might be treated entirely differently depending on how the symptom was perceived to be arising from the overall patterns of imbalance. The best advice that we can give is that you visit a local BAcC member to see what might be possible for you. Seeing the overall pattern as well as hearing your individual account of how it affects you will probably help them to see what causal pathways are involved and advise you on how effective acupuncture treatment may be.

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.

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