Knee problems and Acupuncture

A frequent problem which clients present with at our clinic is knee pain. Knee problems can stem from several causes, ranging from athletic injury to more chronic degenerative pain. Acupuncture is usually extremely useful for treating this entire spectrum and can often completely resolve the problem and, at the very least, can powerfully manage chronic pain. 

Research and Articles:

Though we usually prefer to completely solve knee problems for our patients, occasionally they have already had surgery and seek us out in order to speed the post surgical healing process along. A new study demonstrates just how useful this strategy can be, concluding that,

... compared with rehabilitation training alone, acupuncture combined with rehabilitation training can better improve the patients’ knee joint support and swing torques after meniscus arthroscopy, correct their abnormal gaits, increase their motor function of the lower limb and benefit the balance abilities of their lower limbs during walking.

A landmark study, from the Annals of Internal Medicine, has shown that acupuncture both provides pain relief and improves functionality for people with osteoarthritis of the knee and serves as an effective complement to standard care. The study, the largest Phase III clinical trial of acupuncture for knee osteoarthritis, was funded by NCCAM and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, both components of the National Institutes of Health.

The Effect of Acupuncture on the Knee and Tibialis Anterior Muscle

Chin Med. 2008; 3: 17.

The immediate effects of local and adjacent acupuncture on the tibialis anterior muscle: a human study

Larissa Araujo Costa1,2 and João Eduardo de Araujo2

1Acupuncture specialization course, Instituto Paulista de Estudos Sistêmicos (IPES), Praça Boaventura Ferreira da Rosa 384, Ribeirão Preto (SP) 14049-900, Brazil

2Laboratory of Bioengineering, Neuropsychobiology and Motor Behavior, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine – University of São Paulo, Ribeirão Preto (USP-RP), Avenida dos Bandeirantes 3900, Ribeirão Preto (SP) 14049-900, Brazil

This study compares the immediate effects of local and adjacent acupuncture on the tibialis anterior muscle and the amount of force generated or strength in Kilogram Force (KGF) evaluated by a surface electromyography.

Methods

The study consisted of a single blinded trial of 30 subjects assigned to two groups: local acupoint (ST36) and adjacent acupoint (SP9). Bipolar surface electrodes were placed on the tibialis anterior muscle, while a force transducer was attached to the foot of the subject and to the floor. An electromyograph (EMG) connected to a computer registered the KGF and root mean square (RMS) before and after acupuncture at maximum isometric contraction. The RMS values and surface electrodes were analyzed with Student's t-test.

Results

Thirty subjects were selected from a total of 56 volunteers according to specific inclusion and exclusion criteria and were assigned to one of the two groups for acupuncture. A significant decrease in the RMS values was observed in both ST36 (t = -3.80, P = 0,001) and SP9 (t = 6.24, P = 0.001) groups after acupuncture. There was a decrease in force in the ST36 group after acupuncture (t = -2.98, P = 0.006). The RMS values did not have a significant difference (t = 0.36, P = 0.71); however, there was a significant decrease in strength after acupuncture in the ST36 group compared to the SP9 group (t = 2.51, P = 0.01). No adverse events were found.

Conclusion

Acupuncture at the local acupoint ST36 or adjacent acupoints SP9 reduced the tibialis anterior electromyography muscle activity. However, acupuncture at SP9 did not decrease muscle strength while acupuncture at ST36 did.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615752/?tool=pmcentrez&report=abstract

References

Ernst E, Lee MH. Sympathetic effects of manual and electrical acupuncture of the tsusanli knee point: comparison with the hoku hand point sympathetic effects. Exp Neurol Oct 1986;94(1):1-10.

Fang Z. Arthralgia treated by acupuncture within "chifu" area. J Tradit Chin Med Sep 1999;19(3):207-9.

Jensen R, Gothesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med Dec 1999;5(6):521-7.

Myhal D, Lebel E, Leung CY, Camerlain M. Radioisotope study of the effect of acupuncture on the articular vascularization of the knee. Union Med Can Dec 1981;110(12):1046-8. French.

Shafshak TS. Electroacupuncture and exercise in body weight reduction and their application in rehabilitating patients with knee osteoarthritis. Am J Chin Med 1995;23(1):15-25.

Wu ZM, Chen CG. Treatment of hydrarthrosis of the knee with manual manipulation and herbs. J Tradit Chin Med Dec 1998;8(4):251-3.

Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct 1999;27(3-4):133-40.

Zhang WB, Aukland K, Lund T, Wiig H. Distribution of interstitial fluid pressure and fluid volumes in hind-limb skin of rats: relation to meridians? Clin Physiol May 2000;20(3):242-9.

Knee Pain

3. From Castanet, a Canadian newspaper, comes an article on the use of acupuncture for knee problems.

Acupuncture Extraordinarily Helpful for Vertigo and Dizziness

Many patients seek our help in resolving vertigo, both for acute or chronic symptoms, as well as from a variety of causes. Dizziness tend to respond very well to acupuncture and herbal intervention and clients are usually delighted with their progress.

There are many studies which demonstrate the utility of our strategy including this recent study which found that acupuncture,

. . . conclusively demonstrates that the application of acupuncture to [named acupuncture points] results in immediate reductions in discomfort and improvements of VAS for dizziness and vertigo. The researchers note that the “study provided clinical evidence on the efficacy and safety of acupuncture to treat dizziness and vertigo in (the) emergency department.

Another study found that treating clients for their dizziness led to dramatic improvements in cervical blood flow to the brain:

Researchers made an interesting discovery during the study. Two phenomena occurred simultaneously as a result of acupuncture treatments. Vertigo decreased and blood supply to the vertebral arteries improved significantly.

Study Demonstrates Acupuncture's Efficacy with Coma Patients

Though not routinely seen in American acupuncture clinics, working with unconscious patients, including those in a coma, is something that practitioners are taught in school and familiar with. I post the study below largely because we do frequently see brain injury, strokes and neurologic problems which respond similarly well.

A recent study, which can be read here, found that,

Acupuncture improves the time it takes to regain consciousness from a coma after a severe brain injury.

Irritable Bowel Syndrome Well Treated by Acupuncture and Chinese Medicine

Irritable Bowel Syndrome (IBS) is extraordinarily well treated by acupuncture and traditional Chinese medicine (TCM) and is something that we see at the clinic almost every day. IBS is a functional bowel disorder characterized by chronic or episodic abdominal pain, bloating, and alteration of bowel habits in the absence of any detectable organic cause. Diarrhea or constipation may predominate, or they may alternate. IBS may begin after an infection, a stressful life event, or even without any other medical triggers.

Like most conditions that we treat, irritable bowel syndrome is differentiated according to how it presents in the individual patient and the rest of the person's constitution. As such, each individual will receive a tailored treatment approach.

 Research and Articles 

• An analysis of seven studies on irritable bowel syndrome may be found here, though the consensus from the research was:

Acupuncture and moxibustion alleviate irritable bowel syndrome (IBS). Research confirms that acupuncture and moxibustion significantly reduce abdominal pain, diarrhea, and the ratio of abnormal stools. The research was conducted on patients with IBS-D, a type of irritable bowel syndrome characterized by insidious attacks of diarrhea. The total effective rate was 96.7% with many patients experiencing a complete recovery with no relapses.

• Columbia University published a study which looked at the treatment of IBS with acupuncture, viewable here, which demonstrated that:

After 4 weeks of twice-weekly acupuncture/moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.

• A Chinese medical study, which can be read here, compared a western medical treatment with acupuncture for IBS and found that:

Acupuncture at [the acupuncture points] Tianshu (ST 25) and Dachangshu (BL 25) may remarkably relieve the clinical symptoms of IBS and its efficacy is superior to that of oral medication with trimebutine maleate.

• A research report from the Hong Kong Department of Digestive Health found that:

Electro acupuncture attenuates visceral hyperlagesia through down-regulation of central serotonergic activities in the brain-gut axis.

 From a practical perspective, this means that electro-acupuncture reduces the urgency of IBS in patients.

• The Nanjing Medical School published a study which evaluated the use of acupuncture in managing the chronic constipation which can be associated with one type of constipation. In the conclusion of the study the researchers found that:

The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation and PAC-QOL were obviously improved after treatment . . . The effect of acupuncture for CFC with exact etiology, disease location and classification diagnosis is definite, but different dynamic mechanism has different effect. 

• One of the most famous studies of traditional Chinese herbs for IBS was published in the Journal of the American Medical Association (JAMA) and can be read here. The study found that:

Compared with patients in the placebo group, patients in the active treatment groups had significant improvement in bowel symptom scores as rated by patients (P = .03) and by gastroenterologists (P = .001), and significant global improvement as rated by patients (P = .007) and by gastroenterologists (P = .002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P = .03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. Conclusion: Chinese herbal formulations appear to offer improvement.

Alopecia Often Well Treated by Acupuncture and Chinese Medicine

Alopecia is one of the more frustrating disorders for a patient to experience – the loss of patches, broad swatches, or even all the hair on the body [alocepia areata; alopecia totalis; and alopecia univeralis, respectively]. Happily Chinese medicine, using both acupuncture and herbology, can be extraordinarily useful in remedying this problem for most people.

The process of treating this disorder is highly individualized, as is most of what we do in the field of acupuncture and Chinese medicine. The patient is evaluated based, not only on the hair loss pattern, but also on other health history issues and a tailored treatment plan using acupuncture and herbology is created.

Research/Articles

An fascinating overview of a new study which found that acupuncture and herbal medicine were very effective in treating alopecia can be read here. The summary at the end states,

The researchers note that acupuncture is one of the most significant treatment methods in TCM for the treatment of alopecia areata. Research demonstrates that acupuncture promotes blood circulation, especially to the skin. As soon as blood flow increases, nutrient levels at different areas of the skin are replenished to encourage hair growth. Additional research demonstrates that acupuncture regulates the neuroendocrine system and benefits the immune system. The researchers concluded that acupuncture is safe and effective for alopecia areata treatment when it is combined with the Huoxue Shengfa decoction.

From the Journal of Chinese Medicine, published in Britain comes a well written summary of generally accepted protocol for treating various patterns of alopecia. It can be read here.

From the Journal of Acupuncture Science comes a study comparing a commonly prescribed pharmacetical for alopecia with acupuncture. The article, which can be read here, found that, 

Acupuncture is better than medications in the treatment of alopecia areata.