Acupuncture and the musculoskeletal system
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Orthopedic surgeon Dr. John E. Spieker discusses acupuncture benefits at NARFE luncheon - Cape Gazette

Orthopedic surgeon Dr. John E. Spieker discusses acupuncture benefits at NARFE luncheon - Cape Gazette | Acupuncture and the musculoskeletal system | Scoop.it

Local orthopedic surgeon Dr. John E. Spieker told federal retirees that acupuncture “is one more tool in the orthopedist’s toolkit to treat a problem without resorting to surgery.”

He said, “While the effects of acupuncture cannot be completely explained in terms of Western medicine and physiology, the techniques may be appropriate for a wide range of medical conditions, especially musculoskeletal disorders. As an orthopedic surgeon, I commonly see problems that are not amenable to surgical care, and that also do not respond well to traditional conservative treatment measures.”

Spieker, who practices at Orthopaedic Associates of Southern Delaware in Lewes, was the luncheon speaker at the January meeting of the Coastal Sussex Chapter 1690 of National Active and Retired Federal Employees held at 1776 Steakhouse near Rehoboth Beach.

The local Coastal Sussex Chapter 1690 is part of NARFE, a national organization that represents federal employees, retirees, and annuitants, promotes their general welfare, and provides advice and advocacy services with respect to their rights and benefits under federal and state retirement laws and regulations. Any federal retirees interested in joining the Coastal Sussex chapter should email Ron or Carol Weber at rjw98@mchsi.com for information.

Spieker explained that acupuncture was developed over 2,000 years ago in ancient China, and the techniques were brought to France in the early 1900s by George Soulie de Morant, a French diplomat/scholar. He said in the United States, there are currently two major schools teaching medical acupuncture to physicians: the Helms program is affiliated with UCLA and Stanford medical schools, and the other major program is affiliated with Harvard Medical School. He said the use of acupuncture in the United States combines 2,500-plus years of traditional Chinese medicine with Western medical knowledge of disease and physiology.

Spieker said acupuncture treatment is very effective in eliminating discomfort and pain resulting from physiological problems. “It doesn’t fix the problem itself, but it is effective in releasing neural transmitters in the brain and in resetting the thermostat in the brain that senses discomfort or pain,” he said.

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The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient’s Experiences Nested within a Randomised Controlled Trial

The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient’s Experiences Nested within a Randomised Controlled Trial | Acupuncture and the musculoskeletal system | Scoop.it
Introduction The National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a clinically effective treatment for chronic back pain. However, there is insufficient knowledge of what factors contribute to patients’ positive and negative experiences of acupuncture, and how those factors interact in terms of the acceptability of treatment. This study used patient interviews following acupuncture treatment for back pain to identify, understand and describe the elements that contribute or detract from acceptability of treatment. Methods The study used semi-structured interviews. Twelve patients were interviewed using an interview schedule as a sub-study nested within a randomised controlled trial of acupuncture for chronic back pain. The interviews were analysed using thematic analysis. Results and Discussion Three over-arching themes emerged from the analysis. The first entitled facilitators of acceptability contained five subthemes; experience of pain relief, improvements in physical activity, relaxation, psychological benefit, reduced reliance on medication. The second over-arching theme identified barriers to acceptability, which included needle-related discomfort and temporary worsening of symptoms, pressure to continue treatment and financial cost. The third over-arching theme comprised mediators of acceptability, which included pre-treatment mediators such as expectation and previous experience, and treatment-related mediators of time, therapeutic alliance, lifestyle advice and the patient’s active involvement in recovery. These themes inform our understanding of the acceptability of acupuncture to patients with low back pain. Conclusion The acceptability of acupuncture treatment for low back pain is complex and multifaceted. The therapeutic relationship between the practitioner and patient emerged as a strong driver for acceptability, and as a useful vehicle to develop the patients’ self-efficacy in pain management in the longer term. Unpleasant treatment related effects do not necessarily detract from patients’ overall perception of acceptability.
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Minnesota Timberwolves' Shabazz Muhammad enduring needling to keep ankle healthy

Minnesota Timberwolves' Shabazz Muhammad enduring needling to keep ankle healthy | Acupuncture and the musculoskeletal system | Scoop.it
Nursing a sore ankle since late last month, Minnesota's Shabazz Muhammad is undergoing acupuncture to keep him on the court playing.

 

Minneapolis -- Shabazz Muhammad hates needles.

 

So before Timberwolves director of athletic therapy Mark Kyger started pressing some into the left side of his calf, Muhammad stopped him.

"You're certified to do this, right?" the mild-mannered, ultra-aggressive forward asked Kyger. "I don't want you hurting me."

Kyger is, of course, a well-trained physical therapist. And the work he's carried out to alleviate pain in Muhammad's left ankle has kept the second-year pro -- and his team -- afloat lately.

Nursing a sore ankle since late last month, Muhammad is averaging 16.4 points on 52.4 percent shooting and five rebounds in his past seven games. The pain is severe enough that, in a normal situation, he would have sat out the Wolves' games against Houston, San Antonio, Golden State and/or Portland in the past week.

But these are not ordinary times at the Target Center. With five players out due to injury, Minnesota can't afford to lose any more personnel.

So in the needles go. And on goes Muhammad.

"It hurts a lot," he said Friday morning at the team's shootaround. "It's got me screaming sometimes -- well, not screaming, but like, 'ah.'"

       Timberpups Tracker: Dec. 10 edition 

Acupuncture stimulates specific points in the skin as a means of relieving pain. Muhammad, 22, had never had it performed on him before, but says within 24 hours of treatment, his ankle feels somewhat right again.

It tends to wear off or tighten up in the middle of games, he said. In Wednesday's win against Portland, he scored all 11 of his points in the first half.

But he wasn't fully himself, missing a handful of dunks and faltering down the stretch. "I couldn't get that extra . . . lift. I was disappointed. I can't wait till this ankle gets right. It's just sore, though."

An MRI taken Monday afternoon came back negative. Trainers have told Muhammad he can't injure himself any worse by playing.

And when he's at full capacity, he's one of the league's most improved players.

After barely getting off the bench last year under Rick Adelman -- Muhammad averaged 7.8 minutes, 3.9 points and 1.4 rebounds in 37 appearances -- Muhammad has been the top performer among crop of youthful talent, coach and president of basketball operations Flip Saunders said. With a motor that never stops and a slimmed-down body that can run longer and jump higher, Muhammad averages 11 points, 3.4 boards and 17.8 minutes per game in his second NBA campaign.

"He's been our most efficient young player," Saunders said.

And Kyger's work has helped. Muhammad's gone through it four times so far, with hopes more than a one-day break between games will give the ankle time to actually heal. The Wolves host the Lakers this Sunday and travel to Washington, D.C. on Tuesday, so rest will continue to come at a premium.

"Hopefully, we can string up a couple days where we can get off, but right now, I'm just trying to show that I can play despite injury," Muhammad said. "That takes a great mindset to do."

Follow Phil Ervin on Twitter

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Rehabilitation of proximal hamstring tendinopathy including acupuncture - PubMed - NCBI

Rehabilitation of proximal hamstring tendinopathy including acupuncture - PubMed - NCBI | Acupuncture and the musculoskeletal system | Scoop.it
J Orthop Sports Phys Ther. 2014 Mar;44(3):198-205. doi: 10.2519/jospt.2014.4905. Epub 2013 Nov 21. Case Reports

 

  J Orthop Sports Phys Ther. 2014 Mar;44(3):198-205. doi: 10.2519/jospt.2014.4905. Epub 2013 Nov 21.Rehabilitation of proximal hamstring tendinopathy utilizing eccentric training, lumbopelvic stabilization, and trigger point dry needling: 2 case reports.Jayaseelan DJ1, Moats N, Ricardo CR.Author information AbstractSTUDY DESIGN:

Case report.

BACKGROUND:

Proximal hamstring tendinopathy is a relatively uncommon overuse injury seen in runners. In contrast to the significant amount of literature guiding the evaluation and treatment of hamstring strains, there is little literature about the physical therapy management of proximal hamstring tendinopathy, other than the general recommendations to increase strength and flexibility.

CASE DESCRIPTION:

Two runners were treated in physical therapy for proximal hamstring tendinopathy. Each presented with buttock pain with running and sitting, as well as tenderness to palpation at the ischial tuberosity. Each patient was prescribed a specific exercise program focusing on eccentric loading of the hamstrings and lumbopelvic stabilization exercises. Trigger point dry needling was also used with both runners to facilitate improved joint motion and to decrease pain.

OUTCOMES:

Both patients were treated in 8 to 9 visits over 8 to 10 weeks. Clinically significant improvements were seen in pain, tenderness, and function in each case. Each patient returned to running and sitting without symptoms.

DISCUSSION:

Proximal hamstring tendinopathy can be difficult to treat. In these 2 runners, eccentric loading of the hamstrings, lumbopelvic stabilization exercises, and trigger point dry needling provided short- and long-term pain reduction and functional benefits. Further research is needed to determine the effectiveness of this cluster of interventions for this condition.

LEVEL OF EVIDENCE:

Therapy, level 4.

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Episode 1, Series 2, Trust Me, I'm A Doctor - Can acupuncture be a painkiller? - BBC Two

Episode 1, Series 2, Trust Me, I'm A Doctor - Can acupuncture be a painkiller? - BBC Two | Acupuncture and the musculoskeletal system | Scoop.it

 

 

Dr Saleyha Ahsan investigates why a form of acupuncture is now available on the NHS for some kinds of pain relief.

Medical acupuncture (based on the traditional Chinese medical practice) is becoming increasingly popular and is available on the NHS for chronic lower back pain, chronic tension-type headaches and migraines. Health professionals, from physiotherapists to GPs, are being trained in how to administer medical acupuncture for a range of conditions and in some hospitals it’s even offered as a form of pain relief for women in labour. But what’s the evidence that it’s effective?

Saleyha visits the University of York’s Neuroimaging Centre, where she receives acupuncture while lying inside an fMRI scanner. The scanner measures what is going on inside her brain whilst acupuncture needles are inserted into her hand by Prof Hugh Macpherson, who has been carrying out this procedure on volunteers as part of a trial.

Saleyha’s brain scan, like those of Prof MacPherson’s other subjects, shows a deactivation (measured by a decrease in blood flow) in the limbic system inside the brain. The limbic system, known as the pain matrix, is the part of the brain believed to be responsible for the perception of pain.

Instead of stimulating the perception of pain, as you may expect, having needles stuck in her hand has appeared to reduce the activity of the pain matrix. It’s evidence of an effect that might explain how acupuncture could work as a painkiller, although it’s not evidence as to why it can cause this decrease in the pain matrix.

It’s possible that the needles may stimulate the nervous system to release neurotransmitters involved in pain-suppressing mechanisms – but it’s also possible that the changes in the brain are due to the placebo effect where the mere expectation that something will relieve pain results in a reduction in pain.

Whatever the mechanism, though, it does seem that acupuncture can be as effective a painkiller as some traditional pain 


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Tennis elbow the complementary way - with acupuncture

Tennis elbow the complementary way - with acupuncture | Acupuncture and the musculoskeletal system | Scoop.it
  Apply acupuncture  for tennis elbow
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More Americans using acupuncture for common ailments

More Americans using acupuncture for common ailments | Acupuncture and the musculoskeletal system | Scoop.it

Americans are using acupuncture more to provide relief from pain and common ailments, according to a new survey

More Americans using acupuncture for common ailments

By Dr. David B. Samadi

Published May 15, 2012FoxNews.comFacebook323 Twitter153 livefyre0 Email Print

Acupuncture: Risks and benefits

  

A new survey demonstrates increasing acceptance and utilization of acupuncture for treatment and health promotion. The analysis was published in the journalEvidence-Based Complementary and Alternative Medicine and looked at utilization rates, demographics and reasons for using acupuncture. Overall, the researchers found that between 2002 and 2007 there was a significant increase in the number of patients using acupuncture.

The study is based on results of the 2007 National Health Interview Survey, a series of questionnaires prepared and collected by the U.S. Census Bureau. For over 50 years, the survey has monitored the health of the nation and tracked health status and health care access. In 2007, over 29,000 households responded, totaling more than 75,000 individual responses.

Overall, the study found that six percent of Americans are using or have used acupuncture as part of their health care — over 14 million users, up from 8 million in 2002. The growth is remarkable considering that less than one percent of the population reported trying acupuncture in the last two decades.

While traditionally, acupuncture has been used as a complementary or alternative treatment, this report uncovered a growing population of people using acupuncture to promote general health.  

Acupuncture dates back more than 2,500 years to Chinese doctors who believed that illness was due to imbalances in energy. Acupuncture was thought to stimulate the body’s meridians, or energy-carrying channels, to correct these imbalances and restore health. Some doctors believe that these benefits are derived from the proximity of acupoints with nerves. Stimulation of these points causes nearby nerves to release signal molecules, called endorphins. Endorphins are well known to suppress the sensation of pain.

Pain control is a widely accepted use for acupuncture.  The practice was first introduced to the United States in the 1970s following President Nixon’s visit to China. As part of the visit, the President toured medical facilities, where acupuncture was widely used. During the trip, one of the reporters required an emergency surgery and received acupuncture for post-operative pain. He found the treatment very effective and wrote about his experience upon arriving home.

In addition to post-operative pain, acupuncture has been used to treat an array of ailments ranging from headaches and chemotherapy-induced nausea to joint pain. In fact, the American College of Rheumatology, a major organization for medical professionals that treat arthritis and other musculoskeletal diseases, endorses the use of acupuncture for chronic pain.

If you are considering acupuncture, it is essential to find a reliable and qualified practitioner. Check with your physician to see if acupuncture is right for you based on your medical history and to see if he or she can refer you to a specific practice. This is especially important given that fact that needles are used.

It is important to keep in mind that most treatments take time before experiencing results, so allow for a few appointments before deciding if acupuncture works for you. Some insurance companies will pay for acupuncture, so consult your provider to see if you are covered.

Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. He is a board-certified urologist, specializing in the diagnosis and treatment of urological disease, with a focus on robotic prostate cancer treatments. To learn more please visit his websites RoboticOncology.com and SMART-surgery.com. Find Dr. Samadi on Facebook.

 


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Acupuncture and moxibustion for stress-related disorders - "good for musculoskeletal symptoms" ... "effect on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the wh...

Acupuncture and moxibustion for stress-related disorders - "good for musculoskeletal symptoms" ... "effect on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the wh... | Acupuncture and the musculoskeletal system | Scoop.it

Acupuncture and moxibustion for stress-related disorders

Tetsuya Kondo and Masazumi Kawamoto

Additional article information

Abstract

Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally.

 

This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders.

 

The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy.

 

Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.

 

Keywords: Acupuncture, Moxibustion, Stress, Fibromyalgia, Functional gastrointestinal disorder, Irritable bowel syndrome, Autonomic nervous system, Hypothalamo-pituitary adrenal axis, Sawada-style holistic therapy


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Olympic Gold Medalist Talks Acupuncture - YouTube

Daniel Kowalski, Olympic Gold, Silver and Bronze medalist in swimming, discusses the benefits of Japanese Acupuncture in keeping his troublesome shoulders fu...

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Acupuncture's painkilling secret revealed: it's all in the twist action

Acupuncture's painkilling secret revealed: it's all in the twist action | Acupuncture and the musculoskeletal system | Scoop.it

Twist of a needle damages cells and triggers release of anti-inflammatory chemical adenosine, US scientists find

Ian Sample, science correspondentThe Guardian, Monday 31 May 2010Acupuncture 'meridians' match main nerve pathways, scientists believe. Photograph: Getty Images/Getty

Ever since Chinese doctors first poked their patients with sharp objects 4,000 years ago, and charged them for the pleasure, acupuncture has been shrouded in mystery.

Tradition has it that the procedure works by improving the flow of "qi" along invisible energy channels called meridians, but research published today points to a less mystical explanation for the painkilling claims of acupuncture.

The answer, according to a team of scientists in New York, follows an extraordinary study in which researchers gave regular acupuncture sessions to mice with sore paws.

After each half-hour session the mice felt less discomfort in their paws because the needles triggered the release of a natural painkiller, the researchers say. The needles caused tissue damage that stimulated cells to produce adenosine, an anti-inflammatory chemical, that was effective for up to an hour after the therapy was over.

Modern acupuncture involves inserting fine needles into the skin at specific points around the body. The needles are pushed in a few centimetres, and then heated, twisted or even electrified to produce their claimed medical effects.

Acupuncture has spread around the world since originating in China but conventional western medicine has remained steadfastly sceptical. Although there is now good evidence that acupuncture can relieve pain, many of the other health benefits acupuncturists claim are on shakier ground.

The latest research gives doctors a sound explanation of how sticking needles into the skin can alleviate, rather than exacerbate, pain. The discovery will challenge the view , widely held among scientists, that any benefits a patient feels after acupuncture are due purely to the placebo effect.

"The view that acupuncture has little benefit beyond the placebo effect has really hampered research into the technique," said Maiken Nedergaard, a neuroscientist at the University of Rochester medical centre in New York state, who led the study.

"Some people think any work in this area is junk research, but I think that's wrong. I was really surprised at the arrogance of some of my colleagues. We can benefit from what has been learned over many thousands of years," Nedergaard said.

"I believe we've found the main mechanism by which acupuncture relieves pain. Adenosine is a very potent anti-inflammatory compound and most chronic pain is caused by inflammation."

The scientists gave each mouse a sore paw by injecting it with an inflammatory chemical. Half of the mice lacked a gene that is needed to make adenosine receptors, which are found on major nerves.

The therapy session involved inserting a fine needle into an acupuncture point in the knee above each mouse's sore foot. In keeping with traditional practice, the needles were rotated periodically throughout the half-hour session.

To measure how effective the acupuncture was, the researchers recorded how quickly each mouse pulled its sore paw away from a small bristly brush. The more pain the mice were in, the faster they pulled away.

Writing in the journal, Nature Neuroscience, Nedergaard's team describe how acupuncture reduced pain by two-thirds in normal mice, but had no effect on the discomfort of mice that lacked the adenosine receptor gene. Without adenosine receptors, the mice were unable to respond to the adenosine released when cells were damaged by acupuncture needles.

Acupuncture had no effect in either group of mice if the needles were not rotated, suggesting that the tissues had to be physically damaged to release adenosine.

Nedergaard said that twisting the needles seems to cause enough damage to make cells release the painkilling chemical. This is then picked up by adenosine receptors on nearby nerves, which react by damping down pain. Further tests on the mice revealed that levels of adenosine surged 24-fold in the tissues around the acupuncture needles during and immediately after each session.

One of the longstanding mysteries surrounding acupuncture is why the technique only seems to alleviate pain if needles are inserted at specific points. Nedergaard believes that most of these acupuncture points are along major nerve tracks, and as such are parts of the body that have plenty of adenosine receptors.

In a final experiment, Nedergaard's team injected mice with a cancer drug that made it harder to remove adenosine from their tissues. The drug, called deoxycoformycin, boosted the effects of acupuncture dramatically, more than tripling how long the pain relief lasted.

"There is an attitude among some researchers that studying alternative medicine is unfashionable," said Nedergaard. "Because it has not been understood completely, many people have remained sceptical."

Although the study explains how acupuncture can alleviate pain, it sheds no light on the other health benefits that some practitioners believe the procedure can achieve.

Josephine Briggs, the director of the national centre for complementary and alternative medicine at the US National Institutes of Health, said: "It's clear that acupuncture may activate a number of different mechanisms … It's an interesting contribution to our growing understanding of the complex intervention which is acupuncture."


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#Acupuncture for pain and inflammation:... - Shaftesbury Clinic | Facebook

#Acupuncture for pain and inflammation: now you can see the improvement as well as feel it.
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Trial to test laser acupuncture treatment for osteoarthritis

Trial to test laser acupuncture treatment for osteoarthritis | Acupuncture and the musculoskeletal system | Scoop.it
(PhysOrg.com) -- The potential for laser acupuncture to provide painless and effective treatment for osteoarthritis knee pain is being put to the test in a clinical trial beginning in Sydney.
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Can Acupuncture Help Treat Your Running Injury? - Competitor.com

Can Acupuncture Help Treat Your Running Injury? - Competitor.com | Acupuncture and the musculoskeletal system | Scoop.it
Many athletes use the ancient Chinese therapy to treat their most annoying ailments.

 

Many athletes use the ancient Chinese therapy to treat their most annoying ailments.

The sight of needles can make anyone cringe, but it may be worth a shot to help alleviate an injury.

Marathoner Deena Kastor is among a handful of elite athletes that use acupuncture to treat injuries and reduce the pain and inflammation associated with it. Studies suggest the ancient Chinese therapy can increase circulation and range of motion and accelerate healing time due to its ability to balance the neurological and cardiovascular systems.

How Does It Work?

Patients first fill out a questionnaire about their history. The acupuncturist will then perform a diagnostic test by examining the tongue and pulse, and exploring (by touch) various points on the body.

According to Andrew Castellanos, a licensed acupuncturist at the Stillpoint Wellness Center in San Francisco, acupuncture works by strategically placing needles on pressure points to regulate blood flow to trouble spots via major pathways in the body, thus resulting in relaxed muscles with less swelling, tension and pain. Each needle is connected to an Electrostem valve to deliver currents from one point to another, which increases oxygen flow and delivers white blood cells to the injury.

“Electrostem uses an electrical impulse that contracts and releases muscles. It allows the needles to push fluid out of the [injured] area and deliver blood back to those tissue paths — that lets the muscles relax so the body can heal itself,” Castellanos said.

He adds that the underlying premise lies in our body’s energetic system, which consists of Chi — energy that circulates throughout the body and is responsible for regulating our organs and other processes of the body. “Some theories say the needles trigger the release of endorphins into the brain, which is responsible for the feeling of well-being,” Castellanos said.

RELATED: Alternative Treatments For Running Injuries

The number of treatment sessions, which last about 60 to 90 minutes and range from $60 to $120 per visit, depends on the seriousness of the injury; however, significant improvement can occur after just a few visits.

While acupuncture can be used to treat a number of injuries, it is commonly used for shin splits, muscle pulls, tears or strains, and IT band, hip flexor, glute and quad pain.

Does It Hurt?

Unlike hypodermic needles, which are used for giving an injection, acupuncture needles are hair-thin. Castellanos said that patients associate needle pain with the same pain as receiving an injection, but acupuncture needles are virtually painless.

“The needles are inserted past the skin nerves so there is no pain. If there is any, it would be from the acupuncturist’s thumbs and fingers,” said Castellanos, who suggests the therapy works better than massages, as the needles are able to get to areas where our fingers can’t.

RELATED: 5 DIY Remedies For Plantar Fasciitis

Is It For Everyone?

Acupuncture isn’t for people on blood thinner medication due to the risk of bleeding, and for those who use a pacemaker, as it can interfere with the Electrostem system.


Read more at http://running.competitor.com/2014/01/injury-prevention/can-acupuncture-help-treat-your-running-injury_48747#dBkAHrA5yCLScViJ.99


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Aaron Rodgers Has a Strained Calf, and Everyone Has Advice

Aaron Rodgers Has a Strained Calf, and Everyone Has Advice | Acupuncture and the musculoskeletal system | Scoop.it
Rodgers’s injury diminishes his mobility as quarterback but has not hurt his effectiveness. That has not stopped Packers fans from offering their help.

 

He has been using acupuncture for the injury

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Could acupuncture be the solution to our 'couch potato' inflicted back pain?

Could acupuncture be the solution to our 'couch potato' inflicted back pain? | Acupuncture and the musculoskeletal system | Scoop.it

Could acupuncture be the solution to our 'couch potato' inflicted back pain?

SLOUCHING, eating on your lap and peering at a computer screen - sound familiar? Sedentary lifestyles contribute to millions of adults suffering with back pain, but could the ancient Chinese method of acupuncture be a simple solution to the problem?Published: 11:07, Wed, February 26, 2014By SOPHIE ALEXANDER
 

  Acupuncture could provide relief to millions of back pain sufferers [GETTY: Pic posed by model]

 

A culture of watching TV in bed, slouching at a desk and eating on our laps contributes to more than half of all adults suffering with back pain.

Laziness and sedentary office lifestyles mean that, while 80 per cent of people are in constant pain, many also admit to the "coach potato" behaviour some experts believe is at the root of the problem.

A new study carried out on 5,000 adults found that almost half eat on their laps, 40 per cent sit at a desk all day and almost a third admit to slouching.

Most suffers admit they try to self-medicate with painkillers rather than visiting a doctor to find the actual cause of the pain.

Simple lifestyle changes alongside acupuncture could save millions of people taking medication every day

Rhiannon Griffiths, the British Acupuncture Council

One relatively unrecognised method to dealing with back pain is acupuncture, which some believe could save millions of us from relying on painkillers.

Rhiannon Griffiths, a qualified member of the British Acupuncture Council, commented: “Painkillers often numb the end symptom and mask the problem but do not  address many of the combined underlying causes of back pain.

  Slouching over a computer screen is a contributing factor to back pain [GETTY: Pic posed by model]

 

"By stimulating different points of the body, traditional acupuncture can be extremely beneficial for back pain, providing long-term pain relief and reducing inflammation.”

The treatment involves placing extremely fine, sterile needles painlessly at specific points on the body to trigger a healing response. It has been used by the Chinese for almost 2,000 years and is one of the most popular complementary therapies practised in the UK.

Many sufferers remain unaware that the National Institute of Clinical Excellence (NICE) recommends acupuncture for persistent, non-specific back pain.

Rhiannon added: "Simple lifestyle changes alongside acupuncture could save millions of people taking medication every day.

"It's important to recognise the impact our behaviour has on our bodies and to make sure we are fully informed about all treatment options to promote long-term health and wellbeing."

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Health: Take the pain out of a frozen shoulder - includes acupuncture

Health: Take the pain out of a frozen shoulder - includes acupuncture | Acupuncture and the musculoskeletal system | Scoop.it
Health: Take the pain out of a frozen shoulder

 

Health: Take the pain out of a frozen shoulder

By SARAH STACEY FOR THE MAIL ON SUNDAY

 

 

 

Q After eight months of pain and immobility, my partner, 45, who’s a carpenter, has been diagnosed with a frozen shoulder. Is there anything that might help?

A A true frozen shoulder is stuck in an immobile position and cannot be lifted above the horizontal. It always starts with stiffness and pain, often disturbing sleep. The initial partial restriction of movement gradually progresses to complete immobility – by this point, the pain often subsides. The cause is usually lifting, pulling, stretching or some repetitive action, says consultant rheumatologist Dr Rodney Hughes of St Peter’s Hospital in Surrey.  

A frozen shoulder will eventually resolve itself, but this can take from 12 to 24 months. Surgery, in which the surgeon forcibly moves the shoulder under anaesthetic, causing muscle tears, is reserved for extreme cases.

There are ways of helping the process. Although your partner has left it too late for some options, other readers may be able to act more promptly.

Consult your GP as early as possible. Dr Hughes suggests treating any pain with anti-inflammatory painkillers such as ibuprofen, as long as they don’t upset the stomach or worsen asthma. (Never take such products on an empty stomach.) Alternatively, paracetamol may help.

A standard X-ray is always advisable, to ensure there is no underlying shoulder damage. In the case of a true frozen shoulder, it will be normal. MRI scans are usually unnecessary. 

If the shoulder is treated early with a steroid injection, by an experienced practitioner, it can bring considerable relief and stop the loss of movement, says Dr Hughes. When severe movement loss has occurred, joint injections help less and can aggravate the pain.

Daily rosehip supplements may help, says Dr Hughes. Research suggests that extract of rosehip, which contains an omega-6-like fatty acid called GOPO, can relieve inflammation and help pain, without the side effects of conventional painkillers. Try Litozin Joint Health Sachets (£20.42 for 20, from Victoria Health, tel: 0800 3898 195, victoriahealth.com).

Complementary therapies may be beneficial.  Acupuncture is good for muscle spasms and has anecdotally relieved shoulder pain. (For qualified practitioners, visit acupuncture.org.uk.) Magnesium helps to relax muscles and nerves and has been beneficial for similar problems: try Magnesium Oil Joint Spray (£12.30, from Victoria Health, see above). 

Also try hot compresses. A towel soaked in hot water, wrung out and wrapped over the area is soothing.

 

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Acupuncture in patients with osteoarthritis of the knee: a randomised trial : The Lancet

Acupuncture in patients with osteoarthritis of the knee: a randomised trial : The Lancet | Acupuncture and the musculoskeletal system | Scoop.it

The Lancet, Volume 366, Issue 9480, Pages 136 - 143, 9 July 2005<Previous Article|Next Article>doi:10.1016/S0140-6736(05)66871-7Cite or Link Using DOI Copyright © 2005 Elsevier Ltd All rights reserved.Acupuncture in patients with osteoarthritis of the knee: a randomised trialDr C Witt MD a , B Brinkhaus MD a, S Jena MSc a, K Linde MD c, A Streng PhD c, S Wagenpfeil PhD d, J Hummelsberger MD f,HU Walther MD b, D Melchart MD c e, Prof SN Willich MD aSummaryBackgroundAcupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee.MethodsPatients with chronic osteoarthritis of the knee (Kellgren grade ≤2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat.Results294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26·9 (SE 1·4) in the acupuncture group, 35·8 (1·9) in the minimal acupuncture group, and 49·6 (2·0) in the waiting list group (treatment difference acupuncturevs minimal acupuncture −8·8, [95% CI −13·5 to −4·2], p=0·0002; acupuncture vs waiting list −22·7 [−27·5 to −17·9], p<0·0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0·08).InterpretationAfter 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.

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Should acupuncture be regulated?

Should acupuncture be regulated? | Acupuncture and the musculoskeletal system | Scoop.it

 

Being stuck with needles is more popular than ever as the injured turn to alternative medicines for a cure for what ails them.

The Accident Compensation Corporation (ACC) paid out almost $2 million for acupuncture treatment in Canterbury last financial year and more than $23 million nationwide.

The Ministry of Health does not, however, recognise acupuncture as a registered medical profession.

New Zealand Chinese Medicine and Acupuncture Society president Stephen Xu says patients are at risk without proper ministry regulation. He says practitioners should have a level seven national diploma or a bachelor of acupuncture degree.

While ACC regulates the treatment providers it approves, Xu says ministry regulation is essential for patient security and industry standards.

Xu estimates acupuncturists have been operating in New Zealand for more than 100 years and ACC recognised acupuncture treatment in 1990.

Last year it paid out on 4816 claims in Canterbury with an average cost per claim of $395. More than 150 practitioners were visited by claimants.

Football goalkeeper Andrew Reid, 18, has torn ligaments in his knee twice in the last four years.

He first received acupuncture treatment in 2010, aged 14. The first appointment was stressful, as the treatment involves inserting fine needles into the body at various trigger points.

"I was really nervous at the start because I thought it would hurt," he said. "But in the end, it just felt a bit weird.

"Once you get over the fact that it's needles, it's not so bad. Basically you just have to be very relaxed when you go in there. It helped a lot."

He has had the treatment three times over the last few years.

A ministry spokesman said while acupuncture was not yet a registered medical profession, investigations were underway to see if it could be included. However, results would not be out until next year some time.

"There is a real public risk for people using acupuncture if there is no regulation in place."


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NHS Commissioning: Pinpointing the need for acupuncture

NHS Commissioning: Pinpointing the need for acupuncture | Acupuncture and the musculoskeletal system | Scoop.it

SPENDING on ancient pain-healing treatment has risen by more than a third in Nottingham in the past four years.

The NHS Nottingham City Clinical Commissioning Group (CCG), which buys and plans health services, spent almost £505,000 on acupuncture therapy in the 2013-14 financial year – £145,000 more than in 2010-11.

The treatment, which derives from ancient Chinese medicine, involves inserting fine needles into certain parts of the body to ease pain.

City GPs and specialist clinics said it had become increasingly popular for patients suffering from problems such as chronic backaches and migraines.

Dr Peter Holden, chairman of the British Medical Association in the East Midlands, said: "There's no question that acupuncture does work in the right patients and some of the reasons for the increasing bill is because we have better access to logical pain management clinics. GPs can't just refer someone to acupuncture – we refer them to a clinic, which suggests ways forward.

"It's not that people are now 'wasting' money on alternative medicine – acupuncture has a proven place and there's sound physiology in the way it works."

In the past, sceptics have dismissed it as a myth relying on the placebo effect.

But the treatment has been approved by the National Institute for Health and Care Excellence, though only for chronic lower back pain, chronic tension headaches and migraines, claiming it has scientific evidence.

Dr Arun Tangri, a GP at Riverlyn Medical Centre in Bulwell and GP clinical lead for the city's CCG, said it had carried out a large public consultation, with patients "overwhelmingly" in favour of continuing acupuncture services.

He added: "It can be good because it means people are using less medicine like ibruprofen and co-codamol, which can have long-term side effects, such as damaging kidneys and the liver. People are requesting it more, which is probably because they are getting benefits from it."

Sue Hayes, owner of Riverside Natural Health Centre, at Trent Bridge, said about 10 patients each week had acupuncture at her clinic.

She said: "It's proving to be a popular alternative medicine. I think people are looking in general to other avenues for treatments and don't want to just stay on conventional medicine.

"A lot of people are looking for a more natural and holistic therapy."



Read more: http://www.nottinghampost.com/Pinpointing-need-acupuncture/story-23249765-detail/story.html#ixzz3I2G5f9JJ&nbsp;
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Acupuncture: a GP's view

Acupuncture: a GP's view | Acupuncture and the musculoskeletal system | Scoop.it
Acupuncture: a GP's view

Dr Helen Stokes-Lampard, a GP in Staffordshire and a senior lecturer at Birmingham University, on the issue of prescribing acupuncturetheguardian.com, Monday 29 July 2013 12.36 BST

Dr Helen Stokes-Lampard: 'Some people respond and some do not respond, and it is important people know that before they start.'

Do you prescribe acupuncture?

I don't prescribe it per se, but I refer patients for a physiotherapist assessment with the expectation that acupuncture will be offered to them. I can't refer directly via the NHS provision in my area, and it's variable across the UK. It's available in a limited way and is usually accessed via chronic pain clinics or some physiotherapists.

What for?

The only recommendation we've got at the moment is to refer patients with lower back pain. There are certainly some pain clinics that use it for all other forms of chronic pain. That said, many of my patients ask my advice because they're contemplating trying a course of acupuncture privately for other problems.

Would colleagues prescribe more readily than yourself?

A lot of doctors think it's worth giving acupuncture a go for any sort of chronic pain but the evidence base isn't there for anything outside of pain management. You'll find GPs who practise acupuncture themselves, for all manner of things, but conversely a lot of GPs are more wary than I am of referring patients for accupuncture.

Have you always prescribed it?

No, it was not available a decade ago. Certainly over the past 10 years there's been more use of acupuncture for lower back pain. It's been available for seven or eight years in my area, I think, but only in a limited way. Because it's a grey area in medicine, provision is ad hoc across the UK. The Nice guidelines have given more support for people who want to get acupuncture but more patients are turned away than I would like.

Do you think it has an effect beyond placebo?

Yes, I do believe there is a benefit beyond that of the placebo effect. I have seen positive effects in some of my patients which support the findings of clinical trials that Nice used in making its recommendation. Not in everybody, however. Some people respond and some do not respond, and it is important people know that before they start.

Is there anything wrong with prescribing it merely as a placebo?

If all you will achieve is the placebo effect, then it's a very expensive way of getting it. We have to be fair to all patients, so to offer expensive treatments that don't have benefit is not a fair use of NHS resources. However, you can't tell for an individual patient whether it's placebo effect or a genuine effect. Homeopathic treatments are usually a placebo and I don't prescribe them, even though some people think they are beneficial.


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Acupuncture for Fibromyalgia and Chronic Fatigue Syndrome, including the research base

Acupuncture for Fibromyalgia and Chronic Fatigue Syndrome, including the research base | Acupuncture and the musculoskeletal system | Scoop.it

Acupuncture treatments for fibromyalgia(FMS) and chronic fatigue syndrome (CFS orME/CFS) are becoming much more common, either alone or as a complementary therapy.

Chinese acupuncture dates back thousands of years as traditional Chinese medicine (TCM) but only caught the attention of the American public in the 1970s. The National Institutes of Health formally recognized acupuncture as part of mainstream medicine in 1997, saying the procedure is safe and effective at treating a wide range of conditions, including fibromyalgia.

 

The Research

Multiple studies from both the East and the West suggest that acupuncture is effective for treating FMS. In the West, it hasn't been studied as much for ME/CFS, but many Chinese studies suggest it's effective for that condition. Meta analyses of acupuncture for both conditions conclude that it appears to be a beneficial treatment, but that further high-quality research is needed.

As acupuncture has moved more into the mainstream, many insurance companies have added it to their policies, and some doctor's offices and clinics have begun to offer it at their facilities. Make sure you know the details of your insurance policy before assuming it will cover acupuncture treatments.

How Does Acupuncture Work?

While multiple studies have shown that acupuncture does have the effects taught by TCM, researchers can't pinpoint exactly why it has the effects. Research suggests that it may produce complex changes in the brain and body, possibly by stimulating nerve fibers that then send signals to the brain and spinal cord to release certain hormones that block pain and makes you feel better. A study using images of the brain showed that acupuncture raises your pain threshold -- which is low in people with FMS and ME/CFS -- and therefore gives you long-term pain relief. One British experiment using magnetoencephalography (MEG) brain scans showed that acupuncture actually can deactivate part of your brain's pain matrix.

 

 

According to TCM, acupuncture works by correcting energy pathways through your body. This life-force energy is called qi or chi (pronounced "chee"). Qi flows through meridians in the body, each of which corresponds to an organ or group of organs. If you have too much, too little, or blocked qi, TCM teaches that it will create health problems.

If this is hard to understand, picture a stream. If something blocks the flow of water, pressure builds up behind the blockage and water can go spilling out over the banks. Too much water can lead to floods, while too little water can kill off plants and animals that live there. The purpose of acupuncture is to keep the stream flowing free and at desired amounts.

Benefits vs. Risks

When you consider treatment options for FMS and ME/CFS, or any health condition for that matter, it's important to weigh the potential benefits against the potential risks.

According to experts, both Eastern and Western, the potential benefits of acupuncture include:

Less painBetter sleepRelaxationPossible immune system boostBetter overall health

Research released in 2008 showed that after 20 acupuncture treatments, people with FMS had significant improvements in pain and quality of life that lasted for 3 months after treatment was stopped, with a gradual decline in those areas until all benefit was gone after 2 years.

Acupuncture can be much safer than other therapies, especially if you're combining several different treatments. Benefits as a complementary therapy include:

No negative interactions with other treatments, including drugsExtremely mild side effectsLow risk

Possible risks of acupuncture are extremely rare, especially with a licensed acupuncturist. Risks include:

Infection from non-sterile needlesOrgan puncture (very rare occurrence)NauseaDizziness & faintingBruising

Licensed practitioners in the United States are required to use sterile needles and dispose of them after each use, but this is not required in all parts of the world.

An Acupuncture Exam

When you go to an acupuncturist, he/she will likely take your pulse at several points along both wrists. Don't be surprised if you're asked to stick out your tongue; in TCM, the tongue's shape, color and coating are important diagnostic tools.

The needles only go in about a centimeter. After inserting them, the acupuncturist will twist or gently wiggle them to get them firmly into the proper point. You might get a muscle twitch or brief ache, or you might feel nothing at all. Once all the needles are in (the amount used varies), you'll stay in place and rest for anywhere from 15 minutes to an hour. You'll probably be extremely relaxed and could even fall asleep. Afterward, the acupuncturist will pluck out the needles, which doesn't hurt at all.

A few hours after your first treatment, you could feel some aches around your body. This is normal, and practitioners say it's a sign that the treatment is working. The aches don't typically last long, and over-the-counter pain relievers will help. It's common to sleep more deeply than usual that night, which is a definite bonus for anyone with FMS and ME/CFS.


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#Acupuncture offers low-cost alternative to #knee surgery for #osteoarthritis, finds research. Savings to #NHS

#Acupuncture offers low-cost alternative to #knee surgery for #osteoarthritis, finds research. Savings to #NHS | Acupuncture and the musculoskeletal system | Scoop.it
Acupuncture can relieve the pain of knee osteoarthritis and offer a low-cost alternative to surgery for the condition, new research finds.

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Acupuncture: Thermal Imagery Using Moxibustion Shows the Existence of the Jinglo

Thermal Imagery Using Moxibustion Shows the
Existence of the Jinglou
By Attilio D'Alberto
Recent research conducted by Schlebusch, Maric-Oehler and Popp (2005) is
a major breakthrough in the long standing hunt for the existence of the
Jinglou. Previous research studies concentrated their efforts on finding the
meridian system using acupuncture. None were able to conclusively prove
that the Jinglou existed. They were however, able to prove that particular
acupuncture points stimulated areas of the body, including the brain and that
the areas surrounding the acupuncture points had significantly different skin
resistances. The new study by Schlebusch, Maric-Oehler and Popp (2005)
observed thermal imagery changes within the body when moxibustion is
applied against particular acupuncture points. No symptoms were intended to
be treated during the study and no symptom pattern analysis was conducted
before, during or after the study, only changes in the meridians themselves
were observed during the application of moxibustion.
Various studies have suggested that acupuncture illicits an electrical
response within the body. Research by Becker (cited in Gerber 2000) found
that the DC (Direct-Current) electrical-control system tended to transmit
information by slowly varying the electrical charge or voltage of glial cell
membranes. Becker suggests that the meridians are electrical conductors
that carried an injury message to the brain, which responded by sending back
the appropriate level of direct current to stimulate healing in the troubled area.
The idea that acupuncture responds and initiates electrical reaction has been
further supported in the Schlebusch, Maric-Oehler and Popp (2005) study,
which notes that living matter, including the Jinglou, are in a permanently
electronically excited state.
It was interesting to note in the Schlebusch, Maric-Oehler and Popp (2005)
study that the whole length of the meridian was stimulated and that heat could
be observed along the entire channel. Also interestingly, was as one meridian
was stimulated, its paired meridian was also affected. In the study, the
Stomach and Spleen were both stimulated separately; both showed a
response at the same time. This fits with the Nei Jing theory of paired organs
amongst the Zangfu. However, when an acupuncture point was stimulated on
the Urinary Bladder it was not noted if its paired organ the Kidney was
stimulated. The question of whether the collaterals were equally stimulated by
moxibustion was not mentioned in the study and still remains unclear.
As this new theory of proving the existence of the Jinglou using moxibustion
and thermal imagery has been put forward, it is up to other researchers to
duplicate Schlebusch, Maric-Oehler and Popp (2005) study and observe if the
same results can be successfully replicated. Unfortunately, as the exact list of
acupuncture points used in the study were not given along with make and
brand of moxa stick used, some degree of variability exists. In addition, no
qualified acupuncturist was mentioned in the study. This again can cause a
degree of variability as only a qualified acupuncturist should illicit a responsefrom an acupuncture point using moxibustion. It was also not mentioned
which acupuncture reference texts the researchers used to identify the
particular acupuncture points used in the study. Clearer uses of TCM
reference texts, a concise list of acupuncture points stimulated and qualified
acupuncturists should be used in further studies.
It is still unclear how researchers can observe, analyse and measure the
Jinglou using acupuncture. Recent research by Jiang et al. (2004) in South
Korea has shown the possible anatomical existence of the Jinglou. Further
quality research is needed to explore this exciting area of research.
Biography
Attilio D’Alberto graduated from a program jointly run at Middlesex University
and Beijing University of TCM with a BSc (Hons) in Traditional Chinese
Medicine (Middlesex University) and a MD (Beijing University). He currently
practices in various busy clinics in London. Correspondence:
www.attiliodalberto.com/contact.phpReferences
Gerber, R. (2000). V ibrational Medicine for the 21st
century. Santa Fe: Bear &
Company.
Jiang, X., Lee, C., Choi, C., Baik, K., Soh, K., Kim, H., Shin, H., Soh, K. &
Cheun, B. (2004). ‘Threadlike bundle of tubules running inside blood vessels:
New anatomical structure’, Unpublished.
Schlebusch, K., Maric-Oehler, W. & Popp, F. (2005). ‘Biophotonics in the
Infrared Spectral Range Reveal Acupuncture Meridian Structure of the Body’,
Journal of Alternative and Complementary Medicine, 11, (1), p171-173.


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Acupuncture reduces pain of chronic low back discomfort

Acupuncture reduces pain of chronic low back discomfort | Acupuncture and the musculoskeletal system | Scoop.it
(HealthDay)—Individualized acupuncture treatment reduces some negative symptoms of chronic low back pain (cLBP) better than sham treatment, according to a study published in the April issue of Spine.

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Effects of acupuncture on skin and muscle blood flow in healthy subjects [Eur J Appl Physiol. 2003] - PubMed - NCBI

Effects of acupuncture on skin and muscle blood flow in healthy subjects [Eur J Appl Physiol. 2003] - PubMed - NCBI | Acupuncture and the musculoskeletal system | Scoop.it

Eur J Appl Physiol. 2003 Sep;90(1-2):114-9. Epub 2003 Jun 24

 

 

Effects of acupuncture on skin and muscle blood flow in healthy subjects

Sandberg M1, Lundeberg T, Lindberg LG, Gerdle B.Author information 

 

Abstract

 

In 14 healthy female subjects, the effects of needle stimulation (acupuncture) on skin and muscle blood flow were investigated using a non-invasive custom-designed probe and photoplethysmography (PPG). In randomised order, 2-7 days apart, three modes of needle stimulation were performed on the anterior aspect of the tibia: superficial insertion (SF), insertion into the anterior tibial muscle (Mu), and insertion into the muscle including manipulation of the needle in order to elicit a distinct sensation of distension, heaviness or numbness (DeQi). Before intervention, the subjects rested for 30 min. After the intervention, the needle was left in situ for 20 min. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. In a fourth session, serving as control, corresponding measurements were performed without any needle stimulation. Area under curve was calculated for 5-min periods prior to and after stimulation, respectively, and for the remaining 15-min period after stimulation. Compared to the control situation, muscle blood flow increased following both Mu and DeQi for 20 min, with the latter being more pronounced for the initial 5 min. Skin blood flow increased for 5 min following DeQi. However, no increase was found following SF. The DeQi stimulation was preceded by higher visual analogue scale ratings of anxiety prior to stimulation, which might have influenced skin blood flow to some extent. The results indicate that the intensity of the needling is of importance, the DeQi stimulation resulting in the most pronounced increase in both skin and muscle blood flow.

PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.


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