Gotham Acupuncture

the deltoid

Someone left a comment on the old weblog asking what treatments or exercises are recommended for deltoid pain. Pain specific to the deltoid is really tough to affect through exercise alone. It's an awkward muscle to stretch, and even when you do stretch it with the standard arm-across-the-chest strategy, it never really seems to get the tight bands out. Then if you sleep on the affected side, or try carrying a bag with the affected side, the pain comes right back.

Travell & Simons refer to this aspect of deltoid trigger points as "hyper-irritable." Many patients with deltoid pain also have problems with the posterior shoulder joint or the neck which perpetuate the symptoms. Over time, a tight neck or shoulder - which affects alignment but may not necessarily cause pain - will cause the whole area to be used differently. Carrying or lifting objects, working at a computer, even the way the upper body moves while walking, can all cause and perpetuate trigger points and pain in the deltoid. In these cases, the tight fibers of the neck and the shoulder must be released to allow the alignments to return to normal. Simple stretches and range of motion exercises can help the process by helping the patient re-learn how to use the body in a natural, relaxed manner after it's been release and realigned.

It's nice when stuff works

A patient has been coming for dysmenorrhea treatments. This is where the TuiNa Frank Butler and Tom Bisio teach really shines. I used their protocol three times in the week before the bleeding started, today she reported her period came and went without any cramping. Although there is still some mild back pain left, she didn't miss any time from work and didn't need any pain relievers which is a big step forward.

Functional MRI of brain shows acupuncture reducing pain

This article discusses the use of acupuncture for perioperative treatment. It includes a functional MRI image of the brain which indicates acupuncture reducing pain, very cool. You can download the image, or read the complete article and click on figure 1.

Multiple angles

Like many injuries, it helps with back pain to treat it from as many angles as possible: tui na, acupuncture, heat or cold therapies, diet, exercise. Not everyone needs all of these, most back pain responds very well to acupuncture alone. However, if a problem is really stubborn it helps to have more than one strategy or tool available.

Heat for back pain

I'm not picking on Anahad O'Connor, I swear.

Heat works for back problems because most pain is caused by constriction. In fact the Chinese saying is "No pain without blockage." This also means that tight muscles and constriction of any kind can prevent the proper nourishment from reaching injured and painful areas, making the problem slow to heal or even chronic in nature. The heat helps to open and relax everything so all the blood, nutrients, oxygen, and good stuff can get in and start doing its job. We use heat all the time in the clinic, either in the form of wet or dry heat, or moxibustion. Herbal heat in the form of pain-relieving plasters or liniments is also useful, as well as portable and inexpensive for the patient.

Healing is hard work for your body: give it what it needs

Physical therapists have been getting it right for years: if you don't sleep enough, you will lengthen the amount of time it takes you to heal. Now we know that insufficient rest also heightens the perception of pain.

In Chinese medicine, lack of sleep prevents your body from having enough Qi and nourishment to go around. The less energy you have, the more of an effort your body has to make just to function, the less energy your body can devote to healing an injury.

If you're recovering from an injury to the tendons, ligaments, or muscles, sleep at least eight hours. For injuries to bones, you can up that to 10 hours. You can also support your body in its endeavors to heal itself by avoiding spicy foods, cold foods and drinks, and raw foods.

Comparative study on electroacupuncture in the treatment of gout

A study at Wuhan Hospital in China suggests acupuncture with electrical stimulation is effective for acute gouty arthritis. For acupuncturists, we could have guessed 2 Hz would have had greater effect than 100 Hz, although it is nice to see it in a study. The interesting part: the results suggest electroacupuncture at 2 Hz also showed a reduced serum uric acid level.

Electroacupuncture is the process of adding electrical stimulation to the needles used in treatment, usually only 2 to 4 points, to course the flow of Qi and Blood. We use it frequently for osseous injuries, and to encourage healing after surgery. In addition to being mild and safe, it's also a very effective form of treatment, although modern clinics tend to rely on it too much in my opinion.

Book Review: A Tooth From the Tiger's Mouth

What can be said about a book whose strengths become apparent before finishing the first chapter?

The title of Tom Bisio's first book, A Tooth From the Tiger's Mouth, refers to information which can be arduous to obtain and difficult or even dangerous to use.  But don't let that deter you, this manual on caring for your own acute injuries and chronic pain is becoming the essential reference for professional athletes, performers, martial artists, weekend warriors, and acupuncturists. On more than one occasion I have had patients come in and reference the book as a guide they used to treat the early stages of their injuries.

Through plain English and good writing, Mr. Bisio does more than take the reader from the core concepts of Chinese sports medicine through the techniques necessary to implement self-care.  Tooth illustrates the practical side of the medicine, an aspect the author clearly enjoys.  Readers will also benefit from the common-sense approach to diet and exercise, and the colorful stories which help illustrate the many uses of Chinese medicine will drive the lessons home.  But don't take my word for it... mix up a batch of trauma liniment, just one of many recipes within, and use it on your own injuries.  The proof is in the pudding.

"End Knee Pain Forever"

This month's issue of Backpacker includes a short article on how to "End Knee Pain Forever." Paul Simica, a physical therapist with much experience and himself an accomplished competetive athlete, contributed to the article.

The article focuses on simple exercises to strengthen and stabilize the muscles of the lower body - in particular the glutes, hamstrings, and soleus - an excellent strategy. The instructions are for isolated strengthening exercises - leg extensions, leg raises, and calf raises - all of which will do the job over time. What I wish to discuss here is the difference in approach between how western medicine uses exercise, and how Chinese medicine uses exercise. Bear in mind, one is not necessarily better than the other, they're just different.

We address injury and pain thorugh exercises taken from martial arts and qigong training. Essentially patients are taught to relax while moving the entire body as one unit as much as possible. This recruits all relevant muscle groups to work together synergistically. In this example, this means the goal is to stabilize the leg while performing movements through what should be a natural range of motion.

Some qigong exercises involve coordinating the breath with the movement of the body, some require you to contract one area while learning to relax another, but all require you to relax, and that is something no weightlifting routine talks about clearly. If done correctly, they give you the opportunity to re-learn at an unconscious level (actually a neuromuscular level) how to use the injured limb correctly, and reintegrate it into the whole of your body.

Let's examine a familiar exercise: knee rotations. Many people do these quickly and without thought as a warm-up before training. But if done slowly, in a relaxed manner, you can feel the challenges and benefits very clearly: knee rotations done in this way will show you which hip is tighter than the other, challenge you to stabilize the leg as a whole (especially the adductors and abductors of the upper leg), and remind you to relax the back. Challenge yourself further by keeping the feet flat on the floor, and you're on your way to balancing the strength of the muscles of the lower leg such as the soleus, calves, tibialis anterior, and peroneals, some of which are major players in meridian therapy when it comes to knee pain.

Squats, when performed slowly and with the heels on the floor, can be an even bigger challenge and also engage your core. (Please don't try any of these without proper guidance; these are just two of many exercises we use for knee pain, and they may not be right for your presentation.)

If you're having knee pain, don't wait to have it treated. Usually it's a pretty straightforward thing for acupuncturists to deal with, but it's not going to abate on its own. Most knee pain seen in the clinic is the result of imbalances of the muscles above and/or below the knee, or the ligaments and connections inside the knee. As time goes on, problems tend to get worse as our bad habits (including those when walking) become more ingrained within our mechanics. Get it treated to stop the pain and increase your reange of motion, then rehabbing it should be much easier.

Treating Tennis Elbow

Tennis elbow is inflammation of the tendons which attach at the outside of the elbow. There are at least seven muscles which can affect this area of the elbow, and most commonly in clinic I see the majority of them are involved in myofascial pain and joint dysfunction. This is a condition which is normally ascribed to musicians, athletes, and office workers, but it could affect anyone who uses the arm frequently, especially a palm-up position, as occurs when carrying a box, supinating the forearm to play a string instrument, or holding a small child.

The principles of treating any form of tendonitis is simple: reduce inflammation, relax and loosen the muscles which create tension and pain, and move the Qi and blood which is held in the area by constricted muscle and fascia. In practice, chronic tennis elbow can take anywhere from 3-5 treatments to result in improvement of 80% or more. Unfortunately, many people are unable to stop or reduce the activities which aggravate the condition while undergoing treatment, and this can increase the time the body needs to recover fully; taking time off from your instrument or sport is a heavy price if you depend on your body for your livelihood, and not being able to carry a bag or hold your child is simply not an option for most. In any event, acupuncture and bodywork are especially helpful at reversing the trend towards tightness and pain, and herbal liniments applied directly to the painful joint are very effective at helping the inflammation and heat go down.

Exercise is also key to recovery. Many doctors will tell you that any form of exercise you do will help your tendonitis, but they don't always explain why. In Chinese medicine, this idea is related to the principle of helping one area of the body to heal by moving the blood systemically on a regular basis. By doing so, you actually help lubricate and nourish the tendons and sinews of the whole body, even the ones in the elbow.

Qigong in particular is a valuable adjunct to acupuncture therapy, in fact there are specific exercises which target the neck, arm, elbow, and muscles which surround these structures. the goal of qigong is to teach the body's muscle groups to work together, train the joint to become open, and lubricate injured areas to decrease healing time and promote resilience. I'll try to post a video of such exercises in the next few days, although I recommend not doing them unless you've been supervised by myself or have had your doctor's approval.

Some foods which are known to reduce inflammation systemically include tumeric (curcumin), and omega-3 and omega-6 oils found in many nuts and some fish. You should try to avoid foods which cause inflammation, such as hot and spicy foods, alcohol, broiled and fried foods. Raw vegetables are also not great, as it is very taxing for the body to try to break down the cell walls; cooking vegetables just until the color starts to change ensures that the cell walls have ruptured and the nutrients inside are more easily available to us. Foods which nourish the Blood and Qi should also be given favor, these include greens such as collards, mustard greens, swiss chard, and red meats like beef, ox, and lamb. You don't need a lot of meat, just a little bit on a regular basis, or you can use bones to make stocks or to flavor your vegetables.