Sunday, February 4, 2018

Rugby World Cup Sevens 2018 in SF will offer Acupuncture!

So excited to be a part of the Rugby World Cup Sevens 2018 at AT&T Park in San Francisco. 
I will provide sports acupuncture therapy for the all teams at the hotel the week before the tournament and at the stadium during the tournament. 

Get your tickets soon.  I promise it will be AMAZING. 

San Francisco 2018 will be the seventh edition of the global tournament and the third to feature both men’s and women’s competitions.

Common sports shoulder injury. Simple solution!

ACUTE TRAUMA OR OVERUSE CAN CAUSE THIS TYPE OF SHOULDER PAIN
photo credit: Pink Shorts Photography, shared with permission

A common shoulder injury that I see with rugby players, water polo goalies and MLB baseball pitchers is pain in the shoulder that can present as deltoid pain.   The deltoid is not the problem.

Usually the pain occurs in certain positions, is difficult to pinpoint and will come and go.

There is a small space between the humeral head (the arm bone) and the acromio-clavicular joint (top of the shoulder).  If there is inflammation in that space, there will be pain.

SHOULDER PAIN IN CERTAIN POSITIONS 
Orthopedic evaluation will show that the problem is often the supraspinatus muscle, which is part of the rotator cuff.   With athletes the cause can be acute trauma or overuse.   If the cause is trauma to the shoulder, also assess the AC joint and the SC joint for sprains and the other muscles of the rotator cuff.


REFERRAL PAIN PATTERNS COULD CONFUSE THE ISSUE
Acupuncturists are uniquely able to help with this type of injury.  The treatment is stealthy and not painful, we can skillfully slip needles into the subacromial space and the motor points and trigger points of the supraspinatus muscle to clear inflammation, invigorate blood flow and restore muscle function.  Electroacupuncture is key.

Acupuncture texts show the acupuncture point Bing Feng Si-12 in the muscle belly of the supraspinatus.  The indications for this point include the "inability to raise the arm."
SI-12 BING FENG IN  SUPRASPINATUS MUSCLE BELLY

If your acupuncturist does not know how to treat this, they can learn how in the Acupuncture Sports Medicine Apprenticeship program.

I highly recommend following up treatment working with your movement coach, athletic trainer or physical therapist to create mobility, strength and functional movement patterns.







Upcoming Review Course in Precision Needling for Sports Injuries (space limited)

Acupuncture Sports Medicine ​Review and Practicum
This weekend is open to all those who have completed The Acupuncture Sports Medicine Apprenticeship Program. These two weekends are taught by senior colleagues of Whitfield Reaves, and will be offered in the San Francisco Bay Area.
Instructors: Kenji Hirabayashi, LAc and Jenny Nieters, LAc
Option #1: June 23 & 24, 2018San Rafael, California
Option #2: August 25 & 26, 2018Alameda (Oakland), California

CEUs: There will be 12 hours of instruction. No CEUs/PDAs are offered for this course.Cost: $375.00 per weekend, with a $100.00 deposit needed to hold a spaceEmail (For the San Rafael program): Kenji Hirabayashi at khirabayashi@yahoo.comEmail (For the Alameda program): Jenny Nieters at jennynieterslac@gmail.com
Class size limited to nine practitioners. Instructors Kenji Hirabayahsi and Jenny Nieters both have years of experience in assistantships with Whitfield Reaves and The Apprenticeship Program.

Wednesday, November 8, 2017

Help for acute and chronic groin strains

    
Photo credit: Pink Shorts Photography
I see groin strains in many athletes, but they seem to be more common when athletes are playing on turf.  

 I will assess the injury to see if other muscles might be inhibited which might cause the adductors to overwork.  

My treatment from Chinese medicine will include a Jing Well point on the affected channel, if pressing that point that reduced pain in the the affected muscle. I might also add the motor point on the strained muscle and local "surround the dragon" technique on the damaged tissue.  I will follow up with an herbal liniment and recommend that the athlete ends the day with a hot epson salt bath. This is a generalized treatment protocol which will be tweaked for the individual presentation.

If appropriate, I will follow up with this exercise from Dr. Kathy Dooley.   I love Kathy Dooley's work.  In this segment of Video Dooley Noted, Dr. Kathy Dooley describes a drill for abdominal stability and relief from adductor tightness. With your therapist's/physio's/ATC's permission, give this drill a try for groin and medial thigh tightness.


Wednesday, November 1, 2017

Simple treatment for Shin Splints

Shin splints are a common running injury in my clinic.  Often they can show up when there is a change in shoes, increased miles in training or a change in terrain.   A simple manual muscle test of  resisted dorsiflexion and palpation of the upper 2/3 of the tibia between the stomach channel and the crest of the tibia, helps to confirm diagnosis.  A tibial stress fracture or avulsion fracture should be ruled out.

This can be seen as a Yang Ming channel injury and therefore the Jing Well point of the Stomach channel can be a great place to start with pain relief to treat the tendino-muscle meridian.  However, this should be followed up with a simple and effective course of electroacupuncture at the origin of the tibialis anterior.   The needle technique is deceptively simple to arrive at the correct location of the damaged tissue at the osteotendinous junction.

The photo below is from the final weekend of the Sports Medicine Apprenticeship program in Alameda, CA, where Whitfield Reaves, author of the Acupuncture Handbook of Sports Injuries and Pain, demonstrated the technique to 16 acupuncturists from around the globe.   In these courses we carefully draw the anatomy on several different bodies and demonstrate the needle angle and depth.  Students are then supervised and practice the techniques themselves. 
 

Whitfield Reaves and Jenny Nieters demonstrate shin splints treatment

Thursday, October 12, 2017

Add acupuncture to the quads post ACL surgery to increase range of motion and decrease pain

Acupuncture clinical trial : Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture.  


This recent randomized, single blinded, clinical trial which was published in April 2017, seemed to report all of the pertinent details. They looked at relevant outcomes including pain intensity, range of motion (ROM), stability and functionality. The evaluator of the data was blinded to which intervention had been used. Consistent assessments were performed by a blinded assessor at baseline, 24 hrs, 1 week, and 5 weeks.  Inclusion and exclusion criteria seems fair in that they only took 18-55 year old patients, all in the sub-acute post-surgical phase, all had unilateral reconstruction of a complete ACL rupture.  Detailed exclusion criteria accounted for orthopedic and internal conditions which could influence results.  Detailed descriptions of the two interventions were provided, in terms of rehabilitation (Rh) and  a second group for rehabilitation with trigger point needling (Rh + TrPDN). Needling specifics including location, technique, size of needle  and patient response in the form of a local twitch response (LTR) and sensation of pain, was provided.  Treatment was performed by physical therapists with > 6 years experience and 30 hours per week of clinical practice.  Three patients suffered from the adverse event of a hemorrhage >4cm2, one was lost to follow-up due to this adverse event.   Shortcomings of the study were the small sample size of 44 patients, they did not track analgesic medication intake, the scale used to measure functionality in the Spanish speaking patients (WOMAC) was designed for knee osteoarthritis.


Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis. 

The objective of this review, published in January 2017, was to assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS).   Only RTC’s published in English and Chinese were included. A total of 847 relevant studies were identified, only 16 RCT’s met the inclusion criteria.  Control groups included either sham/placebo or no intervention. Primary outcomes were pain intensity, measured by visual analogue scale or numerical rating scale, and pressure pain threshold (PPT). Secondary outcomes were adverse events and range of motion (ROM) at the neck.  Patient population inclusion and exclusion criteria are clearly identified.  A total of 477 patients were included in the 16 trials.  Risk of bias assessment for each of the studies is included.  The conclusion showed favorable results for pain relief and increased ROM. They recommend a course of treatment for 8 sessions, but acknowledge that more research should be done to determine the optimal number of treatments for individual conditions.

As a sports medicine practitioner, I often treat patients post-knee surgery for pain and weakness. I treat the vastus medialis with electro-acupuncture and prescribe exercises for strengthening this muscle.  The meta-analysis stated that acupuncture when applied to muscle trigger points can activate the endogenous opioid system to induce an analgesic effect. I believe that anyone with an interest using acupuncture to treat pain instead of pharmaceuticals would be excited to see this information, along with the data showing increased ROM, decreased pain and increased pain pressure threshold.  I often share both studies with patients, physical therapists and athletic trainers, so that they can understand my contribution to rehabilitation.

References:
Velázquez-Saornil, J., Ruíz-Ruíz, B., Rodríguez-Sanz, D., Romero-Morales, C., López-López, D., & Calvo-Lobo, C. (2017). Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture. Medicine, 96(17), e6726. http://doi.org/10.1097/MD.0000000000006726

Wang R, Li X, Zhou S, et al Manual acupuncture for myofascial pain syndrome: a systematic review and meta-analysis. Acupuncture in Medicine 2017;35:241-250.

Tuesday, October 10, 2017

Silicon Valley Sevens International Rugby Tournament at Avaya Stadium

Tickets are on sale now  http://www.sevensrugby.com/pages/buy-tickets/

This acupuncturist is excited to attend the tournament and to be providing acupuncture to the athletes.

#sevens #siliconvalleysevens #rugbyacupuncture

Rugby World Cup Sevens 2018 in SF will offer Acupuncture!

So excited to be a part of the Rugby World Cup Sevens 2018 at AT&T Park in San Francisco.  I will provide sports acupuncture therapy...