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

Gentle acupuncture after knee or hip surgery reduces pain

Acupuncture Provides Short-term Pain Relief for Patient in a Total Joint Replacement Program.   

This observational study from 2015, investigated acupuncture as an adjunct therapy for post-surgical pain management.  The study tracked patients who elected to add acupuncture treatment, free of charge, to their post total knee or total hip replacement surgery rehabilitation. The study a also tracked self-reported pain.  The study took place at Abbott Northwestern Hospital in Minneapolis, MN.  The sample included 2,500 admissions from 2,282 unique patients for total hip and total knee replacement.  Exclusions resulted in a sample of 1,977 applications of acupuncture treatment for analysis.   Self reported pain was assessed before and after acupuncture using a 0-10 scale.  Seventy-five percent of the admissions elected to have acupuncture.  Women had higher odds of receiving acupuncture compared to men and non-white patients. Average short term pain reduction was 1.91 points, a 45% reduction from the mean pre-pain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture.  The study concluded that acupuncture can be a viable adjunct to pharmacological approaches for pain management post total hip or total knee replacement.  

The protocol was very simple, Li 11, Li4 bilaterally and St 36, GB34, SP6 and Lv3 on the non surgical side along with auricular points Hip or Knee Joint and Ear Shen Men.  The acupuncture was performed by NCCAOM certified licensed acupuncturists with between four to eighteen years experience. 


This study is useful for my clinical practice as patients and doctors are looking for effective pain management solutions, especially now that the “opioid crisis” is in the mainstream news.   




References:
Crespin, D. J., Griffin, K. H., Johnson, J. R., Miller, C., Finch, M. D., Rivard, R. L., … Dusek, J. A. (2015). Acupuncture Provides Short-term Pain Relief for Patients in a Total Joint Replacement Program. Pain Medicine (Malden, Mass.), 16(6), 1195–1203. http://doi.org/10.1111/pme.12685
go to the study

Sunday, February 26, 2017

Acupuncture evaluation of achilles pain



Simple video for acupuncturists to learn how to differentiate achilles pain.


I have found that achilles pain treated correctly does not have to be a lifelong struggle. 

Acupuncture for Common Rugby Injuries

East Asian medicine modalities of acupuncture, cupping therapy, gua sha and tui na massage for rugby soft tissue injuries of muscles, tendons, ligaments can speed recovery time, reduce inflammation and get players back on the field.

 

Which Rugby Players Suffer the Most Injuries?

  • Hookers and flankers sustain the most injuries.
  • Forwards are more frequently injured than backs because of their greater involvement in physical collisions and tackles.
  • In the backs, wings, fullbacks and centres are at the highest risk of injury.
  • In the scrum, the locks are at greatest risk of facial cuts and cauliflower ear (external deformity to the ear caused by repeated blows.
  • Players in rucks and mauls commonly suffer injuries to fingers and thumbs as well as abrasions and lacerations from cleats.

Common Rugby Injuries

Knee Pain

  • ACL injury
  • Knee Ligament Injuries
  • Meniscus tears
  • Patellofemoral Pain Syndrome
  • Patella Tendonitis (Tendinopathy)
  • Chondromalacia Patella
  • ITB Syndrome
  • Knee Arthritis
  • Plica Syndrome
  • Bursitis Knee

Ankle Injuries

  • Sprained Ankle
  • High Ankle Sprain
  • Anterior Ankle Impingement
  • Peroneal Tendonitis
  • Retrocalcaneal Bursitis

Thigh & Hamstring Pain

  • Thigh strain
  • Hamstring strain
  • Corked Thigh

Shin & Calf Pain

  • Achilles Tendinopathy
  • Achilles Tendon Rupture
  • Calf Muscle Tear
  • Shin Splints
  • Stress Fracture

Foot Pain

  • Metatarsalgia
  • Morton's Neuroma
  • Plantar Fasciitis
  • Stress Fracture Feet

Groin Pain

  • Osteitis Pubis
  • Groin Strain
  • Adductor Tendinopathy

Hip Pain

  • Hip labral tear
  • Femoroacetabular Impingement (FAI)
  • Gluteal Tendinopathy
  • Hip Arthritis (Osteoarthritis)
  • Piriformis Syndrome
  • Stress Fracture
  • Trochanteric Bursitis

Back Pain

  • Back Muscle Pain
  • Bulging Disc
  • Degenerative Disc Disease
  • Facet Joint Pain
  • Sacroiliac Joint Pain
  • Sciatica
  • Pinched Nerve

Shoulder Pain

  • AC Joint Injury
  • Dislocated Shoulder
  • Shoulder Tendonitis
  • Rotator Cuff Syndrome
  • Shoulder Impingement
  • Bursitis Shoulder

Muscle Pain

  • Muscle Strain (Muscle Pain)
  • Cramps
  • DOMS - Delayed Onset Muscle Soreness

Neck Pain

  • Neck Arm Pain
  • Neck Headache
  • Wry Neck
  • Pinched Nerve

Wrist / Hand Injuries

  • Thumb Sprain 
 http://www.physioworks.com.au/Injuries-Conditions/Activities/rugby-union-injuries

Tuesday, February 21, 2017

Relief for tennis elbow with partially torn tendon

 I love treating tennis elbow.  There is nothing like a few well-placed needles with gentle electro-stim to support a reduction in inflammation and stimulate the body to get to work on tendon repair.
"My experience in receiving acupuncture treatments is extensive. I've seen numerous practitioners over the years for infertility, acid reflux and tendinitis. This year, I've been suffering from tennis elbow / partial tear in my tendon.  I've been trying everything from massage therapy, castor oil wrap, flexbar, acupuncture etc. and even stopped playing tennis for 2 months.

Then I recently bumped into Jenny Nieters at a dog park in Pasadena, while she was visiting her family. We started chatting and found out she's an acupuncturist specializing in sports medicine. I was like "WHAT???" Then she told me about her electroacupuncture treatment technique.  Read about  it on her website.  At the risk of intruding on her time off with her parents, I asked if she can treat me. She said sure and agreed to see me at her parents place that day. Needless to say, neither of us felt worried about our safety. She's very kind and approachable.

My pain level that day was about 8.  After her treatment, it went down to almost 0!!!  My pain did come back after a few hours but only about to 3 or 4.  And I believe that if she could treat me on a weekly basis, I would recover much faster.  But she lives in ALAMEDA!!

Please open an office here in Pasadena!!"
Darlene on Yelp!

Sunday, February 5, 2017

Low back pain, what are you waiting for?

One in four (58.8 million) adults suffer from chronic low back pain. Before considering addictive pain medications or costly and invasive surgeries, consider an evaluation to see if your condition could be helped with orthopedic acupuncture.  

The patient often cannot evaluate their condition other than so say, "their back,  hip, or buttock hurts. It can hurt to move, exercise, sit, stand or walk, it can be painful to sleep.  

The acupuncturist with anatomical understanding of pain and functional movement relationships can evaluate the condition, rule-out a serious condition, with simple muscle tests, sensitive palpation, they can develop a treatment protocol with only a few well placed "yin" needles with gentle electrical stimulation (e-stim.).

Common pain generators in low back and buttock pain cases:
  • Quadratus Lumborum aka "the joker of low back pain,"
  • Gluteus Medius aka "the lumbago muscle."
  • Gluteus Minimus  aka "the pseudo-sciatica muscle."
  • Sacroiliac Joint
  • Sacraltuberous Ligament

I just finished three days of helping to teach a course in Maui, with the always inspirational, Whitfield Reaves, on how to evaluate, assess and  treat low back and hip pain with acupuncture.  I realized when I saw the numbers in the graphic below that the work that we are doing, teaching acupuncturists is absolutely vital. Our bodies were simply not designed for the lifestyle that we are living. The world needs more well-trained acupuncturists!


In the acupuncture world, just as in the western medicine world there are areas of specialization.  For example, I never treat skin disorders, I refer out. If you have tried acupuncture for pain or injury and you didn't see a change in your condition within 1-3 treatments, don't hesitate to ask your practitioner to reevaluate their approach and diagnosis.

When I travel and people hear that I am an acupuncturist, I often hear "Oh, I tried acupuncture (for my back pain or for my sciatica) once and it didn't help," or "I don't believe in acupuncture." Every time I hear that I am more determined that acupuncturists should have training so that they can successfully evaluate and treat these conditions.

Acupuncturists need to understand how to evaluate which conditions are likely to respond to treatment and which conditions will not respond and are surgical and which conditions need a team approach with a talented physical therapist, athletic trainer, orthopedist, massage therapist, pilates instructor, corrective movement specialist, chiropractor etc.  As an acupuncturist, I  do not try to be everything to the patient.

It is important that you keep moving. If pain is stopping you, do something about it.




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...