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

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...