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40. Acupuncture and Dupuytren’s Contracture

Apr 11, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (4), April  , 2012, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Dupuytren’s Contracture

http://www.glutenfreeforgood.com/blog/celiac-disease-and-dupuytrens-contracture

 

Luke, a seventy-two-year-old man who was born in Norway, reported that about a year ago he noticed a small lump growing along the fourth finger of his right hand that continued to the area where his palm and fourth finger meet. In the beginning, his finger felt only slightly tender; but six months later, the finger had gradually contracted and he experienced difficulty extending the finger at the metacarpal phalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) finger joints. Though he did not experience much pain, he did notice there was a cord of tissue under the skin of his palm that prevented him from extending his fourth finger and greatly interfered with his hand function and movement. This situation continued to develop over a year, at which point he went to his primary care physician who did not understand what was wrong with Luke’s hand. Luke was then referred to me.

In examining Luke’s hand, I found the cordlike tissue that had formed along his fourth finger and caused it to bend unnaturally towards his palm. There did not seem to be much tenderness in the area, but Luke had difficulty extending his fourth finger and coordinating it with his other fingers. He had tried massage, ultrasound, and physical therapy, including stretching exercises for the hand, but none of it helped and his symptoms were gradually getting worse, leading me to believe he had a condition known as Dupuytren’s contracture.

 

Symptoms, Causes, and Diagnosis

Dupuytren’s contracture is a very specific condition. It often affects people of Scandinavian or Northern European descent and has been called the Viking Disease, though it has also been found in Spain and the Far East.

Its primary characteristics include the following.

  • People who are older than forty are the ones most likely to develop the condition. For anyone older than forty, the disease is more common in men than in women. By age eighty, however, gender is not an important factor.
  • It is often a condition that is passed down through families.
  • It usually happens in the fourth and fifth fingers; the thumb and index fingers are almost always spared.
  • Some may contract Dupuytren’s after developing certain conditions, such as alcoholism, diabetes, epilepsy, liver disease or trauma.

Although Dupuytren’s contracture is poorly understood, many physicians and research scientists think it is caused by fibroblast proliferation and collagen deposits.

It is thought there are three stages of Dupuytren’s contracture.

1. The proliferation stage, which is characterized by the development of nodules. Many of the nodules may be located or felt at the far end of the palm’s crease.

2. The active stage, in which the cord begins to form near the nodule.

3. The residual stage, in which tendonlike cords are visible and the contraction between the palm and fingers becomes obvious.

 

Treatments for Dupuytren’s Contracture in Western Medicine

Noninvasive Treatments

It is not usually necessary to treat this condition. However, if you develop the later stage of this condition, up to the point where your finger function becomes restricted, it may be necessary to seek medical treatment.

Collagenase Injections

This treatment, currently in phase three of FDA approval, utilizes an injection of collagenase along the contracted cords. A small dosage of collagenase is best to dissolve or soften the cords.

X-Rays

Low-energy X-rays can also soften or reduce the contraction of the cords.

Physical Therapy

Warming up the area is important, first with heat, then ultrasound. Manual work on the hand can help remove restrictions, and should be followed by stretches to regain more motion.

 

Surgery

Surgery for this condition consists of opening the skin over the affected cords and removing the fibrous tissue. This procedure is not curative, however, and cannot prevent the affected wrist and palm areas from developing Dupuytren’s disease again at a later date.

After the surgery, you will most likely need further surgery to clean out the remainder of the cord in your fingers. Also be advised that the surgery comes with a risk of injury to the nerves and surrounding connective tissues.

 

Treatments for Dupuytren’s Contracture in Traditional Chinese Medicine

Acupuncture

Acupuncture is a minimally invasive technique. For this condition, the needles are inserted locally along the cords, and electrical stimulation is then added to the highest degree that can be tolerated. It lasts 25–30 minutes, and you are allowed to adjust the stimulation level yourself. This treatment is followed by 5 minutes of ultrasound to soften the cord. Finally, there is a massage and some stretching exercises, all of which together serve to decrease the rigidity of the cord.

Table 41.1

  Points Meridian/Number
1 He Gu LI 4
2 Qu Chi LI 11
3 Arshi As Fig 14.1

 

Figure 14.1

 

 

Luke’s Treatment

Luke underwent the above combination of treatments 15 times. He was also told to soak his hand in very hot water every morning for 15–20 minutes, and to massage and stretch his fourth finger. He repeated these same stretches after acupuncture treatments in my office. After 15 visits, his condition was completely resolved. This treatment routine was also successfully tried in France in 1983, with similar positive results.

 

Additional Treatments for Depuytren’s Contracture

I have treated more than thirty cases of Dupuytren’s contracture and have found that the earlier the treatment, the better the results. For example, I treated a young, twenty-five-year-old man who had a family history of Depuytren’s that had passed on to him. He had developed a nodule in his right hand at the meeting point of the fourth finger and palm. Because he consulted me at the earliest stage of his condition, I was able to cure him in only six or seven visits. If treatment is begun at a very late stage, acupuncture may not be a successful therapy.

 

Tips for People with Dupuytren’s Contracture

  • Your cooperation in the treatment procedures is very important. This includes soaking your hands in hot water for 15–20 minutes every morning and doing stetching exercises on the affected finger.
  • The results will be even better if you self-treat at home by massaging Chinese herbal massage cream or oil—red flower is good—into the affected area.

 

39. Acupuncture and Stroke

Mar 10, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (3), March  , 2012, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

STROKE

 

 

 

 

 

 

healblog.net

William H., a seventy-year-old man with a history of hypertension and diabetes mellitus, came to my office complaining that his left arm and leg had been weak and almost paralyzed for two months. He told me that several months earlier he had experienced a sudden-onset headache. He had felt numbness and a tingling sensation in his left arm and leg, had difficulty opening both eyes, experienced double vision as well as slurred speech and dizziness, and his movements were clumsy. He was rushed to the emergency room where he was given a CT scan, which confirmed that he’d had a stroke. He was immediately admitted to the hospital and was given all possible medical treatment: anticoagulation medication, aspirin, and heparin. He remained in the hospital for a month and, upon discharge, he entered an acute rehab center where he was given exercises for his arm and leg. After a month he felt some improvement in his shoulder and hip joints, but still could not move his elbow, wrist, fingers, knee, or ankles. Finally, he consulted me for treatment.

 

Types and Causes of Strokes

Strokes usually occur in down time, and are usually heralded by all or some of these symptoms: a sudden onset of weakness or paralysis of the arms, legs, side of the face, or any part of the body. They can be accompanied by numbness and a decreased tingling sensation, with slurred speech, an inability to speak or understand someone’s else speech, difficulty reading or writing, blurred vision, difficulty swallowing, drooling, loss of balance or coordination, loss of memory, and vertigo. Some people also experience anxiety, depression, lethargy, nervous energy, or loss of consciousness. These symptoms are usually caused by a blockage in the brain artery, a narrowing of the small arteries within the brain, or a hardening of the arteries and arthrosclerosis leading to the brain.

Strokes are usually divided into three types.

  • Type 1 is ischemic stroke, caused by a blood clot that blocks blood flow to the brain.
  • Type 2 is hemorrhagic stroke, caused by bleeding inside of the brain that is secondary to ruptured aneurysms or uncontrolled high blood pressure.
  • Type 3 is a transient ischemic attack (TIA). This symptom is seen for less than twenty-four hours, after which the person recovers and becomes normal again. A TIA is a warning stroke, or mini-stroke that produces strokelike symptoms, but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke.

Additional causes of strokes, with the exception of strokes caused by old age or high blood pressure, are described below.

  • Coronary artery disease, which can lead to a heart attack or stroke, as can other heart conditions, such as endocarditis, fibrillation, heart failure, or heart valve diseases.
  • Diabetes, which doubles the risk of stroke.
  • High cholesterol, which causes hardening of the arteries.
  • Overweight and diet. Consumption of high-fat food and alcohol abuse can cause a stroke. Too much alcohol increases blood pressure and cholesterol levels.
  • Peripheral artery disease, such as carotid artery disease.
  • Physical inactivity.
  • Smoking, both primary and secondhand.

 

Treatments in Western Medicine

In Western medicine, strokes are treated as follows.

Ischemic Strokes

  • In an ischemic stroke the doctor must quickly restore blood flow to the brain. This emergency treatment, together with medication, usually starts with aspirin, which has proved the best treatment immediately after a stroke, and reduces the possibility of another stroke. The emergency room doctor will likely administer this treatment.
  • Two other useful drugs for treating ischemic strokes are coumadin and heparin.
  • Some who have ischemic strokes may be given tissue plasminogen activator (rt-PA), which is a potent clot-busting drug that helps some people fully recover. According to recent N.I.H. protocol, rt-PA must be injected within 3 hours after the symptoms’ onset, once brain bleeding is ruled out by CT scan and/or doctors are certain that giving a tissue plasminogen activator (TPA) will not worsen any bleeding in the brain. TPA is administered only in ischemic strokes.
  • Surgical procedures might also be used, including carotid endarterectomy, angioplasty, and stents.

Hemorrhagic Strokes Where Surgery Must be Utilized

The most common procedures for hemorrhagic strokes are clipping aneurysms and removal of an arteriovenous malformation (AVM). This is an abnormal connection between veins and arteries, usually congenital, and usually occurring in the central nervous system.

After emergency treatment, early rehabilitation is very important because the most benefit will be obtained within six months of having a stroke.

There will usually be a team of doctors and therapists to help with stroke recovery. It can consist of a dietician, a neurophysiologist, a nurse, occupational, physical, and recreational therapists, a psychiatrist, a rehabilitation doctor, a social worker, and a speech therapist. The goal of stroke rehabilitation is to help the person recover as much independence and function as possible. Much of stroke rehabilitation involves relearning the skills of daily activity, not only for the paralyzed extremities, but also for improving speech and swallowing, as well as for vision and hearing functions.

 

Treatments in Traditional Chinese Medicine

The TCM treatments for strokes are different from Western medicine, where, after emergency room treatment or surgery, the main recovery method is to try and return physical functions to the parts of the body affected by the stroke. Although this method will strengthen the muscles and increase the range of motion, the goal of TCM and acupuncture is to try and stimulate the seat of the stroke, the brain—a method that is believed to help the patient recover more quickly.

Both Western and traditional Chinese medicine recognize the same two forms of stroke: Ischemic and hemorrhagic. Acupuncture should be started as soon as possible after a stroke occurs and the person’s medical condition has been stabilized.

As illustrated in Figure 26.1A, the brain contains many different functional centers. On the motor and sensory zones, as shown in Figure 26.1B, the brain structure looks like an upside down human body, functionally represented on the cerebral cortex.

Figure 3-1

 

 

 

 

 

 

 

Explanation of Points

  • Cheirokinesthetic Center: Center for memories of movements
  • Opticokinetic CoordinatingCenter: Center for movement of the eyeballs in response to the movement of objects across the visual field
  • Motility Speech Center: Center for movements related to speech organs
  • Auditory Center: Center for primary processing of hearing; center for receiving impulses from the ear by way of the auditory nerve
  • Auditory Speech Center: Center for interpretation of sound
  • Visual Center: Center for receiving signal from eyes.
  • Visual Speech Center: Center for understanding of the written and spoken language; enables a person to read a sentence, understand it and say it out loud
  • Sensory Center: Center for entire body’s sensation
  • Motor Center: Center for entire body’s movement

 

Figure 3-2

B illustrates the location of movement of the body’s entire trunk and four limbs. Please refer to its motor area in Figure 3-1

During the course of more than three thousand years of accumulated experience, traditional Chinese medicine (TCM) developed scalp acupuncture, one of its most advanced treatments for people with strokes. TCM studied the relationship between the human body’s function and the anatomy of the scalp, and created systemic points on the scalp, which coincide with contemporary neuroanatomy.

Figure 3-3

 

 

Figure 3-4

 

 

Figure 3-5

 

 

The Importance of Acupuncture Treatments

The most valuable treatment of TCM for strokes is the combination of body and scalp acupuncture. The cause of a stroke is the occluded blood supply to the brain, but the focus of current rehab medicine is mainly on the upper and lower extremities—hundreds of hours are spent on rehabilitation for these upper and lower extremities. Most physical and occupational therapies are designed for both sets of extremities, but there is no exercise or treatment designed for the brain. With acupuncture, however, not only are these extremities treated, but the cause of the stroke is treated as well with the use of body and scalp acupuncture. It is important to change the medical concepts about stroke rehabilitation because the problem is the brain and doctors not only need to work on the body, but also on the brain.

Acupuncture Treatments for TIAs—Transient Ischemic Attacks

In TIAs, there is dizziness, weakness on one side of the body, with numbness and a tingling sensation, and the symptoms gradually disappear within twenty-four hours. The following points are used with TIAs.

  • Body points: Du 23 Shang Xin, Du 20 Bai Hui, Ex-HN 3 Ying Tang, LI 15 Jian Yu, LI 11 Qu Qi, St 36 Zu San Li, and GB 34 Yang Ling Quan.
  • Scalp points: Motor and Sensory area. (Figure 26.3)

Figure 3-6

 

 

Figure 3-7

 

 

Table 3-1

Points Meridian Number Conditions Helped
1 Shang Xin Du 23 Headaches, eye pain, running nose, mental disorders
2 Bai Hui Du 20 Headache, vertigo, tinnitus, nasal obstruction, aphasia by apoplexy, coma, mental disorders, prolapse of the rectum and uterus.
3 Ying Tang Ex-HN 3 See Table 22.1
4 Jian Yu LI 15 Shoulder and arm pain, motor impairment of the upper extremities, rubella, skin disease
5 Qu Qi LI 11 See Table 12.2
6 Zu San Li St 36 See Table 13.
7 Yang Ling Quan GB 34 See Table 15.3

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Acupuncture Treatments for Ischemic Strokes

Symptoms of ischemic strokes are facial paralysis, sluggish language, and paralysis on one side of the body. The following points are used with ischemic strokes.

  • Body points: PC 6 Nei Guan, Du 26 Ren Zhong, Sp 6 San Yin Jiao, Ht 1 Ji quan, Lu 5 Qi Zhe, UB 40 Wei Zhong, LI 4 He Gu, and LI 11 Qu Qi.
  • Scalp points: Motor and Sensory area, especially, M1, M2 , S3, Lan 1, Lan 2, and Lan 3.

Table 3.2

Points Meridian Number Conditions Helped
1 Nei Guan PC 6 See Table 16.1
2 Ren Zhong Du 26 Mental disorders, seizure, hysteria, infantile convulsion, coma, apoplexy, off-center deviation of the mouth and eyes, puffiness of the face, low back pain, and stiffness
3 San Ying Jiao Sp 6 See Table 16.1
4 Ji Quan Heart 1 Pain in the rib and cardiac regions, scrofula (skin disease), cold pain of elbow and arm, dry throat
5 Qi Zhe Lu 5 See Table 13.2
6 Wei Zhong UB 40 Low back pain, motor impairment of the hip joint, muscular atrophy, pain, numbness, and motor impairment of the legs, abdominal pain, vomiting, diarrhea
7 He Gu LI 4 See Table 12.1
8 Qu Qi LI 11 See Table 12.2

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points

Figure 3-8

 

 

 

Figure 3-9

 

 

Acupuncture Treatments for Facial Paralysis of the Central Type

In this type, the facial paralysis is secondary to a brain stroke. The person’s eye is unable to close, the tongue extends to the stroke side, and there is difficulty opening or closing the mouth, which may be drooping. The following points are used with this type of facial paralysis.

  • Body Points: GB 20 Feng Chi, Ex-HN 5 Tai Yang, St 7 Xia Guan, St 4 Di Chang penetrate to St 6 Jia Che, and LI 4 He Gu for the healthy side.
  • Scalp points: Lan 1, S3.

Table 3-3

Points Meridian Number Conditions Helped
1 Feng Chi GB 20 See Table 22.1
2 Tai Yang EX-HN 5 Headaches, eye diseases, off-center deviation of the eyes and mouth
3 Jia Guan St 7 Deafness, tinnitus, toothache, facial paralysis, face pain, jaw impairment
4 Di Chang St 4 Off-center deviation of the mouth, salivation, twitching eyelids
5 Jia Che St 6 Facial paralysis, toothache, swelling of the cheek and face, mumps, spasms of jaw muscles
6 He Gu LI 4 See Table 12.1


Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Figure 3-10

 

Acupuncture Treatments for Language Deficit

When there is a language deficit, the person can understand instructions, but cannot answer questions; or the person can speak, but cannot understand instructions; or the person can neither understand instructions nor speak correctly. The following points are used with language deficits.

  • Body points: D 23 Shang Xin penetrate to D 20 Bai Hui, GB 20 Feng Chi, Ex-HN 3 Ying Tang, Ex-HN 12 Jin Jin, Ex-HN 13 Yu Ye, Ht 5 Tong Li, UB 10 Tian Zhu, and Ren 23 Lian Quan.
  • Scalp points: Lan 1, Lan 2, and Lan 3.

Table 3-4

Points Meridian Number Conditions Helped
1 Shang Xin Du 23 See Table 29.2
2 Bai Hui Du 20 See Table 16.2
3 Feng Chi GB 20 See Table 22.1
4 Ying Tang Ex-HN 3 See Table 22.2
5 Jin Jin/Yu Ye Ex-HN 12/13 Swelling of the tongue, vomiting, aphasia with stiffness of tongue
6 Tong Li Ht 5 Palpitations, dizziness, blurred vision, sore throat, sudden loss of voice, aphasia with stiffness of the tongue, pain in wrist and elbow
7 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
8 Lian Quan Ren 23 Swelling and pain of subglossal region (below the tongue), salivation with speech difficulty, non-speech with stiffness of tongue, hoarse voice, difficulty swallowing


Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Figure 3-11

 

 

 

Figure 3-12

 

 

Acupuncture Treatments for Upper Arm Paralysis

Symptoms of this type of stroke are weakness and an inability to extend the elbow, wrist, and fingers. The following points are used with upper arm paralysis.

  • Body points: GB 20 Feng Chi, Ht 1 Ji Quan, Lu 5 Qi Zhe, LI 4 He Gu, LI 15 Jian Yu, LI 11 Qu Qi, and SJ 5 Wai Guan.
  • Scalp points: M 2 and M 3.

Table 3-5

Points Meridian Number Conditions Helped
1 Feng Chi GB 20 See Table 22.1
2 Ji Quan Ht 1 See Table 26.2
3 Qi Zhe Lu 5 See Table 13.2
4 He Gu LI 4 See Table 12.1
5 Jian Yu LI 15 Shoulder and arm pain, motor impairment of the upper extremities, German measles, skin disease
6 Qu Qi LI 11 See Table 12.2
7 Wai Guan SJ 5 See Table 12.2

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Acupuncture Treatments for Shoulder Pain and Frozen Shoulder

Symptoms include difficulty raising shoulder, limited range of motion, difficulty combing hair, putting on a bra, and inserting the arm into a sleeve. The following points are used for shoulder pain and frozen shoulder.

  • Body points: LI 15 Jian Yu, Du 26 Ren Zhong, SI 9 Jian Zhen, SI 15 Jian Zhong Shu, SI 14 Jian Wai Shu, and St 38 Tiao Kou.
  • Scalp points: M 2 and M 3.

Table 3-6

Points Meridian Number Conditions Helped
1 Jian Yu LI 15 See Table 26.5
2 Ren Zhong Du 26 See Table 29.2
3 Jian Zhen SI 9 Pain in the shoulder area, impairment of hands and arms
4 Jian Zhong Shu SI 15 Cough, asthma, pain in the shoulder and back
5 Jian Wai Shu SI 14 Aching shoulder and back, neck pain and rigidity
6 Tiao Kou St 38 Numbness, soreness and pain of the knee and leg, weakness and impairment of the foot, pain and impairment of the shoulder, abdominal pain

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

Acupuncture Treatments for Lower Extremity Paralysis

Symptoms include weakness, difficulty lifting leg, and walking. The following points are used for lower extremity paralysis.

  • Body points: UB 40 Wei Zhong, Sp 6 San Ying Jiao, GB 30 Huan Tiao, GB 34 Yang Ling Quan, and UB 60 Kun Lun.
  • Scalp points: M 1 and M 2.

Table 3-7

Points Meridian Number Conditions Helped
1 Wei Zhong UB 40 Low back pain, motor impairment of the hip joint, hemiplegia (paralysis), pain, numbness, and motor impairment of the lower extremities, abdominal pain, vomiting
2 San Ying Jiao Sp 6 See Table 16.1
3 Huan Tiao GB 30 Pain of the lumbar region and thigh, muscular atrophy of the lower limbs
4 Yang Ling Quan GB 34 See Table 15.3
5 Kun Lun UB 60 Headaches, blurred vision, neck rigidity, nosebleed, shoulder, back, and arm pain, swelling and pain of the heel, difficult labor, epilepsy

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

Acupuncture Treatments for Poor Balance and Unsteady Gait

The following points are used for poor balance and an unsteady gait.

  • Body points: GB 19 Nao Kong penetrating to GB 20 Feng Chi, UB 9 Yu Zhen penetrating to UB 10 Tian Zhu, Du 17 Nao Hu penetrating to Du 16 Feng Fu, and GB 20 Feng Chi.
  • Scalp points: Balance area.

Table 3-8

Points Meridian Number Conditions Helped
1 Nao Kong GB 19 Headaches, stiffness of the neck, vertigo, painful eyes, tinnitus, epilepsy
2 Feng Chi GB20 See Table 22.1
3 Yu Zhen UB 9 Headaches and neck pain, dizziness, pain in the eye, nasal obstruction
4 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
5 Nao Hu Du 17 Epilepsy, dizziness, pain and stiffness of the neck
6 Feng Fu Du 16 Headaches, neck rigidity, blurred vision, nosebleed, sore throat, mental disorders

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

Figure 3-13

 

 

 

Figure 3-14

 

 

 

Acupuncture Treatments for Blindness

The following points are used for blindness.

  • Body points: GB 20 Feng Chi and UB 10 Tian Zhu.
  • Scalp points: Vision area.

Table 3-9

Points Meridian Number Conditions Helped
1 Nao Kong GB 19 Headaches, stiffness of the neck, vertigo, painful eyes, tinnitus, epilepsy
2 Feng Chi GB20 See Table 22.1
3 Yu Zhen UB 9 Headaches and neck pain, dizziness, pain in the eye, nasal obstruction
4 Tian Zhu UB 10 Headaches, nasal obstruction, sore throat, neck rigidity, pain in the shoulder and back
5 Nao Hu Du 17 Epilepsy, dizziness, pain and stiffness of the neck
6 Feng Fu Du 16 Headaches, neck rigidity, blurred vision, nosebleed, sore throat, mental disorders

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of the

acupuncture points.

 

Acupuncture Treatments for Difficulty Swallowing

The following points are used for difficulty in swallowing.

  • Body points: PC 6 Nei Guan, Du 26 Ren Zhong, GB 20 Feng Chi, and Ren 23 Lian Quan.
  • Scalp points: M 2 and M 3.

Figure 3-15

 

Table 3-10

Points Meridian Number Conditions Helped
1 Nei Guang PC 6 See Table 16.1
2 Ren Zhong Du 26 See Table 29.2
3 Feng Chi GB 20 See Table 22.1
4 Lian Quan Ren 23 Swelling and pain of subglossal region (below the tongue), salivation with speech difficulty, non-speech with stiffness of tongue, hoarse voice, difficulty swallowing

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of the

acupuncture points.

 

Acupuncture Treatments for Constipation

The following points are used for constipation.

  • Body points: St 40 Feng Long, St 28 Shui Dao,and  St 29 Gui Lai.
  • Scalp points: M 2 and M 3.

Table 3-11

Points Meridian Number Conditions Helped
1 Feng Long St 40 Headaches, dizziness, cough, asthma, excessive sputum, chest pain, constipation, epilepsy, muscular atrophy, motor impairment, pain, swelling, or paralysis of lower extremities
2 Shui Dao St 28 Retention of urine, swelling, hernia, painful menstruation
3 Gui Lai St 29 Abdominal pain, hernia, painful, irregular menstruation, absence of menstruation, white vaginal discharge, collapsed uterus

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of the

acupuncture points.

Figure 3-16

 

Acupuncture Treatments for Stoppage of Urine Flow

The following points are used for stoppage of urine flow.

  • Body points: UB 54 Zhi Bian penetrate to St 28 Shui Dao, and Ren 3 Zhong Ji.
  • Scalp points: M 2 and M 3.

Table 3-12

Points Meridian Number Conditions Helped
1 Zhi Bian UB 54 Low back pain, muscular atrophy, motor impairment of the lower extremities, painful urination, swelling around external genitalia, hemorrhoids, constipation
2 Shui Dao St 28 Hernia, swelling, painful menstruationurine retention
3 Zhong Ji Ren 3 Bedwetting, nocturnal emissions, impotence, hernia, uterine bleeding, irregular menstruation, frequency of urination, retention of urine, pain collapse of uterus, in the lower abdomen, vaginitis

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of the

acupuncture points.

Acupuncture Treatments for Urinary Incontinence

The following points are used for urinary incontinence.

  • Body points: Ren 4 Guan Yuan, Ren 6 Qi Hai, and Ki 3 Tai Xi.
  • Scalp points: M 2 and M 3

Table 3-13

Points Meridian Number Conditions Helped
1 Guan Yuan Ren 4See Figure 3-15 Bedwetting, frequency of urination, retention of urine, hernia, irregular menstruation, uterine bleeding, postpartum hemorrhage, lower abdominal pain, indigestion, diarrhea, collapse of rectum
2 Qi Hai Ren 6See Figure 3-15 Abdominal pain, bedwetting, impotence, hernia, swelling, diarrhea, dysentery, uterine bleeding, irregular menstruation, white vaginal discharge, postpartum hemorrhage, constipation, asthma
3 Tai Xi Ki 3 See Table 14.4

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of the

acupuncture points.

 

William’s Treatment

William underwent my treatment for two months, after which his muscle strength gradually improved to the point that he could move his shoulders, elbows, hips, and knees. By constantly flexing these joints, he had no problem with flexion and extension movements in them, but he still needed treatment for muscle strength and range of motion in the wrists and ankles. For these, he came in two to three times a week for eight weeks, then only once a week for ten weeks, at which time he was also given physical therapy to help muscle strength and range of motion for the upper and lower extremities. All these treatments helped William immensely.

Stroke treatment by acupuncture focuses on the brain and blood supply. Since the main cause of a stroke is a decreased supply of blood to the brain in either ischemic or hemorrhagic strokes, replenishing the brain’s blood supply greatly improves the functions of the paralyzed parts of the body. It is necessary to treat not only the upper and lower extremities, but also the brain, or the person will be at a functional disadvantage. Thus the combination of treatments works best for anyone who has had a stroke.

A combination of acupuncture, therapy, and therapeutic massage, done together, is the best hope for totally recovering from a stroke.

 

Tips For People Who Have Had a Stroke

  • You should ask your acupuncturist to perform the acupuncture treatments for both the body and the scalp.
  • The earlier you seek out acupuncture treatment, the better your chances for recovery.
  • Always try to fight the effects of the stroke by not using your unaffected extremity, but instead forcing yourself to use the paralyzed part.
  • The combination of acupuncture, physical therapy, therapeutic massage, and self-motivated exercise is the best approach for recovery.

 

 

38. Acupuncture and Shoulder Arthritis

Feb 21, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (2), Februrary  , 2012, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Shoulder Arthritis

www.drdavidduckworth.com.au

 

Brittany, a sixty-five-year-old woman, experienced on-and-off pain in her shoulder for two or three years, especially upon awakening. The pain was located on the front, sometimes the top, of her shoulder, which made everyday tasks, such as reaching for a high shelf or combing her hair, difficult for her. It also caused swelling of her right shoulder, which became worse when the weather changed, so much so that she told her friends she was a human weathervane. Recently, she began to feel a clicking or grinding sound in the shoulder, and it became increasingly difficult to fall or stay asleep due the pain, which has been increasing for several years.

Brittany was a basketball player in college and sometimes when she shot the ball she felt some pain, but it went away after a day or two. She began taking Tylenol and Advil, which gave some relief, but because she was so occupied with her own business, and because she always assumed the pain would eventually go away, she never made the time to go to a doctor before she came to me.

In my physical exam, I found the deltoid muscle of her right shoulder was atrophied. The right shoulder front, top, and back of the shoulder blade were all tender. When I performed a range of motion test, the flexing in the right shoulder was about 0–120 degrees and her extension was about 0–115 degrees, with pain in the 0–70 degree extension. The grinding, cracking noise that accompanied this extension made the pain in this shoulder feel worse, but I found no signs of arthritis in other joints, including the left shoulder, which was perfectly normal.

 

Symptoms, Causes, and Diagnosis

There are two main shoulder joints

The glenohumeral joint, which is also called the bone-circuit joint. Here, the typical pain is on the top and back of the shoulder and it sometimes involves pain in the shoulder blade, the scapula, and restricted range of motion.

The acromioclavicular joint. Arthritis can develop where the collarbone meets the shoulder blade (scapula), at the bony prominence on the top of the shoulder blade known as the acromion. The pain is at the top of the shoulder and increases when, for example, the arm is crossed in front of the body to touch the other shoulder, or the arm is raised to comb the hair or take something from a high shelf.

Figure 2.1

 

There are three principal types of arthritis.

Osteoarthritis, inflammation of the joints, is caused by wear and tear.

Rheumatoid arthritis, an autoimmune disease that is usually a symmetrical inflammation of the joints, especially the shoulder, knee, and other small joints.

Posttraumatic arthritis, which results from injury.

 

Treatments for Shoulder Arthritis in Western Medicine

Noninvasive Treatments

The first methods to try are the nonsurgical treatments.

Rest

Rest and changing physical activities. The person should avoid any activity that provokes pain.

Compresses

Using hot and cold compresses can be very helpful.

Physical Therapy

Physical therapy and massages. Below are a few exercises that will help strengthen the rotator cuff to allow more fluid motion. Three sets of 10 each should be performed 3 times a week.

 

Figure 2.2

 

 

Figure 2.3

 

 

Surgery

If non-surgical treatments do not work, then surgery would be necessary.

Resection arthroplasty is the most common surgical procedure for arthritis of the acromioclavicular joint. Its purpose is to restore the flexible connection between the acromion and the collarbone. A small piece of bone from the end of the collarbone is removed, leaving a space that later fills in with scar tissue.

Total shoulder arthroplasty for glenohumeral joint arthritis. In this procedure, a surgeon replaces the entire shoulder joint with a prothesis.

Hemiarthroplasty, also for glenohumeral joint arthritis. In this procedure, the surgeon replaces the head of the upper arm bone. One joint surface is replaced with an artificial material, usually metal.

I suggest to most of my patients that they try the nonsurgical treatments first. However, if the pain is intolerable and severely restricts sleep, a surgical treatment might be the better of the two options.

 

Treatments for Shoulder Arthritis in Traditional Chinese Medicine

Acupuncture

When performed appropriately, acupuncture can help with these two types of osteoarthritis.

For glenohumeral osteoarthritis, I use Jian Yu, Jian Liao, Jian Zhen, Quchi He Gu, and also Tian Zhong and Jian Qian. All needles need to be inserted to about 1.5 inches with electrical stimulation for about 30 minutes. The patient must be in a seated position and the electrical stimulation should be as high as can be tolerated.

For acromioclavicular osteoarthritis, it is essential to locate the exact point of tenderness in the front of the shoulder and the AC joint and insert the needle into that AC joint, then the remaining points as in the preceding paragraph. This principle of treatment is called “acupuncture points selection based on the pain location,” aka the specific anatomical location following the pain points.

Table 2.1

Points Meridian/No. Location
1 Jian Qian Extrapoints 23 See Fig 2.4
2 Jian Yu LI 15 See Fig 2.4
3 Jian Zhen SI 9 See Fig 2.4
4 Jian Liao SJ 14 See Fig 2.5
5 Tian Zhong SI 11  See Fig 2.5
5 Qu Chi LI 11 See Fig 2.4
7 Wai Guan SJ 5 See Fig 2.4
8 He Gu LI 4 See Fig 2.4

 

 

 

 

 

Fig 2.4

 

 

 

 

 

 

 

 

 

 

Fig 2.5

 

 

 

 

 

 

 

 

 

 

 

Brittany’s Treatment

Brittany had an X-ray which showed that the cartilage of her right shoulder was wearing out. On the glenohumeral joint there was a loss of joint space and bone spurs were present. She was also given a blood test to rule out rheumatoid arthritis, and it came back negative.

Brittany was advised to avoid lifting anything heavy, to stop using weights, or doing any other upper-extremity exercises, including basketball, if she still played that sport.

If her shoulder was swollen, Brittany was advised to use a cold pad for 15–20 minutes 3 times a day; conversely, if there was no swelling, then she was advised to use a heating pad in the same manner. Acupuncture, physical therapy, and massage were to be tried before any surgery was performed.

Brittany received treatment 3 times a week for 6–8 weeks and her shoulder pain was much relieved. However, I had to advise her that acupuncture cannot change the lost cartilage or remove the clicking, snapping sound. It could decrease the pain, making it improved enough that she would be able to get a good night’s sleep and could prolong the need for surgery. Brittany reported that this was indeed the case after the treatments. For now, her pain has sufficiently diminshed to allow her to go on living her life without having to resort to surgery. [Ed.Supplied an upbeat update that was needed here.].

 

Tips for People with Shoulder Osteoarthritis

  • If your shoulder is a normal temperature, always put a heating pad on it twice a day for 30 minutes each time. If it is hot, place a cold pad there for the same amount of time.
  • After the hot or cold pad, spend 30 minutes a day doing range-of-motion exercises for the shoulder. These will greatly improve your shoulder mobility and decrease the pain.

 

 

37. Acupuncture and Intorable Headache

Jan 14, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments
News Letter, Vol. 4 (1),January , 2012, © Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Robert Blizzard III, DPT
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720
Fax: (203)637-2693

Intolerable Headaches




women-hub.com
Joan T., a sixteen-year-old schoolgirl, was brought to me by her mother because the girl had been experiencing headaches since she was twelve and first got her period. Her headaches were so severe that four or five days a week during her period she was often unable to go to school. These headaches manifested themselves on both temporal regions of her head and also caused severe pain to the left eye. Because of the pain’s severity, the headaches were interfering with her schoolwork. Joan had to call her mother several days a week to pick her up from school, which, for several years made it necessary for the mother to quit her job and begin to home school Joan.
At sixteen, Joan returned to school as a junior because she needed to start preparing for college entrance exams, as well as apply to colleges. Soon afterward, the pain had grown so severe that Joan was sleeping poorly and was extremely stressed, which often resulted in tears and depression, and, in turn, made her eat too much, causing a large weight gain. Her mother had taken her to many doctors over the years, and she had been prescribed a variety of drugs, but nothing seemed to help the migraines. Her SAT exams were coming up in two months when the mother finally brought her to me for evaluation.
A physical examination showed Joan to be a slightly obese young girl, very depressed, and stressed. She spoke in a low tone; did not like light, and felt pain when her temporal area and the back of her scalp, the occipital area, were touched.
Types of Headaches
I considered that Joan might have one of the following three types of primary headaches: tension, cluster, or migraine. She could also have a mix of two or three of them.
Tension Headaches
This is the most common type of chronic and frequent headaches. The symptoms include steady pain on both sides of the head with a feeling of pressure and tightness around the head, as if a band was put tightly around it. The pain radiates from the back, eyes, neck, or other parts of the body, and usually increases over period of hours. As it worsens, it can develop a pulsating quality.
Figure 1.1

Cluster Headaches
This type of headache is often described as a sharp penetrating or burning sensation in one eye where the person feels as if somebody had punched her or his eye. The pain comes on suddenly, without warning, and within a few minutes, excruciating pain develops that can be so severe some women report it is even worse than childbirth. People with cluster headaches often appear restless. These headaches usually last about two to twelve weeks, though some chronic cluster headaches may continue for more than a year. They sometimes go with seasonal change.
Figure 1.2
Migraine Headaches
A migraine headache is a throbbing or pulsating headache that is often on one side of the head and is associated with nausea and vomiting, sensitivity to light, sound, and smell, with sleep disruption and depression. These attacks are very often recurrent and do not change with age, sometimes developing into chronic migraine headaches.
There are two types of migraine headaches: migraine with aura and migraine without aura. Most auras are visual and are described as bright shining light around objects or at the edges of the field of vision, hallucinations, or zigzag lines with a wave image. Some people may experience dizziness, motor weakness, numbness, speech or language abnormalities, temporary vision loss, tingling, or vertigo.
Figure 1.3
An MRI of a Migraine
Causes of the Three Types of Headaches
  • The causes of tension headaches are usually stress, muscular tension, gouty arthritis on the neck or spine, postural changes, vascular dilation, protracted coughing or sneezing, fever and depression, or temporal mandibular joint disorder.
  • The cause of cluster headaches is unknown. However, cluster headaches are known to be triggered by alcohol, nitroglycerin, or similar drugs.
  • The cause of migraine headaches is also unknown. There may be a family history of the disorder, or a migraine can be triggered by many stimulants: alcohol, altitude, color, contrasting pattern, exertion, food, hormonal change, hunger, lack of sleep, medicine, perfume, stress, and weather.
Treatments in Western Medicine
From the Western medicine point of view, there are many different kinds of medications to treat headaches. For example, Topamax and Imitrex are used for migraine headaches with some successful result. However, when beta blockers, antiseizure medication, calcium channel blockers, tricyclic antidepressants, and analgesics, such as aspirin, ibuprofen, and acetaminophen, are used to treat migraine, cluster, or tension headaches, they cannot provide significant improvement for any of these headaches. Therefore, more and more people are starting to look for alternative treatments, and acupuncture is one of the best.
Treatments in Traditional Chinese Medicine
Chinese medicine classifies headaches in two categories.
External Wind Attack Headaches
These headaches are caused by external factors, such as wind cold and wind heat. The headaches are usually characterized by an acute onset and a very severe and constant attack.
  • Wind cold. This causes periodic attacks, where the pain always is connected with the neck and upper back and an aversion to wind and cold. The head feels heavy, as if a tight band is wrapped around it. The person does not feel thirsty, and has a thin, white coating on the tongue, and a floating pulse.
  • Wind heat. This type feels like a headache expanding from inside the head, accompanied by fever and an aversion to heat and wind, with a reddish face and eyes. The person feels thirsty, has constipation, yellowish urine, a red tongue body, with yellow coating on the tongue, and a floating pulse.
Internal Organ Dysfunction Headaches
These headaches are usually of slow onset with mild pain and sometimes the feeling of emptiness within the head. When people are stressed and overworked, the pain will be worse. The pain is on and off and usually lasts for a long time.
The Meridians
According to traditional Chinese medicine, the head, the face, and also the liver are where all six yang meridians go. Since these meridians go up to the top of the head, headaches can be diagnosed based on the meridian distribution. If you know the meridian distribution, it will be easier to make a clear diagnosis and treatment.
  • Tai Yang (Urinary Bladder) meridian headache. This is usually located at the top of the head, or the back of the head, and is connected to the neck.
  • Yang Ming (Large Intestine) meridian headache: This is usually in the front of the head—on the forehead—and includes the upper portion of the eye.
  • Shao Yang (Gallbladder) meridian headache: This is usually on both temporal areas and radiates to the ear.
  • Jue Ying (Liver) meridian headache: This is usually on the top of the head, sometimes connecting to the eyes and forehead.
Acupuncture for Headaches
I first ask my patient the location of the headache and its severity in order to find out which internal organ shows dysfunction. I next ask about the accompanying symptoms in order to differentiate the wind cold from the wind heat.
Figure 1.4
Figure 1.5
Figure 1.6
Figure 1.7
Figure 1.8
Figure 1.9
For Tai Yang (Urinary Bladder) meridian headache on the top of the head and back of the neck, the following are used: GB 20 Feng Chi, DU 16 Feng Fu, DU 19 Hou Ding, BL 9 Yu Zhen, BL 60 Kun Run, and SI 3 Hou Xi.
Table 1.1
Points Meridian

Number
Conditions Helped
1 Feng Chi Gallbladder 20

See Figure 1.7
Headaches, vertigo, insomnia, pain and stiffness of the neck, blurred vision, glaucoma, red and painful eyes, tinnitus, convulsion, epilepsy, infantile convulsions, common cold, nasal obstruction
2 Feng Fu DU 16

See Figure 1.7
Headaches, neck rigidity, blurred vision, nosebleed, sore throat, mental disorders
3 Hou Ding DU 19

See Figure 1.7
Headaches, vertigo, epilepsy
4 Yu Zhen Urinary Bladder 9

See Figure 1.7
Headaches, neck pain, dizziness, nasal obstruction
5 Kun Lun Urinary Bladder 60

See Figure 1.9
Headaches, blurred vision, neck rigidity, pain in the shoulder, back, and arm, swelling and heel pain, difficult labor, epilepsy
6 Hou Xi Small Intestine 3

See Figure 1.8
Pain and rigidity of the neck, tinnitus, deafness, sore throat, acute lumbar sprain, night sweat, fever, numbness of the finger and shoulder, elbow pain
Please refer to the accompanying Figures (illustrations) for the locations of
the points. And please note that these illustrations are for information only
and may not show all the exact locations of the acupuncture points.
The Yang Ming ((Large Intestine) meridian headache centers on the front of the head, the forehead, including the upper portion of the eye. The acupuncture points are Yin Tang and Tai Yang (Extraordinary Points), Lu 7 Lie Que, LI 4 He Gu, and GB 14 Yang Bai.
Table 1.2
Points Meridian Number Conditions Helped
1 Yin Tang Extraordinary Point

See Figure 1.4
Headaches, head heaviness, infantile convulsion, frontal headaches, insomnia
2 Tai Yang Extraordinary Point

See Figure 1.5
Headaches, eye diseases, off-center deviation of the eyes and mouth
3 Lie Que Lung 7

See Figure 12.2
Cough, pain in the chest, asthma, sore throat, spasmodic pain of the elbow and arm
4 He Gu Large Intestine 4

See Figure 12.3
Headaches, pain in the neck, redness, swelling, and pain of the eye, nosebleed, nasal obstruction, toothache, deafness, swelling of the face, sore throat, facial paralysis, abdominal pain, dysentery, constipation, delayed labor, pain, weakness, and motor impairment of the upper limbs
5 Yang Bai Gall Bladder 14

See Figure 1.4
Headaches, pain in the orbital ridge, eye pain, vertigo, twitching of the eyelids, tearing
Please refer to the accompanying Figures (illustrations) for the locations of
the points. And please note that these illustrations are for information only
and may not show all the exact locations of the acupuncture points.
The Shao Yang (Gallbladder) meridian headache is usually on the bilateral temporal area and radiates to the ear. The following points are chosen: GB 20 Feng Chi, Extraordinary Point 1 Tai Yang, SJ 5 Wai Guan, ST 8 Tao Wei, and GB 38 Yang Fu, and GB 39 Jue Gu.
Table 1.3
Points Meridian Number Conditions Helped
1 Feng Chi Gallbladder 20

See Figure 1.7
Headaches, vertigo, insomnia, neck pain and stiffness, blurred vision, glaucoma, pink and painful eyes, tinnitus, convulsions, epilepsy, infantile convulsion, febrile (fever) diseases, common cold, nasal obstruction, runny nose
2 Tai Yang Extraordinary Point

See Figure 1.5
Headaches, eye diseases, off-center deviation of the eyes and mouth
3 Wai Guan San Jiao 5

See Figure 1.8
Fever, headaches, cheek and neck pain, deafness, tinnitus, elbow and arm pain, hand tremor
4 Tou Wei Stomach 8

See Figure 1.10
Headaches, blurred vision, eye pain, excessive tears
5 Yang Fu Gallbladder 38

See Figure 1.9
Migraines
6 Jue Gu Gallbladder 39

See Figure 1.9
Apoplexy, neck pain muscular atrophy of the lower limbs, spastic pain of the leg
Please refer to the accompanying Figures (illustrations) for the locations
of the points. And please note that these illustrations are for information
only and may not show all the exact locations of the acupuncture points.
For Jue Ying (Liver) meridian headache, the pain is usually on the top of the head and it often connects to the eyes and forehead. The following points are chosen: Du 20 Bai Hui, Liv 3 Tai Chong, and Lung 7 Lie Que.
Table 1.4
Points Meridian Number Conditions Helped
1 Bai Hui Du 20

See Figure 1.6
Headaches, vertigo, tinnitus, nasal obstruction, coma, mental disorders, prolapse of the rectum and the uterus
2 Tai Chong Liv 3

See Figure 18.2
Headaches, dizziness, insomnia, congestion, swelling and pain of the eye, depression, infantile convulsions, uterine bleeding, hernia, retention of urine, epilepsy
3 Lie Que Lung 7

See Figure 12.2
Headaches, migraine, neck stiffness, cough, asthma, sore throat, facial paralysis, toothache, wrist pain and weakness
Please refer to the accompanying Figures (illustrations) for the locations
of the points. And please note that these illustrations are for information
only and may not show all the exact locations of the acupuncture points.
If the above symptoms are accompanied with the wind cold or wind heat signs, I add the following points:
For Wind Cold: GB 20 Feng Chi, Extraordinary Point Tai Yang, St 8 Tou Wei, GB 8 Shuai Gu, UB 12 Feng Meng, and UB 60 Kun Lun.
Table 1.5
Points Meridian Number Conditions Helped
1 Feng Chi Gallbladder 20

See Figure 1.7
Headaches, dizziness, insomnia, neck pain and stiffness, blurred vision, glaucoma, pink and painful eyes, tinnitus, convulsions, epilepsy, infantile convulsion, febrile (fever) diseases, common cold, nasal obstruction, runny nose
2 Tai Yang Extraordinary Point

See Figure 1.5
Headaches, eye diseases, off-center deviation of the eyes and mouth
3 Tou Wei Stomach 8

See Figure 1.10
Headaches, blurred vision, eye pain, excessive tears
4 Shuai Gu Gallbladder 8

See Figure 1.5
Migraines, vertigo, vomiting, infantile convulsions
5 Feng Meng Urinary Bladder 12

See Figure 1.11
Common cold, cough, fever and headaches, neck rigidity, back pain
6 Kun Lun Urinary Bladder 60

See Figure 1.9
Headaches, blurred vision, neck rigidity, pain in the shoulder, back, and arm, swelling and heel pain, difficult labor, epilepsy
Please refer to the accompanying Figures (illustrations) for the locations
of the points. And please note that these illustrations are for information
only and may not show all the exact locations of the acupuncture points.
For Wind Heat: GB 20 Feng Chi, Tai Yang, St 8 Tou Wei, GB 8 Shuai Gu, Du 14 Da Zhui, and SJ 5 Wai Guan.
Table 1.6
Points Meridian Number Conditions Helped
1 Feng Chi Gallbladder 20

See Figure 1.7
Headaches, vertigo, insomnia, neck pain and stiffness, blurred vision, glaucoma, pink and painful eyes, tinnitus, convulsions, epilepsy, infantile convulsion, febrile (fever) diseases, common cold, nasal obstruction, runny nose
2 Tai Yang Extraordinary Point

See Figure 1.5
Headaches, eye diseases, deviation of eyes and mouth
3 Tou Wei Stomach 8

See Figure 1.10
Headaches, blurred vision, eye pain, excessive tears
4 Shuai Gu Gallbladder 8

See Figure 1.5
Migraines, vertigo (dizziness), vomiting, infantile convulsions
5 Da Zhui Du 14

See Figure 1.7
Neck pain and rigidity, malaria, fever, epilepsy, cough, asthma, common cold, back pain and stiffness
6 Wai Guan San Jiao 5

See Figure 1.8
Febrile (fever) diseases, headaches, cheek pain, neck sprain, elbow, arm, and finger pain, hand tremors, abdominal pain
Please refer to the accompanying Figures (illustrations) for the locations
of the points. And please note that these illustrations are for information
only and may not show all the exact locations of the acupuncture points.
Joan’s Treatment
Joan’s headaches were very complicated. From the Western medicine point of view, her headaches belonged to the migraine category. However, her headaches were always triggered by nerve pain in the back of the head and worsened with her hormonal changes and menstruation. She had four to five attacks a week, and every time she had the nerve pain or a hormonal change, her headache symptoms would get worse.
After I made a clear diagnosis, I first used GB 20, DU 16, and Bai Hui, and then Tai Yang and LI 4. I gave Joan this treatment three times a week for about two months and also injected her with cortisone to block the left and right nerve pain in the back of her head. Her headaches improved a great deal after this treatment and she was able to take her SATs and apply for college. She was accepted by Boston College and when I followed up on her two years later, her mother reported that Joan had no more major headache attacks. She survived her college study and her mother is very thankful to me.
Acupressure Tips to Use at Home or Office
  • If you have a headache, be specific as to the site of the headache and identify if you have a Tai Yang, Yang Ming, Shao Yang, or Jue Ying headache.
  • After you identify the site of the headache, then try to locate the points by following the tables and illustrations above.
  • Acupressure the points with your knuckle, press with comfortable pressure on the points, count 20, and then change to another point. You should work any symmetric points at the same time.
  • Since the acupressure points are located mainly on your head, use the head points as the major acupressure points. You may ask your friends or family members to help you with moderate acupressure.

36. Acupuncture and Wrist Pain After Bike Riding-Ulnar Nerve Impingement

Dec 11, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

News Letter, Vol. 3 (12), December, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Wrist Pain after Bike Riding- Ulnar Nerve Entrapment


 

photography.nationalgeographic.com

Derek is 43 year-old male, who likes to cycle cross country.  He has regularly biked 100 miles per week for over 10 years.  On weekends he will get up early in the morning and get in a very intensive bike ride. About 2 months ago, he started to feel both hands had weakness and tenderness along with numbness and a tingling sensation bilaterally at the 4th and 5th fingers. He even felt coldness at the 4th and 5th fingers.  He sometimes has difficulty typing, and has to shake his hands to rid of numbness after waking up from sleep. He visited his primary care physician, and was given Advil for his pain and told that after a few weeks the pain and numbness might go away. However, he still feels it and is getting worse, therefore, he comes to me for evaluation and treatment.

Because the 4th and 5th fingers are supplied with ulnar nerve, therefore, his symptom made me think ulnar nerve entrapment, i.e. Guyon’s canal syndrome. By physical examination, the patient had weakness to make a full fist, and weaker to spread out his 5 fingers.

The ulnar nerve is one of the three main nerves in the arm. Ulnar nerve is located underneath the shoulder, arm and little and ring fingers. Along its pathway, there are a few locations the ulnar nerve is easily trapped. As indicated at this figure.

Fig 12.1

The ulnar nerve functions to give sensation to the little finger and the half of the ring finger that is near the little finger. It also controls most of the little muscles in the hand that help with fine movements, and some of the bigger muscles in the forearm that help to make a strong grip.

Fig 12.2

 

 

Fig 12.3


 

  1. The cubital tunnel: Ulnar nerve travels from under the collarbone and along the inside of the upper arm. It passes through a tunnel of tissue (the cubital tunnel) behind the inside of the elbow. While holding your elbow on the desk such as answering your phone, or when lying on your stomach by holding your arm face down, one sometimes feels the funny sensation commonly called the “funny bone.”

Fig 12.4

 

  1. Guyon’s canal : Beyond the elbow, the nerve travels under muscles on the inside of the arm and into the hand on the side of the palm with the little finger. As the nerve enters the hand, it travels through another tunnel (Guyon’s canal). The most common injury is by riding a bicycle for long time, like the above case.

 

Fig 12.5

http://www.hughston.com/hha/a_15_3_2.htm

Presenting symptoms of ulnar nerve entrapment can vary from mild transient pins and needles sensation, i.e. paraesthesias in the ring and small fingers to clawing of these digits and severe intrinsic muscle atrophy.The patient may report severe pain at the elbow or wrist with radiation into the hand or up into the shoulder and neck. Patients may report difficulty opening jars, spreading out hand and fingers or turning door knobs. The patients may feel early fatigue or weakness after repetitive hand motions, such as typing, sorting mails, etc. increasing numbness and paraesthesias may be noticed throughout the day.

Ulnar neuropathy can be caused by nerve damage, which can result from inflammation or compression along the pathway of ulnar nerve:

  • Ulnar nerve at or near the elbow
    • Compression at work, sleep or during general anesthesia
    • Blunt trauma
    • Malnutrition leading to muscle atrophy and loss of fatty protection across the elbow and other joints
    • Deformities (eg, rheumatoid arthritis, fracture of elbow bones)
    • Metabolic derangements (eg, diabetes)
    • Venipuncture
    • Hemophilialeading to hematomas
  • Ulnar neuropathy at or distal to the wrist (ie, at Guyon’s canal)
    • Bicycle
    • Tumors
    • Ganglionic cysts
    • Blunt injuries with or without fracture
    • Idiopathic
Diagnosis:
Proper diagnosis of ulnar nerve entrapment depends on an experienced physician:
·         Clear medical history taken, your physician should ask you in detail, including when, where, how, the symptom started, etc.
·         A comprehensive medical examination, including, inspection of any muscle atrophy, palpation of the tender area,  range of motion, sensitivity, special muscle strength test, etc.
  • Electrodiagnostic studies (EMG) to study nerve conduction within your hands and wrists, which is a gold standard for final diagnosis of ulnar neuropathy
Treatment:

The choice of treatment depends on the severity of your symptom. For mild to moderate ulnar neuropathy, conservative treatment, such as physical/occupational therapy, non-steroidal anti-inflammatory medicine, splints and acupuncture are recommended.

  • Physical Therapy to stretch, strengthen and remove adhesions in the ligaments and tendons in the hands and elbows
    • Ulnar Nerve Gliding: perform this maneuver till the hand is upside down with the fingers around the eye as shown below.  Hold for 20 seconds x 3 reps.

Fig 12.6

 

 

  • The daily use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers to help reduce pain and inflammation
  • Wearing splints to help immobilize and protect the elbow and wrist

Fig 12.7

 

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  • Acupuncture

The most commonly used points are the following:

SI 4 Wan Gu, SI 5 Yang Gu, SI 6 Yang Lao, SI 7 Zhi Zheng, SI 8 Xiao Hai

Points Meridian/No. Location Function/Indication
1 Wan Gu SI 4 On the ulnar side of the palm, in the depression between the base of the fifth metacarpal bone and the triquetral bone Febrile diseases with anhidrosis, headache, rigidity of the neck, contracture of the fingers, pain in the wrist, jaundice
2 Yang Gu SI 5 At the ulnar end of the transverse crease on the dorsal aspect of the wrist, in the depression between the styloid process of the ulnar and the triquetral bone. Swelling of the neck and submandibular region,  pain of the hand and wrist, febrile diseases
3 Yang Lao SI 6 Dorsal to the head of the ulna. When the palm faces the chest, the point is in the bony cleft on the radial side of the syloid process of the ulna. Blurring of vision, pain in the shoulder, elbow and arm
4 Zhi Zheng SI 7 On the line joining SI 5 Yang Gu and SI 8 Xiao Hai, 5 inch above Yang Gu Neck rigidity, headache, dizziness, spasmodic pain in the elbow and fingers, febrile diseases, mania
5 Xiao Hai SI 8 When the elbow is flexed, the point is located in the depression between the olecranon of the ulna and the medical epcondyle of the humerus Headache, swelling of the cheek,  pain in the shoulder, arm and elbow, epilepsy

 

 

Fig 12.8

 

  • Surgery: for severe cases and after the above conservative treatment, the following methods are considered:
  1. At the elbow. Your surgeon will make an incision at the elbow and perform a nerve decompression. Or your surgeon may choose to move the nerve to the inner part of the arm so that it is in a more direct position.
  2. At the wrist. If the compression is at the wrist, the incision is made there and the decompression is performed.

Tips for Acupuncturists:

  1. Make a clear diagnosis, check the causes of ulnar neuropathy, acupuncture may not  change the causes of the disease
  1. Early treatment will help the course, however, acupuncture only may help for the symptom, patients have to change their practice of sports or working

Tips for Patients:

  1. Avoid press your elbow and wrist during sports or work.
  2. Temporary numbness and tingling sensation at ring and little fingers usually will disappear without treatment. However, if you constantly press your elbow and wrist, you may have permanent damage.

 

35. Acupuncture and Hip Pain and Trachanteric Bursitis

Nov 26, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 3 (11), November, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

 

 

Hip Pain – Trochanteric Bursitis


http://jointsupplementreview.org/

 

 

Cindy is a 64 year-old female who complains of right hip pain for about six months after a fall in her garage and injury of her right hip.  She felt immediate pain at right hip.  Then, she put ice pack on the hip and took some Tylenol and Advil.  She thought the pain would go away.  However, after one month, the pain still was very severe and she had difficulty walking.  She was unable to lie on the right side because of the pain, which always awakened her up during the night.  Whenever she tried to walk, run, or lift some weight such as 10 to 20 pounds, her right hip was very painful with right leg weakness.  The pain sometimes also radiated down to her knee but not below the knee.  She then called her primary care physician, and an x-ray was done, which showed no bone spur, no fracture, and no osteoarthritis, and while the PCP examined her, her hip was swelling and slightly warm.  The range of motion of her right hip was slightly limited.  Her PCP told her it was soft tissue injury, it would get better in about one month.  She was prescribed Naproxen. However, the pain is getting worse and worse.  Now, she is limping and leaning to the right side.  The pain interferes her daily activities such as driving, walking, lying on right side, etc. Therefore, she comes to me for evaluation and the treatment.

 

Physical Examination: Cindy is moderately obese and tall.  She walks with a cane because the pain is so severe, she could not walk independently.  I palpated her right hip joints which is swollen and very tender.  The pain also goes along the right side lateral thigh.  I checked her range of motion.  At this time, the range of motion is slightly limited especially at the external rotation.  I asked her to flex and external rotate her hip by  pushing my hand resistant  outward,  she feels excruciated pain.  Her right hip joint muscle seems weak.  By sensation examination, her both legs are equal to the pinprick and light touch.  There is no sensory deficit.

 

Because of the severe right hip pain and debilitating, I decided to order MRI.  The MRI only showed the trochanteric bursa was swollen, tender, and increased in size.  There is no any other tendonitis or arthritis.

 

This patient most likely has hip bursitis, i.e., trochanteric bursitis.  On the hip, we have two trochanteric bursae, one is called superficial trochanteric bursa which is on top of the femoral head, i.e., outside the hip joint. The other one is called deep trochanteric bursa, a deep bursa,  which is underneath the  gluteus medius muscle.  Hip bursitis are inflamed conditions of  hip bursa. The patients with hip bursitis typically complain lot of hip pain, although the hip joint itself is not involved.  The pain very often radiates down to the lateral aspect of the thigh.

Fig 11.1

 

 

 

www.skillbuilders.patientsites.com

 

Fig 11.2

 

 

 

STIR coronal image demonstrates increased signal lateral to the left greater trochanter (arrow).

www.radsource.us

 

The course and risk factors of hip bursitis: The hip bursitis usually is caused by contusions from falls, contact sports, and/or by the bursal irritation resulting from friction by the iliotibial pain (ITB).

this condition is most common in the middle aged or elderly, and especially prevalent among women with the following conditions:

  1. Repetitive activity such as stair climbing, bicycling, standing, running, hiking for long periods of time.
  2. An injury such as a fall, or lying on the side for long periods of time, exerting unnecessary pressure on the hip.
  3. Lower back pain, caused by arthritis, scoliosis, spondylosis, etc.
  4. Previous surgery, such as surgery around the hip or total hip replacement which can irritate the bursa and cause bursitis.
  5. Leg length discrepancy.  This will change the center of gravity and cause irritation of the hip bursa.

 

for example, which is repetitive and cumulative irritation.  Sometimes, leg length discrepancy and lateral hip surgery also can cause hip bursitis.

 

The symptoms of hip bursitis include:

  1. Hip pain.  The pain sometimes radiates to the outside of the thigh to the knee area, as well as to the groin area. The pain may be worse during activities such as running or sitting with the leg crossed over the opposite knee.
  2. The pain may disturb sleep, especially when the patient is lying on her right side.
  3. Swelling may occur from the increased fluid within the bursa.
  4. The condition may cause limping and the patient may have difficulty walking or running.
  5. Heat and redness may occur on the affected bursa.

 

 

Hip bursitis usually is not related to osteoarthritis.  Therefore, by the MRI or x-ray, you cannot see the hip spur, bone spur, or narrowing of the joint space.  You may also not see the tendonitis around the hip joint and only see inflamed enlarged bursa.  The differential diagnosis of hip bursitis is as following:

 

  1. Fracture of the femoral head
  2. Avascular necrosis of the femoral head
  3. hip fracture
  4. Lumbosacral radiculopathy
  5. Iliopsoas tendonitis
  6. ITB tendonitis
  7. Internal snapping hip and external snapping hip, etc.

 

Western Medicine Treatment:

 

  1. Most often, physician will prescribe anti-inflammatory medication such as naproxen, Advil, etc.  Usually, there is no significant improvement after taking the naproxen, etc., because the bursitis is acute and severe inflammation on the bursa of the hip but many patients like to take anti-inflammatory medication.
  2. Rehabilitation program by physical therapy.  Very often, physical therapy should be applied by stretching of the ITB, tensor fascia lata, external hip rotators, quadriceps, and hip flexors.  The physical therapy modality such as cold pad, electrical stimulation, and soft tissue massage might be also helpful.

Fig 12.3

 

 

Fig 22.4

 

 

  1. Corticosteroid injection.  There are many studies which showed the corticosteroid injection at the inflamed bursa can have quick, specific, and effective treatment with prolonged benefit.  Usually, the patient should lie on the unaffected side.  About 40 mg to 80 mg corticosteroid with 5 cc of 1% to 2% of lidocaine mixed to inject to the bursa about 66% of patients at a followup visit at one year and five years feel much improved.

 

As an acupuncturist, we should do as the following

 

  1. Have the patient to rest.  Instructed the patient do not perform any repetitive activity for at least one month, and in the meantime, put ice massage on the hip about 15 minutes to 20 minutes twice a day on the hip and the ITB.  Because the inflammation inside the hip bursa, the fluid very often leaks out followed the ITB and makes the ITB inflammation.  That is why, the pain radiates down to the lateral thigh.  Because of ITB is attached around the knee, the pain will not go down beyond the knee.  Therefore, the massage with ice is a very important procedure to decrease the inflammation and  pain.
  2. Acupuncture.  The acupuncture usually I choose GB 30 Huan Tiao, Arshi GB31 Feng Shi, GB34 Yang Ling Quan, Sp9 Ying Ling Quan, Sp10 Xue Hai and Liv3 Tai Chong.

 

Points Meridan/No. Location Function/Indication
1 Huan Tiao GB 30 At the junction of the lateral 1/3 between the great trochanter and the hiatus of the sacrum. Pain of the lumbar region and the thigh, muscular atrophy of the lower limbs, hemiplegia
2. Feng Shi GB 31 On the midline fo the lateral aspect of the thigh, 7 inch above the transverse popliteal crease. Pain and soreness in the thigh and lumbar region, paralysis of the lower limbs, beriberi, general pruritus
3. Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion
4. Ying LingQuan Sp 9 On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia Abdominal pian and distension, diarrhea, dysentery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genitalia, dysmenorrheal, pain in the knee
5. Xue Hai Sp 10 When the knee is flexed, 2 inch above the medial edge of patella. Irregular menstruation, dysmenorrheal, uterine bleeding, amenorrhea, urticaria, eczema, erysipelas, pain in the medial aspect of the thigh
6 Tai Chong Liv 3 On the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones. Headache, dizziness and vertigo, insomnia, congestion, swelling and pain of the eye, depression,, infantile convulsion, deviation of the mouth, pain in the hypochondriac region, uterine bleeding, hernia, enuresis, retention of urine, epilepsy, pain the anterior aspect of the medial malleolus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 22.5

 

I choose the big diameter needle and with electrical stimulation at the bursa and the big needle usually can make the swelling going down and increase the energy flow go through the bursa.  The stimulation can repetitively stimulate the bursa making the patient pain sensitivity going down and the patient will tolerate more the stimulation and the daily activity.  Other points such as Hegu and Taichong will increase large dosage of endorphin  secretion which will make the patient feel less pain.

 

Cindy underwent my treatment for about 10 visits and with soft massage, ice, and acupuncture with electrical stimulation and she feels much better after the treatment.  She followed up once after two months and her hip pain is completely gone.

 

Tips for Acupuncturist:

 

  1. Always ask the patient to rest and ice massage, and if you understand some Chinese herb, you can choose some Chinese herb cream with anti-inflammation function to massage the patient’s hip and ITB.
  2. If the patient’s hip has obvious severe inflammation or infection, do not treat and you should refer the patients to her or his primary care physicians to check if there is any infection.
  3. A large diameter needle with electrical stimulation will be much more effective than the small diameter needle without electrical stimulation.
  4. You may teach the patient to stretch the right ITB band and hip joints in a certain way.

 

Tips for Patients:

 

  1. Not all the physicians can make a clear diagnosis about hip trochanteric bursitis. You have to consult physicians of orthopedics and physiatrists.
  2. Ice massage is very important treatment method, you must use ice to massage your hip 15 min 2x a day in order to reduce the inflammation and decrease pain.

 

 

 

 

 

 

 

 

 

 

34. Acupuncture and Heel and Foot Pain

Oct 13, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 3 (10), October, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Heel and Foot Pain


literunner.com

Jennifer is a 55 year-old, moderately obese woman. She runs every morning for about 4 to 5 miles, who complains of right heel and plantar foot pain, difficulty walking, especially in the morning after waking up from sleep for 2 years. She went to the podiatrist, who gave her an x-ray, which showed a mild heel spur at her heel. She was given orthotics for the right foot, but she still feels pain, therefore, she comes to me for evaluation and treatment.

By physical examination, there is tender point at right heel and arch. There is no ankle pain, no numbness nor tingling sensation at right leg.  Based on my examination and clinical information, the patient most likely has right plantar fasciitis with possible heel spur.

There are two different concepts of plantar foot pain:

  1. Plantar Fasciitis: Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot, i.e. the plantar fascia. It connects the heel bone to the toes and covers and supports the arch of the foot. The pain is located at the medial heel, however, if the pain is severe, it will spread out to entire foot arch.
  2. Heel Spur: A heel spur is a hook of bone that can form on the heel bone (calcaneus). A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis. However, sometimes, people may have heel spur without any pain, some people may have severe heel pain and the pain may mixed with plantar fasciitis to cause the entire plantar foot pain. An inferior calcaneal spur consists of a calcification of bone, which lies superior to the plantar fascia at the insertion of the plantar fascia, most common in the medial side heel of the foot.

Fig 10.1

Causes, incidence, and risk factors:

The most important key part of plantar fasciitis is overstretched or overused of the thick band of tissue on the bottom. This can be painful and make walking or running more difficult.

Risk factors for plantar fasciitis include:

  1. Obesity.
  2. High arches and/or flat feet.
  3. Overwalking or running, especially running downhill or on uneven surfaces
  4. Tight Achilles tendon, which is the tendon connecting the heel to the calf muscles.
  5. Hard surface of the shoes, especially tight and hard shoes without any arch support or Cushing function.
  6. Men ages 40 to 70.

Symptoms:

The pain in the bottom of the foot usually is sudden onset with most often sharp or burning sensation, sometimes you may feel dull pain.

The pain is usually worse:

  • In the morning when you take your first steps
  • After sitting or standing for a while
  • When climbing stairs or walking on uneven surfaces
  • After intense activity

The pain usually feels better after you warm up with first steps or take hot shower.  The pain may develop slowly over time, or suddenly after intense activity.

Signs and Tests:

The doctor will perform a physical exam. This may show:

  • Tenderness on the bottom of your foot, usually at the medial heel and entire arch.
  • Flat feet or high arches
  • Mild foot swelling or redness
  • Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems, but having a heel spur is not significant.

Fig 10.2

http://spinalphysio.kornberg.net/heel_spurs.gif

Treatment:

  1. Anti-inflammatory medications: Acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) to reduce pain and inflammation.
  2. Rest- At least rest for one week or more, no running, no long walking.
  3. Ice: apply ice to your bottom of the feet for at least 15 min, 2 to 3 x  per day.
  4. Wearing shoes with cushions, custom made shoe insole and heel cups. Boot cast, night splint

Arch Support

Fig 10.3

plantar-fasciitis-fix.com

Fig 10.4

the-good-doctor.net

Fig 10.5

myfootshop.com

Fig 10.6

bannertherapy.com

Fig 10.7

feetinsoles.com

Fig 10.8

foot-pain-store.com

Fig 10.9

woundblog.com

  1. Physical therapy

Fascia-specific stretching exercise by gently pulling back the toes for 10 sets of 10 seconds.  Repeat 3 times a day.

Fig 10.10

Fig 10.11

Another exercise targeted at the plantar fasciia and strengthening the small muscles of the foot is marble pick-ups.  Place a handful of marbles on the floor and pick them up using the toes and place in container.  Repeat for a total of 3-5 minutes.  If marbles are not available, the same motion can be performed using a towel.

Fig 10.12

The use of anti-inflammatory properties of ultrasound targeted to the bottom of the heel is beneficial.  A typical treatment would be around 8 minutes and can be performed by your physical therapist.

  1. Acupuncture

The following acupuncture points are selected: experienced points (Arshi points), Ki 1 Yong Quan, Sp 9 Ying Ling Quan, GB 34 Yang Ling Quan,

Points Meridian/No. Location Function/Indication
1 Arshi Points As indicated For local pain
2 Yong Quan Ki 1 On the sole, in the depression when the foot is in plantar flexion, approximately at the junction of the anterior third and posterior two thirds of the sole Headache, blurring of vision, dizziness, sore throat, dryness of the tongue, loss of voice, dysuria, infantile convulsions, feverish sensation in the sole, loss of consciousness
3 Ying LingQuan Sp 9 On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia Abdominal pian and distension, diarrhea, dysentery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genitalia, dysmenorrheal, pain in the knee
4 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion

Fig  10.13

  1. Steroid injection: Steroid injection sometimes may make a significant improvement. However, you should use is cautiously, because the steroid may cause necrosis of the plantar foot.
  2. Surgery: Last resort.

Jennifer’s Treatment:

Jennifer was advised to stop running immediately. In the meantime, she was given heel pad with two layers of shoe insoles, and changed to a bigger size of snickers. She was given above acupuncture treatment and physical therapy stretch exercise 3x per week for 4 weeks. She also stretch her foot and perform ice massage 3 to 4 x per day. Her plantar faciitis was completely healed. She run again after 2 months.

Tips for Patients:

  1. Early treatment, the earlier, the better.
  2. Always use two layers of shoe insoles to cushion your inflamed foot.
  3. Rest and ice massage

Tips for Acupuncturists:

  1. Arshi 1 and Arshi 2 are most important points to reduce plantar pain.
  2. Use electrical stimulation to desensitize the plantar foot pain.
  3. Encourage your patients to use shoe insoles, two layers are better than one layer.
  4. Try not to use steroid injection.

33. Acupuncture and Lateral Ankle Sprain

Sep 20, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

News Letter, Vol. 3 (9), September, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Lateral Ankle Sprain

Fig 9.1

Douglas is a 26 year-old male football player who has been experiencing right lateral ankle pain after a month of strenuous exercise.  He was training for the 100-meter dash when he felt a pain in his right ankle that caused him to fall.  He was immediately taken to a sports medicine doctor who found his right ankle to be moderately swollen, though because of the severe pain Douglas felt, the doctor immediately sent him for an MRI without contrast of the right ankle.  The MRI showed no fracture, no ankle bone dislocation, though showed there was a ligament sprain of the right ankle.

 

The patient was given preventative treatment known as RICE, which stands for:  R is rest; the patient was ordered to stay off the right ankle.  I is ice for ice packs to be held to the affected area to decrease both the inflammation and the swelling.  C is for compression: the patient was given an elastic sock to wear on his right ankle and E is elevation, so the patient was instructed to elevate his leg to decrease the edema and the swelling.

 

The patient gradually felt better, however he still felt pain in the right lateral ankle after a month, so he came to me for further treatment and evaluation.

 

I noted the ankle was still slightly swollen and the lateral right side of it was very tender.  The range of motion of the right ankle dorsiflexion, i.e. his right foot bend up to his nose was 0-30 degrees and the plantarflexion, i.e. his foot bend down to the ground, 0-20 degrees, though with pain.

 

The patient had suffered a lateral ankle sprain, the most common form of ankle sprains, which accounts for 80% of this type injury.  There are three small ligaments in the ankle which are very easy to sprain.

  1. Anterior talofibular ligament (ATFL):  This is the most common ligament injury
  2. Calcaneofibular ligament (CLF): This is the second most common and
  3. Posterior talofibular ligament (PTFL):  This is the last to be injured.

http://www.webmd.com/hw-popup/ankle-sprain Fig 9.2

All of these three ligaments function to stabilize the ankle during inversion, so when the ankle experiences inversion on the plantarflexed foot, this is the most vulnerable position.

 

http://www.midwestsportsfans.com Fig 9.3

Ankle Sprain Causes

The ankle pain is most often caused by injury to the ligaments, not bone. Ankle ligaments, especially as mentioned above are injured most commonly when the foot is turned inward or inverted by a force greater than the ankle ligaments can sustain. This kind of injury can happen in the following ways:

  • Sports: such as football, basketball, tennis, when the athlete landed with the plantar foot inverted and the downward force. A common example is a basketball player who goes up for a rebound and comes down on top of another player’s foot. This can cause the rebounder’s foot to roll inward.)
  • Fall while stepping on an irregular surface, such as stepping in a hole.
  • The most common ankle sprains are Inversion injuries, in which the foot rolls inward, are more common than eversion injuries (also referred to as a high ankle sprain), in which the foot twists outward.

There are three grades of lateral ankle sprains:

  1. Grade 1 is mild, which includes partial tear of the ATFL and intact CFL and PTFL.  There is no instability, mild swelling and point tenderness at the lateral aspect of the ankle.
  2. Grade 2 is moderate.  There is a complete tear of the ATLF and partial tear of the CLF.  The patient’s ankle is very unsteady and exhibits diffuse swelling and ecchymosis.
  3. Grade 3, severe. This is the complete tear of the ATFL and CFL.  The patient in this case is extremely unsteady.

 

Western medicine treatment.

  1. During the acute stage the ankle is treated with RICE, as detailed above.
  2. Nonsurgical treatment only can treat grade 1 and possibly part of grade 2; grade 3 requires surgery.
  3. Physical Therapy:

 

A rocker boot helps to promote a more natural gait while providing stability for severe ankle sprains, fractures of the foot and for post-operative use.  There are many types of rocker boots, but most feature adjustable air cells to ensure a custom snug fit to accommodate any foot.

 

Ensuring optimal pain free motion is needed to help with recovery.  Starting with Active Range of Motion perform up to 30 pain free reps of the 4-Way Ankle Movements before moving on to resistance with strengthening.  Strengthening the muscles of the ankle and lower leg is important to prevent imbalances and future weakness in the ankle.

 

1: Dorsiflexion – foot is pulled back towards the body against resistance

2: Plantarflexion – foot is pushed down away from the body against resistance

3: Inversion – foot is turned down and in against the resistance

4: Eversion – foot is turned up and out against the resistance

Fig 9.4

 

 

Fig 9.5

 

 

 

Fig 9.6

 

 

Fig 9.7

 

 

 

To continue to strengthen the stabilizing muscles of the ankle and improve proprioception work on standing balance on the ground.  After, continue to progress to balance with a foam pad for 2 sets of 30 seconds.

Fig 9.8

 

 

 

This will assist in strengthening the stabilizing muscles of the ankle and help to regain balance in circumstances where the ankle may be injured again such as in basketball when going up for rebound and coming down on another players ankle.  The wobble board once balance is achieved in standing on a flat surface and on the foam pad can be used again, this time in a standing position.

 

Traditional Chinese medicine treatment:

 

Many patients tried everything before they came to me. They usually had different treatments for years. However, they still feel pain with difficulty standing, and walking. They have extreme pain by walking a long distance, such as during vacation. Acupuncture might be their last resort.

 

My personal experience is that we first have to make a clear diagnosis by palpating the tender points to differentiate injuries of the three ligaments: the most common injured ligament is ATFL, the second most common injured ligaments are ATFL and CFL. You will see rarely the PTFL injury. After palpation, you can clearly understand the source of the problems. Then you can treat the injury accordingly.

 

The following acupuncture points are usually selected: Sp 6 San Ying Jiao, UB 62 Sheng Mai, GB 40 Qiu Xu, UB 60 Kun Lun,  PC 6 Nei Guan, and St 36 Zu San Li.

Sp 6 is the crossing points for three Ying Meridians, therefore, it can adjust all three meridians energy, and smooth the blood and qi. UB62 is located at the ATFL, therefore, it is very important to use for the ATFL injury. GB41 coincident at CFL, it will help UB62, both UB 62 and GB 41 will bring blood flow to the injured ATFL and CFL ligaments to facilitate healing. PC 6 and St 36 helps adjust the entire energy flow in the body.

Points Meridian/No. Location Function/Indication
1 San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibiaFigure 24.22 Abdominal pain, distension, diarrhea, dysmenorrheal, irregular menstruation, uterine bleeding, morbid leucorrhea, prolapse of the  uterus, sterility, delayed labor, night bed wet, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and leg pain, headache, dizziness and vertigo, insomnia
2 Shen Mai UB 62 In the depression directly below the external malleolus Epilepsy, mania, headache, dizziness, insomnia, backache, aching of the leg
3 Qiu Xu GB 40 Anterior and inferior to the external malleolus, in the depression on the lateral side of the tendon of extensor digitorum longus Pain in the neck, swelling in the axillary region, pain in the hypochondriac region, vomiting, acid regurgitation, muscular atrophy of the lower limbs, pain and swelling of the external malleolus, malaria.
4 Kun Lun UB 60 In the depression between the external malleolus and archillus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy
5 Nei Guan PC 6 2 inch above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis. Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomiting, hiccup, mental disorders, epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and pain of the elbow and arm.
6 Zu San Li St 36 3 inch below St. 35 Du Bi, one finger below the anterior crest of the tibia, in the muscle of tibialis anterior Gastric pain, vomiting hiccup, abdominal distension, borborygmus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 9.9

 

 

 

 

Treatment course for Douglas:

Douglas underwent my treatment 2-3 x per week for about 5 weeks, besides acupuncture treatment, he also was guided to have strengthening exercise for his right ankle.  I realized that acupuncture treatment only might take a longer time to recover, however, if we combine acupuncture with physical therapy and ankle brace, the patient will have much less pain and resume their regular walk sooner. After 5 weeks treatment, Douglas started his regular walk with mild tenderness; he can sustain much longer ambulation without pain.

 

Tips for Acupuncturist:

 

    1. Acupuncture and physical therapy can treat only the grade 1 ankle sprain.  If grade 2 or 3 is concerned, you should encourage the patient to consult an orthopedic physician.
    2. Acupuncture is a good treatment for long-term ankle pain, you may need to treat the patient for a few months in order to get better results.
    3. You should encourage your patients to use ankle brace to protect ankle joint.
    4. Electrical stimulation with UB 60, UB 62 and GB40 for 30 min are very important.

 

Tips for Patients:

 

  1. For grade 3 sprain, you may consider surgery for reparation. However, if you have grade 1 or 2, be very cautious to have surgery. I have patients who went through many surgeries, have had long term pain for many years.
  2. You should always massage the three points, UB 60, UB 62 and GB40 5-10 min in the morning and evening everyday. If you have anti-inflammatory cream for massage, you will get better results.

32. Acupuncture and Archilles Tendon Injury

Aug 23, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

 

News Letter, Vol. 3 (8), August, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Achilles Tendon Injury

mediapartnersinc.com

Eric is a 55 year-old man, who recently started training for marathon. He used to play tennis. He believed that he would be an excellent marathon runner. He got up around 5AM, run about 2 hours, then went to work. He runs about 5 to 6 days per week.  Recently, he had a slight fall during training, he heard pop sound, and immediately felt pain and swelling on right back of the ankle. The pain was sharp, he was unable to walk. He called his PCP right away. He was referred to orthopedic physician. By careful examination, he was suspected to have Achilles tendon tear. MRI was done, which showed right Achilles partial tear. He was advised to stop marathon training, and ice was put at the right Achilles tendon. He was instructed to have rest for one month, wait and see, in the mean time, using ice massage three times a day for 10 min of each, if the tendon is not healed, he might need surgery to repair the tendon.

 

After two months of the incident, the patient came to me and reported his right ankle is still painful and mild swelling. He was told by his orthopedic doctor that his Achilles tendon is healing, it is not necessary to have surgery. However, he still felt a lot of pain, he only could walk for one block without pain. He tried ice massage and rest another month, he still felt severe pain at right back of the ankle. Therefore, he came to me for eval and treatment.

 

By physical examination, I saw a swelling and tender Achilles tendon at right with some floating fluid inside. I palpated the ankle, there was some kind of tenderness and the patient was unable to make a full range of motion at right ankle. I believed that the patient was suffering Achilles Tendonitis.

Achilles tendon is the tendon located at back of the ankle that connects calf muscles at the back of the lower leg to the heel bone. Achilles tendon is the thickest and strongest tendon in the body. The Leg muscles are the most powerful muscle group in the body. The contraction of  calf muscles pulls the Achilles tendon upward, which pushes the foot downward and gives the power of standing on the toes, walking, running, and jumping. Each Achilles tendon sustains a  person’s entire body weight with each step. Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-12 times a person’s body weight during a sprint or push off.

Qualitative and quantitative histological analyses in one study showed that the Achilles tendon has a poor blood supply throughout its length, as determined by the small number of blood vessels per cross-sectional area, which do not in general vary significantly along its length. In light of these findings, it is suggested that poor vascularity may prevent adequate tissue repair following trauma, leading to further weakening of the tendon.

(J Orthop Res. 1998 Sep;16(5):591-6. Blood supply of the Achilles tendon.

Ahmed IM, Lagopoulos M, McConnell P, Soames RW, Sefton GK. Department of Human Biology, University of Leeds, England.)

Mechanism of injury:

1. Achilles tendonitis is inflammation of the Achilles tendon. Repetitive eccentric overload causing inflammation and microtears of the tendon. However, recently some researches discovered that most people with Achilles injury besides Achilles tendon rupture have Achilles teninosis, rather than Achilles tendonitis because there is no evidence of inflammation at Achilles tendon, the cells at the Achilles tendon are disorganized, degenerated and scarred. But most people in medical field still call it Achilles tendonitis.

Achilles tendonitis is often a running injury or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles. People, who suffer Achilles tendonitis usually are lack of  flexibility and do not warm up the Achilles tendon before their activities.

2. Achilles tendon rupture

Inflammatory: inflammation and degeneration causing a series of microruptures of breakdown in the collagen fibers.

Poor nutrition: Inadequate vascularization 2-6 proximal to the insertion of the tendon.

Mechanical: Sudden push-off with the foot in the extension position, such as landing from a jump

Gradual pain and the pain worsens over time at back of the ankle is the most common sign of Achilles tendonitis. Signs and symptoms of Achilles tendonitis include:

  • Mild pain at the back of the ankle after running and other sports activities.
  • The pain is getting worse after prolonged running, tennis,  stair climbing and jumping, or other activities. The patient has difficulty walking, stiffness, especially in the morning.
  • If partial tear, swelling and/or bump might show on the Achilles tendon, a crackling or creaking sound might be heard when touching or moving the Achilles tendon.

TREATMENT

    1. Acute Achilles tendonitis:

A: PRICE

Pressure: apply pressure on Achilles tendon with ice bag for 15 to 30 min

Rest: stop lower extremities sports such as running, biking, etc. for at least 2 to 4 weeks. You may continue upper extremities exercises, such as bench weight lift, etc.

Ice: as above

Compression: apply pressure on Achilles tendon with Ace bandage

Elevation: elevate the foot to avoid fluid retention

B: Avoid Anti-inflammation Medication such as Tylenol, Advil, etc. and pain killer, because Tylenol, Advil will not help heal the inflammation and pain killer may mask the pain and you may not be able to feel the pain and may injure your Achilles tendon more

C: Avoid steroid injection at Achilles tendon because steroid injection might cause further rupture of the Achilles tendon.

    1. Chronic Achilles tendonitis:

A: Physical Therapy: Stretching both the gastrocnemius and soleus needs to be addressed as pictured below with both the leg straight and slighty bent in each position for one minute.

Fig 8.1

Stretches for the Achilles can be performed on a specific device called ProStretch or off any sturdy step and held for a minute each.

Fig 8.2

 

B: Acupuncture

Acupuncture treatment can bring blood flow to Achilles tendon and help the healing. The main acupuncture points are as follows,

Local Points: UB 60 Kun Lun, UB 61 Pu Shen, Ki 13 Tai Xi, Ki 14 Da Zhong, Ki 15, Shui Quan

Distal points: Sp 9 Yin Ling Quan, GB 34 Yang Ling Quan, LI 4 He Gu, LI 11 Qu Chi,

 

Points Meridian/No. Location Function/Indication
1 Kun Lun UB 60 In the depression between the external malleolus and archillus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy
2 Pu Shen UB 61 In the depression directly below the external malleolus Epilepsy, mania, headache, dizziness, insomnia, backache, aching of the leg
3 Tai Xi Ki 3 In the depression between the medial malleolus and tendo calcaneus at the level with the tip of the medial malleolus Sore throat, toothache, deafness, tinnitus, dizziness, spitting of blood, asthma, thirst, irregular menstruation, insomnia, nocturnal emission, impotence, frequency of micturition, low back pain
4 Da Zhong Ki 4  Posterior and inferior to the medial malleolus, in the depression medial to the attachment of tendo calcaneus Spitting of blood, asthma, stiffness and  pain  of the lower back, dysuria, constipation, pain in the heel, dementia
5 Shui Quan Ki 5 1 inch directly below Ki 3 Tai Xi in the depression anterior and superior to the medial side of the tuberosity of the calcaneum Amenorrhea, irregular menstruation, dysmenorrheal,  prolapse of uterus, dysuria, blurring of vision
6 Ying LingQuan Sp 9 On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia Abdominal pian and distension, diarrhea, dysentery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genitalia, dysmenorrheal, pain in the knee
7 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion
8 He Gu LI 4 See table 3-1/Fig 3.4 See table 3-1
9 Qu Chi LI 11 See table 4-1/Fig 4.4 See table 4-1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 8. 3

 

C: Heel lift and shoe wedge

There are many products in the market for heel lift, the principal is to lift the heel and reduce the stress on the Achilles tendon.

Fig 8.4

 

http://www.squidoo.com

Fig 8.5

 

bestshoelifts.com

You may put the heel lift simply inside your shoe or have a shoe wedge outside your shoe to help reduce the stretch of the Achilles tendon.

D: Surgery

Surgery is the last resort to repair your Achilles tendon.

Eric’s treatment:

Eric received physical therapy and acupuncture treatment from me for total 12 visits, he stopped sports related to the lower extremities. He also put ice on his Achilles tendon, and wedge into her shoes, she felt much better after the above treatment.

Tips to Patients:

  1. Stop  your lower extremity exercise, such as running, tennis immediately if you feel Achilles tendon pain.
  2. Put ice on and massage the Achilles tendon.
  3. Try to use heel lift or shoe wedge to help yourself rest. You may buy one premade or go to the shoe maker or special orthotist  to add a wedge at your shoe.
  4. Nerve allow anybody inject steroid at your Achilles tendon because steroid injection will cause rapture of Achilles.

Tips to Acupuncturists:

  1. Nerve use heating pad, lamp or moxa on the inflamed Achilles tendon, which will increase more inflammation at Achilles tendon.
  2. If you suspect Achilles tendon rupture, you must refer the patient to orthopedics to handle.
  3. Electrical stimulation will help healing.

 

 

 

 

 

 

 

 

 

 

31. Acupuncture and Shin Splint

Jul 12, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  3 Comments

News Letter, Vol. 3 (7), July, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Robert Blizzard III, DPT
www.drxuacupuncture.co
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720

Shin Splint


http://www.fitnessinformation.net/how-to-heal-shin-splints-ouch

George F is a 16 years old squash player. He’s had a personal coach working with him 4-5 hours of training everyday. The intensive training started when he was 8 years old, and made him one of the top players in US. One day, he complained of right lower leg pain with swelling at the right frontal lower leg. These symptoms happened often, and George’s coach put some ice on it, and asked him to stop training for one day. However, the above treatment did not make him feel any better, and he forced himself to go back for the training. But the pain was getting worse and becoming a constant dull pain with pressure sensation. The pain usually felt worse at the start of exercise and slowly subsided as the exercise continued. When he rested, he felt some relief. The pain often returned after prolonged activity and usually worse in the next morning. He had difficulty jumping, running and even walking, therefore, his mom brought him to me for evaluation and treatment.

By physical examination, there was tenderness at right frontal medial lower leg behind and along the shin bone with slight redness and swelling. The pain spread through the entire right medial shin bone, worse at the lower half of the shin. The lower leg was slightly warm. The pain was worse when I bent his toes and foot downward. George walked with a short stance at the right leg, and leaned to right. He had no knee, hip or low back pain. I ordered X-ray of right leg, which showed no fracture at right tibia and fibular bones. Based on the above, my impression is shin splints, i.e. medial tibial stress syndrome.

Shin Splints is a loose term describing different injuries around lower leg.
The term “shin splints” refers to pain along or just behind the shinbone (tibia) — the large bone in the front of your lower leg. There are two bones in your lower leg. The main bone is called Tibia, i.e. Shin, which hold the stress from your body upon impact from walking, running, etc., the small bone is called fibula, which attaches and stabilizes the muscles around the tibia.
The lower leg is divided into three fascial compartments-anterior, lateral, and postieror-by three membranes, i.e. the anterior and posterior intermuscular septa and the interosseous membrane. Because the septa forming the boundaries of the leg compartments are strong, trauma to muscles in the compartments may produce hemorrhage, edema and inflammation of the muscles. With arterial bleeding, the pressure may reach levels high enough to compress structures in the compartments, which will cause extreme pain called “compartment syndrome”. For severe cases of compartment syndrome, the only treatment is fasciotomy (incision of a fascial septum) to relieve the pressure in the compartments concerned.
Fig. 7.2



hughston.com

Shin splints-edema and pain in the area of the distal two-thirds of the tibia-results from repetitive microtrauma of the tibialis anerior and small tears in the periosteum covering the body of the tibia. Muscles in the anterior compartment swell from sudden overuse, and the edema and muscle-tendon inflammation reduce the blood flow to the muscles. Shin splints are a mild form of the anterior compartment syndrome.
Many athletes have shin splints, such as long distance runners, dancers, tennis, basketball, and football players. etc. There are two predetermined conditions, which will make any athletes prone to have shin splints.
1. High impact and constant stress on your shin, i.e. lower leg’s muscles and bone. This is the key contributor. If you are a sedentary person, you only walk a short distance without any high impact on your leg for your life, you will not have any symptoms of shin splints. However, if you suddenly start to exercise without warm up, or if you have constant, high impact pressure on your leg, it will lead to different types of shin splints.
2. Overpronation or “ Flat Feet”. Many people have flat feet without an arch. This anatomical deficiency changes the dynamic chain from your trunk, hips, knees, ankles and feet. Thus putting tremendous stress on your shins, you may develop shin splints. Inappropriate footwear, such as high heel shoes, as the same token, will change the dynamic chain, and over stretch the muscles and tendons around your shin and cause pain and shin splints.
The high impact and changed dynamic chain make the following symptoms or diseases possible:
• Medial tibial stress syndrome: i.e. the tendonitis and tibial periostitis with Irritated and swollen muscles, often caused by overuse.
• Stress fractures, which are tiny, hairline breaks in the lower leg bones.
• Compartment syndrome, as described above.
Diagnosis of Shin Splints
1. Medical history: As we mentioned before, if you have history of lower leg pain and swelling, warm along the anterior and posterior your shin bone after excessive impact of exercise on your leg without warming up, and if you have pronated feet, you might have the symptoms of shin splints.
2. X-ray: we usually order x-ray to rule out the stress fractures, i.e. to look at if you have a tiny, hairline fracture in your tibia bone.
3. It usually is not necessary to have MRI for the diagnosis of shin splints.
In mild cases, you should treat yourself with the following steps:
• Rest. Avoid high impact activities that cause pain, swelling or discomfort, try low-impact exercises, such as swimming, bicycling or water running.
• Ice massages the affected area. Apply ice packs wrapped with a thin towel to the affected shin for 15 to 20 minutes at a time, four to eight times a day for at least one to two weeks.
• Elevation of your leg: Elevate your affected leg above the level of your heart while you are sitting and sleeping, especially during night.
• Anti-inflammatory drugs. Such as ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve, others) or acetaminophen (Tylenol, others) to reduce pain.
• Wrap your shin with bandage to protect it from swelling further. You should wrap and check it periodically for every a few hours, if the swelling increases, or more pain, or numbness and tingling sensation happens, you should unwrap it right away.
• Wear proper shoes. You should wear a pair of shoe with enough space suited for your foot type, stride and particular sport. If it is necessary you should ask your podiatry or physiatry physicians for recommendation.
• Consider arch supports and appropriate shoe insole. Arch supports and shoe insole can help cushion and disperse stress on your shinbones
In moderate cases, you may need the following treatment:
1. Physical Therapy
Stretches for the lower leg muscles include calf stretches. Maintaining a straight back leg will emphasis the gastrocnemius and then with a bent back leg shift the target to the soleus muscle. The back ankle should be held on the ground with toes pointing straight forward, each stretch should be held for 30-60 seconds.

Fig 7.3


http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/tendinitis/stretching.php

A stretch for the lower leg muscle on the front of the shin, anterior tibialias, can be performed standing or kneeling as shown below with each stretch held for 60 seconds

Fig 7.4


http://www.teachpe.com/stretching/standing_shin.php
http://www.projectswole.com/weight-training/how-to-avoid-shin-splints/

Kinesio Taping is effective to help reduce stress associated with shin splints along with many other physical ailments. There are many varying methods with taping, but the basic theory is to reduce stress through the painful area while activating the proper muscle groups.

Fig 7.5


 

http://sportsmedinfo.net/kinesiology-taping/234-kinesio-tape-shin-splints

Compression Sleeves have also been effective in reducing fatigue and decreasing soreness associated with shin splints when wore while running. Some pairs allow for ice packs to be held in place post activity to speed up recovery and reduce inflammation.

Fig 7.6


http://www.return2fitness.net/Supports_and_Braces/Shin_and_Calf_Supports/mueller-shinsplint
http://revelsports.com/Zensah/6055_Zensah_Compression_Sleeves_Calf_Shin_split.asp

Strengthening the muscles of the ankle and lower leg is important to prevent imbalances in the lower leg. The exercises should be able to be performed for 20-30 reps painfree before adding resistance from a Thera-Band as demonstrated below. The patient should build up to 3 sets of 10 reps for each exercise. These exercises are referred to as 4-way Ankle Exercises. The first motion in DorsiFlexion as the foot is pulled back towards the body as resistance is applied in the opposite direction. The next motion is PlantarFlexion as the foot is pushed down away from the body against resistance. The third motion is Inversion as the foot is turned down and in against the Thera-Band. The final motion is Eversion as the foot is turned up and out.

Fig 7.7


http://www.sportsinjuryclinic.net/cybertherapist/front/ankle/broken_ankle/rehabilitation.php
2. Acupuncture: I usually chose the following acupuncture points, both side LI 4 He Gu, LI 11 Qu Chi,
Then depends on which compartments, I chose different group,
For anterior and lateral compartments:
Sp 6 San Ying Jiao, Sp 7 Lou Gu, Sp 8 Di Ji, Sp 9 Ying Ling Quan, Sp 10 Xue Hai, Sp 11 Ji Men, St 36 Zu San Li, St 37 Shang Ju Xu, St 39 Xia Ju Xu.

Fig 7.8

 


 

 

 

 

 

 

 

For posterior compartment:
UB 55 He Yang, UB 56 Cheng Jing, UB 57 Cheng San, UB 59 Fu Yang,

Fig 7.9

Points

In seve

re cases, i.e. the real compartment syndrome, you may need surgery, i.e. fasciotomy (incision of a fascial septum) to reduce the increased pressure inside the specific compartment.

Fig 7.10

catalog.nucleusinc.com

George’s treatment:

George was asked to stop playing squash immediately. He was advised to have ice massage 10 min on right shin for 4 to 5 times a day for 2 weeks to reduce his inflammation. Acupuncture treatment was performed 3x per week for 4 weeks accompanied with physical therapy. After treatments his right shin splints was much better. He returned to squash training after 2 months.

Tips for patients:

1. If you have flat feet, please try to use a pair of arch support, which will help you to prevent shin splints from occurring.
2. Warm up 15 min before you go to any high impact sports, such as running, tennis, jumping, martial arts, etc.
3. Always ice massage your shin bone 10 to 15 min after your high impact sports, even you only have slightly pain at your shin bone.
4. Prevention is better than treatment!

Tips for Acupuncture Practitioners:

1. Always teach your patients for self care, such as ice massage, arch support and appropriate foot wear for high impact sports. They have to change their shoe if they run long distance every 350 miles.
2. Acupuncture treatment accompanied electrical stimulation about 30 min will get the best results.
3. You should not use moxbustion for the patients.
4. For severe compartment syndrome: If you could not feel pulse at the patient’s feet, you must send the patient to surgeon ASAP. The leg might be saved if the patient has fasciotomy within a few hours.

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