ACUPUNCTURE TREATMENT OF
SOFT TISSUE INJURY AROUND JOINTS
by Dr. Gu Yue Hua of the Nanjing College of TCM, transcribed by TomShanahan, Sheila Tozer and Geoffrey Wadlow.This subject is dealt with under the title of "Injury to the Tendons" in TCM and includes injury to tendons, ligaments, jingluo, the muscles responsible for motility of the joints in question, the articular capsule and cartilage. From the above it is clear that "tendons" has a wide scope of meaning in this context. Injury can be caused by various factors:
- inappropriate exertion or force
- sudden falling down
- hitting against something heavy and hard
- sports injuries
- injury from violent physical labour
Tendon injury is classified into three types:
1. Stagnation of Qi and Blood. This involves injury to the collaterals, including thesmall branches. The tendons themselves are not injured.
2. Displacement of tendons and muscles because of stretching, pulling or twisting.
3. Breaking of the tendons. The tendons or ligaments are snapped. This is the mostsevere type of injury.Acupuncture is applicable in the first and second types of injury; surgery is needed for the third.
1. and 2. can be caused by trauma or overstrain which, in acute cases, leads todisorders of the Qi circulation in the jingluo to produce redness and swelling in thelocal area. In more prolonged cases muscular atrophy or motor impairment canresult. In these instances the injury to the tendons is located in the musculature ofthe twelve main jingluo. To treat this, therefore, one must treat the twelve musclecollaterals to heal the tendon injury.
Soft Tissue Injury In Different joints
1 . The neck
Soft tissue injury often occurs on the posterior aspect of the neck and manifests asrestricted rotation, extension and flexion. Tenderness can appear locally, and paincan radiate downwards to the shoulder and arm, mainly on the side most affected.There can also be muscular spasm in the injured area with local tenderness.
This problem is caused by injury to the soft tissue around the neck leading to localstagnation of Qi and Blood. Consequently, the principle of acupuncture treatment is:Promote circulation of Qi and Blood in the local area, i.e. Taiyang pathways.
Houxi S.I.-3 is usually used. As a Shu/Stream point it is indicated in disorders of thejingluo.Ahshi (locally tender) points and point Tianzhu BL-10 can also be needled.
First needle Houxi S.I.-3, particularly in acute injuries, following the principle ofneedling distal points in acute disorders, and manipulate the needle while thepatient moves the injured area. After 2-3 minutes of this treatment the patientshould experience significant relief of pain and great easing of the movement of theneck.
Then needle point Tianzhu BL-10 and make the needle sensation travel to theinjured area. As soon as the needle sensation reaches the injured area the painshould be almost relieved. If it is not, then add Ashi points and connect the needles to an electric stimulator on "constant" at 1.000 per minute. Needles should be retained for twenty minutes. Treatment should be given daily.The pain should be fully resolved in two to three treatments.If the pain is on the lateral aspect of the neck then points Waiguan SJ-5, Zulinqi GB-41 and Xuauzhong GB-39 are needled. Tianliao SJ-15 and Jianjing GB-21 can also become tender if the injury is to the lateral aspect of the neck. Either point can be needled using short needles.After acupuncture treatment the patient must rest. It is not advisable to receive other therapy, e.g. massage or manipulation, whilst undergoing acupuncture treatment for this type of problem.
Ear acupuncture points
- Cervical Vertebra
Additional points related to the injured area are also selected. Strong stimulation is applied to all the points and the patient should exercise the injured area as the points are being needled. The needles are retained for fifteen minutes.
The shoulder joint
In injuries of the shoulder joint, the long head of m. biceps brachii is often damagedat point Jianyu L.I.-15. If the injury is localised then Jianyu L.I.-15 will be tender. If the forearm is abducted and downward pressure applied to it there will be no resistance. Pain may be experienced in points Jianyu L.I.-15 and Jianneiling (Extra).(Jianneiling, also known as Jianqian, is located midway between the upper end of theanterior axillary fold and point Jianyu L.I.-15, when the arm is adducted).
Note: point Jainyu L.I.-15 will be tender even without pressure being applied to it.Injury to this 'tendon' is common in several sporting contexts, or if the shoulder issuddenly rotated in a posterior direction for any reason.The principle of treatment is the same as for the previous case.
Jianyu L.I.-15 with a 2" needle, needled in a downwards direction into the deltoid muscle.Jianneiling (Extra), also with a 2" needle.Tianfu LU-3, Chize LU-5, Lieque LU-7 and Hegu L.I.-4 can also be added.
With point Jianneiling (Extra) a special needling technique, called 'Huici' in the NeiJing, is used as follows:A 1.5 inch needle is inserted into the point perpendicularly to obtain deqi and manipulated for three minutes. Then lift the needle until it is just below the skin surface and re-angle it upwards at an angle of 45 degrees so that the needle tip actually contacts the most painful spot. Manipulate for a further three minutes, then leave the needle in place.This needling technique is also effective for ligament injury. Its chief advantages are that it resolves pain quickly and invigorates circulation of Qi and Blood.
If there is swelling around Jianneiling (Extra) then one should simply needle thepoint perpendicularly and then connect it to Tianfu LU-3 with electrical stimulation.If there is inflammation one should avoid needling the point directly, but instead needle adjacent points.If the injury is of long duration, and has become chronic, then Warm Needling technique should be used.
every other day is best for long term problems of this type.
Wrist and Ankle' acupuncture
Wrist acupuncture can be applied by using implanted needles 0.5 cun proximal topoint Leique LU-7.
Select the ear on the injured side of the body. Needle sensitive points related to theinjured area plus: Subcortex, Shenmen and Adrenal. The patient should move the arm while the points are being needled.In the acute stage needles should be used and treatment given daily. Once the pain is alleviated then ear seeds can be used instead of ear needles.If percussion pain is pronounced one can use the Seven Star or the Plum Blossom Hammer. This is more usual in chronic cases. Treat twice a week and hammer until there is slight bleeding. Then apply cups on the area to draw out the stagnation of blood.
3. The elbow joint
Injury in this area includes Tennis Elbow and Bursitis. Over-use leads to aseptic inflammation. Tenderness is frequently experienced on the medial side of the lateral epicondyle of the humerus. If the patient squeezes their hand into a very tight fist then the tenderness will be more pronounced. If the patient is asked to wring out a towel this will produce even more pain. Also if the hand is held out from the body and the dorsal aspect is pressed downwards, i.e. wrist extension against pressure, this too will make the elbow tenderness very pronounced.
To treat injuries of the soft tissue around the elbow select Ashi points plus Shousanli L.I.-10 and Hegu L.I.-4. A needle technique called 'Heguci' is applied on all the Ashi points. First needle perpendicularly and obtain deqi. Then partly withdraw the needle to just below the skin surface and re-inserted in three directions: upwards, downwards and then laterally towards the tender area. The pain associated with Tennis Elbow usually radiates upwards or downwards. By employing Heguci needling technique it can usually be resolved.If there is no radiation of pain and the problem is confined to one local area or spot,then one can employ a variant of another special needling technique, also mentioned in the Nei Jing, called 'Qici'. Originally three needles were used, but two now suffice. Two needles are inserted perpendicularly, directly into the painful spot so that they stand absolutely parallel to each other. They are then both connected toan electrical source. It is for this reason that two needles are more appropriate than three originally used in Nei jing times. Qici method is used only in acute cases where the pain is confined to a specific area or spot.If the condition has persisted for one month and has therefore become chronic rather than acute, the two needles can be inserted in precisely the same way, but instead of using electrical stimulation, apply moxa to one of the needles. The patient should also be given several moxa sticks so as to be able to self-treat two or three times a day with local warming.
If the pain is located directly upon the lateral epicondyle then a date stone sized moxa cone on a slice of ginger should be applied 3-5 times.
Points that correspond to the injured area can be used plus: Shenmen, Subcortex and Adrenal.To treat acute cases, treatment is given daily. In chronic cases treatment is given every other day.The patient must rest the elbow.
4 . The wrist joint
Injury to the wrist may manifest as inflammation of the tendon sheath, and pain is often located around point Lieque LU-7. If the thumb is extended, as if to form abridge to position a billiard cue, then the pain is aggravated. Extension and flexion ofthe hand also causes pain, which can radiate upwards along the Large Intestine channel. Also thumb movement can produce a sensation of friction or make a cracking sound. Such wrist injuries are common in volleyball and basketball players,and also in masseurs. The injury can also be caused by any sudden hitting of the thumb. In TCM it is called "Tendon Bi Syndrome".
Ashi points, plus Yangxi L.I.-5, Lieque LU-7 and Hegu L.I.-4.
Use Huici needle technique by first needling on any tenderness at the side of the tendon, then upwards and downwards to tender areas. Treat once a day for five days,then every other day.If there is severe pain or very pronounced tenderness or soreness around point Yangxi L.I.-5 then electrical stimulation can be employed. If the condition is chronic apply moxa.
Points corresponding to the injured area, plus Shenmen and Subcortex.
5 . Cysts on the tendon sheath
Cysts often appear on the dorsal aspect of the wrist joint. They can also appear on the dorsum of the ankle and knee joint. They feel like they are filled with water. If on the wrist, pain and soreness can radiate down to the hand. Making a "limp wrist" gesture makes the cyst more pronounced.
First bend the wrist to make the cyst more prominent, then insert a hypodermic injection needle - which produces an open hole - right down to, and through, the base of the cyst. In this way the cyst is punctured in two places, viz. at the side of the cyst where the needle first punctures it, and then through the base of the cyst.Then squeeze the cyst to remove the fluid. Massaging the cyst will help to expell the fluid, but if some fluid remains then moza on a slice of ginger can be used to expell it.Once the cyst has been drained of fluid, a soft bandage must be tied tightly around the wrist and kept in place for 3-5 days.
6 . The knee joint
Injury to the knee can damage the lateral or medial ligaments, or the patellar ligament. Such injury commonly results in pain and swelling, but without redness,along with limitation of knee joint movement.The test for lateral ligament damage is eversion of the lower limb, i.e. twisting the foot medially and applying pressure to the medial side of the knee.The test for medial ligament damage is inversion i.e. the exact opposite of the above with pressure being applied to the lateral side of the knee.If, when this test is carried out, there is excessive movement of the knee, i.e. beyond the normal range, which is fairy minimal, this may indicate that either the lateral or medial ligament (depending on which side the pressure is applied in the test situation) has been torn or even snapped. Either way, whether the tendon is merely strained, torn or even snapped, there is usually pain when the testing procedure is performed.If lateral movement of the knee joint produces pain this indicates injury on the medial side and vice versa.
It often takes 20 treatments, plus a lot of rest to cure problems like these. Treatment is given every other day. In acute cases electro-acupuncture is permissable. Warm needling may be used.
7 . The ankle joint
Both sides of the ankle can be injured, so tenderness may be found at both Shangqiu SP-5 and Qiuxi GB-40. One can ascertain which side requires attention by using the same type of inversion/eversion test as was carried out in the case of knee injury.Again, if the inversion/eversion is extreme in the accident situation the ligaments could have been snapped. Frequently injury produces swelling with pain that remains tolerable. Since local Stagnation of Blood may be present, moxa is not permissable within the first 24 hours of the injury. Internal bleeding is always possible and moxibustion tends to accelerate blood circulation, and could thereby aggravate the bleeding.
Shangqiu SP-5, Qiuxu GB-40, Sanyinjiao SP-6 and Xuanzhong GB-39 with needle sensation propagated to the injured area. If there is no tenderness at Qiuxu GB-40 orShangqiu SP-5 then needle sensation should be sent down to the injured area.Strong stimulation should be applied, and electrical stimulation used. If the condition is acute, treatment should be given daily; if chronic, every other day.Cupping is not advisable within the first 24 hours if there is internal bleeding, but after that both cupping and Plum Blossom needling can be used. Direct moxa with 3-5 cones is applicable, even if there is bruising. The moxa cones should be applied to the most painful spots.
Select points Shenmen and Foot and points that correspond to the injured areas.Moxa stick may be applied locally to the injured parts whilst these ear points are being needled.
8 . Spasm of the calf muscles
This is often encountered in swimmers. It can also be due to exposure to cold in bed at night.
Chengshan BL-57 and Chengjin BL-56 are the usual points. If the patient is an athlete one can add electrical stimulation to both points. After 15-20 minutes treatment the spasm will be relieved but soreness or distention may remain. Add moxa stick treatment for 10 minutes to resolve any residual soreness or distentioAlternatively, and if the spasm is more due to Cold, one can use warming needles on both points. Although the above constitutes a very effective treatment option it may still take 2-3 treatments to get rid of spasms due to exposure to cold.