Our acupuncturists have extensive training and years of experience treating a wide range of acute and chronic pain, musculoskeletal and neurologic issues. A one-year, post-graduate program at Cedar Sinai Medical Center in Los Angeles with medical doctors including an orthopedic surgeon and anaesthesiologist strongly informs our treatment strategy. We combine the best of Western medicine’s approach to assessment and diagnosis with Eastern medicine’s conservative approach to care.
Research on acupuncture and related modalities for the treatment of osteoarthritis, headaches, muscle spasms and fibromyalgia is especially exciting. Treatment plans will be discussed at the first visit and may include acupuncture, dry-needling, electro-acupuncture, cupping and manual therapies like trigger point release, active-release technique and Trager techniques. Stretches, yoga or various exercises may also be recommended.
Osteoarthritis & Rheumatoid Arthritis
Some of the strongest research we have showing the safety and efficacy of acupuncture is in the management of osteoarthritis (OA) of the knees and hip. Osteoarthritis is the technical term used to refer to the degeneration that occurs in joints with age. Most people will show some signs of joint degeneration in their 60s, but it’s not uncommon for it to begin even earlier in life. Physical changes like osteophyte formation or articular cartilage degradation occur in an osteoarthritic joint. However, these physical changes do not mean there has to be pain or immobility.
Acupuncture does not work by addressing the physical changes that occur in an osteoarthritic joint. Once that damage occurs, those anatomic changes persist. But acupuncture, moxibustion and/or electro-acupuncture can be very helpful in the management of osteoarthritis through their ability to decrease pain, so that movement of the joint is possible; and increase blood flow to the joint so that vital nutrients are available to the synovial (joint) fluid and articular cartilage.
Less pain in a degenerating joint supports more ease in moving that joint. More movement in the joint promotes circulation, bringing vital nutrients to the synovial (joint) fluid and articular cartilage. These nutrients and fluids slow the progression of OA and support the lubrication needed for less pain with movement. Acupuncture thereby supports a positive cycle of increased movement and blood flow in joints suffering from the effects of arthritis.
A typical treatment plan for the management of osteoarthritis is acupuncture twice weekly for 4 to 6 weeks. Studies show, and our clinical experience verifies, that such a series of treatments can decrease pain and increase mobility for anywhere from 3 to 12 months, after which the series is typically repeated. In this way we’ve helped many patients avoid or delay knee and hip replacements.
While OA is not considered an inflammatory condition, rheumatoid arthritis, gout and psoriatic arthritis are. Acupuncture has been shown to reduce inflammation both where needles are placed locally and more systemically. The combination of acupuncture’s pain and inflammation reducing effects can be very helpful in managing each of these conditions. Herbs can also be very helpful with those inflammatory conditions, as there is often an internal medicine or autoimmune component involved that traditional Chinese herbal therapy is adept at addressing.
Headaches
Acupuncture can help reduce both the frequency and severity of chronic headaches. Tension headaches tend to respond the fastest, but migraines, hormonally-driven headaches, cluster headaches and other atypical chronic or constant headaches that don’t fit clear diagnostic criteria also respond to care.
Tension headaches respond best to acupuncture treatments once or twice weekly, for a few weeks. Manual therapy of the upper trapezius, cervical paraspinal muscles, and scalenes usually follows each acupuncture session. If upper back tension and pain also exists, we may recommend cupping therapy in addition to acupuncture, as it is especially useful for muscle spasms and tension. Usually, at the first session we’ll also explore the triggers that may be at the root of your headaches, as we’ll share some stretches or exercises with you that can counteract the effects of the triggers that can’t be avoided.
Chronic migraines often take longer to treat. If the migraines are frequent and severe, twice weekly treatments will usually be recommended for four weeks before reevaluating. If no change within 8 treatments is seen, we’ll usually discontinue care. Usually, however, a reduction in either the frequency or severity of the headaches is seen within that time. Less severe or less frequent migraines require less frequent treatment.
Hormonally driven headaches can take the longest to treat but for someone dealing with debilitating headaches that occur a few days out of each month, the treatment effects can be life-altering. Because hormonally driven headaches are usually tied to hormonal cycles that span a month or more, altering the different components of that rather long time-period takes more time. In this case we usually recommend weekly acupuncture, with daily herbal therapy. It usually takes 2 to 4 menstrual cycles for the full benefit to be seen.
Knee Issues
Pathologies of the knee are classified as being either of the knee joint, patella (kneecap), or surrounding tissues. Your initial visit to our clinic will include a full history and exam to determine exactly what the issue is and how best we can be of assistance in addressing it.
Knee joint issues usually involve some form of arthritis and as mentioned in the arthritis section above, research shows that acupuncture can be especially effective in reducing the pain that comes with arthritic knees.
The patella rests on top of the knee joint capsule. Patellofemoral pain syndrome, otherwise known as chondromalacia patella or runner’s knee, is the most common form of patella pain. Inflammation underneath the kneecap due to overuse or degeneration of the underside of the kneecap is usually to blame. Acupuncture and electroacupuncture locally to the affected knee, usually twice weekly for a few weeks, can considerably decrease patellar pain.
We also routinely treat Iliotibial (IT) band and other myofascial issues related to the soft tissue surrounding the knee. Tightness or overdevelopment of the IT band and lateral quadriceps (vastus lateralis muscle) often overpower the relative underdevelopment of the medial quadriceps (vastus medialis muscle).
When the opposing muscles and tissues of the knee are out of balance, tracking issues of the patella develop that lead to patellofemoral pain or IT band pain. In addition to reducing pain and inflammation, acupuncture with cupping and manual therapy can reduce the contraction and tightness in those overactive muscles. That, paired with appropriate strengthening exercises, can be a permanent solution for persistent knee issues.
Lower Back Pain
Lower back pain is one of the most common reasons that people seek medical care, and probably the most common reason that people come to acupuncture. On any given day at our clinic, an average of 30% of the treatments will address some form of back pain. Acupuncture and related modalities like electroacupuncture, cupping therapy and manual therapy are effective at treating or managing most lower back issues.
Your first visit at our clinic will include a detailed history and physical exam so that we have a complete understanding of what the issue is, and how best to address it. Myofascial issues like muscle strains, spasms and generalized tightness, usually respond fairly quickly to acupuncture and manual therapy. If it’s a more acute issue often the problem can be resolved in 2 or 3 treatments. If your back pain is more severe or chronic, then of course more treatments will be necessary. In these cases we will often show you various stretches or exercises that you can do outside of your treatments to speed recovery.
Though surprising to some, issues like nerve root compression (radiculopathies) with referred pain due to spinal stenosis or disc herniations also usually respond to TCM. Acupuncture will not address or change the anatomical damage that occurs when degenerating vertebrae cause stenosis, or when disc matter from a herniated disc impinges a nerve. What acupuncture and electroacupuncture can do, however, is drastically reduce the inflammation that occurs in the surrounding tissue. Often reducing this inflammation is enough to decrease the pressure on the spinal cord or nerve roots that cause the burning, shooting pain characteristic of these conditions. That, combined with the general pain-reducing effects of acupuncture can help considerably.
Sean Michael Hall, L.Ac., has been selected as a participating acupuncturist in the “Back In Action” study, a multicenter clinical research trial of acupuncture for the management of chronic low back pain among older patients. This study is a collaboration among the research centers at Kaiser Permanente in Washington and Northern California, Sutter Health (California), and the Institute for Family Health (New York); this research is funded by the National Center for Complementary and Integrative Health of the National Institutes of Health (NIH).
Neck & Shoulder Pain
Neck and shoulder pain has many different causes. Your first session at our clinic will involve a detailed history and exam that will give us a clearer idea of exactly what that problem is so that the most effective treatment plan can be developed. We routinely treat a number of different issues of the neck and shoulder, including:
- Cervicalgia
- Cervical radiculopathy
- Thoracic outlet syndrome
- Adhesive capsulitis, i.e. frozen shoulder
- Rotator cuff injuries
- Bicipital tendonitis
Treatment for each of those conditions varies. For example, treatment for cervicalgia from a spasming neck muscle involves trigger point assessment to determine which neck muscles are involved. Often a combination of cervical paraspinals, levator scapulae, upper trapezius and scalene spasming or tension is to blame. Once we know which muscles are involved, local acupuncture with manual therapy can be used to release those muscles. Manual therapy may involve trigger point release, active release technique or cupping therapy.
Another example is the treatment of frozen shoulder. Frozen shoulder involves a poorly understood inflammatory process in the actual joint capsule that forms adhesions. Those adhesions act as glue that severely limit movement and cause pain. Local acupuncture and electroacupuncture can be very helpful at reducing that inflammatory process, while acupuncture and cupping therapy help reduce the muscular tension secondary to the underlying adhesions. Acupuncture, especially when done concurrently with physical therapy, can be highly effective at resolving frozen shoulder. Acupuncture is great at reducing pain and inflammation. Physical therapy is great at increasing mobility, but sometimes those stronger manipulations can cause pain and inflammation. The two therapies done together regularly, work synergistically to both increase mobility while pain is decreased.
If you have any questions about our approach to treating any neck or shoulder issue, please contact us.
Chronic Pain Syndromes
Acupuncture and electroacupuncture decrease pain in a variety of ways. One is through the release of endorphins (endogenous opioid neuropeptides) into the bloodstream. These chemicals decrease pain, improve mood and support homeostasis. Another way that acupuncture seems to decrease pain is through a disruption of the body’s pain-signalling system. Though this mechanism of action is not yet very well understood, it is clear that acupuncture reduces pain in ways other than endorphin release, and research is taking place that will hopefully explain in more depth the full range of acupuncture’s effects.
A variety of chronic pain conditions exist, but the most common include:
- Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD)
- Neuropathies due to previous nerve damage
- Fibromyalgia
In each case chronic pain for months or years over-stimulates nociceptors (nerve endings that sense pain) to the point that the nociceptors send pain signals even when no noxious stimulation or tissue damage is occurring. Pain is meant to be a warning to the body to avoid injury but the chronic pain patient finds him or herself in a state of constant pain that serves no such purpose.
Acupuncture, and especially electroacupuncture, performed regularly within a few months of a chronic pain cycle developing can be one of the few interventions that can disrupt that cycle. The longer a chronic, constant pain cycle exists the harder it is to treat. Even in these cases though, acupuncture can offer some relief. We usually recommend a series of 6 acupuncture treatments over the course of 3 weeks as a trial. If some pain relief is attained in that time, there is a chance that continued acupuncture can reduce the pain permanently.
Repetitive Strain Injuries
The most effective treatment for any repetitive strain injury (RSI) is to not do the activity causing the injury. Of course, this is not possible for most, though we do ask that patients do their best to reduce the activity for the first two to three weeks of acupuncture treatment. The combination of even a little less activity, with the pain and inflammation reducing, tissue healing effects of acupuncture can be highly effective in the treatment of a wide range of RSIs, including:
- Carpal tunnel syndrome
- Cubital tunnel syndrome
- Golfer’s elbow (medial epicondylitis)
- Tennis elbow (lateral epicondylitis)
- De Quervain’s Syndrome
Whether symptoms are caused from inflammation causing nerve impingement of the medial or ulnar nerves, as seen in carpal and cubital tunnel syndromes; or from the tendinosis and micro-traumas that occur with golfer’s and tennis elbow, acupuncture can help. In each case, acupuncture is paired with manual therapy, and specific exercises are given to address underlying postural and myofascial patterns that may have contributed to the injury.
An often overlooked contributor to most upper extremity RSIs is a condition called thoracic outlet syndrome, or brachial plexopathy. The brachial plexus is a bundle of nerves and arteries found at the intersection of the front shoulder, chest and neck areas:
Posture, tight muscles, and other factors can cause subclinical impingement of those nerves or arteries, resulting in reduced nerve conduction or impaired blood flow to the arm, wrist and hand. Good nerve conduction and blood flow is essential for healthy joints, muscles and tendons, and if that is impaired then the body’s tolerance for repetitive motion is reduced, leading to higher incidence of RSIs.
Muscle testing of the scalenes, pectoralis minor and subclavius muscles can help us determine if this is a contributing factor. If so, working to release those muscles with acupuncture and manual therapy can be an important part of the solution.
Sciatica & Piriformis Syndrome
In common parlance, the term “sciatica” is used to refer to a few different conditions, all which involve lower back or buttocks pain that refers down the leg. True sciatica (from multiples causes), piriformis syndrome, and cluneal nerve impingement are all often referred to as “sciatica”. It is important to determine which condition is actually occurring as the recommended treatment depends on a correct diagnosis.
The sciatic nerve is formed from the nerve fibers of 5 different nerve roots exiting the spine, from the fourth lumbar vertebrae to the 3rd sacral foramen.
True sciatica (a term used to distinguish amongst various lower back issues) involves the impingement of one of the five nerve roots exiting the spine. Usually that compression occurs due to hardened disc material from a herniation at the L4/5 or L5/S1 disc space creating an impingement of the nerve root.
Sometimes, though, true sciatica can be caused by foraminal stenosis, or degeneration of the opening that the nerve root passes through. The impingement of nerve roots that form the sciatic nerve can be very painful locally at the lower back and sacrum, and can create referred burning pain, tingling, numbness and weakness down the full length of the sciatica nerve.
Piriformis syndrome also involves the sciatic nerve but it is due to spasming or tightening of the piriformis muscle (or sometimes other hip external rotators) in a way that impinges the actual sciatic nerve (not a nerve root). Piriformis syndrome mimics true sciatica because it also involves pain, tingling and numbness along the full length of the sciatic nerve. A less common form of referred pain from the back into the buttocks musculature involves entrapment of the cluneal nerves, often by the erector spinae or latissimus dorsi muscles.
The first visit at our clinic involves a full history, orthopedic and neurologic exam and review of images (if taken) so that a proper assessment can be made. If evidence of true sciatica is found, patients respond best to a form of electroacupuncture (EA) utilizing microcurrent to the disc space area where the nerve roots are impinged. If evidence of peripheral impingement of a nerve is found, as in piriformis syndrome or cluneal nerve entrapment, then regular acupuncture, often with cupping or manual therapy, can be effective at releasing the impinged nerve.
True sciatica takes longer to respond to care than piriformis syndrome or cluneal nerve entrapment, though we see reductions in pain and other neuropathic signs with each condition. Some patients respond immediately to acupuncture, some don’t. Though, most patients have some reduction in pain after a few treatments.
Once we have determined which form of sciatica you have our acupuncturists will recommend a trial series of treatments to get a sense of how you respond to acupuncture and further recommendations will be made based on that response.
Other Issues
A number or other pain, orthopedic and neurologic conditions respond to acupuncture and related modalities:
- Plantar fasciitis
- Acupuncture to the soleus and gastrocnemius muscles of the calf with manual therapy to the arch of the foot and a few key stretches that we’ll teach you are often enough to address plantar fasciitis. In cases more recalcitrant to treatment, local electroacupuncture with microcurrent to the part of the heel that is painful is necessary, and highly effective.
- Bell’s palsy
- Numerous studies show that acupuncture, moxibustion and electroacupuncture can speed recovery from Bell’s palsy. The sooner one comes for treatment the easier it is to treat the paralysis that occurs with the trauma to the facial nerve.
- Multiple sclerosis, Parkinson’s disease, ALS
- The symptoms of pain, spasm, weakness, numbness, tremors and neuropathies experienced in varying degrees with each these chronic, progressive conditions can be managed with acupuncture. Acupuncture, of course, is not a panacea. There is evidence though, that reduction of pain and an increase in mobility can be experienced with regular acupuncture. Tradition Chinese herbal therapy can also be useful in addressing underlying autoimmune and circulatory issues that contribute to the symptoms experienced.
If you have any questions about acupuncture and any pain, orthopedic or neurologic condition, please contact us. We are happy to share any research we’re aware of, as well as our experience treating any given issue.
