Acupuncture for Rheumatoid Arthritis and Inflammation

The Evidence is Promising

Poking needles under your skin doesn’t exactly sound soothing, but some people swear by the use of acupuncture for their rheumatoid arthritis (RA). Such anecdotal evidence suggests this therapy might be effective in relieving RA discomfort. Yet with few good-quality studies available, proving acupuncture’s safety and benefit has been a challenge.

Many reviews of studies done so far have not found a statistically significant benefit on pain, swollen joints or other measures of disease when compared to a control treatment. Many of the studies that did find positive outcomes weren’t well conducted. Yet there has been enough potential noted for this therapy that researchers say it warrants further study.

Acupuncture’s Effect on Inflammatory Markers

Acupuncture involves inserting tiny needles into a person’s skin. A version known as electro-acupuncture adds a mild electric current. The needles are inserted at some of the 2,000 mapped points along what are called meridians or channels.In Chinese terms, acupuncture restores the optimal flow of energy – called Qi (pronounced chee) – in the body.

In a 2011 Chinese study looking at electro-acupuncture and traditional acupuncture, both significantly lowered tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF). “Both TNF-α and VEGF are associated with chronic inflammation,” explains Nathan Wei, MD, director of the arthritis treatment center in Frederick, Md. “In particular, TNF-α appears to play a pivotal role in the chronic inflammation and joint destruction that characterizes RA. That’s why so many of the biologic medications target TNF-α.”

In a 2008 Arthritis & Rheumatism review of eight acupuncture studies involving a total of 536 patients with RA, five studies reported a reduction in erythrocyte sedimentation rate (ESR), three saw a reduction in C-reactive protein (CRP), and one study described a significant drop in both. Both ESR and CRP are markers of inflammation in the body. Several of the studies also reported decreased pain and a reduction in morning stiffness.

How acupuncture affects inflammatory markers like TNF-α is unknown. “No one has figured out one single mechanism for acupuncture’s effects,” says Jeffrey I. Gold, PhD, director of the pediatric pain management clinic at Children’s Hospital in Los Angeles.

Gold explains that MRI studies show that acupuncture sites specifically induce responses in various portions of the brain. Acupuncture can possibly effect any organ or system: immunological, neurological, hormonal and psychological. “It doesn’t only block pain signals,” he says.

Experts do know that acupuncture relieves pain by stimulating the release of endorphins, the body’s own natural painkillers, says Jamie Starkey, lead acupuncturist for the Tanya I. Edwards, MD Center for Integrative and Lifestyle Medicine at Cleveland Clinic. “We’re activating the peripheral nervous system, which then activates the central nervous system, so that the brain begins to release endorphins.” Acupuncture may relieve pain locally, she says, by not only releasing neurotransmitters, but also by having an anti-inflammatory effect. “How exactly it happens, we are still researching.”

Taking the Acupuncture Route

“The more studies that come in showing the drop in inflammatory markers through acupuncture treatments, the more rheumatologists will take note,” says Starkey. In a 2010 Mayo Clinic survey, 54% of rheumatologists said they would recommend acupuncture as an adjunct treatment. 

Here are some things to consider if you’re thinking of jumping on the acupuncture bandwagon:

Choose Carefully

“Find an acupuncturist who comes highly recommended by your rheumatologist or physician, family friends, and colleagues so you know firsthand what their experience was like,” says Starkey. If you don’t know anyone to ask, search The National Certification Commission for Acupuncture website for a certified clinician in your area. 

Acupuncturists have to be licensed by their state medical board, so you can check there as well. “Ideally, try to find someone who has experience working with RA patients,” says Starkey.  

Know What’s Covered

Some insurance companies cover acupuncture for certain diagnoses, but others do not. Prices for acupuncture vary, depending on your area and can run $75 to $200 per treatment.

Expect Several Treatments

“We tend to see substantial results within three to six treatments,” says Dr. Gold. But each patient responds differently and treatments vary depending on the stage of the disease.

Understand the Limit

Acupuncture doesn’t work on everyone, says Starkey. “In my clinical work, we see a 20% non-response rate.” But,acupuncture has many styles and practitioners. “If it doesn’t work right away, don’t dismiss the whole field of acupuncture,” says Dr. Gold. “Try a different style.”

This article originally appeared on arthritis.org and was written by Dorothy Foltz-Gray

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What is Tendonitis?

Tendonitis or its aliases: tendinitis, tendinopathy and tendinosis are all tendon injuries. 

Tendinopathy (tendon injuries) can develop in any tendon of the body.

Typically, tendon injuries occur in three areas:

• musculotendinous junction (where the tendon joins the muscle)
• mid-tendon (non-insertional tendinopathy)
• tendon insertion (eg into bone)

Non-insertional tendinopathies tend to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.

What is a Tendon Injury? 

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. These tendinopathies therefore do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy.

For example, in explosive jumping movements, forces delivered to the patellar tendon can be eight times your body weight. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

• The pain may get worse when you use the tendon.
• You may have more pain and stiffness during the night or when you get up in the morning.
• The area may be tender, red, warm, or swollen if there is inflammation.
• You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

• Normal tissue adaptation phase
• Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

• Injury rate > Repair rate
• Prognosis: Good. Tissue is attempting to heal.
• It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

• Cell death occurs
• Poor Prognosis - Tendon cells are giving up!

4. Tendon Tear or Rupture

• Catastrophic tissue breakdown
• Loss of function.
• Prognosis: very poor.
• Surgery is often the only option.

It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They'll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
• Do gentle range-of-motion exercises and stretching to prevent stiffness.
• Have your biomechanics assessed by a sports physiotherapist.
• Undertake an Eccentric Strengthen Program. This is vital!

How to Return to Sport

It may take weeks or months for a tendon injury to heal. Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage.

To keep from hurting your tendon again, you may need to make some long-term changes to your activities. These should be discussed with your physiotherapist.

• Try changing your activities or how you do them.
• If exercise caused the problem, check your technique with a coach or sports physiotherapist.
• Perform regular eccentric style exercises.
• Closely monitor and record your exercise loads. Discuss your loading with your physiotherapist and coach.
• Always take time to warm up before and cool down / stretch after you exercise.
   

This article originally appeared on physioworks.com.au and was written by Zoe Russell.

How to Overcome Rotator Cuff Issues

What is your Rotator Cuff?

Rotator cuff syndrome is very common shoulder injury. 

Your shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff.

The subscapularis, supraspinatus, infraspinatus and teres minor are your small rotator cuff muscles that stabilise and control your shoulder movement on your shoulder blade (scapula). 

As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the head of the humerus (shoulder ball).

What Rotator Cuff Injuries are Common?

Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis and rotator cuff impingement and related rotator cuff injuries.

Rotator cuff injuries vary from mild tendon inflammation ( rotator cuff tendonitis), shoulder bursitis (inflammed bursa), calcific tendonitis (bone forming within the rotator cuff tendon) through to partial and full thickness rotator cuff tears, which may require rotator cuff surgery.

Some shoulder rotator cuff injuries are more common than others. 

These include:

• Rotator Cuff Impingement
• Rotator Cuff Tendonitis / Tendinopathies
• Shoulder Bursitis (fluid-filled sac that provides a cushion between a bone and tissues)
• Calcific Tendonitis
• Rotator Cuff Tears
• Bicipital Tendonitis

Where are your Rotator Cuff Muscles?

Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most the the rotator cuff tendons are hidden under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge into your rotator cuff structures.

What Causes a Rotator Cuff Injury?

Your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder.

In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over.

However, nothing is fool-proof. Any of these structures can be injured - whether they be your bones, muscles, tendons, ligaments or bursas.

Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.

What are the Symptoms of Rotator Cuff Injury?

While each specific rotator cuff injury has its own specific symptoms and signs, you can suspect a rotator cuff injury if you have:

• an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.
• shoulder pain that can extend from the top of your shoulder to your elbow. 
• shoulder pain when lying on your sore shoulder.
• shoulder pain at rest (in more severe rotator cuff injuries).
• shoulder muscle weakness or pain when attempting to reach or lift.
• shoulder pain when putting your hand behind your back or head.
• shoulder pain reaching for a seat-belt.

How is a Rotator Cuff Injury Diagnosed?

Your physiotherapist or sports doctor will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests.

A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but have also been known to miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected.

How to Treat a Rotator Cuff Injury?

Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.

Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence. 

These are:

• Early Injury Protection: Pain Relief & Anti-inflammatory Tips
• Regain Full Range of Motion
• Restore Scapular Control
• Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
• Restore Rotator Cuff Strength
• Restore High Speed, Power, Proprioception & Agility
• Return to Sport or Work
  
  This article originally appeared on physioworks.com.au and was written by Sam Moyle

Acupuncture to Safely Increase Chance of Conception

Several studies have found that women who get acupuncture treatments -- whether to treat conditions that can interfere with getting pregnant (such as polycystic ovary syndrome, or PCOS) or to increase the chances of a successful IVF -- have a higher rate of pregnancy and births. Some fertility doctors recommend acupuncture for their patients to help lower overall stress levels, because stress hormones can lower fertility hormones like progesterone. "I've referred patients to acupuncturists to do acupuncture in conjunction with a number of fertility treatments," says Kathleen M. Brennan, M.D., a reproductive endocrinologist with the UCLA Fertility and Reproductive Health Center in Los Angeles.

So how does it work? Acupuncture is a traditional Chinese medicine practice that involves the placing of thin, stainless steel needles at certain spots on the body. From a Chinese medicine standpoint, the needles stimulate the body's meridians -- channels of energy -- along certain points. Depending on where the needles go, a person may feel calmer, sleepy, or more energized, or may experience subtle physical changes, like a drop or rise in certain hormones or increased blood flow to certain areas of the body, like the pelvis. "Acupuncture is thought to shift the body into a repair mode where it's better able to heal itself, as well as calming the nervous system," says Lara Rosenthal, a licensed acupuncturist who works with patients at the New York University Langone Medical Center Fertility Center in New York City. Does it hurt? "It feels a little like getting your eyebrow plucked, just for a few seconds, then you won't feel anything," Rosenthal says. And there are virtually no negative side effects, aside from occasional mild bruising.

Acupuncture can begin at anytime during the fertility treatment -- before you start taking any oral or injectable drugs to help "prep" your body; during drug treatment to help deal with side effects (nausea, moodiness, fatigue); or during IVF cycles. "Doing acupuncture before trying drugs or IVF might help you avoid those treatments altogether," Rosenthal says; she recommends several sessions for the best outcome. Some insurance companies cover acupuncture, though this varies by state and by insurance provider. The average cost between $100 and $300 for an initial visit and $75 to $150 for follow-ups.

Before you look into acupuncture, however, make sure you receive a medical evaluation by a physician. "There are certain conditions that can't be helped by acupuncture, such as blocked fallopian tubes, so you need to know what is going on with your body medically," Rosenthal explains. Ask your doctor for a referral to an acupuncturist who treats infertility, as not every practitioner will be trained in that area. Avoid taking Chinese herbs unless your doctor gives you the go-ahead -- some of them could potentially hurt your fertility, or endanger an existing pregnancy.

This article originally appeared on parents.com and was written by Tula Karras