Agnes was a a 48 year old lady who came to see me with pain in her right knee, which was swollen and hurt whenever she walked and more when she went down some steps. She had been told that she had arthritis and would probably soon need a knee replacement. When i examined her I found a mild clicking in her left knee and no sound at all on movement in her right knee. When I felt the inside of her knee there was a lot of tenderness on pressure but no pain on movement. I could feel a bulging of the cartilage of the knee, which is called the medial meniscus. The X-ray of her knee showed a clear and smooth surface on both the bones which made up the knee. The only indication of a problem was the reduced joint space on the inside of the knee. I gently manipulated the cartilage into place and a few minutes later she was pain free in the right knee. The left knee did show early signs of osteoarthritis which I treated with acupuncture for 2-3 days and the clicking disappeared. Over the next week the swelling in both knees subsided. I advised her to be careful not to twist her knees, to walk for an hour a day and to see me again after 3 months. When she returned a few months later, she was happy and smiling and said " Bless you doctor for taking my pain away. Since I have started walking I have even lost 3 kg in weight."
One of the commonest problems I treat at my clinics are Joint pains. Many of these patients come to me with a diagnosis of arthritis and many of them have been advised surgery. Most of them are able to return to an active pain-free life with my non-surgical treatment.
Joint pains can be due to muscle or ligament spasms or injuries. These may result from falls causing injuries, sprains, incorrect diet, food allergies, badly designed or fitting footwear. Any of these factors can cause imbalance around joints which may have varied effects.
Pain in joints often arises from injuries to the spine and the treatment of the spinal problem often leads to miraculous results. Commonly spinal problems at the 2nd or 4th lumbar vertebra cause knee pain.
There are four or five different types of arthritis of which the acupuncturist normally sees only two types. Arthritis constitutes 20% to 40% of the patients seen by an acupuncturist. Of these roughly 75% have Osteoarthritis, and the balance have Rheumatoid Arthritis. Osteoarthritis normally affects large joints like the knees and hips. It may also occur in other joints especially those, which have been operated or injured. Basically any injury to a joint either by way of trauma or surgery predisposes to Osteoarthritis in that joint in 5-20 years. I find that about 40% of these people have Osteoarthritis which implies wear and tear on the joints. These patients usually have had joint pains for at least 20 years. The cause of this problem is usually cartilage and joint displacements in the knee or the ankle which by making the joint surface irregular, predispose to wear and tear on the joint surfaces. Many of these patients are overweight and the increased weight, increases damage to a joint which is not properly buffered by the shock absorbing cartilage. The rational treatment is to restore the cartilage to its proper alignment and teach the patient about the correct use of that joint. The knee joint is a hinge joint which functions well when used in one plane only. Twisting of the knee joint can lead to displacement of the knee cartilages.
Rheumatoid Arthritis can affect any joint and normally affects multiple joints like the fingers, toes, elbows, ankles, knees and the spine.
A significant number of people with joint pain are erroneously diagnosed as having arthritis when in fact the problem is not arthritis at all. Commonly displacements of the knee cartilages may cause both swelling and knee pain.
The treatment of Osteoarthritis is usually fast & effective with most patients needing between ten to thirty sessions of treatment to be entirely free of pain. Depending on the severity of the arthritis, the patient can expect a pain free interval of two to twenty years. Whenever the problem recurs the patient is advised to return for treatment as early as possible if the patient returns for treatment within the first few weeks of the recurrence of his pain. He may require as few as three to four sessions to be pain free again.
The following is a typical example of a patient with Osteoarthritis. Ms. Daniel, a large lady in her late sixties, came to see me with an eight-year-old complaint of pain and creaking in her knees when she walked. At first she had been able to keep moving with the help of painkillers but now even with the tablets she was unable to move without pain.
Arthritis in the knees is due to wear and tear of the cartilage in the joint, which normally, follows an injury 15 to 2O years earlier. The injury causes the growth of new bone, which wears away the cartilage opposite the injured area. Gradually, over the years the cartilage is completely worn away and replaced by bone. At this stage, movement is very painful and restricted. The body secretes an excess of lubricating fluid in an effort to minimize the pain and to facilitate movement, leading to a swelling of the joint. This swelling is harmless and tells us that the body is trying to help itself.
Ms. Daniel wanted to know how acupuncture would repair the damaged knees. When a person has pain in a joint, the muscles around it contract, in an effort to restrict movement. This pulls the joint surfaces closer to each other, increase friction and damage the joint surfaces. Acupuncture removes the pain and relaxes these muscles. The result is that the joint is able to move freely and this vicious cycle is broken. Gradually nature takes over and the damaged cartilage often regenerates. Glucoseamine & chondroitin sulphate when taken for 6-8 weeks after treatment can significantly aid the regeneration of the joint cartilage.
It is important in arthritis to keep the joint moving. Walking and simple knee bending exercise is all that are required to keep the knee mobile. Heat in the form of a hot water bag is helpful and as effective and safer than infrared or short wave diathermy, which you may receive in a physiotherapy department. A hot water bag is useful in cold or damp climates where arthritis often plays up.
Ms. Daniel received acupuncture treatment for about fifteen sessions and was free of pain. Her arthritis did not recur for the remaining 18 years of her life.
Rheumatoid arthritis responds to treatment slower than Osteoarthritis. This is an inflammatory process, which involves the joints as well as other parts of the body. The patient is treated every day until he has had ten sessions after which he has given a break for a week. He is then treated daily again for ten sittings, followed by a further break of a week. This process is continued for three to four courses of ten sessions each till the patient is entirely pain free.
The ESR (Erythrocyte Sedimentation Rate) of the patient is monitored regularly to assess the progress of the rheumatoid activity. With treatment, the ESR should start to fall and should continue to fall even after the treatment is over, until it reaches normal levels. The normal value of the ESR by the Westergreen Method in a male is up to 10 mm fall in the first hour, while in ladies the accepted value is up to 20mm in the first hour. The patient is advised to have the ESR checked periodically to monitor any increase in Rheumatoid Activity.
The early deformities of Rheumatoid Arthritis can be reversed using Ultrasound. Ultrasound therapy followed by gentle manipulation can make joints that have become stiff, loose and free and can prevent the deformities from becoming worse.
After three to four courses of treatment the patient has a pain free interval of at least nine months. Whenever the pain, stiffness or swelling recurs. The patient is advised to return immediately for a course of treatment. The patient is then treated for one or two courses of ten sessions until the pain, stiffness and swelling subside. He can then expect a further pain free interval of eighteen to twenty four months before the pain returns again. When the pain recurs the patient is treated again, following which he should have a pain free interval of four to five years. In many patients the disease burns out and I now have patients who have not had a recurrence for thirty years.