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Treating pain in leg after meniscus operation


#1

Last week one of my patients asked me to treat her because she had a meniscus operation 3 weeks ago. Something went wrong and a few days later they operated her again.Hher knee is still purple-bleu and thick. It looks like there is a difference in temperature sometimes. She has a lot of pain ( she says nerve-pain) especially in the night, so she can't sleep at all. Doing some cycle -excersises seems to make it a little bit better.

I think that there is a stagnation from Qi and Blood.

She is also going to a fysiotherapist and he told her not to put needles in her leg, abdomen and lower part of her back!!! So, know she is very much afraid that I am doing something wrong. He is afraid that she get's dystrophia. I called him and he says that when I use needles that I give her more pain because the nerves are already over stimulated.

Today I tried to move the blood and Qi in her leg by only using Sp10 and Liv 2. Also in her abdomen RM6 and in her other leg Gb34. After that I did very soft Tui-Na on the leg and that did feel nice.

Do you think that I can really do something wrong in this case and that it is better not to put needles in that leg?

Can someone give me some advise about a good treatment for her?

Thanks allready


#2


Points: Heding, Dubi, St34,35, 36, Gb33, 34, Sp9,10, K9, Ashi points etc. with heat lamp 20 minutes, then herb wine Tuina 10 minutes, after the treaments, put on pain killer patches on both side of the knee for 8 hours a day. twice treaments a week.


#3


While it is good to work with other health professionals you cannot allow them to spread entirely incorrect information about techniques for which they have no obvious understanding. You should treat the person as you would any other patient with the exact same problem. Acupuncture does not simply stimulate nerves (if anything it is often the opposite) to say that somehow acupuncture will add more stimulation to a hyperstimulated area is simply illogical. Now you do need to watch your techniques - you certainly don&#39t use heavy needling techniques, electro-acupuncture, or other methods without a really clear treatment goal. General needling, moxibustion and tuina properly applied can only help the swelling resolve and the area to heal correctly.



Generally you need to just stick to the basics with more difficult cases. Just treat the person as you would anyone else and do not get carried away with the relatively severity of the symptoms.


#4


If the practioner is a professonal acupuncturist, I think it is not a problem to control the situation!



For example: does she/he know to needle the knee, should bend the knee in 90 degree? it is a important key to treatment the knee problem!


#5


I agree that it&#39s not good practice for professionals to offer criticism of each other unless they are sure of the treatment modalities. Sadly, I have had a few problems with physiotherapists who may have done a weekends &#39acupuncture&#39 training and consider themselves experts. I suspect that if someone really knows acupuncture they would never talk about nerve stimulation. It tends to be a belief amongst biomedical practitioners (I speak as a nurse as well as an acupuncturist) that acupuncture needles are inserted into nerves. OUCH!!! That&#39s all I can to that particular theory.



I feel that you should trust your practice and your assessment of the patient. 3 weeks is not a long time following this operation, and it can be 3 months before full mobility is reached, and still longer before any sensations around the scar are normalised. It is likely to be longer given this patients history. Maybe they have been given unrealistic expectations regarding recovery. Encouraging quadriceps exercises (such as straight-leg lifts) helps prevent muscle wasting and strengthens the muscles supporting the knee.



Good luck!


#6


I would also like to comment that even though I am merely a student often get surprised to read already licensed acupuncturists hesitating or avoiding giving certain treatments that they feel is best for their patients because of someone&#39s incorrect advice? A great example (and really just one of many) is Marina&#39s case where she wouldn&#39t do needling on/around the knee because the therapist suggested needles would overstimulate the nerves. Clearly this therapist has no idea about acupuncture - as Chad also pointed it out in his reply. Why would someone hesitate or even avoid using what he/she feesl the best is for the patient when you know the person on the other line does not know what you&#39re really doing? Is it legal issues? Is it fear of not upsetting another professional?





I am just confused why I see so many cases as such. I have already read several others earlier - even just on this forum and I have to add that Chad elegantly corrects most of those - but I only point this out now, I feel it deserve some attention - and again, this is not case specific for Marina, I have seen this so many times before.





Thank you all!



Blade~


#7


Hi Feng,





I am just a student but got a little hung up when you suggested using heat lamp. Did you mean to use the lamp on the knee or at a distant point? From Marian&#39s original post I read that there is a temperature difference in the patient, maybe I misunderstood it but doesn&#39t that mean sometimes there is higher temperature in which case the lamp wouldn&#39t be doing good? Is the main purpose of the lamp here to move the stagnated blood/chi? From Marina&#39s description I immediately thought of using cooling instead of heating at the location of the surgery and was surprised to read you suggested heat lamp. Could you please explain your suggestion in more details?





Thank you!



Blade~


#8


During injury 24 hours use cool pat is for control the blood swollen, after 24 hours, you should use heat lamp to move out the stagnate blood on the injury location when treatment, but keep a distance is important, not too hot for the patient, it should make the patient feel warm and comfortable.


#9


Thank you for the clarification Feng. I assume the 24 hours is generalization and the lamp is used right after the swelling is gone. I understand the use of it now, thank you for your explanation.





Blade~


#10


I want to thank everyone for the support in this case. It&#39s sure that I know what I am doing, but when someone "overrules" you by saing things to the patient that aren&#39t true, but where the patient becomes very afraid, it will give you a very unpleasant and uncomfortable feeling!



Last week I treated her twice again and it seems to go a little bit better!!!



Everytime I try to needle closer to the knee. In her knee is really too painfull!



All the blue color is coming out and it seems not so thick anymore. Also she came in much better looking. Not so down anymore!



Thanks everyone!





Marina


#11


It seems you have a problem, do i needle the knee or not do acupuncture? There are a few other alternatives. One, you could use Master Tung points (distal points), like pc 6 or ub 43 to treat the knee. Or you could use Richard Tan Imaging/Reverse Imaging to treat the knee distally. Do a little research and you&#39ll find the knee is very easy to treat and without the use of local points.



It is too bad this doctor is giiving your patient this advise. No treatment could further damage the knee (Qi and Blood Stasis - Adhesion/Scar Tissue)and cause the patient to develop other knee problem.


#12


I think this case highlights the general level of ignorance about acupuncture in non-acupuncture practitioners. Yet, at the same time, non-acupuncturists feel they know all there is to know about it. Remember I speak as a nurse; I am not being critical of these people for the sake of it. Rather I think we, as acupuncturists, must make a stand and not allow our practice to be diluted or manipulated by health and political systems that do not understand. If you have your LicAc (as it is in the UK) then YOU are the expert, and not someone with a couple of hours &#39training&#39. If research work is done using acupuncture and it does not fit the acupuncture paradigm, we should speak up and not let false perceptions or sloppy clinical messages be put out. It&#39s quite simple - be clear about your intentions toward the patient and be sure you are not practising to prove a point (!) or out of a sense of inferiority. If your intention is good and your practice is sound you will do no harm. You are the master.


#13


Here&#39s a trick that a friend taught me. It kind of comes from Tung&#39s acupuncture, but you can also find it in Maciocia, bless him. It&#39s a way of treating strongly from a distance:



1. Identify which meridian (or meridians) is most affected at the pain site. Let&#39s say it&#39s Spleen.



2. Spleen is leg tai yin.



3. Go to the elbow on the opposite side of the body. (By the way, which knee was it?)



4. Squidge around the elbow along the hand tai yin, which should be the lung, for an ahshi point. Whack in a needle at the ahshi point, or simply in at Lung 5.



5. Do this for all the meridians that are affected at the knee, treating the arm equivalent according to the chinese name for the meridian.



6. LI 11 on the opposite elbow is usually a winner.



You should find that the pain changes quickly; either is reduces or it starts to shuffle down the leg, as if it wants to leave through the toes. If the pain travels down the same meridian, cool; if it shifts into an other meridain, simply whack in another needle at the elbow that corresponds to the new meridian. In a case like this, I would just look for ahshi points around the opposite elbow just in case. The ahshi points include the standard points. Leave needles in for a long time, like 40 -60 mins. While she&#39s cooking,make yourself a drink, and every so often go back and give the needles a twirl. Repeat after a couple of days, and so on.



Just to REALLY freak that physiotherapist out, you should bleed the points around her knee, or where the flesh is darkest. That&#39s what one of my Vietnamese teachers taught us. He said that it was really important to bleed a trauma site sooner or later to avoid pain returning the following season but one, and to avoid arthritis in old age.



Moxa or heat lamp are really important in cases like this. I am writing to you from Italy where the air conditioning is on full in the wards (in the private hospitals, at least) and certainly the operating theatres are kept cold to inhibit blood flow and to impede airborne nasties. Maybe it&#39s the same where you are. That cold really penetrates the tissues and causes havoc, well qi and blood stagnation any way.



Rock on, Sister, and strut your hua tuo shuffle!


#14


Very well said Yeoman, all too often I see acupuncturists hasitate or back down because an MD or someone - with MUCH less knowledge and experience - has an opinion about our treatment or techniques. Even as a student I too already had my arguments with MDs, because they have no knowledge or understanding of what we do yet quick to critisize.





We need to stick together and be confident in ourselves.




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