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Acupuncture versus Physiotherapy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Mar 5, 2006.


  1. Members do not see these Ads. Sign Up.
    All,

    Read in the UK national press of a recent RCT comparing acupuncture with traditional physiotherapy in the treatment of (think it was) knee pain. The study showed acupuncture to be more effective. The study was from Asia I think. Does anyone have reference for this?
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I am not familiar with anything recent on acupuncture and the knee (and have fired off a couple of emails to those who might know), but could it be this that you are thinking of as it got a bit of press a week or so ago:
    Acupressure Eases Low Back Pain
     
  3. I think that I am maybe confusing two seperate studies- The one you list above was the one I was thinking of, but I'm sure I came across something on acupuncture and O/A of the knee?

    So regarding the accupressure trial- how do meridians work? ;)
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Maybe it was this one from December - a lot of outlets carried this story:
    Acupuncture 'works for arthritis'
     
  5. Thanks for that.
     
  6. Atlas

    Atlas Well-Known Member


    Hands-on acupressure getting better results than conventional physiotherapy.


    That is a shock to my system?
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Sham accupuncture works too

    Reuters Press Release
    Acupuncture appears effective for lower back pain
    March 9, 2006 09:36:28 AM PST
     
  8. Stanley

    Stanley Well-Known Member

    A weakness of a muscle can be related to an imbalance in the Accupuncture Meridian System. The way to find out is to stimulate the alarm point for the meridian related to the muscle. In the foot the 3 peroneals and Anterior tibial are associated with the bladder meridian, and all the others are associated with Circulation-Sex. If the associated muscle strengthens by stimulating this point, then you have find the one point that will balance the entire system, and look at the underlying structure for dysfunction.
    I had an interesting case the other day to illustrate how this relates to us podiatrically. The patient had posterior tibial shinsplints. There was some obvious pronation, and an equinus. After checking cortical-cerebellar balance, cranial-sacral, neurolymphatics, and neurovascular, I found that stimulation of the bladder alarm point strengthened the posterior tibial muscle. Then by finding a meridian that did not sedate, and using the pulse points to determine which of two possible meridians would allow the meridan to sedate, I then found the kidney/bladder pulse point would allow sedation of the meridian. The kidney alarm point did not allow for sedation, while the bladder alarm point did. After evaluating the meridian point by point, it turned out that the point was directly over the posterior talo fibular ligament would allow for sedation. So after rubbing the meridian, I performed a ligament release. Upon rexamination, the equinus was reduced and the posterior tibial was able to summate. So the cause of this whole imbalance was a plantarflexed first ray. Just before heel off, with a plantar flexed first, the foot supinates, putting stress on the posterior talo fibular ligament. This resulted in damage to the ligament with an associated equinus, an imbalance in the overlying meridian and subsequent weakness of the posterior tibial. She was prescribed an orthotic with a sub 2-5 post to prevent recurrence.

    Regards,

    Stanley
     
  9. nicpod1

    nicpod1 Active Member

    Simon,

    The research you're thinking of, possibly, was part of a TV programme about a month ago where a 'scientist' was exploring complementary therapy and the main focus of the research institutions she investigated/liased with was Acupuncture and OA of the knee, which may not be published yet.

    What they found was that in a single-blind, placebo trial, acupuncture faired better than placebo acupuncuture in OA of the knee.

    Quite how anyone can compare 'Physiotherapy' against 'acupuncture' for OA of the knee is beyond me as, obviously, the approach of the Physio to the problem will vary dependent on the condition and the patient and, oops, lots of physios use acupuncture, so a bit of a dead-ender really!

    And, dare I say it, OA of the knee, when severe enough, should really be being addressed by surgeons shouldn't it.....................? Perhaps the old waiting list issues in the UK are fuelling this one!

    Having worked with extremely experienced Acupuncturists, what I would also say is that the practitioner needs to be extremely competent!

    This probably doesn't help much!
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Britsh Medical Journal have just published the research that CP referred to in message 2 of this thread:
    Treatment of low back pain by acupressure and physical therapy: randomised controlled trial
     
  11. Atlas

    Atlas Well-Known Member

    No your spot on. What is physiotherapy? It is derived from physical therapy, but unfortunately, there are many that use electrotherapy as if electricity is free!!! What I tell my patients is that "mechanical problems have mechanical solutions". If your pain is non-mechanical, I can't help you. But I could turn the ultrasound machine on and take your money, and compete with good-old mother nature.
     
  12. Talking of physical therapies:

    http://news.bbc.co.uk/1/hi/health/4824594.stm

    Spinal manipulation - which is used by chiropractors and osteopaths in the UK to treat neck and back pain - is of little help, researchers have said.
    Experts from Peninsula Medical School in Devon reviewed 26 studies carried out between 2000 and 2005.

    Writing in Journal of the Royal Society of Medicine, they said the data gave "little evidence" of effectiveness.

    Chiropractors said the team had focused on negative studies which supported the researchers' views - a claim they deny.

    "National clinical practice guidelines, based on much more and better research than the studies this article has selected, has come to exactly the opposite conclusion"- British Chiropractic Association statement

    The researchers said they looked at all studies evaluating the benefits of spinal manipulation for period pain, colic, asthma, allergy and dizziness - as well as back and neck pain up to 2005.

    It was found the data did not show spinal manipulation was effective for any condition - except for back pain where it is superior to sham manipulation, but not better than conventional treatments.

    The researchers said that, as spinal manipulation had been linked to mild side effects in around half of patients, such as temporary stiffness, and - much more rarely - strokes brought on by damage to the vertebral artery in the back, it was not something which should be used instead of other therapies.

    They suggest existing guidelines need to be re-evaluated in the light of their conclusions.

    Professor Edzard Ernst, who led the review, said: "There is little evidence that spinal manipulation is effective in the treatment of any medical condition.

    "The findings are of concern because chiropractors and osteopaths are regulated by statute in the UK.

    "Patients and the public at large perceive regulation as proof of the usefulness of treatment.

    "Yet the findings presented here show a gap and contradiction between the effectiveness of intervention and the evidence."

    "We suggest that the guidelines be reconsidered in the light of the best available data."

    Professor Ernst said the findings should be seen as a "wake-up call" to the chiropractic profession.

    "One way forward is more rigorous clinical trials to test the efficacy of spinal manipulation," he added.

    "After all, the treatment is not without risk and chiropractors must demonstrate why it should be a recommendable medical treatment option."

    But in a statement, the British Chiropractic Association said it was disappointed by the study's conclusions, which it believed were based on "negative" research - other studies had come to the opposite conclusion.

    "The usefulness of manipulation is that it can be added, substituted or modified as part of a package of care that provides management, pain control, advice and recognises risks to a good recovery," it said.

    "Recent clinical trials funded by the Medical Research Council show that manipulation is effective and cost-effective within such a package for back pain."

    The National Council for Osteopathic Research accused Professor Ernst of working with out of date data.
     
  13. Atlas

    Atlas Well-Known Member

    Actually in all seriousness, I reckon acupuncture may be a more powerful tool than either podiatry or physiotherapy in true compartment syndrome. Just a hunch.
     
  14. Particularly if you puncture the compartment and perform a fascial release with the needle ;)
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Accupuncture

    Here is another just released study on accupuncture and knee OA:

    Medscape News are reporting (free registration required to access):
    Acupuncture Needling May Improve Pain of Knee Osteoarthritis
    July 5, 2006
    More on this study (free registration required)
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Acupuncture

    Ivanhoe Newswire are reporting:
    Acupuncture Lacks Evidence, Say Researchers
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Not wanting to reignite the debate, but the BBC have justed reported:
    Acupuncture 'best for back pain'
    Acupuncture is more effective at treating back pain than conventional therapies, research suggests.
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Here is the abstract:
    German Acupuncture Trials (GERAC) for Chronic Low Back Pain
    Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups

    Michael Haake, PhD, MD; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD; Heinz G. Endres, MD; Hans J. Trampisch, PhD; Albrecht Molsberger, PhD, MD
    Arch Intern Med. 2007;167:1892-1898.
     
  19. Admin2

    Admin2 Administrator Staff Member

  20. Shane Toohey

    Shane Toohey Active Member

    Just to add a couple of comments. Thanks for bringing up this article, Newsbot.

    The study above adds to the growing evidence for acupuncture being helpful in the treatment of musculoskeletal pain, wherever it happens to be.

    My comments:
    We still don't have a full explanation for how acupuncture works but there seem to be multiple responses initiated. We don't need to have a full explanation to make use of the modality. We've always done reasonable well with orthotic therapy and our understanding of how it worked has been shown to be untrue (subtalar neutral).

    The study compared acupuncture to "conventional treatment" and found in favour of acupuncture. I'm sure there are the best experts in "conventional" who would have got a better score. What is raised is: "Why not combine the treatments and use all of your current podiatric skills and supplement with acupuncture or supplement acupuncture with mechanical treatments? There is no exclusivity and you might just produce exceptional results.

    Cheers
    Shane
     
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