By: Jean Johnson for Knee1
“I find knee pain responds well to Chinese Medicine,” said Cindy Reuter, N.D., L.Ac., R.D., at Providence Integrative Medicine Program, part of the Providence Cancer Center in Portland, Oregon. “There may be discomfort when the needles are being inserted – we use five to eight locally in and near the knee and maybe another four to six on other parts of the body like the wrists, feet, scalp, or lower legs. I may also use a topical cream or liniment as well as an infrared lamp to help keep the patient warm and improve circulation in the area.
“There are good studies showing that acupuncture helps relieve pain from osteoarthritis. Many of my patients have had some relief after just one visit, although for more significant relief, it generally takes two to three treatments,” said Reuter.
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“I like to treat regularly the first four to six weeks. Optimally it’s best to see people a couple times a week, but usually once a week is all we can manage. More frequent visits, especially in the beginning, are the most beneficial. Many people drop out of acupuncture or think it doesn’t work because they are not treated often enough.
“In China, patients get acupuncture in a series of daily treatments with breaks in between,” Reuter said. “Here in the United States, that’s a little more difficult to do so we try for a good initial regimen of at least weekly visits and then taper off as we see improvement.” Reuter explains that patients who come to see her for knee problems are often those who are trying to avoid surgery, expensive imaging, or they may have already been to a medical doctor and have a diagnosis of a torn meniscus or ligament strain. “As the treatments progress, I’m looking for a decrease in pain, reduced swelling, better range of motion and more stability in the knee,” she said.
While acupuncture may not cure knee problems entirely, Reuter has found it effective in enabling patients to take a wide berth around the operating table. “Some of the patients I’ve treated have almost complete relief, while others have experienced a 30 to 70 percent improvement that has allowed them to avoid surgery.” No matter where Reuter’s patients are on the continuum, though, if they avoid knee surgery, she says that they consider the acupuncture a success. “And,” she adds, “So do I.”
Acupuncture, the Venerable Tradition
This ancient healing art originated in China 2,000 years ago, giving it the distinction of being, as the National Center for Complementary and Alternative Medicine (NCCAM) notes, “one of the oldest and most commonly used medical procedures in the world.” Acupuncture has become more widely known in the United States since 1971 when New York Times reporter James Reston described how successful Chinese physicians were in easing his pain after surgery.
Particularly in the past two decades, acupuncture has gained popularity in the United States with an estimated 8.2 million stating that they had used acupuncture in a 2002 National Health Survey, and the U.S. Food and Drug Administration (FDA) approving acupuncture needles – sterile, nontoxic, and single-use – for use by licensed acupuncturists in 1996. “Acupuncture is one of the key components of the system of traditional Chinese medicine,” states NCCAM.
Pundits go on to explain that in traditional Chinese medicine “the body is seen as a delicate balance of two opposing and inseparable forces: Yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle.” The idea behind traditional Chinese medicine is that when yin and yang get out of balance, disease can ensue. More, the philosophy believes that there are pathways or meridians running through the body and qi (pronounced chee) or vital energy flows through these channels.
When the opposing forces of yin and yang get out of balance, it creates blockages at various points in the meridians, thus inhibiting the flow of qi. Consequently, when licensed acupuncturists treat problems like those in the knee, for example, they also keep a holistic eye attuned to the larger body, looking for problems that might be contributing to symptoms at a particular site. “We treat locally which means needles in the knee, but we also look at constitutional factors that may affect the knee, since the meridians or channels that run through the knee can influence the area,” said Reuter. “For example, a person could have a kidney or liver weakness that disrupts the optimal flow of qi in the channels running through the knee.” According to NCCAM, “It is believed that there are 12 main meridians and 8 secondary meridians and that there are more than 2,000 acupuncture points on the human body that connect them.”
“In Chinese medicine, the emotions and physiology are considered to be intertwining,” said Reuter. “When I’m doing acupuncture, I feel like I’m doing a painting. It’s so elegant and beautiful. Each needle – there’s a real art to it for me. You can treat people on a physical level while you are treating them on a more profound level.
“In Chinese medicine theory, the saying is: ‘as above, so below,’” Reuter continued. “In other words, life and nature are a series of macrocosms and microcosms. Consequently, any disharmony on either the larger or smaller level will be reflected in the greater system. By treating any potential imbalance, we add to the overall harmony or treat disharmony. In traditional Chinese medicine, you do not have to have something wrong to come in for acupuncture. A high level Chinese medicine practitioner is considered able to treat diseases before they arise by restoring balance to the body.”
Summing up, Reuter offered the following observation on the holistic aspect of acupuncture. “I think modern life is more difficult for people than they realize. They come in for treatment and are surprised and impressed at how much better they feel. Acupuncture influences your biochemistry. Studies have shown that is creates changes in endorphins and brain chemistry.”
The Science Supporting Acupuncture
NCCAM notes that while “pre-clinical studies have documented acupuncture’s effects, they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States.” That said, NCCAM states that “It is proposed that acupuncture produces its effects through regulating the nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins and immune system cells at specific sites in the body.” Thus the organization concurs with Reuter and goes even further to point out that “acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and, thus, affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes that regulate a person’s blood pressure, blood flow, and body temperature.”
NCCAM also states that although “relatively few complications from the use of acupuncture have been reported to the FDA in light of the millions of people treated each year and the number of acupuncture needles used.” Nonetheless, the government group underscores the importance of getting treatment from certified clinicians who are scrupulous in their use of sterile needles and procedures. As far as acupuncture needles and pain, goes, Reuter explained that patients may feel some pain when the needles are placed.
Once they are in, however, she notes that some even fall asleep during the treatment and report exceptional rest. NCCAM mirrors her thoughts, noting that “People experience acupuncture differently, but most feel no pain or minimal pain as the needles are inserted. Some people are energized by the treatment, while others feel relaxed.” NCCAM does, however, go on to issue a cautionary note: “Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner.”