Tendon is a tough band of fibrous connective tissue that usually connects muscle to bone Tendons are highly organized connective tissues that transmit muscle force to the bone. Tendons are resilient during the development of tension, but flexible enough to carry on its function. In the resting state, the collagen fibrils exhibit a wavy conformation. As a tendon is stretched, collagen fibrils begin to straighten out, and, as a result, the tendon becomes stiffer with increasing application of mechanical strain. The transition from tendon to bone and from tendon to muscle is progressive to allow an efficient load transfer minimizing stress concentrations.
A healthy tendon is up to twice as strong as the muscle, making the body of the tendon unlikely to tear before the muscle unless the tendon has already been weakened by degenerative changes. The effects of ageing, wear and tear, genetic pre-disposition and inflammation are known factors contributing to tendon injuries. Tendons consist of collagens, proteoglycans, glycoproteins, water and cells. In case of injury, repair will take place only through scar tissue. This leads to decreased functional properties of these injured regions and to a greater risk of recurrent injury. Injured tendon can cause pain, loss of limb function and prevent exercise and activities of daily living.
There are ∼2 million Achilles tendon sports-related injuries each year worldwide. Of these, over 250 000 require surgical intervention and prolonged rehabilitation. However, patients with these injuries seldom regain full pre-injury function. These ailments are difficult to manage, frequently resulting in long-term pain and discomfort. The poor repair of tendons is a direct consequence of their limited vascularity and relatively acellular nature. Most frequently injured are the rotator cuff, the patellar and the Achilles tendons, with pathology ranging from tendinopathy and calcific tendinopathy, to partial tears, to complete ruptures. The poor tendon self-repair makes recovery difficult.
Calcification is the accumulation of calcium salt in the tissue. Bone is the common place to occur, but calcification can happen in the soft tissue, such as fascia and tendon causing hardening of the tissue. Soft tissue calcifications happens anytime and any location of the body. The most common place is in the damaged tissue, such as injured tendon causing calcific tendinitis. Calcium phosphate is accumulated in the tendon causing pain and inflammation. Chronic pain is the most common symptom of tendon calcification. Other symptoms include stiffness, snapping, catching or weakness on related tendon and joints. It is involved in abnormal repairment of damaged tissue. Acupuncture can help to reduce the pain, improve stiffness and improve circulation to help reabsorbing the calcium.
Pain and burning in the affected area, decreased strength and flexibility, and pain caused by everyday activities are very common. This is often caused by tendinopathy-tendon injury.
The healing time for injured tendon varies depending on whether treatment starts with early presentation or chronic presentation. Healing time for acute injury can be a few days to 6 weeks. Treatment at an early stage can be as brief as 6–10 weeks. Once it becomes chronic the treatment can take 3–6 months. The effective treatment might take up to 9 months to 36 months when it is chronic. Knowing these timelines is part of creating an effective treatment plan.
Acupuncture helps with tendon injury
Acupuncture is used to treat tendon injury and it improves pain and functional activity in patients with tendinopathy. This is suggested that acupuncture can modulate both anti-inflammatory and mechanotransduction molecular pathways which can increase type I collagen synthesis. Collagen synthesis is the main factor that influences tendon biomechanical properties. Therefore one reason of acupuncture for tendon healing is that acupuncture increases synthesis and subsequent reorganisation of type I collagen during tendon healing process.
References
MacPherson H et al (2016) Pain Oct 17 Epub ahead of print
https://academic.oup.com/bmb/article/117/1/25/1744499
Saturday, 28 April 2018
Thursday, 5 April 2018
Suffer from low back pain? acupuncture can help
Back pain is a common condition which affects more than 1 million people in the UK. Back pain can be caused by many factors. But some of the causes cannot be found.
95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.
In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.
Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?
There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.
With 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.
Low back pain with acupuncture treatment
Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.
NHS recommended acupuncture combined with self-care for persistent low back pain.
Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.
Mechanisms of acupuncture for low back pain
Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment
References
Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937
Hogeboom CJ et al (2001) Complement Ther Med 9:154-66
Tang WJ et al Acupunct Med 2013 Nove 26. Doi:10.1136/acupmed-2013-010423
Cheshire A et al BMC Complement Altern Med (2013)13:300
http://publications.nice.org.uk/low-back-pain-cg88/key-priorities-for-implementation
Lee SH et al Evid Based Complement Alternat Med (2013) 2013:402180
Weiss J et al J Altern Complement Med (2013) 19:935-41
http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3733-couch-potato-culture-causes-a-generation-in-pain.html
Hsu C et al BMC Complement Altern Med (2014) 14:276
Koppenhaver SL et al Man Ther (2015) Mar 13. pii: S1356-689X(15)00051-X. doi: 10.1016/j.math.2015.03.003. [Epub ahead of print]
95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.
In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.
Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?
There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.
With 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.
Low back pain with acupuncture treatment
Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.
NHS recommended acupuncture combined with self-care for persistent low back pain.
Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.
Mechanisms of acupuncture for low back pain
Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment
References
Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937
Hogeboom CJ et al (2001) Complement Ther Med 9:154-66
Tang WJ et al Acupunct Med 2013 Nove 26. Doi:10.1136/acupmed-2013-010423
Cheshire A et al BMC Complement Altern Med (2013)13:300
http://publications.nice.org.uk/low-back-pain-cg88/key-priorities-for-implementation
Lee SH et al Evid Based Complement Alternat Med (2013) 2013:402180
Weiss J et al J Altern Complement Med (2013) 19:935-41
http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3733-couch-potato-culture-causes-a-generation-in-pain.html
Hsu C et al BMC Complement Altern Med (2014) 14:276
Koppenhaver SL et al Man Ther (2015) Mar 13. pii: S1356-689X(15)00051-X. doi: 10.1016/j.math.2015.03.003. [Epub ahead of print]
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