Acupuncture for Elbow and Knee Pain
Chief Complaint: Chronic left elbow and knee pain
Western Diagnosis: Left triceps strain and left knee sprain
Medical History: Patient is a 37 year old female with a significant family history of arthritis, alcoholism and diabetes. Patient is married with two children, ages 5 and 2. Patient enjoys a well-balanced diet and would like to resume a regular workout activity. Patient complains of constant pain in left elbow and knee.
Questioning exam: Patient’s onset of left elbow and knee pain began during her first pregnancy and severely aggravated during her second pregnancy. Patient has experienced pain in her left elbow and knee constantly for 3 years. She has seen an orthopedist that referred her to physical therapy which has helped her knee a little but has made elbow symptoms worse. Her symptoms include generalized soreness in left elbow (medial and lateral aspect of elbow with radiating pain slightly above elbow and down into forearm )and pain in left medial knee joint and around patellar tendon area. Patient takes Ibuprofen regularly and wears elbow and knee braces to manage pain. There is also generalized weakness in left upper and lower extremities. Symptoms are worsen by caring for her 2 year old, not-so-compliant daughter. Patient also presents with spider veins in lower extremities and bruises from simply bumping into furniture.
Patient’s sleep is fair due to having to wake up in the middle of night to care for children. Patient does not have trouble falling asleep as she is so tired from the day’s activities. Her energy level is generally good. Appetite and digestion is noted as good. Patient generally tend towards feeling hot.
Pulse exam: Pulse rate ranges from 72-80 bpm. Liver position is wiry and Spleen position is thin. Heart position is thready. Both kidney pulses are weak.
Tongue exam: Patient has difficulty presenting her tongue in a relaxed manner. Patient sticks tongue out and tongue is rigid and shape is pointy. Tongue body is purplish-pink with the tip of the tongue generally red.
OM Diagnosis: Patient’s history and current medical history lead me to believe her diagnosis is Spleen Deficiency with Heart Yin Deficiency and Stagnant Qi in the Large Intestine meridian of Left Upper Extremity. Her family history of autoimmune diseases and her weak musculature as well as easily bruising points to Spleen Deficiency. Her disturbed sleep is not allowing her to rest during her yin time and this impacts on the Heart organ and is reflected in the meridian as patient has pain/soreness in Left Hand – Shao Yin (Heart) meridian. There is general Liver stagnation as evident by her tongue and pulse which has interrupted the smooth flow of qi to her tendons and muscles.
Treatment Principle: Deconstrain Liver, tonify Spleen, tonify Heart. Physical therapy to rehabilitate deconditioned structures and muscles. Improve overall function.
Point Prescription: Sp 3 – pain in muscles
Sp 6, St36, CV6, CV12 – tonify Spleen
Left Sp 9, 10 – for medial knee pain
Liv 3 – deconstrain liver stagnation
H2, H3, H7 -tonify Heart and release blockage/excess in Heart channel.
LI 4, LI 10 area, LI 11 – release stagnate qi/blockage from LI channel.
GB 34 – influential point of tendons and in conjunction with Liv 3, tonify Liver
The Spleen tonification points were used in all sessions and other points were used depending what the symptoms were remaining. Mark Seem’s style of trigger point needling technique was used which was found to be most beneficial in relieving the elbow pain.
Herbal liniment massage to left elbow, forearm and left knee. Therapeutic exercises given in very slow progression.
Lifestyle Prescription: Key points of control techniques and child handling strategies were taught to patient on how to improve cooperation from her children and how to handle them when they are not cooperative. These techniques are from my bag of tricks as a pediatric physical therapist.
Results: RESULTS – GREAT!!
Patient has been very happy with the progress. She is no longer taking Ibuprofen or using elbow and knee braces. After 3 years of pain, she is finally close to pain-free. She is able to perform exercises without pain. She is able to use left arm to assist with carrying groceries. Patient is excited to progress onto a regular workout session. Also the techniques really help to improve handling of her children thus not aggravating her symptoms.
Synopsis: I practice a unique style of personalized acutherapy which is a combination of acupuncture and physical therapy for musculoskeletal involvement. I find this to be most effective in treating this type of patient. After pain management and balancing their body, I feel it is essential to include rehabilitation to promote prevention, which is the basis behind Chinese Medicine.