Why can acupuncture help tendon injury?
Tendon is tough fibrous connective tissue which connects muscles to bones. Tendon is made of collagen. Tendon injury includes acute and chronic injury is very common. The symptoms include pain, redness, warmness, swelling, tenderness near the injured tendon. Pain increases with activity. Also pain can radiate to other part of the body. Rest, ice, steroids injection, massage can be used to treat tendon injury. Acupuncture is proven to be effective for tendon injury. Clinical study showed that acupuncture improves pain and functional activity in patients with tendon injury. Recent studies showed that acupuncture can modulate anti-inflammatory and mechanotransduction molecular pathways which subsequently increase collagen synthesis and reorganisation. This underlies acupuncture tendon healing mechanisms.
Effect of acupuncture on chronic Achilles tendinopathy
Achilles tendon is the tendon at the back of the lower legs and it passes posterior to the ankle. It is the thickest and strongest tendon in the body. Achilles tendinopathy (also called Achilles tendonitis) is pain and swelling you can get in your Achilles tendon. Achilles tendonitis is an inflammation in Achilles tendon which is caused by an overuse injury to the thick Achilles tendon at the back of the ankle. It is very common in runners. Achilles tendonitis can be either acute or chronic. Acute Achilles tendonitis is a new injury and usually more painful. Chronic Achilles tendonitis is a prolonged injury and it may follow the acute Achilles tendonitis. The characteristic of this condition is pain and inflammation at Achilles tendon. Many factors contribute to developing the condition. 1, increased activity, for example, suddenly increase distance, speed in running. 2, change to soft training surface, for example running on the soft surface can put on excessive stretch to the tendon. 3, weak calf muscles increases the strain on the Achilles tendon. 4 running on the hill will put on more stretch on the tendon. 5 Wearing high heels constantly shortens the tendon and calf muscles. Sudden change to flat shoes from high heels for exercising will put abnormal stretch to the tendon.
The main symptom is Achilles pain at the back of the ankle, just above the heel bone. There is stiffness in the Achilles tendon especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Redness and swelling are often seen in acute stage. Nodules or lumps may be found in the Achilles tendon, particularly 2-4cm above the heel. Tenderness of Achilles tendon can be seen during examination.
Chronic Achilles tendonitis is a difficult condition to treat due to its poor blood supply.
In acute stage, rest is a must. Continuing to train on a painful Achilles tendon could lead to the injury becoming chronic and more difficult to treat. Appling ice within 24-48 hours of injury will reduce pain and inflammation. Wearing a 1cm high heel pad can take some strain away from Achilles tendon. Achilles tendon taping technique which uses elastic bandages to support the tendon can help. Acupuncture can improve blood flow, improve oxygen supply and nutrients supply to the tendon. Also acupuncture can reduce pain and decrease inflammation. In later stage apply heat to the tendon is beneficial. Pain killers can be used in acute stage, but they may not be very effective. Long term use could delay tendon healing. Steroid injection directly into the tendon is not recommended because this can increase the risk of a total rupture of the tendon in future. Right running shoes prevent from future injury.
Once you can perform daily activities pain-free, move on to next stage which focus on improving the flexibility of the calf muscles. Massage will help prevent adhesions forming within the tendon which stop the tendon sliding smoothly in its sheath and help blood flow of calf muscles. Eccentric exercises have been proven to be very effective in the treatment of chronic achilles tendonitis. If the injury has been severe and required a sustained period of rest and the neural control or co-ordination of the ankle has been affected, proprioception which is the neural control or co-ordination of a joint may need to be improved. Finally when the pain has disappeared at least a week and the range of motion at the ankle has improved then you can begin to return to training.
There are some examples of research that suggested that acupuncture is effective to treat Achilles tendinopathy
There was a clinical study of acupuncture for chronic Achilles tendinopathy. This study investigated whether acupuncture treatment would improve outcome in chronic achilles tendinopathy. In this study, 64 patients aged from 18-70 year old with chronic Achilles tendinopathy were recruited and randomly allocated into two groups: acupuncture treatment group and control group (received eccentric exercises). The effects were assessed at the start of the treatments, 8, 16 and 24 weeks after the treatments. They found that 8, 16 and 24 weeks acupuncture significantly improved the pain sensation and activity in patients with chronic Achilles tendinopathy compared with the eccentric exercises. This finding provided an alternative treatment option for patients with chronic Achilles tendinopathy.
A case report of Achilles tendinopathy
There was a case report of conservative treatment of Achilles tendinopathy. This was a 77 year old female patient with chronic Achilles endinopathy. The pain was present in the midportion of the Achilles tendon for 8 months. The pain was progressing. Activity makes the pain worse. Her tight lower leg was swelling around the right Achilles tendon. Right ankle movement was limited. There was tenderness and soft tissue thickening. Acupuncture and electric stimulation were applied for the treatment. Also physiotherapy exercise programme was performed. The treatment was twice a week for 4 weeks and then once a week for 4 weeks. The total treatments were 12. Gradual improvement was seen during each treatment. At the end of week 9, the improvement was significant. The only symptom was the mild tenderness of the Achilles tendon. Other tests were all within normal range. After finish whole course of treatments, the patient was encouraged to continue exercise programme. At 12 month follow-up, there was no recurrence occurred.
How can acupuncture help with Achilles tendinopathy? Studies have shown that acupuncture releases pain, increases in local blood flow and oxygen and nutrients supply to promote tissue healing.
Almeida MD et al Acupunct Med 2013 Dec 11Doi:10.1136
Zhang BM et al Chin J Integr Med (2012) Dec 21
Papa JA J Can Chiropr Assoc (2012) 56:216-24
Kubo K et al Int J Sports Med (2011) 32:807-13
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