Throughout my career as an acupuncturist I’ve been interested in the treatment of injuries due to trauma. My background in sports and martial arts has probably stoked this interest. Centuries ago the treatment of trauma was often referred to as hit and fall medicine, and was primarily the domain of the bonesetter, many of whom were martial artists. Acupuncture, moxibustion, massage and herbalism all played a role in the treatment of trauma. Aside from applications after an injury, this medicine also has applications following surgery and can play a useful role during the rehabilitation process. At our Gold Coast acupuncture clinic we have often been asked to assist with surgical trauma and rehabilitation after ACL (anterior cruciate ligament) reconstruction and knee arthroplasty. Treatment begins once wound healing has been achieved.
For the remainder of the article we will follow the rehabilitation process of an ACL reconstruction. This surgery is used to replace a complete rupture of the ACL which occurs commonly in both contact and non-contact sports. During the surgery a graft is made, usually from the patient’s own hamstring, and is implanted into position. The body uses this graft as a scaffold to remodel into a ligament. This process is slow and takes approximately 12 months. During this time the patient needs to be cautious but also needs to constantly improve their physical condition to get back to a pre-injury state.
Initial Injury – Complete Rupture of ACL – Signs and Symptoms
Incident – severe pain often accompanied by a snapping or popping sound
Pain – worse for movement/ weight bearing, worse at end ranges of movement (i.e. during flexion and extension)
Stiffness – reduced range of movement and as a subjective symptom associated with the pain
Swelling – mild to extensive (characteristically at the front of the knee but can also occur at the back)
Heat – warm to palpate
Other tissue damage to supporting structures (commonly accompanied by sprains to other ligaments, strains to supporting muscles and their tendons, fractures to adjacent bones and meniscal damage)
Instability – joint may become unstable and feel weak, sluggish and on occasion give way (this may not be apparent on the day of injury)
Phase 1 - Pre-surgery Treatment
If surgery is elected to reconstruct a ruptured ACL, surgeons often prefer the patient regain full and pain free range of motion before the procedure. This leads to a better result post-surgery. Normal activities should be able to be accomplished with little to no difficulty. Exercise may remain problematic but many sufferers should be able to perform movements that do NOT require directional change, twisting, changes of balance and extreme flexion and hyperextension (for instance straight running and cycling can be achieved). On many occasions a recovery from the initial injury should take several weeks to months.
Acupuncture, moxibustion, massage and herbal medicine can play a pivotal role in assisting a patient to achieve normal movement and a return to exercise after injury. When treating trauma, the guiding principal is to encourage effective healing. To do this we must avoid strategies that delay or reduce the body’s natural healing ability. In Traditional East Asian Medicine there is an idea that when the body’s form is damaged, the resulting bleeding and inflammation may not resolve naturally with complete tissue healing, instead the area remains diseased. The remaining pain and its associated signs were referred to as blood stagnation (more on this later). Treatment was designed to reinforce the body’s natural healing mechanisms in order to avoid or limit any ongoing complications from blood stagnation.
Phase 2 – Post-Surgery Treatment
At our acupuncture clinic on the Gold Coast we have been seeing an increasing number of post-surgical patients in the last few years, particularly after ACL reconstructions. Surgical trauma is created during the implantation of the ACL graft. In the Days afterward, the patient is required to recommence normal activities and begin their rehabilitation. The first few weeks of rehab are the hardest. It is during this time that acupuncture, moxibustion and massage are useful to assist in pain management and progression through the rehab program. At our clinic patients have reported quicker rehab outcomes and increased comfort during exercises. The aim of the treatment is to promote good tissue healing and to complement an exercise program with sensible hands on therapy. Treatment is most useful in the month or two following surgery, but may be continued occasionally if desired.
Traditional East Asian Medicine – Concept of Blood Stagnation
In Traditional East Asian Medicine pain is attributed to a breakdown in the circulation of the blood and fluids that nourish the body tissues. Referred to under the traditional medicine vernacular as blood stagnation. When we reflect on this idea, you might find it unusual that pain is not associated with tissue damage, as it is in modern medicine. I believe this was largely due to it being obvious, instead the ancient doctors were more interested in the circumstances associated with effective healing. Tissue damage causes inflammation; identified by pain, swelling, heat, redness and loss of function. Inflammation stimulates tissue healing and as tissue damage is repaired inflammation diminishes. Unfortunately healing does not always go to plan. Inflammation can endure, tissue healing can be slow/ incomplete and the function of the damaged area does not always return properly. Blood stagnation was the traditional way of describing defective healing processes that allow pain to persist.
Signs and Symptoms of Blood Stagnation (Poor Tissue Healing)
Indurations and stiffness found on palpation
Tissues feel more painful when palpated and pressed
Mild swelling at the site of injury
The site of injury may appear darkened
Physical conditioning is often diminished at the site of injury
This article article’s purpose is to provide general information for prospective patients searching for acupuncture Gold Coast. If you have any questions or would like to book an appointment Contact us today.