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Acupuncture

Acupuncture is the insertion of tiny, hair thin needles in areas of the body that are called acupuncture points. They are usually inserted to a depth of about 1/2 or 1 inch or more, depending on the body part involved. The needles were sterilized by the factory when they were sealed in their package, they are one use only, and are discarded as medical waste after removal. There are over 400 acupuncture points on the body. Where the needles are inserted and how many are inserted depends on your specific condition and what you are comfortable with.

During the first visit for patients who are new to acupuncture, I tend to use very few needles. These might be in the hands and feet or in the back. It's not that the needles hurt, but the idea of having acupuncture is a new concept for most people and I think it's better to do things slowly and let people have some control over how the first treatment progresses. I want everyone to feel comfortable with me and realize that if they have questions or anything makes them uncomfortable, I would like them to communicate that with me. In general, patients may be a bit nervous during a first treatment, but quickly exclaim "that didn't hurt at all!".

Some styles of acupuncture teach that pain or fishing the needle around under the skin ("de qi" sensation) is necessary for a good result. I think this is false. I use distraction (light grasping of the skin near the needle) and excellent quality needles to make acupuncture more pleasant. Cheap needles can have tiny barbs on them which can snag on the first layer of skin and cause some pain, so well made acupuncture needles are important.

An acupuncture session lasts anywhere from 30 to 45 minutes. The initial intake (where I am asking you all my questions) can take anywhere from 15 to 30 minutes. An intake includes questions about things that you also tell your doctor: medical history, medication you are taking, review of systems (including gastrointestinal problems, sleep quality, mood, etc) and detailed questions on pain. The type of pain and location, duration, frequency, and aggravating/relieving factors are important. It is good to notice if your pain moves anywhere, e.g., into the shoulder, or if you have any pattern of numbness or tingling. If you have medical imaging like an MRI, that is helpful to me. 

The acupuncture treatment consists of you laying face up or face down on a massage table, depending on what makes you comfortable. If you are face up, you only need to remove your socks and shoes. If you have a face down treatment, I will give you a gown to wear since I will need access to the entire back. Usually I will put a heat lamp over the painful area, and may do some cupping. Once you have needles in, I will leave the room and let you relax. Sometimes people fall asleep, sometimes not. I also use a lot of liniments or topical gels made mostly of menthol and some Chinese herbs. These also help with pain. I may give you some take home handouts or other recommendations. In general you will feel calm and relaxed after the treatment.

For most returning patients, I use anywhere from 10-20 needles. This is where I differ from some acupuncturists. I treat people mainly for chronic pain and in addition to traditional acupuncture points, I am using a lot of "ashi points". This is basically needling areas of tension in the muscle, and I will go across the direction of the muscle fibers to try to break up a spasm in a tight muscle. Again, this doesn't hurt.

I may do trigger point needling, depending on what I am feeling in your back. Trigger points are little spots of spasm or knots that can cause pain elsewhere. There are a build up of the lactic acid that normally moves the muscle. Why these knots gather in particular places, we don't really know, but there are actually maps of trigger points for each muscle that show their referral patterns (you can search "Travell" "trigger points" if you are curious). A trigger point can cause reduced blood flow (ischemia) in the muscle which makes the muscle even tighter and more painful. When these trigger points are released by needling, they may spasm a little for a few seconds but this doesn't hurt. It is actually sort of neat to see the muscle "jump" when it releases. The area may be sore later as the irritant is slowly is moved out of the area by the body, similar to how you feel after a massage. Sometimes these knots come back and need to be treated again, sometimes they don't. Usually posture will cause a lot of these problems. I might recommend some changes to your workstation or give you some stretches to try.

The amount of acupuncture treatments that are necessary to relieve your pain varies greatly. In general, severe pain that you have had for many years will need more treatments than acute pain. It is also important to know that acupuncture isn't for everyone. A small amount of patients may not get relief from pain and might have better success with physical therapy or treatments from their doctor. Most of my patients are under a doctor's care and I believe in complementary care, not a rejection of Western medicine for alternative medicine. I like to think of acupuncture as an alternative to reliance on opiate medications and I think acupuncturists work best as a support for the pain management doctor or orthopedist. Acupuncture is a type of pain management and one that has very few side effects. 

Cupping

Cupping has been part of Chinese Medicine for over 2,500 years. It is also used in Russian and Arabic folk medicine. It relieves aches and pains, improves circulation, and also helps with respiratory and digestive issues. During fire cupping, a vacuum is created in a glass cup with a lit piece of cotton soaked in alcohol, the cotton is discarded and the cup is placed on the body (usually the back). The cup will "stick" to the body because of the vacuum drawing up the skin. Sometimes the cups are moved back and forth like a deep tissue massage, sometimes they are left for about 15 minutes. It is important to know that cupping can and usually does leave a red mark or even a purple bruise for a few days. This will fade just as a bruise does.

Electroacupuncture

Electroacupuncture is sometimes added to regular acupuncture, especially in chronic pain conditions. A low level electrical change is delivered to the acupuncture point by a small estim unit attached to the needle. It is not painful, the most common sensation is a pulsing feeling. Contraindications to electroacupuncture are heart problems, epilepsy and pregnancy.

Gua Sha

Gua sha is another ancient treatment used across cultures, mostly for muscle aches and colds. A smooth rounded object like a spoon or plastic gua sha tool is scraped against the skin, leaving small red marks called petechiae. The marks will fade as a bruise does.

Moxibustion

Moxibustion is a Traditional Chinese Medicine technique that involves the burning of mugwort, a pungent smelling herb, to warm and activate the acupuncture point. The warming sensation is particularly helpful for pain due to arthritis.

 

Tui Na

Tui Na is a form of bodywork that combines massage and acupressure, usually on the back. It is similar to massage but different techniques are used such as pulling, rolling and pinching on the skin near acupuncture points.