Background. Background. Acupuncture Protocol

Transcription

1 Background The Achilles tendon is a problematic structure in the general population and in competitive and recreational athletes Specifically affecting middle aged runners (Paavola et al, 2002; Woo et al, 2007) By Berj Kishmishian Supervisors: James Selfe and Jim Richards Cochrane review (McLauchlan & Handoll, 2009) state that not enough evidence to show an effective treatment of Achilles tendinitis mainly medication and did not include Eccentric Training... Eccentric exercises are a popular treatment (Rees, 2009) Promising results (Kingma et al, 2006) poor heterogeneity of data Combination treatments better than eccentric alone (Flint et al 2009) Background Acupuncture has been widely used for musculoskeletal disorders Main evidence base is around its physiological mechanism of pain relief (Wu, 1999; White 2006; NICE 2009) The physiological effects such as blood flow, oxygenation and heating in acupuncture is lacking, but is being developed (Kubo et al, 2010) Acupuncture Protocol Picture of herring bone technique Needles are inserted both vertically and off to the sides of the Achilles tendon Research in tendinopathies use mainly TCM points (Fink et al 2002) No meridian directly penetrates the Achilles tendon Recently - dry needling rather than a true protocol at the Achilles tendon (Kubo et al, 2010) Chinese Quotation described in the yellow emperors internal medicine 恢刺法 方法 恢刺法要求 直刺傍之, 举之, 前后恢筋急, 以治筋痹也 操作时可在患病肌腱处直刺进针, 也可以斜刺进针, 并让患者升举活动肌肉, 同时捻转提插针, 使筋拘急松弛, 功能得到恢复 恢有扩大 宽松的含义, 因这种刺法可使拘急痉挛的肌肉松弛, 故称恢刺 其特点是多方面刺其肌腱, 并捻转 提插针体, 结合活动肢体 故又称为 多向刺法 临床应用 主要终于治疗筋痹, 即肌腱拘紧, 活动受限 疼痛等 也可治疗腱鞘囊肿, 肌腱损伤, 关节炎等 恢刺刺筋旁, 时提针或向前, 或向后以恢筋急治筋痹 English Translation described in the yellow emperors internal medicine Method Hui Acupuncture requires sticking needles in tendon both vertically and off to one side... As needles can be inserted in tendon, in all directions - backward and forward, upward and downward, it is also called Multi-Direction Acupuncture. Clinical Application It plays a main part in treating muscle tension and rheumatism, such as tendon tension, movement restraint and pain problems, etc. It also helps treatments of tendon sheath cyst, tendon injuries and arthritis, etc.

2 Mphil Aim To estimate changes in physiological parameters and when administering: a) acupuncture with eccentric exercises b) sham acupuncture with eccentric exercises c) eccentric exercises alone to the Achilles tendon in healthy subjects. MPhil Objectives 1 To establish optimum data collection techniques for physiological parameters of each group to the Achilles tendon in healthy subjects. 2 To estimate effects in physiological parameters of each group to the Achilles tendon in healthy subjects. 3 To explore differences in physiological parameters between groups to the Achilles tendon in healthy subjects. Preliminary PhD Aim A Randomised Control Trial using acupuncture on patients with chronic Achilles tendinopathy. Methods - NIRO Physiological parameters measured using: Near InfraRed Oxygenation Monitor (NIRO) Noninvasive, continuous measurement of tissue oxygen Measurements gained by light emitted by a light sensor Light Detected with 2 sensors at different distances from the light source Detection of the scattered and absorbed loss of light Measures O2Hb, HHb, chb and TOI NIRO Measures Methods - Imaging Imaging (TI) measured by using high resolution infrared images that immediately identify thermal changes to tissue Measures thermal changes in tissues of upto 3cm in depth

3 Acupuncture technique Herring bone technique adapted by inserting needles at a standardised distance in relation to leg length Using Sham acupuncture similarly to Streitberger (1998) who designed the 1 st sham needle Stimulated in a thrusting and twisting motion Needle stimulated for 5 seconds each Methods of Sham Needle Picture of sham Needle Based on a retractable blunt needle Appears to penetrate the skin with the patient feeling the sensation of the needle Needle is actually retracted up the needle shaft (McManus, 2007) Sham or Real Acupuncture? Eccentric Exercise Protocol 1A 2A 3A 1B 2B 3B Perform exercise a) and b) fifteen times, resting for one minute, before repeating 3 times (15 reps 3 sets) Eccentric Flow chart Subject Enters 0 mins 0 mins Acupuncture and Eccentric Flow chart Subject Enters 0 mins 0 mins Baseline 15 mins Eccentric Exercise- 10 mins NIRO 15 mins mins Every 5mins Baseline 15 mins Swab 15 mins Acupuncture mins NIRO 15 mins mins 60 mins NIRO mins Every 5 mins 55 mins Eccentric Exercise- 10 mins 70 mins Subject Departs 10 mins 65 mins NIRO mins Every 5 mins 100 mins Subject Departs 10 mins 110 mins

4 Sham Acupuncture 4 min 14 min Sham Acupuncture 31 min 32 min 16 min 18 min 52 min 54 min 0 min Acupuncture Swab Acupuncture Insertion Acupuncture 20 min Acupuncture Baseline SteriStrips Acupuncture Out After Eccentrics Changes to protocol 1 Complete consent forms and mark skin during 15 min baseline period whilst lay prone Place ankle straight ease of analysis Mark skin to avoid inaccuracies Possibly use visible markers on skin limit number Use only 2 visible markers to identify tendon midline: Calcaneal Tuberosity 1 st marker 2 nd marker Ö of the distance from the popliteal crease to the calcaneal tuberosity Changes to protocol 2 Skin marked 1/4, 1/2, 3/4 distance from calcaneal tuberosity/marker 1 to marker 2 15mins baseline, NIRO and TI 15 mins alcowipe (ensure evaporation) To ensure needles are inserted inline with tape in order not to cause problems with TI analysis NIRO mins post treatment

5 Original Contribution to Knowledge Little is known regarding the pro-inflammatory and physiological effects of acupuncture Questions No study has investigated the effects of an acupuncture protocol on the Achilles tendon The initial MPhil phase of this study will establish the optimal protocol and focus on healthy subjects The PhD phase will progress and focus on a group of subjects with Achilles tendinopathy