tennis elbow

Can Five-Element Acupuncture help with ‘Tennis Elbow’?

By August 30, 2019 No Comments

A Clinical Case Study

By AFEA member Johnny Childs

In this case study I show how diagnosing and treating the emotional/spiritual troubles in my patient had an almost immediate positive impact on his main complaint of ‘Tennis Elbow’ (‘lateral epicondylitis’) and his overall health.

To monitor the effectiveness of the treatment, I used the ‘’Measure Yourself Medical Outcomes Profile’ (MYMOP). This quantitative data demonstrated an excellent change with the patient’s overall health and wellbeing over the course of five treatments. His ‘Tennis Elbow’ improved by 100%; Stress improved by 60%; activity rose by 100% and wellbeing 80%.

What is Lateral epicondylitis (‘Tennis Elbow’)?

From a medical point of view, Lateral Epicondylitis is a condition that causes pain around the outside of the elbow. More specifically, it is a condition caused by inflammation of the extensor muscles at the lateral epicondyle of the humerus.

Lateral epicondylitis is typically an injury from overuse.  It occurs when the muscles and tendons in the forearm are strained due to repetitive or strenuous activity, such as excessive constant gripping or squeezing. Signs and symptoms of lateral epicondylitis include tenderness of the elbow joint and general morning stiffness of the elbow with persistent aching. The discomfort can also spread to the forearm, and the pain is usually worse when grasping or holding an object. There can be underlying causes of tennis elbow too, usually due to lack of blood flow to the area and inflammatory conditions such as arthritis and even tiredness and stress.

It is reported that it affects around 1-3% of the adult population every year most often between the ages of 40 and 60. It most commonly affects people in their dominant arm but it can also occur in the non-dominant arm or both arms.

When it comes to treating tennis elbow, patients are usually advised to rest the arm with pain, and avoid any movements and activities that may aggravate it, as it is a self-limiting condition. Actively resting it will accelerate the healing process, this, however, may take up to two years.  Physiotherapy is also an option – stretching and applying pressure can promote blood flow to the area to promote healing and relieve pain. Taking painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease mild pain and inflammation.

More invasive treatment can include corticosteroid injections that may help reduce the pain of lateral epicondylitis for up to 6-8 weeks. A systematic review titled ‘Treating lateral epicondylitis with corticosteroid injection or non-electrotherapeutical physiotherapy’ reports that corticosteroid injections have a short-term beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Other treatments available are shock wave therapy and in extreme cases, surgery to remove the damaged tissue of the tendon altogether.

Five-Element Acupuncture Treatment

Five Element acupuncture diagnosis and treats the one true cause of disease in each of us. Treatment is unique to the individual regardless of whether it is ‘Tennis Elbow” or period pain and takes a more ‘Taoist’ approach by assisting nature to do the work of healing the patient (internal medicine).

My case study looks at the effectiveness of using Five-Element acupuncture to help my patient with ‘Tennis Elbow’ and how choosing acupuncture points for their ‘spiritual connotations’ can address tangible physical complaints.

Five treatments were carried out across 6 weeks. The first 4 treatments were weekly; the fifth was extended to a two week interval, to see if treatment would hold over an extra extended period.

I used the ‘Measure Yourself Medical Outcome Profile’ (MYMOP) questionnaire to ascertain the efficacy of treating a physical symptom by addressing his more ‘spriritual’ (the way he felt in himself) challenges. MYMOP measures patient-perceived changes in two prioritised symptom severity, as well as wellbeing and ability.

My Patient

My patient is a 46-year-old male who had been diagnosed with lateral epicondylitis one month prior to coming to me for Five-Element acupuncture treatment.  He was advised to have a corticosteroid injection by his GP as his symptoms had persisted for longer than 3 months.  The patient had previously suffered with lateral epicondylitis ten years ago for a period of approximately 2 years (on and off) and had received a corticosteroid injection during the time – which he claimed, “did not do too much to help relieve the pain and wore off completely after 3 weeks.”

He also complained that this recent reoccurrence was affecting his quality of life: that the pain would sometimes prevent him from falling asleep and therefore he was not getting sufficient rest. He said he was becoming increasingly irritated by the condition. He also complained of feeling stressed at his job.  He is a manager at a high-end luxury travel company, working six days a week and up to twelve hours a day.

The Five-Element approach

Diagnosis involves isolating the ‘Causative Factor’ or the underlying energetic weakness in the person and the ‘Level’ (Body, or Mind, or Spirit). According to ancient Chinese philosophy, the entire universe can be experienced through the five elements as found in nature; Wood, Water, Fire, Earth and Metal. J.R Worsley who is credited with bringing Five-Element acupuncture to the West realised that every human being has one true cause of disease rooted in one of the five elements we know from Nature and does not change throughout the person’s life.

The human being is also comprised of a body, a mind and a spirit, so when making a diagnosis we need to establish at which level i.e. mind, body or spirit is the primary level of distress. This depth of diagnosis supports our treatment of the Causative Factor.

The Treatment

The diagnosis of my patient is Wood – meaning that the Liver and the Gall Bladder are the cause of all imbalances in my patient (more specifically on the side of gallbladder) and that he struggled at a ‘Spirit Level’. This combined diagnosis informed every treatment.

The clinical course of treatment is recorded in the table below. It includes the treatments carried out; their rationale, any observations, MYMOP scores, and patient feedback.

Treatment process/results

Treatment 1

The Treatment

Rationale

  • Aggressive Energy (AE) drain. The examination resulted in no AE to clear.
  • Akabane diagnosis and treatment. The examination resulted in no imbalances.

 

  • Vll-40 & Vlll-3 ˙

A standard protocol for Five-Element acupuncture on the first treatment.

To see if the meridians that flow bilaterally are distributing the shared energy equally and efficiently. This is a protocol that is good to do early on in treatment as an imbalance can act like a block to treatment if there is an imbalance.

The Source Points of wood (the Causative Factor) were tonified with needle only.  The Source Points have the capacity to re-connect the person back to the Source (the Dao), and if the correct CF is treated and no subsidiary blocks are present, a profound rebalancing is set in motion. This allows one to see if I am treating on the correct CF (Wood). If this is true, the pulses of all the Officials will respond/change, including (but not necessarily the CF (Wood) which may stay the same or even drop – reassured that help is on the way. Moxa was not used on the first treatment as minimum intervention is a requirement to simply be ‘asking a question’, if this is the right CF.

Observations

  • Interestingly, after the first treatment, the Wood pulse didn’t change at all, but all the others did, and he had a change in CSOE and his symptoms.

MYMOP results for treatment 1

  • Tennis Elbow decreased from 5 to 3
  • Stress decreased from 5 to 4
  • Activity decreased from 3 to 2
  • Wellbeing stayed the same at 4

Patient feedback and/or including comments on MYMOP

  • The patient was happy with the improvement in his main complaint. He therefore decided not to get the corticosteroid injection – for now.
  • The patient said he slept very deeply the night of treatment until 5am, where he woke up in a complete fever that lasted for about half an hour – then went back into another very deep sleep. When he woke up he said he felt amazing. What I’m assuming is that this is the body in a deep state repairing itself. He also said he felt more relaxed.

Treatment 2

The Treatment

Rationale

  • Vll-37 3  ˙     ‘Bright & Clear’
  • Vlll 5   3  ˙     ‘Insect Ditch’

Treatment on the CF (Wood). Needled with the intention for the sprit. When the Gb receives the purity and clarity of judgment from within, it makes good decisions through its power of vision and its innate “knowledge of time and timing – so that when there is an imbalance here – this mechanism becomes jarring, therefore giving rise to tension, & frustration.

On the CF and needled for the Spirit. When there is a feeling of irritability coming from Wood, it is often the Liver as it is responsible for smooth flow of qi, and can only do this when it gets the clarity from the Gall Bladder. It’s the Gall Bladder that says “go”, but it is the Liver that suggests where to go and that’s how they work together. If this forward motion is not happening (a natural movement), things start to swirl like an “insect ditch” – Treating this point will therefore help smooth the liver qi.

Observations

  • There seemed to be a profound change in him at the Spirit level – meaning it wasn’t just his pain that was resolving; he seemed to be more comfortable in his own skin/lighter in himself.

MYMOP results for treatment 2

  • Tennis Elbow from 3 to 2.5
  • Stress remained at 4
  • Activity remained at 2
  • Wellbeing remained at 4

Patient feedback and/or including comments on MYMOP

“I’m so relieved my tennis elbow is easing off – although it’s only eased a little since last session, I’m happy it’s going in the right direction.”

Treatment 3

The Treatment

Rationale

  • lll-18, lll-19 5  ˙     
  • Vll-43,  Vlll-8 3  ˙     

Used as the AEP’s of the CF. To really encourage these Officials to keep going. To be used only once certain of the CF – which I now was based on CSOE and pulse change.

Used as Tonification Points on the CF. This helps reinforce the very natural relationship of the mother (Water) nourishing its child (Wood). In turn – this helps balance the Sheng and Ke cycle and has an immediate positive knock-on effect for ALL the Officials.

Observations

  • There was a change in CSOE
  • The pulse picture showed an increase to -1 in volume immediately after the AEPs were needled. After the Tonification Points were needled, all of the pulses settled at a lower rate with earth remaining the strongest – but still an improvement overall.

MYMOP results for treatment 3

  • Tennis Elbow decreased from 2.5 to 1
  • Stress remained at 4
  • Activity decreased from 2 to 1
  • Wellbeing decreased from 4 to 2

Patient feedback and/or including comments on MYMOP

“Really pleased that my Tennis Elbow has almost gone. Makes life a lot easier at work etc. Not a massive shift in stress, but can’t expect acupuncture to improve work related issues. Anyway, I came for treatment for my elbow. Anything else is a bonus”

Treatment 4

The Treatment

Rationale

  • Vll-13   ˙ “Root Spirit’
  • Vll-41 3  ˙

     ‘Foot Above Tears’

  • Vlll-3 3  ˙

     ‘Supreme Rushing’

Spirit Level patients themselves can be unaware in how they struggle. As the practitioner, we are an instrument there to record the experience in which way the patient is struggling in themselves beyond the physical symptoms. But in spite of the patient saying how much better he felt, i.e. the symptoms going away; what became clear is how he in himself isn’t really peaceful or settled. I sensed that he needed to be rooted in himself. The perfect point for that is Vll-13 ‘Root Spirit’.

Being the wood point of Wood, this point highlights the deep frustration one can feel when unable to put one foot in front of the other (nothing to do with sadness). This point is selected to help relieve frustration and access the rootedness in the mother element (Water) and links with Vll-13. Water feeding wood helps us see who we really are, and from this place it is easier to move forward.

Thinking of the flow of the meridian, it starts with wood within wood (the hun) at Vlll-1, whereupon the wood reaches to fire (the Hun follow the Shen), which takes it to Vlll-2. Once reaching the Shen – The Heavens, ‘Supreme Rushing is about engaging with life in a smooth and effortless motion.

Observations

  • Looking at his MYMOP score, although his lateral epicondylitis had improved quite dramatically, his stress level had scored the same at ‘4’ for the third time.
  • It became clear that one could see how he struggles, e.g. stressed at work, not as much as he was, but I could really see at ‘the level’, that he was stressed. Which is why the level was the focus of this treatment

MYMOP results for treatment 4

  • Tennis Elbow decreased from 1 to 0
  • Stress decreased from 4 to 2
  • Activity decreased from 1 to 0
  • Wellbeing decreased from 2 to 1

Patient feedback and/or including comments on MYMOP

“Can you do whatever you did last week as the pain has GONE. Also have been less reactive at work (so my colleagues tell me)”

Treatment 5

The Treatment

Rationale

  • Vll-24 5  ˙  ‘Sun & Moon’
  • Vll-34 5  ˙

     ‘Yang Mound Spring’

  • Vlll-2    3  ˙  ‘Walk Between’

The patient’s behaviour was chaotic and his management of time demonstrated how he struggled with order and regulation. This point on Gall Bladder helps the person’s capacity to balance both sides of life.

The Gallbladder is responsible for the duality of life – it is the judge. The experience of my patient was that his life is chaotic – another unveiling of where he struggles and watching the consequences of that unfold. Vll-24 will help him separate the relative chaos in his life.

This point is the empirical point for all tendons and ligaments. It gives the ability to rotate and be flexible on all levels.

Gives the capacity to advance and retreat, to give flexibility and gain a better perspective.

Observations

  • What I could now see is how the chaos in his life – the mismanagement of his time, working 6 days a week, cancelling holiday plans, postponing his appointments at short notice, thinking still about getting a PA – but not taking action… is getting in the way of living a more balanced life. Thus causing stress and tension.

MYMOP results for treatment 5

  • Tennis Elbow remained at 0
  • Stress remained at 2
  • Activity remained at 0
  • Wellbeing remained at 1

Patient feedback and/or including comments on MYMOP

“Pleased my pain has stayed away, feeling a bit more on top of things also. More of the same please”

Results (see table below)

With regard to the first symptom (symptom 1) the lateral epicondylitis, the largest decrease with the MYMOP score occurred after the first treatment dropping from ‘5’ to ‘3’. The smallest decrease took place after the second treatment dropping by only ‘0.5’. The score continued to drop to ‘0’ by treatment ‘5’.

The second symptom, stress (symptom 2) saw its largest decrease of ‘2’ after treatment four from ‘4’ to ‘2’. The smallest decrease of ‘1’ was seen after treatment one from ‘5’ to ‘4’. The score plateaued at ‘4’ from treatment two to four. Over the course of treatment the score dropped by ‘3’.

‘Activity’ decreased from ‘3’ to ‘0’ over the course of five treatments with it plateauing at ‘2’ for treatments two and three.

‘Wellbeing’ remained at a score of ‘4’ for the first three treatments. It eventually decreased by largest drop of ‘2’ from ‘4’ to ‘2’ at treatment four. By treatment five it decreased further to by ‘1’ to a score of  ‘1’.

Measured Outcome – Quantitative data

Score before

Treatment 1

Score at

Treatment 5

Score at

Follow up

Change Score

Symptom 1

Tennis Elbow

5

0

0

5

Symptom 2

Stress

5

2

2

3

Activity

3

0

0

0

Wellbeing

4

1

1

3

Profile score

4.25

0.75

0.75

2.75

The change in profile score was 2.75 making this a clinically meaningful change

(The Acupuncture Academy 2014)

Graph showing the patients MYMOP scores throughout the course of treatment

Quotes the patient volunteered with the MYMOP scores

“I’m so relieved my tennis elbow is easing off – although it’s only eased a little since last session, I’m happy it’s going in the right direction.”

“Really pleased that my Tennis Elbow has almost gone. Makes life a lot easier at work etc. Not a massive shift in stress, but can’t expect acupuncture to improve work related issues. Anyway, I came for treatment for my elbow. Anything else is a bonus”

“Can you do whatever you did last week as the pain has GONE. Also have been less negatively reactive at work (so my colleagues tell me)”

The qualitative and quantitative data combined shows an excellent change with the patient’s overall health and wellbeing over the course of the five treatments. The main complaint of Tennis Elbow showed 100% improvement. His second symptom, stress, improved by 60%; activity rose by 100% and wellbeing 80%. The profile score has gone from 4.25 from before the first treatment to 0.75 at treatment five. These giving a change in profile score of 2.75 making this a clinically meaningful change.

The patient noticed that he didn’t receive local treatment to the affected area.  He seemed to understand the notion of being treated holistically and stated, ‘I’m glad those needles didn’t go near the pain in the elbow… I’m starting to see what all the fuss is about with this style of acupuncture, pain relief and I’m getting to rediscover and feel like the person I used to be all those years ago’. Treating the Causative factor (Wood) and the level (Spirit), using points for their spiritual connotation, has made a difference in the health and wellbeing of my patient. It must be said that patients of Five-Element acupuncture rarely have just one symptom and in this single case study, stress and a sense of well-being were also symptoms that improved.

In this case study it became evident that my patient was stressed from his workload – but my Five-Element acupuncture diagnosis exposed that he was fundamentally not okay in himself – or in our language – distressed at the level of Spirit. This is why using points on the Wood element for their spiritual connotation had the greatest effect on his physical symptoms and also his sense of well-being.

Conclusion

The outcome from this single case study is encouraging. Through qualitative and quantitative data, this single case study demonstrates that by correctly diagnosing and treating the Causative Factor and the Level and using points for their spiritual connotation, Five-Element acupuncture can successfully treat lateral epicondylitis.

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