Tethered Cord - A Personal Story

How Acupuncture has helped me

 

After I had had a particularly bad time with the erythromelalgia during 2004, and despite my needle phobia, I decided to try acupuncture to try to alleviate the worst symptoms of the EM and Complex Regional Pain Syndrome. I consulted the British Acupuncture Council website and found Jason Davies, Lic Ac, BAcC, who practices at the Centre for Sports Exercise and Health at the University of Bristol, as well as clinics in Bristol (Southville Surgery) and Emery House Clinic, Chippenham. You can follow my progress in the Personal Story section, but Jason has written below how acupuncture works, and how he has approached the treatment of the chronic Em and CRPS symptoms.

Acupuncture in the treatment of EM / CRPS

What is Acupuncture?

Acupuncture is a holistic system of medicine which has been practised in China and other Eastern countries for thousands of years.

In Chinese Medicine the body's motivating energy is known as 'Qi'. When a person is healthy, Qi is abundant and flows smoothly, linking all parts and functions of the body and allowing them to work harmoniously.

Illness is understood to arise when this natural flow becomes excessive, deficient or blocked.

By the insertion of hair-like needles into specific points on the body, our natural healing response is stimulated and the flow of Qi is restored.

The effect of good acupuncture, however, is to do more than just relieve physical symptoms. As treatment tends to balance the whole system, many people find it also leads to increased vitality, greater confidence, better appetite and sleep, as well as an overall sense of well-being.

How does it work?

Many studies have documented acupuncture's wide ranging effects on the body, and this has prompted researchers in the West to try and explain exactly how it works within the framework of Western medicine. Several processes have been proposed.

In general, acupuncture points are believed to stimulate the central nervous system, which, in turn, releases chemicals into the muscles, spinal cord, and brain. These chemicals either alter the experience of pain, or release other chemicals that influence the body's self-regulating systems - such as the immune system and hormonal system. These biochemical changes stimulate the organs to work to overcome imbalances existing in the body, naturally promoting physical and emotional well-being.

Attention has been focused on the following theories to further explain how acupuncture affects the body:

Conduction of electromagnetic signals:
Evidence suggests that acupuncture points are strategic conductors of electromagnetic signals. Stimulating these points enables electromagnetic signals to be relayed at greater-than-normal rates. These signals may start the flow of pain-killing biochemicals, such as endorphins, or release immune system cells to specific body sites.

Activation of the body's natural opiod system:
Considerable research supports the claim that acupuncture releases opiods, synthetic or naturally-occurring chemicals in the brain that may reduce pain or induce sleep. These chemicals may explain acupuncture's pain-relieving effects.

Stimulation of the hypothalamus and the pituitary gland:
Joined at the base of the brain, the hypothalamus and pituitary glands are responsible for many body functions. The hypothalamus activates and controls part of the nervous system, the endocrine processes, and many bodily functions, such as sleep, regulation of temperature, and appetite. The pituitary gland supplies some of the body's needed hormones. Stimulation of these glands can result in a broad spectrum of effects on various body systems.

Change in the secretion of neurotransmitters and neurohormones:
Studies suggest that acupuncture may alter brain chemistry in a positive way. This is accomplished by changing the release of neurotransmitters (biochemical substances that stimulate or inhibit nerve impulses) and neurohormones (naturally-occurring chemical substances that can change the structure or function, or impact the activity of, a body organ).

Clinical application of these theories

As a system of medicine, acupuncture has existed for perhaps thousands of years and over that time has developed its own unique methods of diagnosis. As a result, illnesses are categorised in a very different way to which they are in western medicine.

In Chinese medicine one looks for patterns of disharmony rather than specific disease entities. For example, there is no such thing in Chinese medicine as 'migraine'; there are, instead, many different patterns of disharmony that can lead to the symptoms your GP may diagnose as migraine. In practice this means that 10 different people with a western diagnosis of 'migraine' may go to their acupuncturist and each get a different diagnosis. Treatment is then tailored to the individual, rather than focusing solely on the condition. It is based on the principle of re-establishing harmony, rather than simply eradicating symptoms.

This is not to say that any one method is necessarily 'better' than another. It is more a question of finding a treatment that works in any one individual case.

Case History

Nina has described in detail her ongoing difficulties with what has been diagnosed as CRPS (Complex Regional Pain Syndrome). She was the first person to come to me for treatment with this condition and I am indebted to her for pointing me towards the research that has been done into it in the hope that acupuncture may provide some relief. It is clear from current research that the pathology of CRPS is very poorly understood, and that western treatment options are very limited and frequently offer little help.

Diagnostically, from a Chinese medicine perspective, CRPS does not fit neatly into any one pattern either and this has led me to try a number of different approaches with Nina. Thus far I have mainly worked from 4 different angles:

1. Constitutionally.

There are, in brief, 2 main schools of acupuncture: Traditional Chinese Medicine (TCM), and Five Element Acupuncture. Whilst both styles are holistic in nature, TCM tends to focus on signs and symptoms, whereas Five Element looks more at who we are as a person and how that may be affecting us physically, mentally and emotionally. A Five Element treatment is considered to be a constitutional treatment in as much as it attempts to balance out any of the negative ways in which we act and react in our daily lives. Anyone who has undergone excessive stress in their lives of one sort or another will know how this can affect their health and produce all manner of unpleasant symptoms - the types of symptoms that arise seem to depend very much on who we are at a constitutional level, and a Five Element treatment aims to address this.

With this in mind, one of the first routes I took in treating Nina was at this level. The results have been quite dramatic on occasion, but, it must be said that, what was affected was Nina's emotional state and not the nature of her symptoms. This type of reaction is a very good indicator that her condition is not dependant upon her constitutional make-up. Which is to say that, whilst her symptoms obviously affect the way she feels, by and large how she is feeling does not have a large impact on her symptoms.

2. TCM

In putting together a diagnosis within a TCM framework I focused on the specific symptoms that Nina experiences - namely excessive heat and swelling of both feet which, when bad, can reach up to a mid-calf level. The treatment principles I followed therefore were to select points which are known to resolve oedema, clear heat and relax the tendons.

Of all the approaches I followed this proved to be the least effective and after a number of attempts, trying various combinations of points, this approach was discontinued.

3. The Extra Channels.

Chinese medical theory holds that our energy, or Qi, flows through our bodies in a series of 12 channels or meridians. These are not physical entities, but rather more lines of influence that follow specific pathways. Each channel is associated with one of our internal organs - hence there is the Heart channel, Liver channel, Spleen channel and so on. In addition to these 12 main channels we have 8 Extra channels which are not associated with any organ. It is suggested that these Extra channels are the first channels to be formed as we develop in the womb, before our cells have got to the point of differentiation, and thus form the blueprint, or matrix, around which we develop. In my experience, working with the Extra channels can be effective when dealing with conditions which are either congenital, or seem to be so deeply embedded in the system that they do not appear to be linked with any specific organ system.

The Extra channel that particularly interested me in this instance is called the Du Mai. Its pathway runs up the midline of the spine, over the top of the head to finish on the top gum.

Nina has spina bifida occulta, which, as a congenital condition involving the spine, could be seen in Chinese medicine as being related to either a blockage or deficiency of Qi as it flows through the Du Mai. On the assumption that the symptoms Nina experiences in her feet may be a complication of spina bifida occulta (especially given the fact that she also has tethered cord syndrome, causing the tendons and ligaments of her lower legs to tighten and contract over time), I decided to try working with this extra channel and its paired channel, the Ren Mai, which runs up the front midline of the body, to end below the lower lip.

It was in following this protocol that we soon began to see the first signs of improvement in Nina's condition. It was far from a miracle cure, but gradually, over the course of weeks, the severity of her symptoms and the reactiveness of her feet to temperature change began to decrease. In addition, when the symptoms did flare up, they seemed to be calming down more quickly.

Progression has not been a straight line and there have been many ups and downs along the way. However, there was a strong sense that overall things were moving in the right direction. Having got the results by working with the Extra channels, it was a strong indication to me that the CRPS was indeed linked to both blockage and deficiency in Nina's low back. As such, I felt we might be able to move things on further by doing some more direct work in the area, and so got Nina's agreement to start developing another protocol.

4. De-sensitisation and treatment of the low back area.

The whole of Nina's low back and sacrum was initially hypersensitive to touch. It was virtually impossible to even lay a hand on the area, let alone place needles into the points. So I began with some very gentle hands on work to her whole back, gently stimulating points and very gradually, over the course of weeks, worked further down towards her sacrum. Nina's part in this was crucial. She has had to work extremely hard at allowing herself to relax and let go of tension in that area, resisting the urge to tense up. Her courage and willingness to try this new approach in spite of how difficult it was, has made working with her in this way a pleasure and an inspiration.

After about 6 weeks of this hands on desensitisation it became perfectly possible for Nina to tolerate direct touch to the whole low back and sacrum - to the point that I was then able to start needling points in that area.

The results from working in this way have been very encouraging. Although working with the Extra channels had definitely been moving things in the right direction, adding in this approach seems to have moved the whole process along that much more quickly. There is a lot of congestion in the area from L2 - S4, both from the underlying condition and from the de-tethering operation Nina has had. The idea in working in this area has been to encourage the musculature and channels to relax and open up and thereby allow Qi to once more flow freely.

As a result, this winter (2005/06) (Nina's worst time) has been significantly better than the previous four. There is still some way to go, and symptoms do still flare up occasionally, but it is my belief that we can continue to make progress with this most difficult of conditions. It is perhaps unrealistic to expect that it will be totally cured but I hope at least to be able to get to the point where her feet are largely stable and symptom-free with perhaps the odd flare-up only when the weather conditions or temperature fluctuations are particularly unfavourable.

As I mentioned above I have found Nina to be a huge inspiration in her willingness to trust the processes we have gone through in order to find the right treatment. She often finds some of the needles uncomfortable and there has been the odd treatment that for some reason has sparked a brief flare-up of her symptoms. Through all of this she has bravely kept going, to the point now where it is clear that we have identified two treatment protocols that really do make a difference - and will hopefully continue to do so.

February 2006

Jason Davies is a member of the British Acupuncture Council and has been working with the Chinese system of medicine and healing since 1990.

He is a graduate of the College of Integrated Chinese Medicine in Reading. The College teaches an approach which integrates the two main styles of acupuncture - Five Element acupuncture, which focuses on our underlying constitutional make-up, and Traditional Chinese Medicine (TCM), which looks more at the physical signs and symptoms of illness.

Jason has also completed further studies and clinical work at the University for Complementary Medicines in Sri Lanka.

Membership of the British Acupuncture Council (BAcC) guarantees a thorough training of at least 3 years in traditional acupuncture alongside western medicine appropriate to the practice of acupuncture. The BAcC maintains high standards of education, ethics, discipline and practice. Members are covered by public indemnity and liability insurance.

Jason has clinics in Bristol and Chippenham. If you have any questions about acupuncture or would like to book an appointment, please call one of the clinics:

Bristol University clinic: 0117 9288810
Bristol, Southville Surgery: 0117 9669724
Chippenham: 01249 447147