A Clinical Study On Treatment Of Lateral Epicondylitis By Dong’s Extra-points And Contralateral Acupuncture Methods

BackgroundLateral epicondylitis (LE, better known as tennis elbow) is a common upper extremity disorder of nowadays, it is often caused by repetitive movements accumulating strain slowly over time. Typical symptoms include tenderness and weakness of the common extensor tendon at the lateral epicondylar region; grip strength may be decreased when the extensor digitorum communis is affected, or when the brachial plexus nerve is entrapped, it may cause neurological symptoms such as numbness at the upper limb. Clinically, about 50% of the Lateral Epicondylitis cases originated from cervical problems. Likewise, Lateral Epicondylitis is not an impairment of a single spot. From current clinical researches, it is apparent that majority of the acupuncture treatments are targeting at "Ashi" points for healing related elbow pains. But looking critically into the pathogenesis of Lateral Epicondylitis, it actually involves different level of subcutaneous tissues such as tendons, bones, muscles, arteries and meridians; also it encompasses multiple joints including the neck-shoulder-elbow-wrist-finger, which run along the same axis of the upper limb. This research considers that the traditional treatment method of focusing on "Ashi" points may not be adequate to address the problem fully, an effective cure should not be restricted to treating the affected area only. By browsing through the various school of acupuncturists in modern time, the unique treatment by using Dong’s Extra-points has considerable advantages. Dong’s contralateral acupuncture style of not needling the painful parts, is fundamentally different to the traditional method of treating the affected area. Dong’s needling method including Dong-qi needling method, Qian-yin needling method and Dao-ma needling method, all bearing the characteristics of "unblocking as means, activating (Qi) as initiative", which emphasized on directing "Qi" in concentration towards the affected area to achieve therapeutic purpose. Dong’s treatment methods have many other benefits, such as taking fewer acupoints, simple application, no need to apply supplementation or drainage techniques and can be used notwithstanding the inner health status of patients. In short, the practice is safe, economical and effective, it provides an acceptable alternative to LE patients of the contemporary time. At the moment, not too many clinical studies on Lateral Epicondylitis had applied Dong’s Extra-points or acupuncture methods as the main therapy. Dong’s Extra-points are chosen, of ten as a supplementary measure in support of other traditional treatment methods, so it is difficult to assess the effectiveness of Dong’s Extra-points by itself. Besides, there have been few randomized controlled clinical trials conducted so far. This research reckons the need to conduct a controlled trial in order to procure clinical evidence on the application of Dong’s Extra-points and acupuncture methods. If results are favorable, will enhance the confidence of both patients and acupuncture practitioners when formulating their therapy strategies.ObjectiveThrough randomized controlled methods, this research aims to observe the clinical efficacy of:(i) solely applying Dong’s Extra-points (ii) comparative differences among Dong’s Qian-yin needling method, Dong-qi needling method and the traditional needling method in treating cases of Lateral Epicondylitis.Method90 cases of Lateral Epicondylitis were selected in accordance with the selection criterion. They were randomly allocated to one treatment group (Qian-yin Needling Method group) and two control groups (Dong-qi Needling Method Group and Traditional Needling Method Group), each with 30 patients. Acupoints applied:(a) The treatment group was treated contralaterally by Dong’s Extra-points of Huofuhai and Houquchi, ipsilaterally by Points Linggu and Dabai, plus Point Shenguan of both sides; needling of the 6 points were conducted close to bone edges; (b) Dong-qi Needling Method Group were treated contralaterally by Dong’s Extra-points Linggu and Dabai, plus Point Shenguan of both sides; needling of the 4 points were conducted close to bone edges; (c) Traditional Needling Method Group were treated by Points LI 4, LI 10 and LI 11 in the normal way. Acupuncture method:For Qian-yin Needling Method Group, needling of the contralateral points were applied before the ipsilateral points; after obtaining Qi, the needles were twirled manually from both ends at the same time for 30 seconds in order to direct Qi towards the painful part of the upper limb, the patients needed only to move slightly to cope. For Dong-qi Needling Method Group, after needling of the contralateral points and obtaining Qi, the needles were twirled for 30 seconds during which the patients were requested to focus their attention onto their elbows with tenderness and keep moving them in order to attract Qi to go towards the painful areas. For the Traditional Needling Method Group, after needling and obtaining Qi, needles were also twirled for 30 seconds. Twirling of needles in the same manner took place for 30 seconds every 10 minutes. Needles were maintained in place for 30 minutes same for all 3 groups. Treatment sessions were conducted twice a week for 2 courses, there are 4 sessions in each course. Every patients were assessed individually before and upon completion of each course of treatment for monitoring their progress of recovery. Full assessment included 3 aspects:(1) the patient-rated tennis elbow evaluation by using visual analogue scale (VAS); (2) clinical diagnosis assessment (3) assessment of motor recovery for upper extremity. These measures covered the overall situation and different aspects of primary and subsidiary symptoms, such as pain, functional deficiency, related movement synergies and coordination, quality of sleep etc. All data were put together for statistical analysis. Results(1) General informationComparison of the general information including age, sexuality, seriousness of symptoms, location and course of symptoms were conducted before the clinical trial with no significant difference detected after statistical analysis (P＞0.05). The findings indicated that the participants of all three groups satisfied the guiding principles of uniformity and heterogeneity, they were therefore suitable for comparison purposes.(2) Total effective rateSubsequent to statistical analysis, the overall effective rate of Qian-yin Needling Method was the best among the three groups. In this treatment group, 13 cases (43.3%) fully recovered,14 cases (46.7%) rated very effective and 3 cases (10%) rated effective, making an overall effective rate of 100%. In Dong-qi Needling Method Group,8 cases (26.6%) fully recovered,18 cases (60%) rated very effective,2 cases (6.7%) rated effective and 2 cases (6.7%) rated ineffective, making an overall effective rate of 93.3%。In Traditional Needling Method Group,4 cases (13.3%) fully recovered,15 cases (50%) rated very effective and 11 cases (36.7%) rated effective, making an overall effective rate of 100%。On the overall effective rate, all 3 groups achieved similar results. However, judging from the number of fully recovered and very effective cases, it was evident that the Qian-yin and Dong-qi Needling Method Group had better therapeutic effects, and the time taken to attain recovery was shorter. By two-two analysis, the difference between Qian-yin and Traditional Needling Method was most spectacular, the difference between Dong-qi and Traditional Needling Method was closer, than the other two-two comparisons.(3) Comparison of each group before and afterThe difference before and after the treatment of each group was statistically significant (P＜0.05), which indicated that all 3 different acupuncture methods were effective in treating Lateral Epicondylitis. According to the significant level of a=0.05, P＜0.05 indicated that the 3 needling methods, i. e. Qian-yin Needling Method, Dong-qi Needling Method and Traditional Needling Method were all effective, however, Qian-yin Needling Method was the most outstanding amongst the three.ConclusionThe 3 different acupuncture methods:Qian-yin, Dong-qi and Traditional Needling Methods were all effective in treating Lateral Epicondylitis with statistical significance. For symptoms of pain and functional deficiency that are closely related to the psychological and biological aspects of LE patients, Qian-yin Needling Method had made the best improvement in the clinical trial, followed by Dong-qi and then the Traditional Needling Methods. Regarding improvement to quality of life including symptoms of pain persistence and sleep interference, Qian-yin Needling Method was more effective in comparison with Dong-qi Needling Method. The reason that accounted for this variance in performance can be explained by the different way of how Qi was conducted. The Qian-yin Needling Method is more reliable because Qi was conducted directly by the acupuncturist, it would not be disrupted by the varying mental strength of different patients treated. Its effectiveness is therefore more predictable. For patients who are more sensitive to pain, others like the impatient ones, the aged or those of tender age, they are often less able to control their attention and less willing to keeping moving their painful parts of body in order to direct’Qi", as a result may restrict the application and affect the effectiveness of Dong-qi Needling Method. Subsequent to the clinical observation and statistical analysis, the following conclusions were drawn:(1):Dong’s Extra Points, when apply solely, is effective in relieving pain and restoring motor recovery of the injured upper limbs.(2):The short term therapeutic effect of Dong’s Qian-yin Needling Method is most outstanding in comparison with Dong Qi or Traditional Needling Methods.(3):Upon alleviation of the elbow pain, continued moderate exercise training is effective in restoring muscle strength & joint agility, and will slow down the overall degeneration process.