Tai Chi for patients with Parkinson’s disease

http://jhsacupuncture.co.uk/tai-chi-balance-patients-parkinsons-disease

There have been, for some time now, reports that Tai Chi has a positive effect for people who suffer from Parkinson's disease and from a teaching perspective I can understand how this would be true but I wanted to see if there was any peer reviewed literature that would support this.

So here are a few articles I have found that provide some quantatitive evidence to the positive effects that Tai Chi can bring to people with Parkinson's disease.

Effects of Tai Chi on balance and fall prevention in Parkinson's disease: a randomized controlled trial.

A Chinese research team has found that Tai Chi can improve balance and decrease fall risks in patients with Parkinson's disease (PD). Seventy-six patients with PD took part in 60 minutes of Tai Chi form three times a week for 12 weeks. The control group received no intervention.

The balance of subjects in the TC group was found to improve more than those in the control group.

During six-month follow-up, eight (21.6%) patients in the Tai Chi group experienced falls, compared to 19 (48.7%) patients in the control group.

Effects of Tai Chi on balance and fall prevention in Parkinson's disease: a randomized controlled trial. Clinical Rehabilitation 2014 Feb 11th.

 

Tai Chi Exercise can Improve the Obstacle Negotiating Ability of People with Parkinson's Disease: A Preliminary Study.

The purpose of this study was to examine the effects of Tai Chi based exercise on dynamic postural control during obstacle negotiation by subjects with mild or moderate Parkinson's disease (PD).

Twelve subjects (mean age, 65.3±6.1?years) diagnosed with idiopathic PD were enrolled for this study.

All the subjects were tested a week before and 12 weeks after the initiation of the TC exercise. In the test, they were instructed to negotiate an obstacle from the position of quiet stance at a normal speed. They were trained with TC exercise that emphasized multidirectional shift in weight bearing from bilateral to unilateral support, challenging the postural stability, three times per week for 12 weeks.

Center of pressure (COP) trajectory variables before and after TC exercise were measured using two force plates.

A comparison of the results between pre- and post-intervention showed a statistically significant improvement in anteroposterior and mediolateral displacement of COP.

Twelve weeks of TC exercise may be an effective and safe form of stand-alone behavioral intervention for improving the dynamic postural stability of patients with PD.

Journal of Physical Therapy Science 2014 Jul;26(7):1025-30. doi: 10.1589/jpts.26.1025. Epub 2014 Jul 30.

 

 

Tai Chi for improvement of motor function, balance and gait in Parkinson's disease: a systematic review and meta-analysis.

Recently, several studies assessed the effectiveness of Tai Chi for Parkinson's disease (PD), but the role of Tai Chi in the management of PD remained controversial. Therefore, the purpose of this systematic review is to evaluate the evidence on the efficacy of Tai Chi for PD.

Six English and Chinese electronic databases, up to April 2014, were searched to identify relevant studies. The risk of bias in eligible studies was assessed by Cochrane Collaboration's tools. The primary outcomes were motor function, balance and gait in individuals with PD. Standardized mean difference (SMD) and 95% confidence intervals (CI) of random-effect model were calculated. And heterogeneity was assessed based on the I2 statistic.

7 randomized controlled trials and 1 non-randomized controlled trial were eligible. 

The aggregated results suggested that Tai Chi showed beneficial effects in improving motor function (SMD, -0.57; 95% CI -1.11 to -0.04; p?=?0.03), balance (SMD, 1.22; 95% CI 0.80 to 1.65; p<0.00001) and functional mobility (SMD, 1.06; 95% CI 0.68 to 1.44; p<0.00001) in patients with PD, but not in improving gait velocity (SMD, -0.02; 95% CI -0.58 to 0.54; p?=?0.94), step length (SMD, -0.00; 95% CI -0.57 to 0.56; p?=?0.99), or gait endurance (SMD, 0.53; 95% CI -0.07 to 1.12; p?=?0.08). Comparing with other active therapies, however, Tai Chi only showed better effects in improving balance (SMD, 0.74; 95% CI 0.38 to 1.10; p<0.0001).

Tai Chi should be a valid complementary and alternative therapy for PD, especially in improving motor function and balance. However, more studies with long follow-up are warrant to confirm the current finding of Tai Chi for PD.

Public Library of Scienc One. 2014 Jul 21;9(7):e102942. doi: 10.1371/journal.pone.0102942

For the full article click here

Therapeutic effects of Tai Chi in patients with Parkinson's disease

The purpose of the study was to investigate the effects of a 12-week program of therapeutic Tai Chi on the motor function and physical function of idiopathic Parkinson's disease patients (PDs).

The participants were 22 clinically stable PDs in Hoehn-Yahr stages 1-2 randomly assigned to a therapeutic Tai Chi group (TTC, N = 11) or a control group (CON, N = 9). Two subjects in control group did not complete the study for personal reasons. Tai Chi was performed three days a week (60?min/session). Motor symptoms by the UPDRS were assessed, and tests of physical function were administered before and after the 12-week trial.

The Tai Chi group, as compared to the control group, showed changes in the mentation, behavior, mood, and motor scales of the UPDRS (P < 0.05, P < 0.01, resp.), with no significant main effects on the activities of daily living scale (ADL).

However, there was a significant interaction between the time and intervention group on ADL (P < 0.05). There were no significant main effects for any of the physical function variables. There were significant interaction effects in balance and agility (P < 0.05, resp.). Conclusions.

This study showed that TTC training had modest positive effects on the functional status of Parkinson's disease patients.

ISRN Neurology. 2013 Oct 31;2013:548240. doi: 10.1155/2013/548240

 

Tai Chi classes are run at the Hope Centre on Monday and Friday click here for more details

Treating Sciatica with Acupuncture and Acupressure (Tui Na)

http://jhsacupuncture.co.uk/treating-sciatica-acupuncture-acupressure

One of the most common complaints I see in my clinic is Sciatica and Sciatic type pain.  Generally patients will present when they are unsatisfied by the progress they are making with Western Medical treatment or they wish to reduce the amount of pain medication they are taking.  My rule of thumb is that you should see a good reduction in pain within 4 to 6 sessions at my clinic but you must continue with any medical advice or treatment unless you talk to your Doctor first.

Sciatica is generally used as a catch all term for a set of  symptoms  that can include; pain, which can be caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve or by compression or irritation of the left or right or both sciatic nerves leading to  lower back pain, buttock pain, and numbness, pain or weakness in various parts of the leg and foot, a “pins and needles” sensation, or tingling and difficulty moving or controlling the leg, numbness, muscle weakness and loss of tendon reflexes.

Typically, symptoms only manifest on one side of these body but can be on both sides in some cases and typically the pain will radiate above the knee, but every person will exhibit a unique set of presentations.

When you attend my clinic you will first have a full medical history taken and then I will ask a number of diagnostic questions and I will look at your tongue, take your pulse and palpate the area involved (please wear lose clothing).  I will then discuss with you my diagnosis and findings and hopefully answer any questions you have.  With your agreement we will start the treatment which will most likely included Tui Na (acupressure) massage, heat (either with a TDP Lamp or Moxa/Moxibustion) and Acupuncture, all of which is included in the first consultation and should last about 90 minuets.

In Traditional East Asian Medicine sciatica can have many causes  but it is most likely related  or caused by an imbalance to one of the zang-fu organs or meridians or an invasion of one of the six pathogenic factors into the body, meridians or organs.  No matter what the underlying cause I will try to give you an explanation that you understand and feel free to ask any questions.

Serious pain in your life has many consequences to your mood, sleep, family life, work and appetite and the sooner you get some relief the better, and don’t get me wrong I think that oral pain medication can have a dramatic effect on pain and its power should not be underestimated or ignored.  Your Doctor has your best interests at heart and will use the tools the tools they have to help you but in some cases it will not help, just as in some cases my treatments may not help, there is no guarantee but my clinical experience is that the majority of patients will see a reduction in their levels of pain over the first few sessions.

If you would like to make an appointment or to discuss your condition please don’t hesitate to contact me.

For the up to date research on this subject please see the BAcC (British Acupuncture Council) website here.

How acupuncture can help

There is now a body of research to show that acupuncture is significantly better than no treatment and also at least as good, if not better than, standard medical care for back pain.  There is less specific research on acupuncture for sciatica, but there is evidence to suggest that it may provide some pain relief (Wang 2009, Chen 2009, Inoue 2008, Wang 2004).

Acupuncture can help relieve back pain and sciatica by:

• stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008).
• reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003).
• improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.
• causing a transient change in sciatic nerve blood flow, including circulation to the cauda equine and nerve root. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves (Inoue 2008).
• influencing the neurotrophic factor signalling system, which is important in neuropathic pain (Dong 2006).
• increasing levels of serotonin and noradrenaline, which can help reduce pain and speed nerve repair (Wang 2005).
• improving the conductive parameters of the sciatic nerve (Zhang 2005).
• promoting regeneration of the sciatic nerve (La 2005)

Acupuncture as a treatment for back pain

http://jhsacupuncture.co.uk/acupuncture-as-a-treatment-for-back-pain

Acupuncture as a treatment for back pain

Most people will suffer from back pain at some point in their lives, it’s the UK’s leading cause of disability and one of the main reasons for work-related sickness absence in the UK affecting more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back costing the NHS and community care services more than £1 billion each year*.

Most lower back pain is caused not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve. It can also occur during pregnancy, or because of stress, viral infection or a kidney infection.

Can acupuncture can help?

Research has demonstrated that acupuncture is significantly better than no treatment and at least as good as (if not better than) standard medical care for back pain.  Acupuncture appears to be particularly useful as an addition to conventional care especially in  patients with more severe symptoms and for those wishing to avoid analgesic or pain management drugs. There is some evidece to suggest that it may help back pain in pregnancy and I have certainly seen evidence within my clinic to substantiate this.

Acupuncture can help back pain by:

• Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord
• Reducing inflammation – by promoting release of vascular and immunomodulatory factors
• Improving muscle stiffness and joint mobility – by increasing local microcirculation, which aids dispersal of swelling and bruising.
• Reducing the use of medication for back complaints
• Providing a more cost-effective treatment over a longer period of time
• Improving the outcome when added to conventional treatments such as rehabilitation exercises
• The National Institute for Health and Clinical Excellence guidelines on best practice now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain*

*National Institute for Health and Clinical Excellence clinical guideline 88 – Low back pain.www.nice.org.uk/CG88

Here are some articles on this subject:

There was an interesting article in the British Medical Journal (BMJ) regarding acupuncture for lower back pain, you can read the full article here.

National Institute for Health Research (NIHR) – Effectiveness of acupuncture and standard care for pregnant women with lower back pain 

Acupuncture News March/April 2014

I thought I would start a monthly round up of Acupuncture News from around the world, or as much as I can find, so here it is:

http://jhsacupuncture.co.uk/acupuncture-news-april-2014

Chinese medicine could become available on the NHS

Jeremy Hunt indicates that health service may look at integrating traditional Chinese cures with Western medical techniques.  The Health Secretary indicated that the health service could look at integrating traditional Chinese medicines with Western medical techniques.

See the articles in the Telegraph and the Daily Mail

*Note:  Some observers suggest that using Chinese medicine could add to the pressure on endangered species and this is entirely correct, but there are herbal alternatives that does not use animal organs and these should be embraced by any herbal practitioner.  There is also a worry about impurities in herbal medicine and I can totally appreciate this, I have see the quality of some herbs that are offered in high street chains and some private clinics and I would not touch them with a barge pole.  This is why I practice 4 of the 5 branches of Chinese Medicine namely Acupuncture, Massage, Qi Gong and Tai Chi and I do not practice herbal remedies.  If you do take herbal remedies make sure your practitioner is properly qualified, regulated and insured.

Using traditional acupuncture to help manage diabetes

Source: Diabetes update
Date/Issue: Spring 2014

Using traditional acupuncture to help manage diabetes
Complementary therapies can support a patient in dealing with long-term conditions such as Type 2 diabetes. Mark Bovey, Research Manager of the British Acupuncture Council, explains what acupuncture has to offer to someone with diabetes and shares the experiences of some patients who have benefited from this traditional practice.

See the full pdf article here

Tried and tested: acupuncture at The Seven Heavens Clinic, Finsbury Park

Source: wahanda
Date/Issue: 06 March 2014

Tried and tested: acupuncture at The Seven Heavens Clinic, Finsbury Park.  Prickly as it might sound, acupuncture is steadily becoming one of the most popular and talked about ways to relax the mind, body and soul, with a whopping 2.3 million acupuncture treatments carried out each year in the UK.

Read the full item on the wahanda website

Couch potato culture

New study by British Acupuncture Council shows risk in back pain epidemic caused by unhealthy habits and sedentary lifestyles

See the full article here

Well that’s the round up of all the news, hope your all well and happy

Jason

Acupuncture and Moxabustion for Breech Birth

One of the most common questions I get asked is “can acupuncture help with breech birth”, the simple answer is yes it can but I use Moxabustion (Moxa) and Acupuncture.

From a western medical perspective a breech presentation is when the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation, and there are a number of presentations:

• Frank breech – where the baby’s bottom comes first with their legs flexed at the hip and extended at the knees so that the feet are near the ears and approximately 65–70% of breech babies are in the frank breech position.
• Complete breech –  the baby is sitting cross-legged, with feet beside the bottom.
• Footling breech – one or both feet exit first and the bottom is at a higher position; this is more common with premature foetuses than full term births.
• Kneeling breech – the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees; this is extremely rare.

In most cases by week 37 most breech presentations will turn naturally and no intervention will be needed. However if the breech presentation persists then depending on where you live it may be possible to find a Doctor or mid-wife who will be willing to perform a vaginal breech birth but these are rare in my experience.

A bottom-down position presents some hazards to the baby during the process of birth, and the mode of delivery (Vaginal versus Caesarean) is controversial in the fields of obstetrics and midwifery and though vaginal birth is possible for the breech baby, certain foetal and maternal factors influence the safety of vaginal breech birth which leads to the vast majority of breech babies born, in the west, being delivered byCaesarean section mainly due to the lack of training and experience within western medical practitioners.  It should be noted that in most cases a breech birth, if handled by a suitably experience doctor or mid-wife can be safely delivered vaginally.

Generally in England mid-wife’s will attempt an EVC (External cephalic version) in an attempt to turn the baby by manipulating the baby through the mother’s abdomen. ECV has a success rate between 40–70% depending on practitioner.

For centuries traditional practitioners from East Asia have been using Moxa (Moxibustion) to turn breach presentations with out the need to manipulate the mother and thus avoid any stressors that may be incumbent in an EVC.

Moxibustion is a type of Chinese medicine which involves burning a herb (Mugwort or Artemisia vulgaris) close to the skin over the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin, Reaching Yin), located at the tip of the fifth toe, has been proposed as a way of correcting breech presentation.  The Cochrane Library (which can be found here), in 2012, conducted a gold standard review of the evidence and concluded that:

There is some evidence to suggest that moxibustion may be useful for turning babies from breech presentation (bottom first) to cephalic presentation (head first) for labour when used with either acupuncture or postural techniques of knee to chest or lifting buttocks while lying on the side.

Moxa brings energy in to the Foot Taiyang (Greater Yang) Meridian (often called the Urinary Bladder Channel (UB)) at the point where the Foot Taiyang meets the Foot Shaoyin (Lesser Yin) Meridian connect, helping to regulate and tonify Qi. If the Qi is not sufficient or is exhausted  will be difficult to maintain the fetus in the correct position as the foetus requires both Shaoyin Qi and Taiyang Qi.

A deficiency of Qi also causes lack of strength, making the labor difficult. UB 67 regulates and tonifies Qi.

Click here for my definition of Qi

See here for Wikipedia definition of Qi

It is important to understand that in any treatment there are certain factors that can be contraindications and moxa is no different so it is important to establish that there is no:

• Recent uterine surgery, including Caesarean section
• Low-lying placenta, placenta previa
• Uterine or pelvic abnormalities, eg uterine fibroids, septum: obstetric staff clearance advised
• Insufficient liquor (oligohydramnios) or excessive liquor (poly-hydramnios): obstetric staff clearance advised
• History of any bleeding in pregnancy, antepartum haemorrhage
• Threatened premature labour
• Any query about ruptured membranes
• Any fetal distress
• Fetal abnormality, any sign of compromised foetus
• Multiple pregnancy
• Significant maternal hypertension, any signs of pre-eclampsia, diabetes, cardiac problems or thyroid disease: obstetric staff clearance advise
• Rh negativity
• Where Caesarean section is to be performed for other reasons

The best results are seen when Moxa is used for a 10 day period for 20 mins per day, now clearly that would be beyond most peoples finances to visit an acupuncturist for 10 days in a row so I have developed a special package where I come to your home and teach the mother and partner how to apply the moxa treatment and provide 10 days of moxa at a cost of £50.

If you would like to contact me to book your treatment or if  you have any questions please contact me here.

I completed my Acupuncture and Moxabustion CPD training with Jani White in 2011