Is De Qi Essential To A Therapeutic Effect From Acupuncture?

There are many studies to show that acupuncture can be used effectively in orthopedics cases and for pain management. As students of acupuncture and Oriental medicine, we are eventually faced with a dilemma in our training. Some schools of thought state that "De Qi," or the arrival of qi at the acupuncture point must be obtained in order to have a therapeutic effect. Systems such as Traditional Chinese Medicine-style of acupuncture posit that it is essential and others such as Kiiko Matsumoto's style of Japanese acupuncture claim that it is not necessary. How can there be so much difference in opinion and whose school of thought can be believed?

The concept of "De Qi" is taught in acupuncture schools throughout California. In his book The Art of Acupuncture Techniques (a book on the list of required texts for the California Acupuncture Licensing Exam), Robert Johns discusses "De Qi" as follows, "Needling response (de qi) is typified by increased feeling of tightness or heaviness around the needle. It is described as a fish hooked on a line, jumping up and down, floating and deep. The patient's response to the arrival of qi may be light or very slow in coming. When the qi comes late or takes a long time to arrive, it indicates that the patient is weak and that overall response to treatment will be slow.

The strong patient experiences a quick arrival of qi. When the qi comes quickly the therapeutic results also are quick. Slow arrival of qi or a weak response can also indicate incorrect depth of needling or wrong placement of the needle. The importance of the arrival of qi cannot be overstated: in order to apply the desired technique there must first be arrival of qi, or needling response."1 It is generally accepted that the action of a given acupuncture point is assured only when needling is accompanied by "De Qi."

I recently came across a study that caused my eyebrows to rise a bit. It is regarding whether or not "De Qi" is necessary in treatment response to acupuncture in pain treatments.2 I am specializing in the treatment of chronic pain conditions and am concerned for the comfort of my patients so I became very interested to read this study. The aforementioned study comes out of the University of Southampton School of Health Sciences, Southampton, UK. The object of this study was to assess the importance of the strength of "De Qi" on the outcome of acupuncture treatments for patients with osteoarthritis of the knee and hip. The interventions used in this study included real acupuncture, Streitberger needle and mock electrical stimulation on 140 patients.

The relevant outcomes were pain reduction (they used a visual analog scale to assess) and the Park needling sensation questionnaire. The results showed that a) there was no significant correlation between the strength of "De Qi" and improvement of pain and b) that there was no significant difference in pain relief from those who felt "De Qi" and those who did not. The study concludes, "These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA [osteoarthritis]. This result may have implications for both acupuncture treatment and for future trial methodology."

This eye-opening experience has caused me to focus more on my patient's comfort level than that of obtaining "De Qi" to ensure therapeutic effect with acupuncture treatment.

Cycling Tips To Avoid Cycling Injuries

Cycling is one of the best forms of exercise that there is and it is for all ages and abilities as well as being as affordable or expensive as you wish to make it! So whether you're a keen cyclist or a casual peddler, you can improve your performance, wellbeing and comfort with these tips:

**Brake correctly by placing your hands at the ends of the levers.

**On a long downhill, don't stay on your brakes. This may overheat the tire rims, which could cause a blow out. Rather, tap the brakes from time to time.

**Don't pedal in high gear for long spells. This can increase the pressure on your knees and lead to injury.

**Position the handles accurately - about 1, 5 cm lower than the top of the seat.
**Change your hand and body positions frequently to avoid stiffness.

**Keep your arms loose and don't lock your elbows, they should be bent in order to absorb any bumps, rather than the knock going straight on to the joint.

Cycling is a wonderful activity for fitness and fun, but beginner cyclists need to be aware of ways they can reduce strain and injury on the joints and muscles.

The right gear

Wearing a bicycle helmet is an obvious preventative measure. But many beginning riders aren't aware of the importance of having a bike that fits you properly. For example, a bike that's not correctly sized and fitted to the rider can cause knee, back, neck, arm and wrist problems.

A good bike shop will help you to find the correct size of bike and adjust it to fit you properly. Improper riding techniques can also cause cycling injuries. If you ride with too much pedal resistance, you can strain your quadriceps or knee. Too little pedal resistance can cause increased pressure on your back and the base of the pelvic region.

Experienced cyclists pedal at between 90 - 100 pedal revolutions per minute. A reasonable resistance for beginning cyclists is from 60 to 80.

Hydration

Drinking ample amounts of fluids helps prevent muscle cramping. It is recommended that you consume 120 to 240 ml of sports drink every 15 to 20 minutes while cycling.

Saddle sores such as chafing and skin irritation are a likely cycling injury. To help prevent this, you should have a properly fitted saddle and should wear cycling shorts with padding in the bottom to protect skin.

Osteoarthritis - What Can You Do?

Most people in their fifties or older will have mild or moderate wear and tear of joints, called osteoarthritis. Joints with mild osteoarthritis can be asymptomatic. Osteoarthritis can manifest as a swelling of the end joints of the fingers, aching in the knees, or pain around the big toes. Mild osteoarthritis does not show on Xray, although will usually be detected on MRI.

Typical symptoms include intermittent pain, worse with activity and better with rest. As the arthritis progresses, there is often a loss of range of motion. For example, if the arthritis is in the knee, the knee might not be able to straighten fully. The joint often swells. Most people do not know how to tell if a joint is swollen, unless the swelling is extreme. A physiotherapist does two tests to determine the amount of swelling in a joint, and these tests can detect less than one teaspoon of fluid. With moderate or advanced osteoarthritis, you probably limp sometimes.

Risk factors for developing arthritis are obesity, prior injury, and family history. The quality of cartilage is determined by a number of genetic factors, and some families tend to develop osteoarthritis earlier than others.

What can be done to prevent osteoarthritis from becoming worse? Lose weight. A reduction in even 5 or 10 pounds helps. Learn to exercise in ways which you enjoy. Even with the most advanced arthritis, it is possible to exercise without pain. One solution is to learn pool exercises. Another is to learn land exercises tailored to your joints. The physiotherapist will assess your joints, strength, and gait, and provide a program to reduce pain and improve function. Studies show that of people with knee osteoarthritis, those with weak quadriceps muscles are seven times more likely to become worse within three years.

If you limp, use a cane or Nordic poles. Using a cane in the left hand reduces the load in the right knee by approximately thirty percent. If you have hip, knee, or foot symptoms, purchase comfortable shoes with good arch support and shock absorption. Running shoes offer more shock absorption than walking shoes. However, comfort and good fit are the most important variables.

Many people ask if the herbal supplement glucosamine helps. Studies show that of people with knee osteoarthritis, glucosamine is no more effective than a placebo pill in reducing knee pain. There is also no evidence that changing your diet helps arthritis pain. However, a healthy diet will optimize your weight, which will then reduce pain. Heat and cold offer temporary pain relief. Ice is best if the joint is warm and swollen.

Many people report that heat, in the form of a microwavable or electric heating pad, helps reduce aching. If you have osteoarthritis, visit your physiotherapist, for a through assessment and to be prescribed an exercise program. It will save you needless pain.

Top 5 Tips To Prevent Osteoarthritis

The most common type of arthritis, osteoarthritis results in damage due to wear and tear on the cartilage of your bones. Healthy cartilage is smooth which allows your joints to move freely and tough, to act as a shock absorber between your bones. But in osteoarthritis, the cartilage breaks down in slow stages:

1. It becomes soft, frayed, and less elastic.

2. Large sections wear away completely, letting the ends of bones rub together.

3. As a result, your bone ends thicken, and the joints may change shape, grow spurs (bony growths), and develop fluid-filled cysts.

No one knows for sure what causes osteoarthritis or even if it is actually age-related, but heredity, obesity, injury, and overuse all appear to play roles in osteoarthritis. Osteoarthritis can affect any joint in the body, but it is mostly found in the knees, spine, fingers, big toes, and hips. Men are especially likely to suffer from osteoarthritis of the hip.

Here are the helpful tips to lower your risk of developing osteoarthritis:

1. Exercise

It can be your best tool against osteoarthritis because exercise strengthens your muscles and works to keep your joints flexible. Exercise can also help you to maintain a healthy weight (or lose weight if necessary). Obesity is often considered a factor in some types of arthritis. However, be sensible: Don't overdo high-impact aerobics such as running. And if a particular joint (for example, those in your knees, ankles, and feet) starts to suffer from overuse, change your exercise regimen. Try low-impact exercises such as walking and swimming and stretching exercises to loosen your joints, increase your range of motion, strengthen your muscles, and more important, relieve arthritis pain.

2. Protect your knees against injury during sports, starting in your teens

Wear protective gear such as knee and elbow pads when playing contact sports or other, riskier sports such as in-line skating.

3. Sit straight and don't slump

Your mother was right! Good posture, whether sitting or standing, can help reduce the pressure on the joints, especially those in your spine.

4. Learn to perform your job without stressing your joints

If your job requires repetitive movement (such as typing) or movement that stresses your joints, be sure to vary your activities and working position as much as possible.

5. Safety First

Some safety concerns that may help to prevent osteoarthritis in your daily life, for example, wear a seat belt to prevent injury to your knees (and other body parts) in case of a car accident.

Someone Has to Wear the Green Tights

Have you ever witnessed one of those moments at a glittering event, where the company envoy ostentatiously hands over the enormous polystyrene dummy cheque to the suitably grateful charity representative. The cameras flash, the recipient's knees bend a little, the company boss swells and flashes a self satisfied smile. People clap and everyone swoons in awe at the selfless generosity of business. Onlookers declare: "They do have a heart." And "It's not just about the money." Let's not pretend that business doesn't need positive affirmation from the community. Face it; we all like a good pat on the back.

Which brings up a growing trend in the world that has found its feet in South Africa. Green Buildings. If ever there was a way of scoring points with the community, government and those with not only green fingers but whose superhero sports green underwear - the environmentalist, this is it. IF you're a land lord don't knock, because something in it for you.

In the news at the moment is the latest extension to that Mecca of upmarket shopping, Sandton City. A splendid dome graces the new Protea Court. This crowning expansion, involves interior refurbishments and 30,000sqm of new retail space. The Protea Court roof has been created with a product called Texlon, which is made up of multiple layers of foil known as ethylene-tetra-fluoro-ethylene (ETFE) it's so green it could be mistaken for peas.

"Texlon is an innovative technology used worldwide but has been used for the first time in South Africa at Sandton City," affirms architect Tia Kanakakis from MDS Architecture. "It was selected as a suitable roofing material as it is lightweight and an environmentally-friendly climatic envelope".

Kanakakis pointed out excitedly: "The ETFE material is unique in that it does not degrade under ultraviolet light or atmospheric pollution. " The material doesn't harden, yellow or deteriorate. Furthermore, as the surface is very smooth and has anti-adhesive properties, the envelope self-cleanses in rain." For Sandton City this means going Green and they are being richly rewarded already. Sandton City Manager Sharon Swain was able to announce the arrival of international names like Dumond, Inglot, Carlo Pignatelli, Miguel Vieira and Kurt Geiger to the centre.

Of course Green buildings aren't new. Twenty-one years ago two initiatives were launched which were foundational to establishing the concept of energy-efficient buildings and green building: BRE (British Research Establishment) released BREEAM, and BREEAM became the basis for a host of other rating tools including LEED in the US and the much talked about Green Star in Australia.

What about the landlord cost/tenant benefit scenario? Investors landlords may well ask what's in it them, surely more of a good old pat on the back? The Australian Financial Review explored the importance of green-star ratings, which basically determine how Green a building is, in attracting tenants to buildings. When looking for leasing locations tenants are now demanding at least a four star rating. In Australian cities the demand for the now-coveted green buildings is driving up costs in refurbishing and retrofitting older buildings. Greener adds value and demands higher rents.

According to property investment analysts IPD, Green Star buildings are outperforming non-rated buildings on a financial basis by a significant margin.

Here in South Africa, Llewellyn van Wyk, Editor at Large for Green Building South Africa writes: "Ultimately I believe green building is in the national interest, and should be an issue driven by Government: for this reason, I strongly supported the establishment of a Part X "Environmental Sustainability" to the South African National Building Regulations and look forward to it being populated with the full range of deep green building imperatives in due course."

In the US the Green standard is held up by LEED, which has not been without it's squabbles: Henry Gifford has made his living designing mechanical systems for energy-efficient buildings in New York City. And he admits the (LEED) program has popularized the idea of green building: "LEED has probably contributed more to the current popularity of green buildings in the public's eye than anything else. It is such a valuable selling point that it is featured prominently in advertisements for buildings that achieve it. LEED-certified buildings make headlines, attract tenants and command higher prices."

By mean of counter point Ben Ikenson reports on the current controversy embroiling LEED and hence whole Green Building bureaucracy in the US: "But for years, Gifford has been a tenacious and vocal opponent of LEED, claiming that the program's "big return on investment' is more a matter of faith than fact, and that LEED simply "fills the need for a big lie to the public." Last October, Gifford filed a class-action lawsuit for more than $100 million against the USGBC, accusing the nonprofit of making false claims about how much energy LEED-certified buildings actually save and using its claims to advance a monopoly in the market that robs legitimate experts - such as himself - of jobs. We may ask ourselves if we need this in South Africa.

Back to the benefits, conventional wisdom has it that not only does the environment benefit from the carefully considered construction that goes with Green building, but that people are generally happier and more contented working or living in Greener buildings. Comments Dr Suzan Oelofse, IWMSA Central Branch Chairman, "The environmental benefits derived from green buildings can further be enhanced by including waste minimisation and recycling principles in this type of environment."

Further to this, Oelofse believes that Green buildings should be orientated in such a way as to reduce the heat load and to optimise shade and thereby enabling the use of more energy efficient lighting systems and air conditioning. This makes economic sense in the light of increasing Eskom electricity costs to be implemented shortly, and it makes sound economic and environmental sense to use renewable resources and to become as energy efficient as possible.

It seems the devil may be in the bureaucracy and that making buildings greener may require state rather than private regulation if the LEED struggles are anything to go by. But there are clearly many practical and financial benefits to Greening up the workplace. Besides there's nothing quite like that warm approval that comes from cosying up to a superhero or heroine in green tights.

Psoriatic Arthritis - More Than Just Joint Pain

What could be worse that this awful joint pain and stiffness, you wonder as you try to will yourself out of bed. While the pain and fatigue that goes along with rheumatoid arthritis can be excruciating and is without a doubt a possibly debilitating condition, there is actually a form of arthritis that is worse. Psoriatic arthritis is a form of the disease that affects not only the joints, but also the skin, and possibly the tendons, eyes, spine, heart and lungs.

In most people who suffer from psoriatic arthritis, the first sign that something is wrong is the inflammation of the skin. Patients can develop psoriasis on their elbows, knees, scalp, and area around the navel and around the anus or genitals. Psoriasis causes red, raised areas of scaly skin. The signs of the skin disease are first seen in the forties or fifties and generally precede joint pain by several months to years. Once the joint pain starts, it generally involves the joints in the feet, ankles and knees. Inflammation can cause the joints to become red, hot and swollen. Often toes and fingers swell so badly they can resemble sausages. Psoriatic arthritis can also affect the spine.

In addition to skin inflammation and joint pain, psoriatic arthritis also attacks the ligaments and tendons of the body. One of the most common tendons to become affected it the Achilles tendon. This Achilles tendonitis causes the patient to have pain when walking and when climbing steps. Along with affecting the tendons in the heels, the arthritis can also inflame the chest wall and the cartilage that links the breast bone and ribs. This inflammation can cause chest pain and shortness of breath.

Along with the joints and tendons, psoriatic arthritis can also affect the major organs of the body such as the heart and lungs. The lungs can become inflamed causing both shortness of breath and chest pain, especially with deep breathing. If the heart becomes inflamed by the disease, the aortic valve can leak. This leak could result in breathing trouble as well as heart failure.

In its rampage on the body, psoriatic arthritis can also damage the eyes. Redness and itching are common results of the condition. The iris or colored area of the eye can also become painfully inflamed, especially when exposed to bright light. Often the only way to relieve this irisitis is to inject cortisone directly into the eye.

Psoriatic arthritis can often be difficult to diagnose especially in the early stages. One common symptom of this form of arthritis, however, is the pitting of finger or toe nails. Sometimes the disorder can cause the nails to turn loose and fall off completely.

Like rheumatoid arthritis, psoriatic arthritis results from the body's own immune system turning against itself. Unlike the rheumatoid variety, however, psoriatic arthritis can affect not only the joints, but also the skin, eyes and many of the major organs of the body. Left untreated this disease can progress until it become debilitating and sometimes even life threatening.

Causes of Knee Pain

Excessive use or abuse of the joint, incorrect positioning during movement, inadequate warm up or cool down activity prior to and after exercise, and insufficient stretching are some of the physical causes of knee pain. Knee pain resulting from these simple causes may resolve on its own through rest and careful self-nurturing. However, excess weight or obesity can increase the risk of developing painful disorders of the knee.

Some of the diseases that cause knee pain include:

• Arthritis - rheumatoid arthritis, osteoarthritis, gout, and other connective tissue disorders like lupus.


• Baker's cyst - when the posterior region of the knee is inundated with fluid, swelling and arthritic inflammation occurs. This engorged cyst can burst, causing pain to travel down the back of the calf.


• Bursitis - symptoms include inflammation from constant knee stress (e.g., prolonged kneeling, excessive joint use, or injury).


• Disorders of the hip - pain causing ailments which affect the knee. The Iliotibial Band Syndrome is one such example. This injury occurs in the thick band of tissue that extends from the hip to the knee exterior.


• Joint infection.


• Kneecap dislocation.


• Knee injuries - these injuries can result in internal knee bleeding, thereby aggravating the pain.


• Strains and sprains - these are minor ligament injuries that are caused by abrupt or irregular joint wrenching motions that may cause ligament trauma.


• Tendinitis (tendonitis) - characterized by anterior knee pain that is exacerbated by activities like going up or down stairs and other inclines. Athletes like runners, skiers and cyclists are more prone to this disease than most.


• Meniscus tears (cartilage tears) - these type of injuries result in pain in the interior or exterior knee joint.


• ACL tear (ligament tear) - the resulting pain and damage also causes the knee joint to become unstable.

Knee pain can also result from other less common illnesses which include:

• Bone tumours


• Osgood-Schlatter disease