Back Pain

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Back pain affects up to 90% of us at some stage of our life, with nearly 4 million Australians suffering from this every year[1]. There are many various causes of this and we recommend that this get checked out by your medical doctor. This must be assessed thoroughly, and investigations may be required. As Dr Justin Lim and Dr Selina Lim have worked in the Emergency Departments in major Australian and European Hospitals they understand the importance of ensuring that this is not caused by a major critical condition such as a Myocardial infarction (MI) or an Abdominal Aortic Aneurysm (AAA) and then referring for imaging if appropriate to find the cause of the back pain.

Professor Yoland Lim Health Care’s Fong Yang Therapy Back Pain program is a natural form of treatment aimed at getting you back to more functioning of activities of daily living. We have worked closely with medical specialists such as neurosurgeons, orthopaedic surgeons and anaesthetic pain specialists to reduce the requirement of potentially addictive prescription only opioid medication, which may also have possible severe side effects for some patients. 

Harvard Medical School stated in a 2012 medical study involving approximately 18,000 patients over 23 high-quality randomized controlled trials showed that acupuncture is beneficial low back pain, in addition to headache and osteoarthritis [2].  Studies published in American Family Physician stated acupuncture  was of benefit for chronic low back pain in certain situations[3].
The Royal Australian College of General Practitioners have education activities for doctors which include "Non-pharmacological therapies in back pain" which is education "to provide an update for GP’s on risk factors for low back pain, screening tools, and evidence for non pharmacological therapies including exercise, manual therapy, and acupuncture in the management of low back pain"[4]. 

Additionally, the safety profile of acupuncture is excellent, and as Professor Yoland Lim's catch phrase states- "Without drugs, without side effects". Other potential benefits may include lowering blood pressure along with relaxation. Acupuncture has emerged as an important non-drug option that can help chronic pain patients avoid the use of potentially harmful medications, especially opiates with their potentially serious risk of substance use disorder.

References:
[1]  aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems 

[2]  health.harvard.edu/alternative-and-complementary-medicine/acupuncture-for-pain-relief 

[3] Chronic low back pain: evaluation and management. Am Fam Physician. 2009 Jun 15;79(12):1067-74.Last AR1, Hulbert K.Medical College of Wisconsin, Racine, WI 53403, USA. ncbi.nlm.nih.gov/pubmed?term=Last%20AR,%20Hulbert%20K.%20Chronic%20low%20back%20pain:%20evaluation%20and%20management.%20Am%20Fam%20Physician%202009;79:1067%E2%80%9374. 

[4]  racgp.org.au/education/courses/activitylist/activity/?id=84627 

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by:

1. Stiffness and 

2. Pain 

in your shoulder joint[1]. It may take two to nine months to develop. Although the pain may slowly improve, stiffness continues, and range of motion remains limited[2].

What Causes Frozen Shoulder?

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when the normal capsule (of bones, ligament and tendons of the shoulder) thickens and tightens around the shoulder joint, restricting its movement[3],[4].

The exact cause is unknown, but patients with diabetes or those who have had a period of immobility for a long period, such as after surgery or an arm fracture. Risk factors[5]are:

• Diabetes
• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• Cardiovascular disease
• Tuberculosis
• Parkinson's disease

Management

We may arrange for imaging or other tests to further investigate.

Treatment

Frozen shoulder may be treated with various specific exercises. Professor Yoland Lim Health Care may advise on Fong Yang exercises to enhance management. According to The National Centre for Biotechnology Information (NCBI), acupuncture is an effective treatment for treating chronic pain[6], like that of shoulder pain.

References

[1] mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

[2] health.harvard.edu/pain/how-to-release-a-frozen-shoulder

[3] mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

[4] health.harvard.edu/pain/how-to-release-a-frozen-shoulder

[5] mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

[6] ncbi.nlm.nih.gov/pubmed/29563830

Knee pain is a common problem in people of all ages and can occur suddenly or over a period of time[1]. 

The knee is a large joint comprised of four main structures: bones, ligaments, cartilage and tendons - each being susceptible to injury[2]. 

Common knee problems as a result of aging and continual wear and stress on the knee joint include[3]:

• Sprained or strained knee ligaments (more commonly the anterior cruciate ligament or ACL) as a result of a blow to the knee or a sudden twist of the knee
• Cartilage (menisci) tears. 
• Tendon tears
• Patello-femoral pain syndrome or pain felt behind the kneecap

Although knee pain can affect all, it is more prevalent in individuals who are overweight, have history of arthritis or those who engage in certain sports such as basketball and skiing[4]. Along with pain, other symptoms may include[1]:

• Swelling, redness or heat in the knee
• Locking or clicking
• Inability to straighten your knee
• Bruising around the knee

In many cases, knee pain can be treated conservatively. These strategies include putting as little weight as possible on the knee, using an ice pack and ensuring adequate analgesic management. However, if the pain is persistent, seeking medical attention may be required. In these cases, treatment options can include aspiration (releasing pressure by removing some of the fluid in the knee joint), physiotherapy to reduce pain and in more severe cases arthroscopic surgery and open surgery[5].

References

[1] Health Direct (2019, January) Knee pain healthdirect.gov.au/knee-pain

[2] Versus Arthritis. How is the knee structured? versusarthritis.org/about-arthritis/conditions/knee-pain/

[3] John Hopkins Medicine. Knee Pain and Problems hopkinsmedicine.org/health/conditions-and-diseases/knee-pain-and-problems

[4] MedlinePlus (2020, Februayr) Knee pain medlineplus.gov/ency/article/003187.htm

[5] Better Health Channel (2012, July) Knee injuries betterhealth.vic.gov.au/health/conditionsandtreatments/knee-injuries

Muscle cramps is a condition which can affect most of us at some stage of our lives. The cause of cramps is not always very clear as it is largely associated with the patient’s physical as well as emotional condition. 

Cramps related to sport are common occurrences during and after physical exercise in both non-athletes and professional athletes. This is where there is uncontrollable spasms and pain in single or numerous multijoint muscles. The exact cause of cramps secondary to sport and exercise are unknown. However, there are plausible theories to suggest the causation of cramps to be attributed to:

• Electrolyte imbalance
• Dehydration
• Muscle fatigue
• Neuromuscular causes[1] 
• Poor blood circulation[2]

In some cases, a medical condition is known to cause this condition such as pregnancy, kidney failure or low thyroid gland function[3].

Muscle cramps can affect people of all ages in different areas of the body. However it is most commonly seen in middle-aged and the elderly during rest, post exercise or at night during sleep. The symptoms are usually painful and uncontrollable spasms of muscles[4]. Commonly affected areas include abdominal wall, lower leg, thighs and arms. Some people experience difficulty walking due to intense pain. 

As the duration and onset of muscle cramps varies in individuals, conventional western treatment can consist of a variety of components such as gentle massages and stretches, application of an icepack or medications to control the spasms. Effective prevention strategies to minimise the onset of cramps include frequent exercise, hydration before and after exercise, incorporation of stretching and nutritionally adequate diet[5].

According to data provided by The National Centre for Biotechnology Information (NCBI), acupuncture can be an effective treatment for patients with cramps by improving muscle metabolism through the release of energy[6].

Although they are generally harmless, it is important to note that regular occurrences of cramps that last longer than a few minutes should be consulted by a medical doctor as they could be a symptom of an underlying medical disorder such as atherosclerosis (narrowing of the arteries) or spinal nerve compression[7].

References:    

[1] Miller et al (2010, July) Exercise-Associated Muscle Cramps: Causes, Treatment, and Prevention. SAGE Journals Vol 2 (4) 279-283. doi: 10.1177/1941738109357299

[2] betterhealth.vic.gov.au/health/conditionsandtreatments/muscle-cramp

[3] niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease

[4] healthline.com/health/muscle-cramps

[5] Better Health Channel (2013, September). Muscle cramp.  betterhealth.vic.gov.au/health/conditionsandtreatments/muscle-cramp

[6] ncbi.nlm.nih.gov/pmc/articles/PMC5301059/

[7] msdmanuals.com

Fractures are breaks or cracks in a bone and generally occur when the force exerted against a bone is stronger than the bone can structurally withstand[1]. Fractures may occur as a result from traumatic incidents such as sporting injuries, vehicle accidents or increased risk as a consequence of underlying medical conditions such as osteoporosis or some types of cancers that cause bones to fracture more easily[1].

Common sites for bone fractures include the wrist, ankle and hip and are typically treated by immobilising the bone with plaster cast as broken bones heal by themselves. There are three stages of pain from a fracture[2]:

1. Acute pain- pain which occurs immediately after the fracture when the bone has broken

2. Sub-acute pain- pain occurring the first few weeks during the healing process

3. Chronic pain- pain which persists after the fracture has finished healing

Pain management post fractures includes self help strategies such as reducing movement of the limb and ensuring plenty of rest as well as administration of pain relief medicines such as opioids,  paracetamol and anti-inflammatory drugs[3]. In addition to these measures, acupuncture has been found to be effective for enhancing pain reduction[4]. More so, one study found acupuncture showed a greater pain relief effect compared to individuals who did not receive acupuncture[5]. Although acupuncture has proven to show some benefit in management of pain as a consequence of fractures[6], more research around the world is currently underway investigating the analgesic effect of acupuncture in patients with fractures[7]. 

References

[1] Better Health Channel (2014, September) Bone fractures betterhealth.vic.gov.au/health/conditionsandtreatments/bone-fractures

[2] Osteoporosis. General Information about pain after a fracture osteoporosis.ca/bone-health-osteoporosis/living-with-the-disease/after-the-fracture/general-information-about-pain-after-a-fracture/

[3] National Institute for Health and Care Excellence (2016, February) Fractures (Non-Complex): Assessment and Management ncbi.nlm.nih.gov/books/NBK368141/

[4] HealthCmi (2015, November) Acupuncture Relieves Osteoporotic Spinal Fracture Pain healthcmi.com/Acupuncture-Continuing-Education-News/1548-acupuncture-relieves-osteoporotic-spinal-fracture-pain

[5] Xiang et al (2017) The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis hindawi.com/journals/ecam/2017/3837194/

[6] Ho et al (2014, May) A novel and effective acupuncture modality as a complementary therapy to acute pain relief in inpatients with rib fractures ncbi.nlm.nih.gov/pubmed/24923573

[7] Clinical Trials (2020, March) Analgesic Effect of Acupuncture for Patients With Rib Fractures clinicaltrials.gov/ct2/show/NCT03822273

Scoliosis is a common type of abnormal spinal curvature whereby the spine has a sideways curve. The exact cause of scoliosis is unknown with current theories suggesting genetic, hormonal and connective/nervous system abnormalities are possible causes[1]. However, most cases of scoliosis are idiopathic, that is, not associated with any other disease or condition. For this reason, medical professionals have classified idiopathic scoliosis in three categories: 

1. Infantile (before a child is 2 years old)

2. Juvenile (aged between 2-10 years) and 

3. Adolescent (during early adolescence)[2]. 

Diagnosis of scoliosis includes a physical examination involving the forward bending test, observing shoulder and shoulder blade height, hip location and positioning of lower back upon bending[3]. Treatment varies on the severity of the curvature with all treatments aiming to straighten the spine. This can include wearing a brace or surgery for severe to very severe cases or frequent monitoring for mild cases[4]. 

References:

[1] Better Health Channel (2014, August) Scoliosis. betterhealth.vic.gov.au/health/conditionsandtreatments/scoliosis

[2] Scoliosis Australia. About Scoliosis – Causes, Symptoms, Treatment. Information for Patients and Parents. scoliosis-australia.org/about-scoliosis/types-of-scoliosis/

[3] Department of Health – Healthy WA (2019, May). Scoliosis. scoliosis-australia.org/about-scoliosis/types-of-scoliosis/

[4] Health Direct (2019, April) Scoliosis. healthdirect.gov.au/scoliosis