With 4.5 million Americans currently living with knee replacements, it is fast becoming in extremely common procedure. While improved technology and surgery techniques are making this procedure much more successful, patients are still not well informed as to the reality of post surgery recovery. One study of patients undergoing physical therapy post knee replacement showed the majority of patients only completed eight weeks of physical therapy, and at this point their mobility was worse than before the surgery. The recovery is even worse for people who are obese, elderly, have multiple joints replaced or multiple joints affected with pain. Acupuncture is an approach that has been used very successfully post-surgery and many more studies are showing acupuncture helps this process by reducing inflammation and pain post surgery. However, when people only look at scientific articles it is difficult to translate this into what this actually means for your recovery post surgery, specifically what are you actually going to feel and be able to do with your new knee. For this reason here is a story of two patients who came in for knee problems post knee replacement surgery. The first patient came in immediately after surgery, the other six months after.
For patient #1, while their knee was sore and swollen like it typically is post replacement, they were only a week out of their surgery and everything lay before them as they endeavored to do everything they could to recover well. For patient #2, it had certainly been “the worst of times.” Six months out from their knee replacement adhesions had formed all around the knee, walking was a continually painful exercise and the tension and pain was not only worse than it had been before the surgery, but now the hip, the back and the opposite knee were also starting to become very painful. This all despite the fact both patients were undergoing physical therapy for their knee directly after their surgery.
When treating patient #1 immediately after their surgery we did not do acupuncture and massage directly over the replaced knee as the risk of infection is still high in the initial stages. The treatment consisted of acupuncture points above and below the knee, points in other areas of the body, which are beneficial for pain and healing of the knee, and massage on the leg, hip, back. In general, the treatment was designed to not only help the affected knee, but to also treat other areas of the body to help the muscles and tissues not become tight and sore from the compensation of walking with a limp post surgery. As the treatments went on we were able to treat more directly on the affected knee and electrical stimulation was applied to further decrease pain and increase circulation through the affected area. After only four weeks patient #1 was able to ride a bike, have nearly 110o of flexion in the knee, and perform many different weight bearing exercises. Not only that, but the opposite knee(which the doctors advised replacing in the future) was having no problems and felt better than it had in years. At six weeks the knee would feel some soreness post a heavy workout, but otherwise felt mostly recovered. At eight weeks the knee felt as good as it had in years. At this point was when I saw patient #2 who was six months post surgery, walking with a cane and having problems throughout their back, hip and other knee. Immediately we began a similar procedure as in patient #1 with the addition of massage to break apart the scar tissue and adhesions that had formed. After 4 weeks the patient was recovering well, they had increased movement, were riding a bike daily and had a decrease in their pain, however the knee still would get sore after a mild workout and it took a few more months before they began to see the improvements that patient #1 saw after only 6 weeks.
These stories are by no means singular cases. While anecdotal case studies are not an depth scientific analysis as to the physiological mechanisms involved in post surgical care, they are perhaps more relevant to you the patient. Through hearing these stories you can know what you should expect post surgery, and more importantly what kind of treatment you should be receiving. Too often I see patients come in many months post surgery in the same state as patient #2 because they were never told what their options were for optimal recovery. Inevitably when I explain to them what there recovery plan should have looked like they are frustrated they didn’t receive the information beforethe surgery. So, if you are looking at getting a joint replacement, or any surgery for that matter, please seek a qualified acupuncturist, massage therapist and physical therapist. It will be the difference in recovering twice as fast with little to no complications.
Whenever people ask me what I do, I always tell them I practice acupuncture and Chinese Medicine. Inevitably they know what acupuncture is but are often unsure as to what Chinese Medicine is. Given that most people don’t know that acupuncture is only one part of Chinese Medicine, and aren’t familiar with Chinese Medicine as a whole, I figured I’d give a brief explanation as to what this type of medicine is.
Chinese Medicine has five main branches of treatment modalities, acupuncture, massage (tui na the Chinese form of massage), herbal medicine, nutrition and exercise. Acupuncture also includes more than the use of hair-thin needles to stimulate points throughout the body, and includes the techniques of moxibustion, gua sha, or scraping, and cupping. In fact the Chinese word for acupuncture is zhen jiu which literally translates to acupuncture-moxibustion. Most people in the West, when they think of the acupuncture system only picture the channels, or meridians, and acupuncture points that and don’t realize that Chinese Medicine is in fact a whole system of medicine with its own unique physiology and diagnostic system. This is why it takes 3-4 years of graduate level education, just like in traditional Western Medical education, to learn how to properly treat someone using these techniques. First, we have to learn the basic ways in which the body functions, then we have to learn the ways in which those functions become diseased, and finally we have to learn how to treat them. Not only that, but we learn this from both a Western and Chinese viewpoint.
For example, from the view of Chinese Medicine everything, and everybody, has a balance of yin and yang. Yin qualities are all the cooling, moistening, physical, substantial, nutritive qualities, whereas yang are all the heating, warming, energetic, moving, metabolizing aspects. Everyone must maintain this balance of yin and yang, because if either becomes more or less than the other disease will result.
Yin and yang can further be subdivided into the five elements. The elements correspond to the specific functions each organ must carry out in the body and the various processes which take place not only through the day but throughout our lives as well. The word “element” in Chinese is translated from the word xing, which actually translates better to a fundamental process and not a static thing. For example, the word xing is used for pedestrian as well. If any one of these “elements” is not balanced with the rest than these fundamental processes in the body break down and disease will result. To connect everything further, the elements, the organs and the yin yang balance is all tied in through an energetic flow within channels, or meridians. There are twelve main meridians that distribute all the energy and various substances through the body. Just like yin and yang and the five elements if any of these is not balanced with the rest, or if any become blocked than disease results.
Overall, these processes and systems are connected in very specific ways. They are affected by the food we eat, the activities we do and the environment around us. It is very important to know exactly what system is affected by what and how to arrive at a proper diagnosis to figure out the best treatment to bring it all back into balance. This treatment at its core is preventative. Therefore it is always our goal to use the tools available to us to prevent disease before it becomes a bigger problem. This is why even though we will often use acupuncture, herbs and/or massage, nutrition and exercise are in reality the most profound treatments. Nutrition and exercise are the simplest and easiest ways that you can prevent disease on a daily basis. This is reflected in a basic tenant of Chinese Herbal Medicine medicinals that can be taken on a daily basis with no risk of side effect, i.e. food, are considered the most superior forms of medicine, as opposed to the medicinals consumed for a short period of time because they have a high risk of side effects are considered the most inferior forms of medicine. This idea of food as medicine is very important in Chinese Medicine and every person should have a basic understanding of what they should or should not eat depending on who they are as a person and what type of illness may be affecting them. Exercise is also very important in China where, even in the largest cities, there are many beautiful parks with walking paths, there are parks with outdoor exercise equipment on many corners and every morning you will see people doing exercises such as qi gong and tai qi throughout the parks and in their homes. Ultimately, when you take care of your body on a daily basis with nutrition and exercise you may only need to see a practitioner for massage, acupuncture and/or herbs once in a while.