In this article, I'd like to write a little about the process behind treating shoulder pain.  You've read last time about the theory of how TCM looks at shoulder pain, but what about the practice of it?  Every patient that practitioners see is different in the way they manifest pain.  This is to be expected, since everyone is different and so is the cause of their pain.

A session always begins with the patient stating their problem and going into detail about it.  I then ask a few questions and observe the patients tongue and pulse to pinpoint a cause and formulate a treatment.  When I have a better handle on the problem, I begin palpating the area.  This is to find any sore spots or confirm the location where the pain is.  Once that's done, I give my findings, tell them the treatment I'd like to follow up with, and ask if they're okay with it.

Case 1: Frozen shoulder

This patient was around 50-60 yrs old complaining of decreased range of motion in the right shoulder.  She said the shoulder felt "stuck" and it was hard to reach up for things.  I was part of student clinic at the time, so asking some more questions, we came up with the diagnosis of "Frozen Shoulder".  The patients tongue looked fairly normal, if a slight purplish color, and the pulse was wiry.

For acupuncture, we used local points:
Small Intestine: 10, 12
Large Intestine: 14, 15
San Jiao: 14

When we were done, our clinical manager explained that we should also do ST 38 by itself.  We would have the patient rotate her arm in circular motions, starting out small, but gradually increasing as we manipulate the needle.  However, before starting the movements, we had to get "De Qi" in the area first.

"De Qi" means the "Arrival of Qi".  Many people think this concept is a farce, but much of acupuncture and its efficiency depends on De Qi.  One of my teachers explained to us once that De Qi is like fishing and the needle is the bait and hook.  There's a feeling you get once Qi arrives in the area and you need to know what that feeling is.  Once it's there, you can start working.

When dealing with muscles, De Qi is different than De Qi on the meridians.  When you insert the needle, it feels "rough" going in, sometimes feeling like it's scraping against stone.  This is the tightness of the muscle and the resistance it has against the needle.  You don't want to force the needle down or else you can cause some slight bleeding.  Instead, you coax it down, little by little.  You know you have De Qi when that resistance just seems to disappear.  When you move the needle up and down a little, it feels like it's floating in water. 

Manipulating the point for several minutes while having her do the rotation gave her quite a bit more range of motion.  Not a full range, but it did improve.  The patient came back for treatment a few days later, as the range started to decrease again.  After about a month of treatment, once a week, she was able to reach up again.  I should point out that is wasn't the last treatment though.  It took several maintenance treatments to keep the range up for a few more months.  They weren't as frequent as normal treatments though.  Maybe it was about once a month for 6 months.

Case 2: Soccer injury

Also in student clinic, there was a young girl around 16 years old who had hurt her shoulder while playing soccer.  Her doctor recommended trying acupuncture, as her pain was lingering and her mother was worried about her being on pain medication all the time.  She had pain on the right shoulder, but she also heard/felt a "clicking" noise when she moved a certain way. When we asked about the clicking, she said her doctor told her the ligament in the shoulder was loose.  She had a purple tongue, white coat, and wiry pulse.

For acupuncture, we used local points:
Small Intestine: 10, 12
Large Intestine: 14, 15
San Jiao: 14
Gallbladder: 34
Spleen: 10
Ashi: around the area of the injury

She was okay after the first treatment.  There was no apparent improvement.  When she came back a few days later, she mentioned there was less clicking and only a slight reduction in pain.  After the second treatment, she had more relief, although slight.  I believe she came a total of ten times before she was able to fully move her arm again without clicking or pain. However, she needed monthly maintenance, as the muscles didn't seem to want to strengthen. She stopped coming a couple treatments later, so I'm not sure whether it completely healed.

Case 3: Dull, constant pain in the shoulder

While I was visiting my old school, I was talking to an old friend who worked there.  They were having constant shoulder pain and some of the students were trying out different treatment theories.  I learned they had this pain for almost a week, but no amount of treatment or medicine could take away the pain.  They really didn't do anything to injury it.  It just came up one day.  They asked if I could try treating them, which I did, but it also had no effect.

When I came back a week later, I happened to see the person again and I asked how their shoulder was.  They said it was much better and they barely had any pain at all after one treatment.  This made me curious, because how could one treatment fix everything where all the other treatments failed?  I asked what points the practitioner used and they mentioned  some on the shoulder, but the one they didn't expect was one on the top the head (GV 20: Bai Hui).

"Why did they do that point?", I asked.  The practitioner explained that the pain wasn't from a physical injury, but from a stress/mental problem.  A major accident had occurred that affected them very deeply, but they never talked about it.  The body needed an outlet for that mental pain, because it doesn't "hurt" in the same way as physical pain.  So, it manifested as shoulder pain to let the person know something was really wrong and that they had to take care of it.

Bai Hui was used to remove some of the emotional pressure.  As one of my old teachers say, it's like taking the top off of a steaming teapot.  None of the treatments were working, because they weren't actually treating the main problem.  Once it was, they felt much better.

Conclusion:

Always remember that knowing the root cause of a problem can help you treat it.  Just treating pain where the pain is doesn't always work.  This is part of life as well.  If you leave whatever is bothering you alone for too long, it starts to hurt.  Emotionally or physically.

I hope you enjoyed this article and some of the insight into the diagnosis and treatment process.  The next article will be about knee pain, which is another common issue I've run into in clinic.