Oscillation and joint cavity needling

Posted on: March 5th, 2018 by admin No Comments

Joint needling and Joint movement

 

Oscillation and joint cavity needling

Purpose

Increased local blood flow, more immune cells and nutrient to joint structures.

Joint lubrication by moving synovial fluid, which brings nutrients to joint structures

Mobilization of  fibro-fatty proliferation, intra-articular adhesions.

Detaching adhesive facie, tendons, ligaments, and other joint capsule tissue.

Increased fluid re-absorption from capillary beds and lymphatics

Indication

Frozen shoulder pain, Knee pain, Hip joint pain, Back pain

Acupuncture

Center of joint movement.

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Needling is inserted pivot point of joint. This point is the axis of movement, so movement of this center is minimized. It is like center of see-saw, both extremities move large amplitude, middle part barely moves. So, basic acupuncture of joint cavity is putting needles just right at the middle of pivot point. Acupuncture is better to minimize penetrating strong ligament and tendons. For instance, if you insert at ST35, put needle side of patelo-tibial tendon.

Examples: Femoro-tibial joint: ST35, Gleno-humeral joint: SI10(노수), Ankle joint: BL60, KI3, Wrist joint LI5, SI5, Inter-vertebral space: GV line

Oscillation

Patient should be at ease without pain, and related muscles should be fully relaxed. Sometimes showing them moving practitioners arms and legs with needles helps. Actually needles are so fine, and movement is minimal there is little pain.

First start with very minimal gentle shaking. Usually as needed, combine with joint traction. Traction itself makes the patients pain easier already. Give a oscillation from the end of limbs. You can give a oscillation starting from fingers. Starting from fingers you can convey oscillation to shoulder, elbow and wrist. By doing this, you can apply very small vibration(barely visible) on the target. Amplitude on the fingers can be larger, but vibration on shoulder can be very gentle. But, if there is unwanted or immobilized lesion, you need to isolate target joint as much as possible. Oscillation should be always predictable for patient, and there should not be any sudden move. Gradually increase the amplitude and speed.

  1. Grade 1: very small amplitude and rhythmic slow oscillation
  2. Grade 2: small amplitude(visible vibration on target joint) and rhythmic oscillation
  3. Grade 3: small amplitude and rhythmic fast oscillation
  4. Grade 4: large amplitude and rhythmic fast oscillation

For improving ROM, you can apply grade 3 oscillation at the limit of ROM. It is the very effective way increasing ROM with least amount of pain.

Usually Oscillation is combined with other joint play, traction, sliding, rolling.

Traction and and joint cavity needling

Purpose

Decompress mechanical entrapment of nerve

Cavitate  joint contractures, cartilage, meniscus, disc, etc.

Stretch the ligament and facie around joint

Release the muscle contractures

Increase the blood supply on compressed joint

Indications

Lumbar disc herniation, Cervical disc herniation, Acute low back pain

Inner joint injury: Cartilage, Meniscus, lumbar disc, TFCC, Sinus Tarsi syndrome

Acupuncture

Main purpose is ease the joint. With  acupuncture, making a small trauma around poor blood supply lesion, helps healing of injury and proliferation and mature. Needle can be inserted any direction of joint, because movement do not affect needle it self.

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Traction

Back traction and acupuncture

Most common traction and acupuncture for back applied on a inversion table prone position. After checking muscles are fully relaxed, insert the needle between lumbar vertebrae. You can more easily insert the needle to the target space.

There are various own weight tractions. Supporting with two helpers are traditional way, but hanging traction is more accessible way for most acupuncture clinic. Let the patients fully relax and check their is no tension on their low back. Even with full traction, many patients still do not let muscles go easy because of pain and fear. You can apply hot pack, TENS or distant needling to handle their pain and fear. Carefully insert needle between vertebrae and leave it, and let patients relax more.

Joint traction and acupuncture for ankle/ wrist

After inserting needles on joint spaces of ankle or wrist, give a gentle traction about 3-5 seconds 2-3 times and repeat this before removing needles. Usually after removing needles, if you let them move their joint around, they feel much easier. This maneuver is essential for Sinus tarsi syndrome, ankle impingement, wrist TFCC

Other joint traction and acupuncture

Knee and shoulder traction is usually combined with oscillation. When you apply oscillation, occasionally tract the joint as needed.

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