Treatment of Scar Tissue with Acupuncture and Electro-Acupuncture
Evidence Based Practices
AOMA Spring 2015
Abstract:
This case report describes the use of acupuncture and electro-acupuncture
(e.stem) for reducing the thickness and size of post-knee surgery scar tissue. Western medicine utilizes physical therapy (PT), oral and topical analgesics and “nerve blocks” to treat post-surgery pain, numbness and mobility. For scar reduction there are a myriad of topical creams to choose from online. Within the Traditional Chinese Medicine (TCM) community it is generally practiced and known that acupuncture and e.stem are effective in reducing the size and thickness of scar tissue. This
case report discusses the effects of acupuncture and e.stem in a case where the patient has had
multiple knee surgeries and is using TCM in conjunction with PT and topical analgesics in her
recovery. Over the course of six months of weekly post-surgical treatments, the use of
acupuncture and e.stem has significantly reduced the size and thickness of the patients scar
tissue. This case shows how utilizing these modalities could provide patients with scar tissue a
more rapid reduction in size and thickness.
Key words:
Scar, acupuncture, electro-acupuncture, e.stem, post-op., post-surgery, scar-tissue
Introduction:
Injury to the tendons, musicals and ligaments of the knee is relatively common, especially in
athletic people. Running over long periods of time on surfaces without any shock absorption
such as pavement can cause a wearing down of the cartilage and lead to pain and a loss of
mobility. Falling a twisting of the knee is also a common way in which people can injure the
knee. The lateral and medial tendons as well as the cruciate ligaments can be strained or sprained
with overuse, trauma or misuse. The most common western treatments for these types of injuries
are arthroscopy or more invasive knee surgery (Mayo Clinic 2013). In this case report we see a
patient with a long athletic history as well as traumatic injury of her left knee. She was given the
initial diagnosis of of chondromalacia patella and has undergone an arthroscopy and most
recently a realignment surgery of her knee. She began PT approximately three months after
surgery, was prescribed a topical analgesic, wears a knee brace and walks with a cain. The
patient has a history of positive results using TCM for postop.
healing on shoulder surgeries.
Patient Information:
A 55 year old Chinese female is a retired tax examiner and in her younger years was an active
runner and swimmer. The patient has undergone 2 previous knee surgeries done by her
orthopedic surgeon, is going to PT two times a week and is practicing low impact
water aerobics once a week. The patient began TCM treatment of her knee three months after her last surgery. At that time she presented with pain, numbness, reduced range of motion, reduced balance and two quarter sized scars on the medial side of her left patella.
Clinical Findings:
The patient was previously a runner and swimmer and generally enjoyed an active lifestyle. She
initially injured her knee from sports related overuse but also sustained a fall in which she re-aggravated her previous injury. She has also had multiple surgeries on both her shoulders due to
overuse from swimming. She grew up in China and lived in a rural community where she picked
tea leaves and was not provided a fully balanced diet for many years. She moved to the U.S. as a
young women and currently has a husband and one adult child. Despite her many injuries and
surgeries she has a particularly positive outlook in terms of her recovery and at times pushes
herself “too far” physically. Since the most recent surgery the patient has reported difficulty with
sleep due to the pain. She wakes up 2-4 times a night and has difficulty falling back asleep.
Despite this she has relatively good energy throughout the day. Since the surgery she has also
reported a diminished appetite, only ingesting 600-1200 calories a day. Because of this the
patient has lost 15-20lbs over a six month period, though she remains within the limits for a
healthy BMI. The patient also suffers from seasonal allergies with symptoms such as sore itchy
throat and eyes, congested sinuses causing yellow sticky discharge and occasionally frontal
headaches. From the TCM perspective her pulse is thin, sometimes weak and/or choppy and can
be fast if she is in more pain due to overuse previously that day. Tongue is slightly red and dusky
with a coat ranging from thin and white to thicker and more yellowish.
Diagnostic Focus and Assessment:
By focusing on her western medical diagnoses and treatments we were able to reference the
TCM theory to find her TCM differentiation. In traditional Chinese medicine (TCM), post-surgical
pain, numbness and scar formation is referred to as local Qi and blood stagnation in the
specifically affected area or channel due to the trauma. When Qi and Blood are obstructed due to
scar formation it is also common to see a Qi and blood deficiency locally or systemically
(Cooper 2013). In this patients case there was an underlying LV and KD yin deficiency as well
as some SP Qi deficiency. These underlying patterns may have contributed to her history of more
easily overused tendons, ligaments and muscles.
Therapeutic Intervention:
Acupuncture and e.stem were provided weekly to the local area starting three months postsurgery
and continue currently into the 6 month. Points were chosen surrounding each scar on a
45 degree angle going toward the center of the scar. If possible the needles were inserted into the
interior of the scar as well. E.stem was set between 30Hz-60Hz depending on the pain tolerance
of the patient on each specific treatment day. Additional Ashi points were inserted as well. Distal
points were chosen based on the differential and from week to week on specific systemic
symptoms. Points which were commonly used include: KD3, SP6, LV8, GB34, ST36. Points and
e.stem were left in for 20-25 mins and on occasion e.stem Hz were increased after patient
reported electrical sensation had dissipated.
Followups and Outcomes:
Patient’s scars both reduced in size by close to half and thickness was reduced by more than half.
Pain on palpation around scars was reduced and scar tissue was softer. Patient reported waking
less at night due to pain, from 4 times at one month post-op.to 2 times at 6 months. General knee
pain was more difficult to assess due to the amount she exercised during PT. She would leave PT
and feel the pain had gotten much worse so any improvement from the TCM treatment went
unnoticed. It was suggested she back off on PT, but it wasn’t until her orthopedic surgeon
brought it up that she reduced her sessions and any exercise that caused impact stress. Patient did
report that her orthopedic surgeon commented on multiple visits how “amazed” she was by the
accelerated healing of the scar tissue.
Discussion:
After 3 months of TCM treatment the patient’s scar tissue visually and tactilely diminished by
half on average. There is insufficient evidence in this case showing causation between the TCM
treatment and any reduction in pain. Despite this fact it is well documented in many research
studies that TCM modalities do cause a reduction in pain. In Forrest Cooper’s (Dipl AC
[NCCAOM], LAc) case report chronicling the TCM treatment of one patients post-surgical
kneepain, he finds that, “Acupuncture may be effective as a treatment for post-surgical
pain”(2013). Though it should be noted, in this case the patient had only undergone one surgery, as opposed to multiple. It should also be noted that my patient was attending PT two times a week and that her pain was often aggravated by the exercise; which could have contributed to her pain diminishing more slowly. Currently there is no research being done on scar tissue regeneration. A study like this would lend itself well to a randomized control trial due to the TCM treatment being the same for all patients. There could also be multiple TCM treatment groups where some patients get
acupuncture and others acupuncture with e.stem. What has been found in this case study is that
scar tissue is diminished in size and thickness through the use of local acupuncture and e.stem on
a post-knee surgery patient.
Chondromalacia patella. (2013, February 5). Retrieved July 1, 2015, from
http://www.mayoclinic.org/diseasesconditions/chondromalaciapatella/basics/definition/con20025960
Cooper F. A Case of Post-Surgical Knee and Thigh Pain with Numbness Treated with
Acupuncture and Associated Therapies. American Acupuncturist [serial online]. Winter2013
2013;62:1648. Available from: Alt HealthWatch, Ipswich, MA. Accessed July 1, 2015.
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