Acupuncture and Moxibustion for Lateral Epicondylitis
This Acupuncture and Moxibustion for Lateral Epicondylitis blog is a modified excerpt from the soon to be released Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine by Matt Callison.
Figure 1. Lateral epicondylitis is marked by pronounced tenderness at the tendinous attachment on the lateral epicondyle.
Lateral epicondylitis is commonly known as tennis elbow. In TCM, it is traditionally known as zhou lao, meaning “pain at the outside elbow”. Lateral epicondylitis is the most common overuse injury of the elbow and it is observed up to 10 times more frequently than medial epicondylitis. The lateral epicondyle is a small bony protuberance that can be easily overburdened by the strong forces that it is subjected to as the attachment site of the wrist extensor muscles. Lateral epicondylitis is usually precipitated by repetitive contraction of the wrist extensors and it is a very common injury in racket sports. Overuse of the wrist extensors and lateral epicondylitis is also common among electricians, plumbers, carpenters or anyone who spends a significant amount of time working on a computer keyboard.
The primary muscles involved in lateral epicondylitis are the extensor carpi radialis brevis (the most commonly affected), extensor carpi radialis longus, extensor carpi ulnaris and extensor digitorum communis. The diagnosis of lateral epicondylitis can usually be made from physical examination alone and it is evidenced by pronounced tenderness at the tendinous attachment onto the lateral epicondyle (Fig. 1). The patient will often present with sharp pain at the lateral epicondyle with activity and periodic dull, aching pain in the region of LI 10 (shousanli) – LI 11 (quchi) during rest. While lateral epicondylitis typically presents with a fixed pain site on the lateral epicondyle, there are three other injuries that occur in very close proximity to this bony protuberance: anconeus strain, triceps tendinopathy and supinator syndrome. The practitioner should carefully differentiate between tennis elbow and these other injuries.
In the 40+ age group, which is the most commonly affected population with this injury, lateral epicondylitis often presents as a tendinosis condition. As a reminder, tendinosis is typically related to chronic overuse, enthesopathy and microscopic degeneration of the tendon. The common local TCM Patterns for this condition are Qi and Blood Stagnation with Cold and Wind-Cold Painful Obstruction. In the younger age group, the practitioner may commonly find a different local TCM Pattern to present itself. Qi and Blood Stagnation with underlying Liver Blood Deficiency, which the TCM practitioner would develop the appropriate treatment plan for these different patterns.
Acupuncture & Moxibustion (Zhenjiu) for Lateral Epicondylitis
When treating lateral epicondylitis, the practitioner can choose appropriate points from the categories listed below. These categories include: Huatuojiaji Points, Motor Points of the Hua Tuo Arc, Target Tissue Needling, Acupuncture Point Combinations for TCM Patterns and Moxibustion.
Huatuojiaji Points
- C6-T1 (innervating spinal segments for the lateral elbow)
Motor Points of the Hua Tuo Arc
The Hua Tuo Arc is a treatment method developed by the author and consists of motor points of the agonist and antagonist muscles, along with the Huatuojiaji points of the innervating spinal segments of these muscles. The points of the Hua Tuo Arc can be included in the treatment protocol for patients of any age.
The practitioner should choose 1-2 motor points from both the agonist and antagonist muscle groups. Selection is based on maximum tenderness upon palpation of the motor points.
- Agonist muscles: Extensor carpi radialis brevis and longus, extensor digitorum communis and/or extensor carpi ulnaris.
- Antagonist muscles: Flexor carpi radialis, flexor carpi ulnaris and/or palmaris longus.
- Another supportive motor point is the teres major.
- Channel Mirror Image Motor Points: For lateral epicondylitis, use the medial head of the gastrocnemius, located on the Kidney channel. This choice is based on the midday/midnight channel correspondence between Kidney and Large Intestine.
Target Tissue Needling
- Lateral Epicondyle: Multiple Needle Puncture (Qi Ci)
The author modified the classical needle technique Qi Ci as a way of substantially improving the circulation of qi and blood at the injury site in lateral epicondylitis. Palpate the tendinous insertion on the lateral epicondyle to locate the most tender point (Fig. 2A). Insert two needles side-by-side superficially into the site. Twist the needles together back and forth until the patient reports a vibrating, spreading and warming sensation at or near the site of needle stimulation (Fig. 2B). To properly perform this technique, it is important to use uncoated needles with a coil handle.
Figure 2. Multiple Needle Puncture. A) Palpating the lateral epicondyle in preparation for needling. B) Rubbing the coil-handled needles together creates a vibratory, spreading and warming sensation to promote the movement of qi and blood.
- Channel Ashi Needling (Jing Luo Ci)
This classical needle technique, known as Jing Luo Ci, consists of needling ashi points along the affected channel. With lateral epicondylitis, the Large Intestine sinew channel will have many tender points located above and below the elbow. The practitioner will often find muscle motor points along the channel to be tender ashi points, specifically the following extensors: digitorum communis, carpi radialis brevis and longus. The practitioner should also include palpation to the lateral intermuscular septum in the region of LI 13 (shouwuli) for ashi point tenderness that when needled can be very effective in reducing the pain at the lateral epicondyle. Watch this cadaver dissection video of acupuncture to the LI myofascial sinew channel at the lateral intermuscular septum.
Acupuncture Point Combinations for TCM Patterns
- Qi and Blood Stagnation with Underlying Liver Blood Deficiency
LI 1 (shangyang), LI 5 (yangxi), LI 15 (jianyu), SJ 3 (zhongzhu), SJ 8 (sanyangluo), LIV 3 (taichong), LIV 8 (ququan), GB 34 (yanglingquan), SP 6 (sanyinjiao), UB 20 (pishu), ST 36 (zusanli), REN 6 (qihai). - Qi and Blood Stagnation with Cold
LI 5 (yangxi), LI 7 (wenliu), LI 11 (quchi), K 4 (dazhong), LIV 3 (taichong). - Wind-Cold Painful Obstruction
DU 14 (dazhui), LI 11 (quchi), SI 12 (bingfeng), LI 5 (yangxi), SJ 4 (yangchi), SP 9 (yinlingquan), ST 40 (fenglong), LU 7 (lieque).
Moxibustion
- Qi and Blood Stagnation with Underlying Liver Blood Deficiency
Direct moxa on the tendinous insertion site onto the lateral epicondyle. Pole moxa over the extensor carpi radialis brevis motor point, SP 6 (sanyinjiao), ST 36 (zusanli), REN 6 (qihai). - Qi and Blood Stagnation with Cold
Direct moxa on the painful extensor attachment site at the lateral epicondyle. Pole moxa over the extensor carpi radialis brevis motor point, LI 5 (yangxi), LI 7 (wenliu), LI 11 (quchi). - Wind-Cold Painful Obstruction
Direct moxa on the painful extensor attachment site at the lateral epicondyle. Pole moxa over the extensor carpi radialis brevis motor point, DU 14 (dazhui), LI 5 (yangxi), SJ 4 (yangchi), SP 9 (yinlingquan), ST 40 (fenglong), LU 7 (lieque).
The reader is encouraged to come back to the SMA blog as there are articles with unique insights in the assessment and treatment on musculoskeletal injury written by clinically successful practitioners of Sports Medicine Acupuncture.
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About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.
Related Posts
About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.