In a recent issue of New York Times Magazine, a Mount Sinai hospital advertisement was headlined: "Knees are like car parts. It's better to get replacements from the original manufacturer."1
Huh? Meet soccer player Philip Pizzano whose knee injuries prompted osteochonditis. When microfracture surgery accelerated his pain, the solution was an allograft transplant.
Curious to know if Phil sought ABT or acupuncture? I called him. Phil knew nothing about acupuncture until he experienced a "lot of complications after surgery" that made him "feel lopsided." When physical therapy wasn't enough, friends nudged him toward acupuncture.
He praises Yuka Hagiwara LAc of NYC, whose needling helped alleviate the plantar fasciitis he experienced in his right foot that bore all his weight after (left) knee surgery. At 38, Phil is finally painfree and able to resume an active life. No more soccer but he's ardent about CrossFit training.
How About Those Aching Knees?
Phil's story isn't typical but it highlights a combo of knee therapies. Prevention is best, with cross training, stretching, building up the quads, and avoiding excessive weight gain. The National Center for Complementary and Integrative Health (NCCIH) advocates acupuncture for osteoarthritis of the knee.2
Many of my generation of Zen Shiatsu practitioners know the "knee dilemma" because of training, teaching and working on our knees on futons and tatami mats. Little did we know decades ago of the hazards ahead.
Our Dojo Training
In our training in the late 1970s-early 80s, the "form" required deft, Qi-inspired floor movements, seiza position and hours in Zen meditation. We slept on futons and ate cross legged at low tables. Even those of us who cycled, ran, did weights and practiced Qigong, faced knee problems after a couple of decades, and swapped work futons for tables. I advise all my students to cross train and include tables and chairs in their Shiatsu practice.
We attract clients with similar problems. We innovate treatments out of our raw experience. We talk in shorthand. About swollen knees, cluster varicose veins behind our knees, dancing patellas, pain caused by cold, damp weather conditions, water-on-the-knee, and the after effects of bicycle, or skiing, accidents.
Several years ago after teaching through a grueling Berlin winter on hard mats, I developed such knee pain and swelling I consulted an orthopedic surgeon in Basel Switzerland before my next workshop. He took one look at my knees and said, "What's this work you do?" He thought I was crazy. He prescribed intense physical therapy.
Within a week I received regular acupuncture and Shiatsu from Wilfried Rappenecker — founder of Shiatsu Schule Hamburg where I taught after Basel. My Swiss colleagues gave me a gel made from sea mussels and advised me to lather my knees with it every night — front and back. Such relief ! I recommend the gel to friends and clients on both sides of the Atlantic.
Insights Prompted by A Bike Accident
After a bike accident caused a compression fracture of the head of my tibia, I traveled across Europe and taught in a leg brace, jumping on and off the floor — one leg extended! A helpful exercise evolved spontaneously to alleviate stiffness and discomfort.
Balancing on my good leg, I performed circular midair movements with my leg in a brace by using the pull of gravity. It was fun, easy to do anywhere at anytime, even at the airport. This ensured hip flexibility — and taught me the value of using one set of joints to help the next in line. Every hip circle moved Qi down to my knee and on to my ankle joint.
I visualized Qi descending internally from the core of my hip, through femur to knee, then through tibia and fibula to ankle and metatarsals. Invaluable!
My great Shiatsu colleague and physical therapist, Bernhard Ruhla of Dresden Germany, performed daily isometric exercises with me when I taught for his group. Ruhla also advised me to walk barefoot and climb plenty of stairs.
Tips For Chronic Knee Pain
Another wonderful Shiatsu and Qigong colleague, Inge Berlin, a global teacher of physical therapy — taught me her "bounce" technique. Bounce? Cup your hands under the client's thigh in supine position, keep your hands on the table and elevate your fingertips into UB 36. Then bounce down the length of your client's leg UB to UB 60, pausing on UB 40 and UB 57. Repeat on the other leg. Then focus on points I have found most useful for a variety of knee problems. Points surrounding the knee:
Hold UB 40 and K 10 simultaneously, then curl your inner finger around K 10 toward the patella — very soothing for the tendons.
Face the knee — place four fingers at each corner of the patella. Alternate gentle pressure for a few seconds. Place the palm of your hand on the patella and do gentle circular movements.
Activate GB 37, and ST 36, then hold ST 36 and SP 6 simultaneously.
Some 700,000 knee replacement surgeries are performed in the U.S. each year.2 I advise clients, family members and friends to try every form of therapy before opting for a knee replacement.
My Swiss nephew faced such a choice but experienced intense pain after surgery, so I worked on him in his hospital bed in Basel. I performed ST and GB Shiatsu on the opposite leg, followed by on-and-off-the-body meridian-and-acupoint Qi-focus around the replaced knee and his feet. He was quick to tell me which points best alleviated pain.
After watching me work, his physical therapists invited me to teach the techniques to the entire physical and occupational therapy departments. They marveled at the simplicity.
References
"Knees are Like Car Parts." New York Times Magazine ad by Mt. Sinai, 2017.
Laliberte R. "Stop Knee Pain." AARP Magazine, Feb/March 2017.
Austin DR, et al. "Chronic Knee Pain: A study of Female Triathletes." Massage Today, August 2017.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Traditional Chinese medicine and the Vedic traditions both offer rich frameworks for understanding human health, emphasizing the balance of physical, mental, and spiritual aspects. The concept of "souls" or spiritual components in TCM, namely Hun, Po, Shen, Yi, and Zhi, bears significant similarities to the yogic concept of koshas. Their similarities and differences provide insights into how these systems contribute to holistic health practices.
