Avascular Necrosis and Acupuncture: A Comprehensive Guide

This guide explores the causes, symptoms, and stages of AVN, alongside the science and benefits of acupuncture as a complementary therapy. We’ll discuss how acupuncture can alleviate pain, improve circulation, and potentially slow disease progression, supported by research and clinical insights. Whether you’re newly diagnosed or exploring treatment options, this article provides a roadmap to understanding AVN and how acupuncture, offered by trusted providers can play a role in your recovery journey.

Understanding Avascular Necrosis

What is Avascular Necrosis?

Avascular necrosis occurs when blood flow to a bone is interrupted, causing bone cells to die. Without adequate blood supply, the bone structure weakens, leading to microfractures, collapse, and eventual joint damage. The hip, specifically the femoral head, is the most commonly affected site, but AVN can also occur in the knees, shoulders, ankles, and other bones. If untreated, AVN can result in severe pain and disability, often requiring surgical intervention like joint replacement.

Causes and Risk Factors

The exact cause of AVN varies, but several factors contribute to its development:

• Trauma: Fractures or dislocations, particularly in the hip, can damage blood vessels, leading to trauma-related AVN. For example, a hip dislocation may disrupt the blood supply to the femoral head.
• Corticosteroid Use: Long-term or high-dose use of steroids (e.g., prednisone) is linked to 35% of non-traumatic AVN cases, as steroids may impair blood flow or cause fat emboli to block vessels.
• Alcohol Consumption: Excessive alcohol use can lead to fatty deposits in blood vessels, reducing blood flow to bones.
• Medical Conditions: Diseases like systemic lupus erythematosus, sickle cell disease, and diabetes increase AVN risk by affecting vascular health.
• Other Factors: Radiation therapy, chemotherapy, and genetic predispositions may also contribute.

Approximately 50% of AVN cases are bilateral, affecting both sides of the body, such as both hips.

Stages of Avascular Necrosis

AVN progresses through four stages, each with distinct characteristics:

1. Stage I: Early changes detectable only by MRI, with no visible symptoms or minimal pain.
2. Stage II: Mild pain and haziness in bone structure on imaging, indicating early degeneration.
3. Stage III: Noticeable bone necrosis, slight collapse of the bone, and increased joint space on X-rays.
4. Stage IV: Severe bone collapse, joint deformity, and osteoarthritis, leading to significant pain and disability.

Early detection is critical, as interventions in Stages I and II are more likely to preserve joint function.

Symptoms of Avascular Necrosis

Symptoms of AVN develop gradually and vary by stage:

• Early Stages (I-II): Mild, intermittent pain in the affected joint, often worse with activity. For hip AVN, pain may radiate to the groin, thigh, or buttocks.
• Later Stages (III-IV): Persistent, severe pain, even at rest, with limited joint mobility, stiffness, and limping. In advanced cases, joint collapse can cause significant disability.
• Associated Symptoms: Muscle weakness, reduced range of motion, and, in bilateral cases, difficulty walking or performing daily tasks.

Diagnosis typically involves imaging (X-rays, MRI, or CT scans) and a physical exam to assess joint function and rule out conditions like osteoarthritis or fractures.

Conventional Treatments for Avascular Necrosis

Standard treatments aim to relieve pain, slow progression, and preserve joint function, but they vary by stage:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and bisphosphonates (e.g., Fosamax) to reduce the risk of bone collapse.
• Physical Therapy: Exercises to maintain joint mobility and strengthen surrounding muscles, often using crutches to reduce weight-bearing.
• Core Decompression: A surgical procedure to remove part of the bone’s inner layer, improving blood flow and relieving pressure. Effective in early stages.
• Joint Replacement: Total hip or knee replacement for advanced cases where the joint is severely damaged.
• Other Therapies: Electrical stimulation or shock wave therapy may be used to stimulate bone healing, though results are inconsistent.

While effective for some, these treatments have limitations. Surgery carries risks like infection or prolonged recovery, and medications may cause side effects. This has led many patients to explore acupuncture as a non-invasive, complementary approach.

Acupuncture: A Natural Approach to AVN Management

What is Acupuncture?

Acupuncture, a cornerstone of traditional Oriental  medicine (TOM), involves inserting thin, sterile needles into specific points on the body, known as acupoints, to restore balance and promote healing. In TOM, health depends on the smooth flow of energy and blood through meridians. Blockages or imbalances can cause pain and disease. Acupuncture aims to correct these imbalances, enhancing circulation and reducing inflammation.

For AVN, acupuncture targets acupoints around the affected joint and distal areas to alleviate pain, improve blood flow, and support tissue regeneration. Modern research suggests acupuncture influences the nervous system, releasing endorphins and modulating pain pathways, making it a promising therapy for musculoskeletal conditions like AVN.

How Acupuncture Works for Avascular Necrosis

Acupuncture addresses AVN through several mechanisms:

1. Enhanced Blood Flow: Acupuncture stimulates local circulation, potentially improving blood supply to the affected bone and surrounding tissues. Infrared imaging studies have shown increased circulation in joints like the ankle and wrist during acupuncture, suggesting similar benefits for larger joints like the hip.
2. Pain Relief: Needling triggers the release of endorphins and other natural painkillers, reducing discomfort without relying on medications.
3. Reduced Inflammation: Acupuncture may modulate the immune system, decreasing inflammation that exacerbates AVN symptoms.
4. Tissue Regeneration: Some studies indicate acupuncture influences stem cell activity, which could support bone repair in early-stage AVN.

Key acupoints for AVN, particularly of the femoral head, include LI4 (Hegu), ST36 (Zusanli), GB34 (Yanglingquan), SP6 (Sanyinjiao), and local points around the hip like GB30 (Huantiao). These points enhance circulation, relieve pain, and strengthen the musculoskeletal system.

Benefits of Acupuncture for Avascular Necrosis

Acupuncture offers several advantages for AVN patients:

• Non-Invasive: Unlike surgery, acupuncture involves minimal risk and no recovery downtime.
• Low Side Effects: When performed by a licensed practitioner, side effects are rare, typically limited to mild soreness or bruising.
• Holistic Approach: Acupuncture addresses pain, stress, and systemic imbalances, improving overall well-being.
• Complementary Therapy: It can be combined with physical therapy or medications to enhance outcomes.
• Potential for Early-Stage Intervention: Acupuncture may slow progression in Stages I-II, potentially delaying or avoiding surgery.

A 2016 randomized controlled trial found that acupuncture, compared to acupotomy (a more invasive needle-knife technique), improved Harris Hip Scores in patients with early- to mid-stage AVN, indicating better joint function and pain relief.

What to Expect During an Acupuncture Session

Initial Consultation

Your first session at a provider like Fuji Wellness begins with a detailed consultation. The acupuncturist will review your medical history, AVN diagnosis, and symptoms, assessing pain levels and joint function. They may ask about lifestyle factors like stress or activity levels to tailor the treatment.

Treatment Process

1. Preparation: You’ll lie on a treatment table, and the practitioner will sterilize the skin around targeted acupoints.
2. Needle Insertion: Thin needles are inserted into local points (e.g., around the hip) and distal points (e.g., on the hands or legs). You may feel a slight pinch or tingling, known as the De Energy sensation, indicating effective stimulation.
3. Needle Retention: Needles remain in place for 15-30 minutes. Some practitioners use electroacupuncture or laser acupuncture for enhanced effects, as seen in a case study where laser acupuncture improved bilateral femoral head AVN.
4. Post-Treatment: Needles are removed, and the practitioner may recommend follow-up sessions or complementary therapies like moxibustion (heat therapy) or massage.

Frequency and Duration

Treatment plans vary based on AVN stage and severity. Typically, patients attend 1-2 sessions per week for 6-12 weeks. Early-stage AVN may require fewer sessions, while advanced cases may need ongoing care. A case study reported significant improvement after three courses of 20 laser acupuncture sessions over several months.

Scientific Evidence Supporting Acupuncture for AVN

Research highlights acupuncture’s potential for AVN, particularly in early and middle stages:

• 2016 Randomized Controlled Trial: A study comparing acupotomy and acupuncture for femoral head AVN (Ficat-Arlet Stages I-II) found both treatments improved Harris Hip Scores, with acupotomy slightly outperforming routine acupuncture. However, acupuncture’s non-invasive nature makes it more accessible.
• 2021 Meta-Analysis: A systematic review of nine randomized controlled trials (630 patients) showed that acupuncture and moxibustion, combined with conventional therapy, improved effective rates, Harris Hip Scores, and reduced adverse reactions compared to conventional therapy alone.
• Case Report (2018): A 55-year-old woman with bilateral femoral head AVN experienced significant pain reduction and bone regeneration after three courses of laser acupuncture, avoiding surgery.
• Clinical Observations: Practitioners like Dr. Sinha in Delhi report improved circulation and pain relief in AVN patients after acupuncture, with benefits observed over 20 years of practice.

While more large-scale studies are needed, these findings suggest acupuncture is a safe and effective adjunctive therapy, particularly for pain management and functional improvement in early-stage AVN.

Key Acupoints for Avascular Necrosis

The following acupoints are commonly used for AVN, especially of the femoral head:

1. GB30 (Huantiao) – Gallbladder 30

Location: On the lateral hip, one-third of the distance between the greater trochanter and the sacral hiatus, near the gluteal muscles.

Function:

• Relieves hip pain and stiffness.
• Improves local blood circulation to the femoral head.
• Relaxes surrounding muscles and tendons.

Why It’s Used: GB30 is a primary local point for hip AVN, directly targeting the affected area to enhance blood flow and reduce pain, critical for addressing the ischemic nature of AVN.

Clinical Note: Often used with deep needling or electroacupuncture to stimulate circulation in the hip joint.

2. ST36 (Zusanli) – Stomach 36

Location: On the lower leg, 3 cun (about four finger widths) below the knee, one finger width lateral to the tibial crest.

Function:

• Boosts overall energy and blood flow.
• Strengthens the spleen and stomach meridians, supporting bone health.
• Enhances systemic circulation and reduces inflammation.

Why It’s Used: ST36 is a powerful distal point that promotes general vitality and improves blood supply to affected bones, making it effective for AVN management.

Clinical Note: Frequently combined with local hip points for a holistic effect, especially in early-stage AVN.

3. LI4 (Hegu) – Large Intestine 4

Location: On the hand, in the webbing between the thumb and index finger, at the highest point of the muscle when pressed together.

Function:

• Provides potent pain relief.
• Promotes Energy circulation throughout the body.
• Reduces systemic inflammation.

Why It’s Used: LI4 is a key distal point for pain management in AVN, helping to alleviate discomfort in the hip or other affected joints while supporting overall balance.

Clinical Note: Contraindicated in pregnancy due to its strong stimulating effects.

4. SP6 (Sanyinjiao) – Spleen 6

Location: On the inner lower leg, 3 cun above the medial malleolus, posterior to the tibia.

Function:

• Nourishes the spleen, liver, and kidney meridians, which are linked to bone health in TOM.
• Enhances blood flow and tissue repair.
• Reduces pain and muscle tension.

Why It’s Used: SP6 supports bone regeneration and systemic circulation, making it ideal for AVN patients, particularly in early stages where tissue repair is possible.

Clinical Note: Often used in combination with ST36 to strengthen the body’s foundational energy.

5. GB34 (Yanglingquan) – Gallbladder 34

Location: On the lateral lower leg, in the depression anterior and inferior to the head of the fibula.

Function:

• Relaxes tendons and ligaments.
• Improves circulation in the lower limbs and hip.
• Alleviates pain and stiffness.

Why It’s Used: GB34 is effective for musculoskeletal issues, including hip AVN, as it supports tendon health and enhances blood flow to the lower body.

Clinical Note: Useful for patients with referred pain or stiffness extending to the legs.

6. BL11 (Dazhu) – Bladder 11

Location: On the upper back, 1.5 cun lateral to the lower border of the T1 vertebra, near the medial border of the scapula.

Function:

• Strengthens bones and joints.
• Promotes circulation in the upper body.
• Relieves pain and stiffness in the shoulder or upper back, which may accompany AVN.

Why It’s Used: BL11 is a key point for bone-related conditions in TOM, making it valuable for AVN, especially in cases affecting the shoulder or when systemic bone health is a concern.

Clinical Note: Often paired with local points like GB30 for comprehensive treatment.

7. Ashi Points (Local Tender Points)

Location: Variable, typically tender areas around the affected joint (e.g., hip, knee, or shoulder).

Function:

• Directly targets localized pain and inflammation.
• Improves blood flow to the specific site of necrosis.
• Relaxes surrounding muscles.

Why It’s Used: Ashi points are individualized to the patient’s pain patterns, making them essential for addressing the unique presentation of AVN in each case.

Clinical Note: Identified by palpation during the session, often combined with other acupoints for enhanced effect.

How These Acupoints Are Used in Treatment

• Local Points (GB30, Ashi Points): Target the affected joint (e.g., hip) to improve local circulation, reduce pain, and alleviate stiffness, addressing the core issue of reduced blood flow in AVN.
• Distal Points (ST36, LI4, SP6, GB34, BL11): Enhance systemic Energy and blood flow, support bone health, and provide additional pain relief by stimulating distant meridians connected to the affected area.
• Combination Therapy: Acupuncturists at Fuji Wellness often combine local and distal points for a holistic approach. For example, needling GB30 locally and ST36 distally can maximize pain relief and circulation to the femoral head.
• Techniques: Practitioners may use manual needling, electroacupuncture (applying mild electrical stimulation), laser acupuncture (non-invasive light-based stimulation), or moxibustion (applying heat to acupoints) to enhance outcomes. A 2018 case study noted improved bone regeneration with laser acupuncture on GB30 and SP6.

Risks and Considerations

Acupuncture is generally safe when performed by a licensed practitioner. Potential risks include:

• Minor Discomfort: Temporary soreness, bruising, or tingling at needle sites.
• Infection: Rare with sterile needles and proper technique.
• Contraindications: Not suitable for patients with bleeding disorders or those on blood thinners without medical clearance.

Choose a certified acupuncturist, such as those at Fuji Wellness, with experience in treating musculoskeletal conditions. Discuss your AVN stage, medications, and health conditions to ensure safe treatment.

Complementary Therapies for AVN

Acupuncture is often combined with other therapies to enhance outcomes:

• Moxibustion: Applying heat to acupoints to warm meridians and improve circulation.
• Massage Therapy: Vigorous massage targeting leg meridians (e.g., kidney, spleen) can enhance Energy and blood flow to the hip.
• Physical Therapy: Exercises to maintain joint mobility and strengthen muscles, reducing stress on the affected bone.
• Herbal Medicine: TOM herbs like kidney yang tonics or blood-vitalizing formulas may support bone repair.
• Ayurvedic Treatments: Some patients combine acupuncture with Ayurvedic therapies like medicated enemas or herbal pastes, which have shown promise in AVN management.

Lifestyle Tips for Managing AVN

• Reduce Weight-Bearing: Use crutches or a cane to minimize stress on affected joints.
• Healthy Diet: Anti-inflammatory foods like omega-3-rich fish, nuts, and greens support healing.
• Limit Alcohol and Steroids: Avoid triggers that worsen vascular health.
• Stress Management: Practices like yoga or meditation can reduce pain perception and improve well-being.

Choosing an Acupuncturist

When selecting an acupuncturist for AVN, consider:

• Credentials: Look for certification from organizations like the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
• Experience: Choose a practitioner skilled in treating orthopedic conditions, like those at Fuji Wellness.
• Patient Reviews: Check testimonials for evidence of successful outcomes.
• Communication: Ensure the practitioner explains the treatment plan clearly and addresses your concerns.

Acupuncture vs. Other Treatments

Treatment	Pros	Cons
Acupuncture	Non-invasive, low side effects, improves circulation	Requires multiple sessions, limited evidence for advanced stages
Physical Therapy	Maintains mobility, non-invasive	May not address pain fully, time-intensive
Medications	Quick pain relief, may slow progression	Side effects, limited long-term benefits
Surgery	Effective for advanced cases	Invasive, risks complications, long recovery

Acupuncture’s non-invasive nature and ability to improve circulation make it a compelling option, especially for early-stage AVN.

Conclusion

Avascular necrosis is a challenging condition that can significantly impact quality of life, but acupuncture for avascular necrosis offers a promising, non-invasive solution. By improving blood flow, reducing pain, and supporting tissue repair, acupuncture can complement conventional treatments, particularly in early stages. Research and patient stories underscore its efficacy, making it a valuable option for those seeking holistic care.

If you’re considering acupuncture for AVN, consult a licensed practitioner to develop a personalized treatment plan. With consistent sessions and complementary lifestyle changes, you can manage symptoms and potentially slow disease progression. For expert care, contact Fuji Wellness today, a trusted provider of acupuncture and holistic health services, to start your journey toward pain relief and improved mobility.

Fuji Wellness:

• Address: 132-0031 Matsushima 1-chome, 21-14, Tokyo, Japan
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• Email: sunnyphamsensei@gmail.com