Sports injuries
Everyone knows exercise is good for you, but taking part in fitness activities or sports can lead to injury. Sports injuries can be caused by accidents, lack of fitness, poor training practices, improper gear or failure to warm up. Sports injuries fall into two general types. Acute traumatic injuries occur suddenly and usually involve a single application of force, for example, a hard tackle in football. They include fractures, breaks, bruises, sprains, strains and abrasions. Chronic or overuse injuries, by contrast, happen over a period of time. These injuries are usually the result of training that involves repetitive movements, such as running or serving a ball in tennis. Common types include shin splints and tendonitis. While it may be tempting to ignore overuse injuries as minor, seeking treatment is advised, as, left untreated, chronic injuries tend to get worse.
Injured athletes who receive acupuncture are often able to return to training more quickly than would otherwise be possible, and the treatment is therefore used by top sports people and athletes, including the British Rugby team, many Premiership football teams and the British Olympic team, to treat musculoskeletal problems.
Since keeping the body in balance promotes more efficient training, acupuncture is also increasingly being used to enhance athletic performance.
How acupuncture can help
Acupuncture stimulates the nervous system and causes the release of chemical messenger molecules. The resulting biochemical changes influence the body's self-regulating systems, stimulating its natural healing abilities.
Research has shown that acupuncture treatment can promote resolution of injuries by:
• providing pain relief (Pomeranz, 1987).
• increasing local microcirculation (Komori et al, 2009) which aids dispersal of swelling and bruising.
• suppression of the peripheral inflammatory response (Kim et al, 2008) and other anti-inflammatory mechanisms (Kavoussi & Ross, 2007, Zijlstra et al , 2003).
• breaking down scar tissue – controlled microtrauma causes a local inflammatory response, which initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures.
• promoting faster recovery after training sessions (Pan & Pan, 2007).
Acupuncture can be effectively combined with other treatments such as massage and rehabilitation exercises.
Research
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Conclusion
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Vrchota KD, Begrade MJ, Johnson RJ, Potts JF. True acupuncture vs. sham acupuncture and conventional sports medicine therapy for plantar fasciitis: a controlled, double-blind study. Int J Clin Acupuncture. 1991;2:247-252.
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Randomized controlled trial of acupuncture for plantar fasciitis. Compared real electroacupuncture with sham acupuncture and conventional sports medicine. 43 subjects randomised to the three treatments received 4 weekly treatments. At end of treatment period, and at 3-week follow-up, real acupuncture group experienced significantly greater decrease in pain than sports medicine group, allowing more rapid return to sports activity.
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Yang J. 32 cases of femoral adductors syndrome treated by electroacupuncture and moxibustion. J Tradit Chin Med. 1998 Dec;18(4):263-4.
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Ramdomized controlled trial of acupuncture for femoral adductors syndrome (FAS) caused by sports injury. 40 subjects, 32 treated with electroacupuncture plus moxibustion and 8 controls who received anti-inflammatory drugs. Both groups received 10 treatments. Acupuncture group performed better than control group with total effective rate of 87.5% vs 75%.
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Kleinhenz J, Streitberger K, Windeler J, Güssbacher A, Mavridis G, Martin E. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain. 1999 Nov;83(2):235-41.
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Randomized controlled trial of acupuncture for rotator cuff tendonitis involving 52 sportsmen. Compared real acupuncture with acupuncture using placebo needle. Patents received 8 treatments over 4 weeks. Found shoulder function scores in acupuncture group improved by 19.2 points, vs only 8.4 points in control group, a significant difference.
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Jensen R, Gøthesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med. 1999 Dec;5(6):521-7.
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Randomized controlled trial of acupuncture for patellofemoral pain syndrome. 75 patients randomly assigned to receive either semi-individualised acupuncture or no treatment. Patents received 8 treatments over 4 weeks. Over 12-months of trial and follow-up, acupuncture group knee pain and function scores improved by 17.2 points, vs 5.6 points in the controls, a significant superiority. Authors concluded that acupuncture showed a clear and long-lasting effect in reducing pain and improving function.
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Callison M (2002) Acupuncture and tibial stress syndrome (shin splints). J Chin Med. 2002:70: 24-7.
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Randomized controlled trial of acupuncture for shin splints. 40 athletes with shin splints were divided between three treatment groups, standard sports medicine, acupuncture and a combined group who received both. Participants received a minimum of 2 treatments per week for 3 weeks. Acupuncture and combined groups recorded significantly lower pain levels after treatment than sports medicine group – both during sports and non-sporting activities, and at rest. For overall effectiveness of the treatment on pain, 72.5% of the acupuncture group reported an improvement vs 54.5% of the combined group and 46.5% of the sports group. Self-medication with anti-inflammatories was also significantly lower in the acupuncture and combined groups.
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Pan H, Pan H. Impact of Acupuncture Applied to Sanyinjiao on the Movement Ability of Female Athletes. Int J Clin Acupuncture 2007;16(3):157-61.
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Observational study of effects of acupuncture on female swimmers. Found that acupuncture improved exercise tolerance, increased haemoglobin and blood glucose concentrations and promoted quick recovery. Authors concluded that acupuncture can delay the appearance of sports fatigue.
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Dhillon S. The acute effect of acupuncture on 20-km cycling performance. Clin J Sport Med. 2008 Jan;18(1):76-80.
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Prospective single blind crossover design study. 20 male cyclists underwent three tests a week, riding a stationary bike for 20km as fast as possible. Before each test, they received acupuncture, 'sham' acupuncture (shallow needling of known acupoints), and no intervention once each in a random order. Cyclists receiving acupuncture before their ride achieved greater levels of exertion, with faster cycling times and experienced less pain.
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Hübscher M, Vogt L, Bernhörster M, Rosenhagen A, Banzer W. Effects of acupuncture on symptoms and muscle function in delayed-onset muscle soreness. J Altern Complement Med. 2008 Oct;14(8):1011-6.
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Randomized controlled trial of acupuncture for exercise-induced muscle soreness. 22 healthy adults were randomly assigned to real acupuncture, sham acupuncture (superficial needling at nonacupuncture points) or control (no needling). Soreness of the elbow was induced through eccentric muscle contractions until exhaustion. After 72 hours, pain perception was significantly lower with acupuncture vs sham acupuncture and no treatment. Authors concluded that acupuncture reduced perceived pain arising from exercise-induced muscle soreness.
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Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.
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Needle activation of A delta and C afferent nerve fibres in muscle send signals to spinal cord, where dynorphin and enkephalins are released. Afferent pathways continue to midbrain, triggering excitatory and inhibitory mediators in spinal cord. Ensuing release of neurotransmitters serotonin and norepinephrine onto spinal cord leads to pain transmission being inhibited both pre- and postsynaptically in spinothalamic tract. Finally, these signals reach hypothalamus and pituitary, triggering release of adrenocorticotropic hormones and beta-endorphin.
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Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.
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Suggests hypothesis for anti-inflammatory action of acupuncture. Insertion of acupuncture needle initially stimulates production of beta-endorphins, CGRP and substance P, leading to further stimulation of cytokines and NO. While high levels of CGRP have been shown to be pro-inflammatory , CGRP in low concentrations exerts potent anti-inflammatory actions , therefore, a frequently applied 'low-dose' treatment of acupuncture could provoke a sustained release of CGRP with anti-inflammatory activity, without stimulation of pro-inflammatory cells.
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Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.
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Review article. Suggests that anti-inflammatory actions of traditional and electro-acupuncture are mediated by efferent vagus nerve activation and inflammatory macrophage deactivation.
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Kim HW, Uh DK, Yoon SY, Roh DH, Kwon YB, Han HJ, Lee HJ, Beitz AJ, Lee JH. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705. Epub 2007 Dec 26.
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Experimental study on rats. Results suggest that suppressive effects of low frequency electroacupuncture on carrageenan-induced paw inflammation are mediated by sympathetic post-ganglionic neurons, while suppressive effects of high frequency electroacupuncture are mediated by the sympatho-adrenal medullary axis.
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Komori M, Takada K, Tomizawa Y, Nishiyama K, Kondo I, Kawamata M, Ozaki M. Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg. 2009 Feb;108(2):635-40.
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Experimental study on rabbits. Acupuncture stimulation was directly observed to increase diameter and blood flow velocity of peripheral arterioles, enhancing local microcirculation.
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