Influence of acupuncture on physical performance capacity and haemodynamic parameters

Acupuncture in Sports Medicine

Acupuncture is gaining popularity and wider acceptance as a treatment modality within the field of sports medicine. Our objective was to provide a comprehensive review of the existing literature pertaining to acupuncture in sports medicine to shed light on approaches utilized in acupuncture while revealing its personalized nature and its impact on athletes' preparation, performance, and recovery. We evaluated acupuncture research in the context of medicine and sports-related injury treatment, assessing its impact on athletic performance across demographics of athletes. Athletes participating in most sports have shown positive outcomes from acupuncture interventions. Acupuncture improves peak oxygen levels, maximum heart rate, delayed-onset muscle soreness, pain, swelling, explosive force production, and joint mobility. Furthermore, the efficacy of acupuncture appears to be similar regardless of age and sex. Lastly, the acceptance of acupuncture is influenced by cultural factors, with Western and traditional East Asian cultures exhibiting distinct perspectives on its rationale and mechanisms of action. Traditional East Asian acupuncturists typically employ qi and meridian theories in their acupuncture practices, with the recent incorporation of Western concepts. Acupuncture shows promise as an effective treatment for musculoskeletal pain and neuropathies in athletes across different age groups and for addressing injuries in various sports. Our comprehensive review will enhance our understanding of acupuncture's potential as a complementary or distinct therapeutic approach compared to conventional therapies. Additionally, our review explores its specific applications within different sports and delves into the cultural dimensions involved in integrating this practice into modern sports medicine.

Acupuncture and Dry Needling for Sports Performance and Recovery

ABSTRACT

Acupuncture and dry needling share many similarities in their proposed mechanisms of action and their sports medicine-related applications. Pain is the most common indication for these needling treatments, but there also are some limited studies on their use for ergogenic purposes. Needling can likely improve muscular strength and power, including increasing jump height, and it also can increase flexibility. In terms of sports recovery, acupuncture can not only be used for pain relief after injury, but also can help with routine recovery, such as in delayed onset muscle soreness. There are numerous case reports of acupuncture and dry needling being used to treat athletes for various diagnoses and conditions, however more high quality studies are needed in order to make more specific evidence-based recommendations. Given the high degree of safety and limited adverse events associated with needling treatments, it can likely be promoted in athletes.

Effect of acupuncture in physiological parameters and endurance running performance

BACKGROUND

Few studies have examined the effect of acupuncture (AC) treatment in aerobic capacity and endurance performance in healthy adults. Thus, the aim of the present study was to evaluate the effects of AC on selected physiological parameters and 3 km running performance.

METHODS

Twenty-four healthy subjects with low to moderate aerobic capacity participated in the study and randomly assigned in two groups: AC group (ACG - N.=14) and control group (CG - N.=10). The subjects completed an incremental test to exhaustion and a 3 km race on a treadmill to evaluate their physiological responses and endurance running performance respectively, prior and after 4 weeks (8 sessions, twice a week) of acupuncture treatment.

RESULTS

AC treatment had a significant main effect in T3km [F(1, 21)=7.173, P=0.014, partial η2=0.255], as well as in VT [F(1, 21)=8.476, P=0.008, partial η2=0.288] and HRmax@3km [F(1, 21)=4.930, P=0.038, partial η2=0.190], after controlling for the effect of the pre-test, while no other significant main effects were detected.

CONCLUSIONS

Healthy physically active adults significantly improved their endurance running performance after 4 weeks of AC treatment. This is mainly due to the enhancement of the speed corresponding with VT, comparing with their baseline values.

TREATMENT OF SPORT INJURIES WITH ACUPUNCTURE: A LITERATURE REVIEW

ABSTRACT As acupuncture is growing in popularity in Brazil and worldwide, it is necessary to study the benefits and possibilities of this type of treatment more in depth, especially as it is believed to produce fast results with few side effects and does not involve substances banned in sports. Thus, it seems like a good option to be considered as main or adjuvant therapy in sports-related injuries. In order to gain more knowledge about this subject, this article is an integrative review analyzing the publications of the period between January 2012 and January 2017 on the Cochrane and Pubmed platforms that analyzed acupuncture in the treatment of sports injuries. We found 49 articles, 11 of which fulfilled the inclusion criteria: two case reports, three clinical trials and six literature reviews. Although all the articles analyzed produced favorable results with the use of the therapeutic technique in question, flaws in the designs of the studies and the difficulty of creating a placebo control group in acupuncture hinder the qualification of the articles on evidence rating scales. Therefore, it is suggested to the researchers that further studies be published with experimental animal models and observational studies, and that STRICTA recommendations be followed to improve the level of evidence of acupuncture research. Level of Evidence II; Systematic review of level II studies.

The Effect of Auricular and Systemic Acupuncture on the Electromyographic Activity of the Trapezius Muscle with Trigger Points-A Pilot Study

The purpose of this study was to analyze and compare intra and intergroup the immediate effect of the auricular and LR8 systemic acupuncture on the electromyographic activity of the trapezius with the trigger points. This is an experimental clinical trial; 40 people were split in 4 distinct groups (n = 10): GI mustard seed application in the auricular acupoint; GII bilateral needle application in the LR8 acupoint; GIII combination of the techniques; GIV/Control Group mustard seed application in an acupoint not linked to the muscle tension. The EMG was used to assess the muscle contraction for 5 seconds during the resting time and during the isometric contraction time. The EMG signal was first collect without the acupuncture intervention; then both techniques were applied for 5 minutes; and the EMG was collected again right after these applications. The Shapiro-Wilk test was used, the t test was paired with the Wilcoxon test to the intragroup comparison; One-way analysis of variance test for intergroup comparison. There was no statistical difference in the intragroup comparison for the groups. The same happened to the intergroup comparison before and after application. Systemic and auricular acupuncture did not promote immediate changes in the EMG activity of the trapezius muscle in individuals with MTrPs.

Electromyographic and strength analyses of activation patterns of the wrist flexor muscles after acupuncture

This study analyzed the electromyographic and strength responses of the flexor muscles of the wrist following stimulation of acupuncture points. A total of 52 participants were randomly divided into four groups: local (heart 3, HT3), distant (heart 4, HT4), control (bladder 60, BL60), and naïve control groups. To obtain the root mean square electromyographic activity, we placed surface electrodes over the wrist flexors. To obtain kilogram force (kgf) values, we attached a force transducer to the floor and to the hands of participants. Both values were recorded over three repetitions of maximal isometric wrist flexion contractions. Data were analyzed using one-way analyses of variance, followed by Dunnett's post-hoc tests. We found reductions in electromyographic activity contralateral to the stimulated point in the distant group 10 minutes after removal of the needles (F(3,48) = 3.25; p < 0.05). Regarding muscle strength, ipsilateral and contralateral stimulation in the distant group produced kgf levels prior to and 10 minute and 20 minutes after withdrawal of the acupuncture needle that were lower than that obtained prior to insertion of the needle (F(3,48) = 5.82; p < 0.05). Thus, stimulation of the acupuncture points distant from the wrist flexors reduced ipsilateral and contralateral muscle strength and decreased the root mean square values contralateral to the site of stimulation.

Effects of Acupuncture Stimulation on Recovery Ability of Male Elite Basketball Athletes

Developing effective methods for helping athletes recover from muscle fatigue is deemed essential, particularly on the eves' important competitions. This study aimed to investigate the effects of acupuncture stimulation on athletes' recovery abilities. Subjects were selected from 30 male elite university basketball players who were randomly assigned to 3 groups: acupuncture group, sham group, and normal (control) group, each containing 10 subjects. Acupuncture was carried out on each athlete in acupuncture group at the Neiguan (PC6) and Zusanli (ST36) acupoints, beginning at 15 min prior to exercise and continuing until exhaustion of the subject. Similar acupuncture was also carried out on each athlete in the sham group but the positions were 1 cm away from the PC6 and ST36 acupoints. No acupuncture was conducted on the athletes in the normal group. During the experiments, each subject performed separate runs on the treadmill. The data of heart rate (HRmax), oxygen consumption (VO2max), and blood lactic acid were measured during the rest period and at 3 recovery points of time (5th, 30th and 60th min) post-exercise. The results showed that the acupuncture group (PC6 and ST36) has significantly lower HRmax, VO2max and blood lactic acid than both the sham and normal groups at the 30th min post-exercise. Blood lactic acid of the acupuncture group was also significantly lower than that of the other two groups in the 60th min post-exercise. Our findings have shed some light on the development of effective acupuncture schemes to enhance the recovery ability for elite basketball athletes.

Stimulation of acupoint ST-34 acutely improves gait performance in geriatric patients during rehabilitation: A randomized controlled trial

OBJECTIVE

To determine whether a specific regimen of acupoint stimulation improved gait performance in geriatric patients.

DESIGN

Multiple-blinded, randomized, controlled intervention trial.

SETTING

Geriatric ward rehabilitation.

PARTICIPANTS

60 geriatric patients during rehabilitation.

INTERVENTIONS

Both groups received a 1-time acupoint stimulation according to randomization. Stimulation of a verum acupoint (verum treatment) according to principles of traditional Chinese medicine was compared with a technically identical needle application on a nonacupoint (control treatment) in the control group.

MAIN OUTCOME MEASURES

Descriptive parameters were documented by valid, established tests. Gait performance was objectively measured by an electronic walkway before needling and after needling.

RESULTS

All gait parameters showed statistically significant improvement after verum treatment compared with control treatment (velocity, cadence, stride length, cycle time, step time, single support, double support: P values all <.05) except for the base of support (P=.163). Effect sizes achieved by 1-time stimulation of an acupoint were low and ranged from .08 to .24. No severe adverse clinical events related to the intervention occurred.

CONCLUSIONS

Study results showed that a 1-time administration of a specific acupoint stimulation regimen statistically significantly improved gait performance during geriatric ward rehabilitation. If sustainability of effects can be documented, acupuncture may prove to be an inexpensive intervention that may mildly improve motor performance in frail geriatric patients.

The acute effect of acupuncture on 20-km cycling performance

OBJECTIVE

To examine acupuncture's effect on cycling performance.

DESIGN

This was a prospective, single-blind, patient as own control (repeated measures), crossover design. Subjects underwent 3 tests a week, riding a stationary bike for 20-km as fast as able. Before each test, they received acupuncture (test A), "sham" acupuncture (test B), and no intervention (control, test C) once each in a random order.

SETTING

University of Alberta, Faculty of Rehabilitation Medicine.

PARTICIPANTS

20 male cyclists (age, 18 to 30 years) were recruited via convenience sampling of students and general public. Athletic ability was assessed through a questionnaire and modified Par-Q.

INTERVENTIONS

Acupuncture, sham acupuncture, and no intervention in random order with each subject before each test. Acupuncture points were chosen on the basis of Traditional Chinese Medicine and administered immediately before cycling. Sham was shallow needling of known acupoints.

MAIN OUTCOME MEASUREMENTS

The outcome measures of each of the tests were time to completion, VAS for lower extremity/exercise-induced pain, Borg rating of perceived exertion (RPE), and blood lactate concentrations, recorded immediately following each test.

RESULTS

Mean times to Test A, B, and C completion were 36.19 +/- 5.23, 37.03 +/- 5.66, and 37.48 +/- 6.00 minutes, respectively, P = 0.76. Mean RPE scores after tests A, B, and C were 17.65 +/- 0.67, 16.95 +/- 0.99, and 16.85 +/- 0.88, respectively, P = 0.0088. Mean VAS scores after tests A, B, and C were 7.72 +/- 0.86, 7.94 +/- 0.78, and 8.08 +/- 0.69, respectively, P = 0.76.

CONCLUSIONS

The only statistically significant finding was that acupuncture gave higher RPE scores compared to the other tests. The clinical significance was that the higher RPE scores gave lower time and VAS scores.

Effect of transcutaneous electrical acupoint stimulation on fatigue recovery of the quadriceps

The aim of this study was to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) at selected acupoints on enhancing the rate of muscle force recovery after strenuous knee extension/flexion exercise. Ten male and seven female healthy young adults participated in this study in which they performed isokinetic knee fatigue exercise on the Biodex System 3 ergometer on three separate days. After the familiarization trial on day 1, subjects underwent 15 min of either TEAS or pseudo-TEAS recovery treatment after the isokinetic exercise in the following two trials on days 2 and 3, respectively. The TEAS treatment was applied on four selected acupoints [Zusanli (ST36), Chenshan (BL57), Yanglingquan (GB34) and Sanyinjiao (SP6)] while the pseudo-TEAS treatment was applied to the points away from the true acupoints. Isometric knee extension peak torque was measured before and immediately after the test exercise, and again during the 15-min recovery period at 5-min intervals. Blood lactate and median power frequency (MF) of the vastus medialis, vastus lateralis and rectus femoris were also measured at the same time points. The results indicated that the TEAS treatment was significantly more effective than the pseudo-TEAS treatment in enhancing the rate of muscle force recovery (knee extension peak torque recovery after 15 min, from 155 to 195 Nm in TEAS group and from 155 to 182 Nm in the pseudo-TEAS group), but had no effect on lactate removal and MF restitution rate. It is proposed that pain control is a plausible mechanism to explain the benefit of TEAS treatment. As TEAS is a non-invasive and simple treatment, it is feasible to apply it during and immediately after training.

[Acute effects of needle acupuncture on power performance during stretch-shortening cycle]

BACKGROUND

Some studies have shown beneficial effects of needle acupuncture on physical performance.

OBJECTIVE

To evaluate immediate effects of a standardized acupuncture treatment on vertical jumping performance.

SUBJECTS AND METHODS

12 healthy sport students participated in the study. A randomized crossover design was used to investigate specific effects of real acupuncture, sham acupuncture and a no-acupuncture waiting list condition on myoelectric activity and kinematic parameters (duration of ground contact, maximum jumping height) in one-legged drop jumps.

RESULTS

The results of the present study do not demonstrate significant treatment effects on myoelectric and kinematic parameters. However, real acupuncture tends to result in a relative decrease in the duration of ground contact accompanied by increased muscular innervation.

CONCLUSION

Acupuncture treatment had no significant impact on muscular performance of lower leg in stretch-shortening cycle under the present conditions. As to further research, the potential efficacy of acupuncture for improving reactive strength should be investigated in terms of controlled trials with stratified randomization according to physical performance capacity.

Effects of acupuncture on the 5-hydroxytryptamine synthesis and tryptophan hydroxylase expression in the dorsal raphe of exercised rats

In the present study, the effects of acupuncture on the endurance treadmill exercise, serotonin (5-hydroxytryptamine, 5-HT) synthesis, and tryptophan hydroxylase (TPH) expression in the dorsal raphe nuclei were investigated. Acupunctural stimulation were bilaterally inserted into the locus of Zusanli in each hind leg for 20 min. Onset of exhaustion time on the treadmill running was increased significantly by acupunctural stimulation and exercise-induced increments of the 5-HT synthesis and TPH expression in the dorsal raphe were suppressed by acupunctural stimulation. Based on the results, it can be suggested that the suppressive effects of acupunctural stimulation on the 5-HT synthesis and TPH expression in the dorsal raphe during exercise is one of ergogenic mechanisms of acupuncture.

Pressor effect on blood pressure and renal nerve activity elicited by electroacupuncture in intact and acute hemorrhage rats

The neural mechanism underlying the effect of electroacupuncture (Ea) on arterial blood pressure (BP) and renal nerve activity (RNA) in the intact state and during acute hemorrhage was investigated in anesthetized rats. Two acupoints, Hoku (Li-4, at the junction of the first and the second metacarpal bone) and Tsusanli (St-36, at the lateral upper tibia bone), were tested using Ea of two different frequencies (2 and 20 Hz). In the intact state, Ea at Hoku elicited an elevation of BP in parallel with RNA, while Ea found no response with identical parameters at Tsusanli. The pattern of the pressor response caused by a low frequency Ea (2 Hz) at Hoku was different than a high frequency one (20 Hz), i.e. a tonic effect was elicited with 2 Hz, while a phasic one was induced with 20 Hz. In mild hemorrhage conditions (10% of BP decrease), similar pressor effects, as in intact rats, were also elicited by Ea. However, in severe hemorrhage conditions (20 and 30% BP decrease), Ea induced a pressor effect on RNA and an attenuated effect on BP. BP and RNA showed a significant correlation in intact and mild hemorrhage conditions, but not in severe hemorrhage conditions. All the results suggested that Ea at Hoku with appropriate stimulation parameters can increase and maintain BP in normal and hemorrhage conditions, and such a therapeutic technique has potential in clinical practice.

Stages in the development of a research project: putting the idea together

We have considered some of the most important factors involved in designing a viable study that will adequately address the research question. Although we do not profess to be experts in all aspects of the above, we have learned through experience that attention to many of the above points will help to avoid frustration during the experimental process and when the study is presented for external review and subsequent presentation and publication. Good luck in your research.

Effects of non-invasive stimulation of acupoints on the cardiovascular system

OBJECTIVE

To study the effect of two non-invasive methods to stimulate acupoints on the cardiovascular system.

DESIGN

Blind randomized-controlled trial.

SETTING

An experimental setting in a university-affiliated hospital.

INTERVENTIONS

The subjects (24 healthy male volunteers) were randomized to receive either an active stimulation consisting of pressure on acupoints (P), an active stimulation consisting of stroking along the meridians (S) or a control stimulation (C).

MAIN OUTCOME MEASURES

Data on skin blood flow, arterial pressure, heart rate and EKG were recorded continuously from 20 min before stimulation to 30 min after.

RESULTS

In P group there was a decrease in systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate and skin blood flow. These changes were significantly different from those in C group and, as regards diastolic pressure and mean pressure, also from those in S group. There were no significant differences between S and C groups.

CONCLUSIONS

Pressure on acupoints can significantly influence the cardiovascular system.

Methodological and ethical issues in clinical trials of acupuncture

In this review, controlled clinical trials of acupuncture are placed into five categories on the basis of the treatment with which acupuncture is compared. Methodological and ethical issues relevant to each category are discussed. Wait list (or no treatment) controls, which are ethically acceptable for stable, chronic conditions, assess the efficacy of acupuncture relative to the natural history of the condition but do not control for nonspecific treatment effects. Placebo controls, defined here as noninvasive procedures such as inactive transcutaneous electrical nerve stimulation (TENS) or mock needling, assess whether acupuncture has an effect beyond that of the therapeutic milieu. Sham controls, defined as invasive but inappropriate procedures such as shallow needling at nonacupoint sites, assess whether acupuncture efficacy depends on the style and location of needling. Standard care comparisons assess whether acupuncture performs at least as well as a medication, medical device, or physiotherapy. Adjunctive care comparisons assess the efficacy of acupuncture plus standard care relative to standard care alone. From an ethical perspective, active debate surrounds placebo and sham controls. Those who argue against these procedures consider withholding treatment to be improper. They favor the wait list and both standard care designs in which all patients receive treatment. Others argue that testing a treatment prior to demonstrating its efficacy against a placebo is equally improper. From a methodological perspective, it should also be considered that most clinical trials of acupuncture have assessed its efficacy by administering a fixed course of treatment based on biomedical diagnosis. The challenge for future trials is to design conditions that more closely mimic the delivery of acupuncture in clinical practice, as individualized treatment informed by its own diagnostic traditions.

Acute effects of acupuncture on physiological and psychological responses to cycle ergometry

OBJECTIVE

Recent research has reported an improvement in exercise capacity following a series of acupuncture treatments. We examined the immediate effects of a single acupuncture treatment on perceived exertion and physiological responses during submaximal dynamic exercise, and maximal exercise capacity in human subjects.

DESIGN

Ten healthy subjects (5 men, 5 women) participated in the study. After demonstrating consistency in using the rating of perceived exertion (RPE) scale, each subject underwent graded continuous maximal exercise testing on a cycle ergometer after genuine acupuncture, sham acupuncture, and rest without needles being inserted. Treatment conditions were randomized for each subject, and tests were conducted at least 72 hours apart. Heart rate and oxygen uptake were measured, and RPE was requested during the last 30 seconds of each 3-minute exercise stage. Data were analyzed with repeated-measures analysis of variance.

RESULTS

There were no statistically significant differences among conditions for RPE, oxygen uptake, heart rate, respiratory exchange ratio, ventilation, and ventilatory equivalent for oxygen at submaximal workloads. In addition, none of the physiological measures at peak exertion or the duration of exercise differed among conditions.

CONCLUSIONS

A single acupuncture treatment has no significant immediate effect on the perceived exertion and physiological responses during submaximal dynamic exercise or upon maximal exercise capacity among healthy individuals.