Injuries and Sport

Who uses Acupuncture for Injuries?

Acupuncture for sports injuries: Tour of Britain cycle race between Crediton & Tiverton In this introduction to acupuncture treatment for injuries, the term injuries can be taken to include all physical trauma, whether caused by playing sport, accidents, falls etc. On the sports front in particular, acupuncture is used by the British Olympic team, the British Rugby team, and many Premier League football teams, because it allows them to return to training more quickly.

Double-Olympic champion Rebecca Adlington, says acupuncture helped her throughout her career, having received it for a shoulder injury among other things. Retired Olympic heptathlon champion Jessica Ennis-Hill, says “I’ve had acupuncture after training injuries, just to get deep into the muscle. It works really well.” Chris Hoy, Olympic cycling champion, has used acupuncture for both injury treatment and prevention, describing it as an integral part of his therapy routine. Whilst he was an England batsman, Kevin Pietersen had acupuncture to help with injury. Former British tennis number one Tim Henman says,“When I’ve had muscle soreness or tightness in my lower back, feet and elbows, acupuncture has been very good.”

In the military arena, a full-time acupuncture consultant reports to the US Air Force Surgeon General. He ensures use is made of the experience gained by the USAF using acupuncture to help with injuries sustained during campaigns in recent years.

Injuries are of two broad types:

Acute Injuries

These result from sudden incidents eg. spraining your ankle walking over uneven ground, being badly tackled in football, or suffering a whiplash injury when hit from behind in a car. These benefit from prompt assessment. A few acupuncture sessions spaced closely together and started as soon as possible, can be extremely helpful.

Chronic Injuries

Racquet sports are fast and fun, but can lead to sprains and strains.When problems have persisted for weeks or months, they are classed as chronic. They usually result from the repetitive application of forces to the same part of the body. Tennis elbow and cyclists’ knee problems are common examples from sport, but there are many occupations which require repetitive movements or use of a particular tool or body joint all day long. These injuries essentially stem from overuse and/or overload of the affected area, so rest is a crucial component of treatment. Acupuncture in this case may be required for a little longer, depending on the severity of the condition. Sessions can though be more widely spaced, say a week apart.

Research shows acupuncture can promote the healing of injuries by providing pain relief, breaking down scar tissue, and reducing swelling, bruising and inflammation. In the sports arena, it has also been shown to promote more rapid recovery after training sessions.

Below, you will find a selection of research papers, which have looked at the usefulness of acupuncture for injuries.

Acupuncture helps Exercise-Induced Muscle Soreness

Acupuncture helps Exercise-Induced Muscle Soreness. Researchers at Fernando Pessoa University in Portugal have shown that acupuncture helps exercise-induced muscle soreness. A total of 45 university physiotherapy students were randomised to either an acupuncture treatment group, a sham acupuncture group, or a control group. Exercise-induced muscle damage was brought on by five sets of twenty, barefoot drop jumps. Muscle soreness and pressure-pain threshold were then assessed at different time points: before the first acupuncture session; 20 minutes after acupuncture; 24 hours later; before the second acupuncture session; 20 minutes after acupuncture. Acupuncture was performed for two minutes. The control group simply rested for two minutes.

Both acupuncture groups exhibited improvements, but only in the true acupuncture group did pressure-pain threshold increase significantly. True acupuncture reduced the occurrence of acute muscle soreness by one-half, and delayed-onset muscle soreness by one-third. The authors state “The outcomes of our study may be of notable relevance to athletic healthcare, as acupuncture could have beneficial effects on training capacity, long-term competition performance and the incidence of sports injuries.”

(Acupuncture can be beneficial for exercise-induced muscle soreness: A randomised controlled trial. Journal of Bodywork & Movement Therapies, January 2020.)

Acupuncture helps Prevent Muscle Soreness in Footballers

Acupuncture helps prevent muscle soreness in footballers. American researchers have shown that acupuncture can help to prevent delayed-onset muscle soreness in footballers. In a prospective feasibility study, 42 healthy male participants aged 13 to 18, received treatment on at least one of five treatment days. In all, 147 individual treatments were given, lasting 15 minutes each and targeted at the main muscle groups of the legs. Delayed-onset muscle soreness (DOMS) was significantly improved.

The researchers conclude that providing acupuncture to multiple adolescent football players in their training environment is feasible with appropriate staff and resources. Despite mild adverse effects such as tingling or numbness, the treatment was well tolerated. This study provides guidance on acupuncture delivery to other athletes in their training environments.

(The Feasibility and Effects of Acupuncture on Muscle Soreness and Sense of Well-being in an Adolescent Football Population. American Journal of Physical Medicine & Rehabilitation, November 2019.)

Acupressure Improves Aerobic Performance

Acupuncture in Exeter: acupuncture research from Turkey. Research from Turkey suggests acupressure improves aerobic performance in healthy young men, by 10%. Forty subjects were randomly allocated to receive either three minute acupressure at three acupuncture points, or a placebo acupressure session. Both groups were subjected to a six minute step test both before and after the intervention, and VO2 max measured. In the true acupressure group, this figure had increased significantly from baseline, whereas in the placebo group it remained unchanged.

The team suggest that acupressure decreased participants’ anxiety levels, allowing better utilisation of available energy sources.

(Effect of Meridian Acupressure on Aerobic Performance of Healthy Young Population: A Randomized Controlled Study. Journal of Alternative & Complementary Medicine, 20 February 2018.)

Cupping Therapy

Cupping therapy: a selection of cups of different sizes.
Since this summer’s Olympics, and those widely publicised photos of Michael Phelps, many people have asked me about cupping therapy. In particular, is there any research evidence to support its use? It’s been practised by acupuncturists for centuries alongside their needling, but it’s only in recent years that it has really captured public interest. Most of the attention has been on sportsmen and women, but I am likely to offer cupping to anyone with muscle tension eg tight back or shoulders.

Cupping therapy: burning off the oxygen in a cup.
Firstly, how is it done? I momentarily burn a small alcohol swab inside the purpose-made thick glass cup. This burns off the oxygen so that if the cup is then quickly applied to the skin, you can preserve the partial vacuum you have created, and the cups sticks. In doing so, it draws the tissue up into the cup and stretches the tight muscle. I warn patients it might leave a mark for a few days, though I have to say, it’s not usually as strong as the marks that have been photographed this summer. Cups come in different sizes, so we choose one appropriate to the area, and cupping strength can be varied. I usually leave them on for three to four minutes.

Secondly, what evidence is there for its effectiveness when used for muscle aches and pains in sport? Well elite international athletes and their coaches are unlikely to be using cupping therapy if they haven’t noticed worthwhile benefits, but several research papers have been published too.

Cupping therapy: treatment of neck and shoulder pain.
In a randomised controlled trial undertaken by Taiwanese researchers and published this year, 60 patients with neck and shoulder pain received either cupping or no treatment. Neck pain intensity in the cupped group decreased by 6 points on a 10 point scale, whilst it remained unchanged in the control group. Cupping also reduced blood pressure. The authors say that their findings strongly suggest that cupping is effective for relieving pain, with no adverse effects, and that it has the potential to eliminate reliance on analgesics and reduce health care costs.

In a 2013 study by a German team, 61 patients with chronic neck pain were randomised to receive 12 weeks of either cupping or progressive muscle relaxation. Both groups had similar, clinically relevant reductions in subjective pain reports compared to baseline, but cupping performed significantly better in terms of increased wellbeing and decreased objective pain thresholds.

Cupping therapy: treatment of lower back pain.
Small pilot studies have been performed in the US and Germany, looking at cupping for lower back pain and osteoarthritis of the knee respectively. Significant improvements were found in perceived lower back pain and there was greater range of movement. The authors stated, “Chinese cupping may be a low-risk, therapeutic treatment for the prompt reduction of symptoms associated with subacute and chronic low back pain. Cupping may allow patients to progress to functional movement training in a timely manner by promptly reducing pain and muscle tenderness and improving range of motion.” Cupping therapy: treatment of osteoarthritis of the knee.
In Germany, knee pain, stiffness and function improved significantly after four weeks of cupping, and these improvements persisted at 8 week follow-up. Further, researchers in India found the effects of cupping on the symptoms of knee osteoarthritis, were comparable with those of paracetamol, and with minimal side effects compared to the drug.

A very comprehensive review of the evidence to support the use of cupping therapy for musculoskeletal pain, was published in 2015. If you have a clinical background, then this along with Arya Nielsen’s paper on gua sha (Chinese scraping therapy), look in detail at the neurobiological mechanisms which may be at work in cupping.

Finally, you may see mention of “wet cupping” or references to the skin being cut prior to a cup being placed over the area. For health and safety reasons, that is not something that a member of the British Acupuncture Council will do. We only cup over unbroken skin.