Category Archives: Injuries & Sport

Acupuncture for sports injuries, plus research on acupuncture and other interventions for enhanced performance & recovery.

Injuries and Sport

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 has helped her throughout her career, having received acupuncture 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 physical 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, ensuring use is made of all the experience gained by the USAF using acupuncture to help with injuries sustained during campaigns in recent years.

Injuries are of two broad types:

(1) Acute injuries 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, and a few acupuncture sessions spaced closely together and started as soon as possible, can be extremely helpful.

Racquet sports are fast and fun, but can lead to sprains and strains.

(2) Chronic injuries on the other hand, have persisted for weeks or months, and 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, but sessions can 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.

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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.

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Interval Training as Effective as Endurance Training

Interval training.

A study at McMaster University in Ontario has investigated whether sprint interval training (SIT) is a time-efficient exercise strategy to improve insulin sensitivity and other indices of cardiometabolic health to the same extent as traditional moderate-intensity continuous training (MICT). SIT involved 1 minute of intense exercise within a 10-minute time commitment, whereas MICT involved 50 minutes of continuous exercise per session.

Twenty-seven sedentary men, mean age 27, were each assigned to one of three groups: three sessions of either SIT or MICT per week for 12 weeks; non-training controls. SIT involved 3×20 second ‘all-out’ cycle sprints (~500W) interspersed with 2 minutes of cycling at 50W, whereas MICT involved 45 minutes of continuous cycling at ~70% maximal heart rate (~110W). Both protocols involved a 2-minute warm-up and 3-minute cool-down at 50W.

Indices of cardiometabolic health, such as peak oxygen uptake and glucose sensitivity, increased equally in both groups, despite sprint interval training requiring a five-fold lower exercise volume and time commitment.

The authors point out that most studies of high intensity training have lasted only a few weeks to several months, and have involved small numbers of subjects. Much of this work has examined physiological changes in young healthy individuals. Only a handful of studies have looked at non-healthy individuals including those with cardiometabolic diseases such as type-2 diabetes. While generally found to be safe, perceived as enjoyable and well-tolerated in laboratory studies, only a few studies have examined the feasibility of implementing the training in normal life, where people have to undertake it on their own. It also remains unknown whether adherence to this form of training is any better than for continuous moderate-intensity exercise.

(Twelve Weeks of Sprint Interval Training Improves Indices of Cardiometabolic Health Similar to Traditional Endurance Training despite a Five-Fold Lower Exercise Volume and Time Commitment. PLOS, 26 April 2016.)

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Acupuncture helps Post-Exercise Fatigue

Acupuncture fatigue: The Exeter Great West Run
A pilot study has shown that acupuncture can speed the relief of post-exercise fatigue, by re-regulating energy metabolism and reducing the effects of oxidative stress. Fourteen young male athletes were given a standard dietary plan for two days, and then undertook a series of exhaustive running exercises followed by a short rest. They were then either given a 30 minute acupuncture treatment, or were allowed to simply rest for a further 35 minutes. NMR-based metabolomics analysis was used to assess the metabolic profiles of urine samples collected from all the athletes before exercise, before & after acupuncture, and while taking the extended rest period.

The results indicated that levels of key metabolites which had been disturbed by exercise, recovered significantly faster in the athletes given acupuncture, compared with those who simply rested. In addition, markers related to choline metabolism and oxidative stress caused by the generation of reactive oxygen species, recovered faster in the acupuncture group. The authors say this work begins to unravel biochemical mechanisms behind the effect of acupuncture on recovery, and they speculate on its usefulness in sport.

(The Intervention Effects of Acupuncture on Fatigue Induced by Exhaustive Physical Exercises: A Metabolomics Investigation. Evidence Based Complementary & Alternative Medicine, 2015.)

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Skipping Breakfast Impairs Sports Performance Later in Day

Breakfast and sports performance: Eating breakfast can help you perform better.
Elsewhere on my website, you will see my strong encouragement to eat breakfast. Now, besides the other benefits, researchers at Loughborough University have found that skipping breakfast can impair sports performance much later in the day.

Ten male, habitual breakfast eaters were put through two different trials. All participants arrived at the laboratory having fasted overnight, but they then either consumed or omitted a 733kcal breakfast. Subjects were allowed to eat freely their lunch 4.5 hours later and dinner 11 hours later. At the 9 hour point, they were put through an evening exercise test, completing a 30 minute cycling test at around 60% VO2 peak followed by a 30 minute maximal cycling performance test.

Perhaps not surprisingly, those who had not eaten breakfast, consumed around 200kcal more at lunch, but those who did eat breakfast, interestingly consumed more at dinner. The novel finding is that those who consumed breakfast, performed a significant 4.5% better during the exercise performance test.

(Effect of Breakfast Omission on Energy Intake and Evening Exercise Performance. Medicine & Science in Sports & Exercise, online 12 May 2015. See http://journals.lww.com/acsm-msse/Abstract/publishahead/Effect_of_Breakfast_Omission_on_Energy_Intake_and.97761.aspx)

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