Acupuncture: is there any point?
Sports therapy: What athletes should know about using acupuncture to improve sport performance
Acupuncture, used in traditional Chinese medicine for centuries, is gaining popularity as a means of pursuing improved athletic performance. While this approach appears to offer promise, Alicia Filley explains the pros and cons of acupuncture, and why it may not be appropriate for every athlete.
Practiced in traditional Chinese medicine for over 2,000 years, acupuncture is used to restore the balance of vital energy, or ‘Qi’, within the body. The theory proposes that this vital energy is composed of two opposing yet complimentary forces, yin and yang. The balance of these forces contributes to optimum health, and illness is thought to result from an imbalance.
Qi flows through the body along specific channels called meridians (see figure 1). Meridians occur along both sides of the body and run both superficially and deep, with acupuncture points occurring along each. Traditional Chinese medicine (TCM) believes that stimulating certain points along the meridian with very thin needles restores the balance of vital energy within the body. The points are selected based on an individual’s diagnosis by a TCM practitioner.
Because each patient is diagnosed by the imbalance of energy along his meridians, there are no standardised treatment protocols within acupuncture. Certain standards do exist, however, among reputable practitioners. Needles are sterile, disposable, and usually 25mm to 40mm long with a .22mm thickness. The patient is typically lying down with the area to be stimulated exposed and alcohol is used to cleanse the skin before needle insertion.
Once inserted, needles can be manually or electrically stimulated depending on the particular technique of the practitioner. Treatments last 20 to 30 minutes and continue weekly for three to six weeks. Side effects are rare but may include bruising, light-headedness or fainting. More serious side effects are usually the result of an inexperienced practitioner.
Using acupuncture to increase strength
Acupuncture was initially used for strengthening after sports injury, but trainers soon began to wonder if it could increase strength in healthy subjects. Research by physicians at Istanbul University is often cited as an answer to this question(1). In this study, the strength of knee flexion and extension of 24 healthy university soccer players was measured at baseline and after two different acupuncture treatments.
The purpose of this study was to compare the effectiveness of the two different acupuncture points; therefore there was no control group. The authors assume that increased strength is an end result of acupuncture. However, while both acupuncture treatments resulted in a significantly increased force production for knee flexion and extension, the fact that there was no control group means there is no way to really draw a conclusion about the effectiveness of acupuncture on strength (versus sham acupuncture or no treatment at all).
Most recently, investigators at Goethe-University in Germany conducted a randomised, double-blind, crossover design study in which 33 subjects were treated once a week with either acupuncture, sham acupuncture (where needles are inserted into the skin but not at acupuncture points) or placebo laser acupuncture(2). Drop jumps with both feet, the maximum isometric voluntary force (MIVF) of each subject’s dominant leg’s knee extensors, and isometric muscular endurance (IME) of the same knee extensors were measured at the beginning of the study and within five minutes of each treatment session.
Acupuncture resulted in a significant increase in MIVF for all subjects. However, there was not a significant difference in the mean change in MIVF between acupuncture and sham acupuncture, while the change between acupuncture and placebo acupuncture was statistically significant (see figure 2). This effect is often found in studies using sham acupuncture and shows that simply inserting the needles in an area close to an acupuncture point often produces physiological changes.
With an increase in strength in the knee extensors, investigators hoped to find an increase in drop jump height as well, signalling a functional carryover of treatment. Disappointingly, there was no such change. One acupuncture treatment, while showing evidence of change at the muscular level, does not appear to be beneficial from a functional standpoint.
Using acupuncture to increase endurance
Researchers at the Medical College of Wisconsin examined the immediate effects of acupuncture treatment on cycling endurance(3). On three different days, each of 10 subjects underwent an acupuncture treatment, a sham acupuncture treatment, or a control treatment that consisted of rest only.
After each intervention, subjects cycled on a cycle ergometer until fatigued. Researchers recorded each subject’s perceived exertion, heart rate and pulmonary measurements after each cycling session. The results did not show any statistically significant changes on any of the measured parameters for any of the variables. One acupuncture treatment did not show any immediate effects on endurance.
A more recent study conducted in Canada examined similar variables using 20 male cyclists(4). Each subject underwent a weekly interventional treatment of acupuncture, sham acupuncture, or no intervention at all. After each treatment, subjects cycled on a road bike mounted on a stationary trainer as fast as possible for a simulated 20km.
Time to finish, blood lactate concentrations, visual analogue scale pain rating, and perceived exertion were measured for each cycling session. The acupuncture group’s cycling times were lowest and the control groups were highest, but there was not a statistically significant difference between the two. The blood lactate levels did not show any significant change with the treatment variables. The visual analogue pain scale revealed lower scores for the acupuncture group than the other groups, but did not reach statistical significance. However, the rate of perceived exertion scores did reach a statistical significance with the acupuncture group showing the highest scores, the controls the lowest (see table 1).
The rate of perceived exertion score is a subjective test that allows participants to rate the intensity of their work on a numerical scale. The Canadian researchers hypothesise that the acupuncture treatment enabled the cyclists to work harder during the 20km cycle, therefore decreasing the time to finish. They claim this explains the trend, albeit statistically insignificant, of faster finish times for the acupuncture treatment group.
The Wisconsin and Canadian studies evaluated similar parameters after one acupuncture treatment and appear to have somewhat conflicting results. However, the Wisconsin study measured time to volitional fatigue at sub maximal effort whereas the Canadian study evaluated time to finish with maximal effort over a set distance. With a time reduction of 1.3 minutes between the acupuncture group and the control group in the Canadian study, a difference between a race win and second place could place a real significance on this trend.
Using acupuncture to improve immunity
Nothing sidelines a training programme like an illness, and an athlete’s health is most vulnerable when training intensity is at its peak. To measure whether acupuncture could counter the immunosuppressive effects of exercise, researchers at the University of Tokyo evaluated 21 elite female soccer players during an international soccer competition(5). The subjects were divided into two groups; one group received an acupuncture treatment the day before and at the end of each day of competition, and one group did not.
Saliva samples were collected at the end of the day from all athletes and salivary secretory immunoglobulin A (SIgA) concentrations and cortisol levels were measured. In addition, athletes rated their physical wellbeing and mood state each day. The results show the levels of SIgA, which began at similar baseline levels, were significantly higher in the treatment group throughout the study. The cortisol levels were also significantly lower in the treatment group on the second and third day of the competition. The measures of wellbeing were improved in the treatment group, but not consistently significant in all categories.
This same group of researchers took their study to the lab at the University of Tsukuba in Japan(6). The same variables were evaluated in 12 non-athletic healthy men after cycling for one hour at 75% of their maximal effort. The men served as their own controls, receiving an acupuncture treatment after one cycling session and only rest after another.
This study echoed the results of the Tokyo study, with the SIgA levels remaining higher in the treatment group and significantly decreasing in the control group (see figure 3). The measures of mood and wellbeing did not differ between groups. While the Tokyo study included several acupuncture treatments over several days, this study shows that one acupuncture treatment post exercise can reduce the effect of exercise on immunity.
So, what’s the point?
Will acupuncture treatments turn you into a world-class athlete? Probably not, but consider the case of a modern pentathlete who incorporated acupuncture into his training early in his career(7). Once nominated to the German national modern pentathlon team, he identified the physical limitations to his performance: weakness, pain, and unsteadiness in certain areas. An experienced acupuncture practitioner evaluated him, and acupuncture treatment began for the diagnosed problems. After several treatments with the practitioner, the athlete and his trainer were trained to perform the treatment themselves.
The athlete noted an immediate improvement in his performance after the initiation of acupuncture treatment. The treatment continued as needed throughout his career with steady improvement in his performance the entire time (see figure 4). Although the athlete attributed his success to the acupuncture program, he also trained at an elite level with world-class coaches. His coach reported a strong psychological impact from the acupuncture, which may have enabled the athlete to take full advantage of his training. Or, perhaps the rehabilitative effects of acupuncture enabled the athlete to stay in good health, which also enhanced his training.
The studies on the effects of acupuncture on strength appear to show a positive influence. However, the study sizes are small, lack good control or placebo components, and fail to show any functional carryover. There doesn’t appear to be any impact on endurance parameters with the use of acupuncture, except to possibly improve the athlete’s ability to work harder. The small size of the data in the endurance studies and lack of any statistical significance in the objective markers makes it difficult to draw any solid conclusions.
The most consistently impressive studies are in the area of immunity. It is known that intense exercise lowers the body’s immunity and makes athletes more susceptible to upper respiratory illness. Acupuncture post exercise is shown to mitigate that phenomenon and could possibly improve an athlete’s overall immune resistance. Staying healthy would improve an athlete’s ability to train and therefore, improve performance. Long-term studies are needed to prove the impact of acupuncture used in this way.
There is also a philosophical problem with using Western methods to study an Eastern technique. Whereas in Western medicine everyone with a particular problem is treated in the same way, in TCM, no two treatments are identical. Acupuncture is performed in TCM based on observation, history and evaluation of the flow of Qi in each individual.
Western science reveals that acupuncture produces physiological effects in the body. How these changes come about and what benefit they have remains to be clarified. In the meantime, acupuncture may be a powerful adjunct to your training regime for issues that are not improving with a conventional training approach.
Alicia Filley, PT, MS, PCS, lives in Houston, Texas and is vice president of Eubiotics: The Science of Healthy Living, which provides counselling for those seeking to improve their health, fitness or athletic performance through exercise and nutrition
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