Rodgers’s injury diminishes his mobility as quarterback but has not hurt his effectiveness. That has not stopped Packers fans from offering their help.
He has been using acupuncture for the injury
Via Shaftesbury Acupuncture Clinic
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Acupuncture Proven To Heal Tennis Elbow
ON 17 JUNE 2014.
Acupuncture combined with massage is effective for the treatment of tennis elbow, lateral epicondylitis. Recent research was conducted on ninety athletes at the Science and Experiment Center of Guangzhou Physical Education Institute. The athletes were randomly divided into three groups. Group 1 received acupuncture only. Group 2 received massage only and group 3 received acupuncture combined with Traditional Chinese Medicine (TCM) massage. All three groups showed significant positive clinical outcomes. The acupuncture combined with massage group showed greater improvement than the other groups suggesting a synergistic effect. No adverse events occurred. The data was compiled after 20 days of treatment. The researchers concluded that acupuncture and TCM massage are safe and effective for the treatment of lateral epicondylitis.
Tennis elbow (lateral epicondylitis) is a form of tendinitis. Symptoms are usually elbow and arm pain. Repetitive motions often lead to lateral epicondylitis such as movement during tennis, weight lifting, painting, typing, knitting and woodwork. The pain typically worsens when lifting, gripping, twisting and straightening the wrist. Conventional medical approaches for treating lateral epicondylitis include physical therapy, non-steroidal antiinflammatory medications (NSAIDs), icing, bracing, local steroid injections and surgery. Acupuncture and TCM tuina massage have a historical record for the successful treatment of lateral epicondylitis that is over 1,000 years. This new scientific experiment using a carefully controlled investigation for examining the efficacy of these ancient modalities confirms the historical record.
The acupuncture group received acupuncture in either the sitting or supine posture. The acupuncturist used 40mm disposable acupuncture needles. Needle retention time was 30 minutes after the arrival of the deqi sensation at each acupuncture point. The acupoints used in the study were primarily local points based on the clinical presentation of each patient. Acupuncture points included LI12, LI11, LI10, LI4, SJ5 and ashi points.
The massage group received TCM massage in a sitting posture with the elbows bent and relaxed. Techniques included kneading, grasping, one finger meditation manipulation and plucking ashi points. Massage was applied to acupuncture points including: Quchi (LI11), Chize (LU5), Hegu (LI4), Neiguan (PC6), Waiguan (SJ5), Yangxi (LI5), Shousanli (LI10). Each massage lasted for 15 to 20 minutes. Following the massage, the patient was told to relax with the forearms at rest.
The combination group received acupuncture treatment after being massaged on the same day. Each treatment modality was applied once daily for all groups. One course of either massage and/or acupuncture consisted of 10 days. There was a two-day pause following the first course. The entire treatment was 2 courses for a total of 20 treatments.
The group that received both acupuncture and TCM massage showed the greatest clinical improvements. A total of 20 patients in the combination group were completely cured after the 20 treatments. Another 5 patients made excellent improvement and an additional 5 patients made moderate improvement. One patient in the combination group made no improvement. Occasionally, patients felt uncomfortable after the acupuncture needling for approximately one day, however, the soreness disappeared after one day’s rest. Based on the results, the researchers conclude that acupuncture and massage are effective in treating lateral epicondylitis for athletes and that combining the therapies increases positive patient outcomes.
Posted on 05/23/2014by Dr. DresnerProfessional Athletes Improve Their Sports Performance with Acupuncture
For many professional athletes, acupuncture is the key to their better performance in sports. Acupuncture is not only limited to pain intervention and treating disease, but it is quickly gaining popularity in sports medicine. Professional athletes are reaping the benefits of acupuncture for the relief of soft tissue injuries such as sprains, tendonitis, and muscle strains.
More and more professional athletes, as well as college and high school sports teams, are incorporating acupuncture into their programs and use it to treat players and improve performance.
Even equestrians are recognizing the value of acupuncture in Wellington. Acupuncture is sought out by athletes to help in recovery from fatigue, contracture, and delayed onset muscle soreness (DOMS). These are all commonly experienced by equestrians and other athletes during high intensity training and competitions. Acupuncture helps relieve stress and improve blood circulation in athletes, helping them recover from injuries quickly and return to their sports in no time.
Acupuncture is not only used to treat injuries sustained from sports, it can also be used to enhance athletic performance. An athlete undergoing acupuncture treatments will have increased physical capabilities exceeding what they previously had, allowing the athlete to reach a higher level of performance.
Dr. Dresner, a licensed and professional doctor of acupuncture in Wellington, will assess the athlete’s movement, then diagnose and correct any problems that could affect the proper function of the muscles and joints through acupuncture treatments. After all the problem areas are corrected, then acupuncture for better performance in high intensity training and competition can begin.
Too many athletes are being suspended for the illegal use of performance enhancing drugs (PEDs). Acupuncture offers a suitable alternative to the unhealthy and illegal PEDs. Acupuncture, when done properly, can help the athlete improve their power, strength, acceleration, flexibility, and endurance. Athletes are also cautioned to avoid over training to prevent injury.
Acupuncture helps athletes stay in tip-top shape. Olympic athletes and weekend warriors have known this for years. Learn how acupuncture can help you, too.
This blog post is part of our Olympics Series on Qi. Find out which other Olympic athletes use acupuncture here.
The London games are in full swing and several smart Olympians are showing that acupuncture helps athletes for health maintenance, performance enhancement, and pain relief. US gymnast and gold medalist McKayla Maroney recently used acupuncture along with other treatments to help speed the healing of her big broken toe and get her in shape for the vault jump, her specialty.
Another American Olympian showing that acupuncture helps athletes is 400 meter dynamo Dee Dee Trotter. Dee Dee has brought her hometown acupuncturist to London with her in order to continue treatments during the games just as she did during the Olympic trials. And my favorite, Amy Acuff, a fellow acupuncturist (!), is an Olympic high jumper who relies on acupuncture for maintenance as well as for faster recovery from injuries.
by Jennifer Dubowsky, LAc
Olympic athletes are men and women who depend on their bodies to work expertly under stressful and difficult conditions. We can adopt some of their methods of healthcare for ourselves.
Most of us are never going to somersault into the air or hurl ourselves over a bar six feet above the ground but we can certainly learn some of the methods that these amazing athletes use to keep themselves in world class form.
1. Pain relief: Acupuncture is well known for its powerful ability to reduce and often eliminate pain. This is a huge attraction for athletes who are plagued by strain and injury. Using acupuncture to relieve pain, the athletes never have to worry about experiencing side effects from pharmaceutical drugs or failing a drug test. How does acupuncture alleviate pain?
There are several studies which have shown that when needles are inserted, they stimulate points that boost our natural painkillers. In one study, researchers at the University of Michigan (published by University of Michigan Health System in Journal of NeuroImage, Vol. 5, No. 83, 2009) found acupuncture affected the brain’s long-term ability to regulate pain.
2. Muscle relaxation: Athletes train for thousands of hours which is punishing to their bodies. Acupuncture reduces soreness from workouts and increases blood flow throughout the body. This helps athletes get ready for another day by relaxing their tight muscles and reducing inflammation.
3. Fast healing: When an athlete has to skip training or miss a competition, precious time is lost. Acupuncture helps injuries to heal faster so athletes do not miss valuable training time.
4. Energy enhancement and better sleep: Acupuncture boosts athletes’ energy when they are awake and helps them to sleep at night. The body repairs itself at night so sleeping well is vital to a good performance.
5. Improved blood flow: Acupuncture increases the amount of nitric oxide in the body. A study from UCLA Medical Center (Responses of Nitric Oxide-cGMP Release in Acupuncture Point to Electroacupuncture in Human Skin In Vivo Using Dermal Microdialysis. In Microcirculation, 2009 May, 26:1-10) concludes that one reason acupuncture is effective is because the needles increase the release of nitric oxide throughout the body. Nitric Oxide causes the blood vessels to relax and to widen, thereby opening up the arteries. This allows better blood flow to the heart and your other important organs.
Whether you are an Olympian, a sports enthusiast or, like most of us, a person with a busy schedule who needs all the energy you can muster, acupuncture offers many benefits. We all want to perform at our best no matter how big or small the competition; the high jump or the business meeting.
Acupuncture can improve your well-being because it alleviates pain, increases blood flow, helps speed the healing of injuries, relaxes muscle tension, boosts energy during the day and helps us to sleep at night.
Jennifer Dubowsky, LAc, is a licensed acupuncturist with a practice in downtown Chicago, Illinois, since 2002. Dubowsky earned her Bachelor of Science degree in Kinesiology from University of Illinois in Chicago and her Master of Science degree in Oriental Medicine from Southwest Acupuncture College in Boulder, Colorado. During her studies, she completed an internship at the Sino-Japanese Friendship Hospital in Beijing, China. Dubowsky has researched and written articles on Chinese medicine and has given talks on the topic. She maintains a popular blog about health and Chinese medicine at Acupuncture Blog Chicago. Adventures in Chinese Medicine is her first book. You can find her on www.tcm007.com.
This blog post is part of our Olympics Series on Qi. Read another blog post in this series here and here.
Acupuncture Secrets of Tour De France Winner
Eddy and VincenzoFriends, we are extremely lucky that Eddy De Smedt, acupuncturist for the 2014 Tour de France winnerVincenzo Nibali and team Astana, has taken the time for an interview. I've asked him questions that I wondered about and I think you will be intrigued by his responses. (with Eddy's permission, there has been some minor edits because his first language is Dutch although his English is excellent)
Jenny: Eddy, What is your background?
Eddy: I have a background in nursing and studied TCM for 5 years in Belgium and China. Now, I am practicing Acupuncture for 12 years in my private practice in Aalst, which is 20 km from the capital Brussels. I started working with athletes after being more educated in sports acupuncture and I see, on regular basis, athletes who are performing in cycling, tennis, motocross and soccer. Having some expertise, I now give workshops concerning sports acupuncture in Belgium at the ICZO.
Jenny: Is it different to work with elite athletes than to work with "normal" people?
Eddy: In preparing athletes (for elite competition), there aren't any big differences from treating a "normal" patient. I hang on to the usual TCM screening to find (or not) energetic disturbances within Yin, Yang, Xue and Qi and adjust. During competition, when there is less time, I focus on recovery, relaxation (pure muscle relaxation if they are tense or psychologically distressed to ease the shen) and complaints of pain.
Concerning treatments when pain is involved, and after a daily briefing with the team doctor and osteopath, I mostly use distal acupuncture treatment (on Ting points and Jing Well), which gives a great result. If the results aren't satisfactory, I re-evaluate and start to treat local acupoints on the involved meridian, xi cleft if tender, ashi points combined with Hegu and Taichong and depending on the condition, integrating electro acupuncture.
*Note from Jenny: For non-acupuncturists, ease the shen means to ease the spirit. Also, a distal treatment means away from the area of pain, so if Vincenzo was experiencing knee pain Eddy would not start by inserting needles into his knee but rather at acupoints away from the painful area. I’m excited to hear he uses this technique because it is one I often employ with great success as well.
Jenny: How did you get involved with the riders from the Tour?
Eddy: I was already working with the Team Doctor, Dr. De Maeseneer in Belgium, where I had referrals of athletes on a regular basis. He engaged me to become a member of the medical staff of team Astana at the end of 2012. Beginning with season 2013, I work 35 to 40 days for the team. I hope my colleagues in acupuncture will find their way to other pro cycling teams.
Jenny: Me Too!
Jenny: What types of assistance did you provide for the bikers? How did you prepare for supporting them during the race?
Eddy: As I mentioned earlier, the focus of the acupuncture treatments is on recovery, relaxation and pain relief. The exact protocols would take me to much time to explain, but I 'm thinking of giving some courses to explain in detail.
Jenny: Great, please keep us updated on your courses.
Jenny: What are the most common complaints of the Tour cyclists?
Eddy: Generally, the most common complaints that I treat are muscle tension in the lower and upper legs, pain in the lower back, neck and knee problems, quite common for cyclists. I also treat some stomach issues, and every evening before going to bed I treat the athletes with my "relaxation protocol" to promote rest, relaxation and recovery.
Jenny: Did the bikers like acupuncture? Find the treatments helpful?
Eddy: In 2013, when I started with the team, for most of the riders, acupuncture was totally unknown and new. Step by step, and with good communication with the riders, sports club, and medical staff, they soon got used to it and found the treatments helpful. I also wrote a paper concerning sports acupuncture, including its possibilities and mechanisms for riders.
I also needed to be critical of myself. I used ear acupuncture in the beginning, and although I am convinced of its therapeutic possibilities, I skipped this method because of the discomfort for bikers due to the communication system they already have in the ear. For any treatment, including acupuncture, continuous education and adjustments are necessary.
Jenny: What was your experience treating the cyclists during this world famous race?
Eddy: After already working with the team for two years, I know the riders quite well and vice versa; they know I'm there if they need any help, which gives great satisfaction to my job as an acupuncturist. Now, some weeks after team Astana won the tour the France with Vincenzo Nibali, one of the biggest sports events in the World, I realize that the entire team did something special. I am proud that I was part of that!!
Acupuncture helped the rider with backpain after a bike crash early in the tour de France race
Acupuncture Helped Rider with Back Pain in the Tour de France Race
By Jerome Pugmire, ASSOCIATED PRESS, July 12, 2004
LIMOGES, France – Injuries and falls have yet to stop Tyler Hamilton in this year's Tour de France
Now, the American rider with the Phonak team is ready to make his move.
"The Tour starts now," he said Monday, during a rest day in the world's premier cycling competition. "I'm still in contention, so I have to be pleased with that."
Hamilton is one of the main threats to Lance Armstrong's bid for a record sixth straight Tour victory. Hamilton is 11th overall after the eighth of 20 stages, 36 seconds behind his former U.S. Postal teammate.
Hamilton stole headlines last year while riding with Team CSC. He finished fourth overall despite riding most of the race with a double break of his collarbone after being caught in a massive pileup.
Just a week into this year's race, Hamilton flew off his bike again, hurting his back and shoulder in another big spill.
"I was involved in the crash three days ago and hurt my back pretty badly," Hamilton said. He has been receiving treatment since. "I just finished doing some acupuncture on my back."
He also was busy on his bike, taking a "leisurely" 2½-hour ride." Tour competitors normally like to ride during a day off in order to maintain momentum and rhythm.
Despite his bad luck, Hamilton remains upbeat.
"If I had to grade this past week, I'd grade it A-plus for teamwork, and C for luck," he said. "In the team time trial we had four flat tires and a broken handlebar. Something like that almost never happens and to finish second is almost incredible."
A fierce climber in the mountains and a competent time-trialist, Hamilton believes he could come into his element as the Tour enters its more difficult stages.
"Right now, the time differences are really close between the contenders," he said. "I believe the upcoming stages will really show who is here to win the Tour de France."
Tuesday's ninth stage, a 100-mile ride from St.Leonard-de-Noblat to Gueret in central France, featured climbs of about 2,300 feet – the highest hills before the grueling Pyrenees appear Friday.
"There are nine climbs and no flat after the 20th kilometer (12th mile)," said Hamilton, adding he expected the stage to be difficult.
Looking ahead, he hinted that an aggressive, all-out attack by the Phonak team could be the key to unsettling Armstrong and his Postal team in the mountains.
"I don't want to give away secrets, but we have a lot of strong riders on this team," Hamilton said. "Certainly one tactic is to attack. I'm the leader, but I have a guy to the right of me, Oscar Sevilla, who is riding incredibly well right now.
"He's dangerous for all the contenders. If he goes up there (in the mountains) early it's going to force the other teams to chase."
CHRONIC PAIN AND THE NEED FOR A GUIDELINE
Chronic pain, defined as pain lasting beyond normal tissue healing time (taken to be 3 months),1 is a syndrome that affects a large proportion of the primary care population. It is ‘significant’ in around 14% of UK adults, imposing a heavy burden on the physical and psychosocial health of sufferers, their families and society, at high cost to the healthcare services.2 It was estimated in 2002 that people with chronic pain account for 4.6 million GP appointments in the UK, at an annual cost to the NHS of £69 million, equivalent to the employment of 793 GPs.3 Although many clinical conditions can lead to chronic pain, there are common underlying neurobiological and psychosocial mechanisms, and the impact is generally independent of the clinical aetiology. Effective assessment and treatment of chronic pain therefore means that GPs should have:
adequate education and knowledge;
access to evidence-based effective management strategies; and
agreed criteria for referral to specialist clinics.
Unfortunately, none of these requirements is generally in place.
Undergraduate training in management of pain is demonstrably minimal, accounting for <1% of programme hours,4 despite its high prevalence and impact. Much of the available evidence for potential interventions is derived from specialist settings or in specific clinical conditions, making it difficult to apply to a general primary care population. Even standard treatments, such as drugs, often lack evidence for effectiveness …
Via Bedford Acupuncture
It is unclear exactly how acupuncture needling works but there is evidence that in many cases it can be an effective addition in the treatment of sports injuries. Acupuncture has historically been used for the treatment of pain which is often a hindrance to functional recovery and confidence following a sports injury. The techniques used in sports acupuncture are similar to those of recognised Western and Chinese acupuncture disciplines. The difference is that the treatments are administered by practitioners with an interest in sports injuries and with a focus specifically on rehabilitation of injuries usually occurring within the sport setting. Other standard therapies such as physiotherapy, osteopathy and chiropractic treatments can be used in conjunction with acupuncture to ensure maximal beneficial effect.
Via Bedford Acupuncture, Shaftesbury Clinic
Many athletes use the ancient Chinese therapy to treat their most annoying ailments.
Many athletes use the ancient Chinese therapy to treat their most annoying ailments.
The sight of needles can make anyone cringe, but it may be worth a shot to help alleviate an injury.
Marathoner Deena Kastor is among a handful of elite athletes that use acupuncture to treat injuries and reduce the pain and inflammation associated with it. Studies suggest the ancient Chinese therapy can increase circulation and range of motion and accelerate healing time due to its ability to balance the neurological and cardiovascular systems.How Does It Work?
Patients first fill out a questionnaire about their history. The acupuncturist will then perform a diagnostic test by examining the tongue and pulse, and exploring (by touch) various points on the body.
According to Andrew Castellanos, a licensed acupuncturist at the Stillpoint Wellness Center in San Francisco, acupuncture works by strategically placing needles on pressure points to regulate blood flow to trouble spots via major pathways in the body, thus resulting in relaxed muscles with less swelling, tension and pain. Each needle is connected to an Electrostem valve to deliver currents from one point to another, which increases oxygen flow and delivers white blood cells to the injury.
“Electrostem uses an electrical impulse that contracts and releases muscles. It allows the needles to push fluid out of the [injured] area and deliver blood back to those tissue paths — that lets the muscles relax so the body can heal itself,” Castellanos said.
He adds that the underlying premise lies in our body’s energetic system, which consists of Chi — energy that circulates throughout the body and is responsible for regulating our organs and other processes of the body. “Some theories say the needles trigger the release of endorphins into the brain, which is responsible for the feeling of well-being,” Castellanos said.
RELATED: Alternative Treatments For Running Injuries
The number of treatment sessions, which last about 60 to 90 minutes and range from $60 to $120 per visit, depends on the seriousness of the injury; however, significant improvement can occur after just a few visits.
While acupuncture can be used to treat a number of injuries, it is commonly used for shin splits, muscle pulls, tears or strains, and IT band, hip flexor, glute and quad pain.Does It Hurt?
Unlike hypodermic needles, which are used for giving an injection, acupuncture needles are hair-thin. Castellanos said that patients associate needle pain with the same pain as receiving an injection, but acupuncture needles are virtually painless.
“The needles are inserted past the skin nerves so there is no pain. If there is any, it would be from the acupuncturist’s thumbs and fingers,” said Castellanos, who suggests the therapy works better than massages, as the needles are able to get to areas where our fingers can’t.
RELATED: 5 DIY Remedies For Plantar FasciitisIs It For Everyone?
Acupuncture isn’t for people on blood thinner medication due to the risk of bleeding, and for those who use a pacemaker, as it can interfere with the Electrostem system.
Acupuncture Today is a leading provider of acupuncture and oriental medicine news, info and research information in the world
What is foot pain?
The foot is one of the most complex parts of the body. It consists of 38 bones connected by numerous joints, muscles, tendons and ligaments, and is susceptible to many stresses. As a result, foot and ankle problems are a common reason for visits to a doctor's office (4.8 million office visits a year, according to the American Academy of Orthopaedic Surgeons). Foot problems may be caused by pain, inflammation or injury, thereby limiting a person's range of motion (and in some cases, a person's quality of life).
Foot pain is caused by a variety of conditions, most often improper foot function or poor posture. In fact, the most common reason for people to have foot problems is a condition called abnormal pronation, in which the foot does not strike and/or leave the ground as it is supposed to. However, several other factors can cause (or lead to) foot pain. Footwear can worsen and, in some cases, produce foot problems. Shoes that are too tight, for instance, can increase pressure and stress, while shoes that are too loose can let the foot slide and rub, creating friction. Overuse and exercise-related problems can also cause foot pain.
There are various types of fot problems that may affect the heels, toes, nerves, tendons, ligaments and joints of the foot. Among the most common types of foot problems are heel spurs (an abnormal growth on the heel bone); corns (yellowish callous growths that develop on the top of the toes); bunions (a protrusion of bone or tissue around a joint); neuromas (a buildup of tissue in the nerves running between the long bones of the foot); or hammertoes (a condition that causes the middle joint of the toe to poke out).
Who suffers from foot pain?
Nearly everyone suffers from some form of foot pain during their lifetime. The condition is most prevalent in infants and newborns just learning to walk, and people over age 50. Women who wear high-heeled shoes are also more susceptible to foot pain, as are athletes who either do not warm up their feet prior to exercise, or who use improper foot techniques while exercising.
What can acupuncture do?
Studies have shown acupuncture to be effective in relieving certain types of foot pain. A study published in the journal Acupuncture in Medicine in 1996 found acupuncture to be effective in relieving otherwise unresponsive chronic foot pain. A 1999 study, meanwhile, found that electrical stimulation of acupoints on the feet could increase blood flow to the foot and lower leg. There have also been anecdotal reports of individual acupuncturists using different techniques to relieve pain associated with the ankle, heel, and ball of the foot.
As with any other form of care, however, remember that not all patients will respond to all forms of treatment. Make sure to discuss the situation thoroughly with your acupuncturist before undergoing treatment for foot pain.
ReferencesBirch S, Hammerschlag R. Acupuncture Efficacy: A Compendium of Controlled Clinical Studies. Tarrytown, NY: National Academy of Acupuncture and Oriental Medicine, August 1996.Chen BX, Zhao YL. Treatment of painful heel with combined method of traditional Chinese medicine and Western medicine. Clinical analysis of 900 cases. Chin Med J Jul 1985;98(7):471-4.Erickson RJ, Edwards B. Medically unresponsive foot pain treated successfully with acupuncture. Acupuncture in Medicine November 1996.Noguchi E, Ohsawa H, Kobayahi S, et al. The effect of electroacupuncture stimulation on the muscle blood flow of the hindlimb in anesthesized rats. J Auton Nerv Syst Feb 15, 1999;75(2-3):78-86.Steinmetz M. Treatment choices for plantar fasciitis. Am Fam Physician Dec 1999;60(9):250-54.
Eur J Appl Physiol. 2003 Sep;90(1-2):114-9. Epub 2003 Jun 24
Effects of acupuncture on skin and muscle blood flow in healthy subjects
Sandberg M1, Lundeberg T, Lindberg LG, Gerdle B.Author information
In 14 healthy female subjects, the effects of needle stimulation (acupuncture) on skin and muscle blood flow were investigated using a non-invasive custom-designed probe and photoplethysmography (PPG). In randomised order, 2-7 days apart, three modes of needle stimulation were performed on the anterior aspect of the tibia: superficial insertion (SF), insertion into the anterior tibial muscle (Mu), and insertion into the muscle including manipulation of the needle in order to elicit a distinct sensation of distension, heaviness or numbness (DeQi). Before intervention, the subjects rested for 30 min. After the intervention, the needle was left in situ for 20 min. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. In a fourth session, serving as control, corresponding measurements were performed without any needle stimulation. Area under curve was calculated for 5-min periods prior to and after stimulation, respectively, and for the remaining 15-min period after stimulation. Compared to the control situation, muscle blood flow increased following both Mu and DeQi for 20 min, with the latter being more pronounced for the initial 5 min. Skin blood flow increased for 5 min following DeQi. However, no increase was found following SF. The DeQi stimulation was preceded by higher visual analogue scale ratings of anxiety prior to stimulation, which might have influenced skin blood flow to some extent. The results indicate that the intensity of the needling is of importance, the DeQi stimulation resulting in the most pronounced increase in both skin and muscle blood flow.
PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Via Shaftesbury Clinic Bedford, Shaftesbury Clinic
Alberto Contador is using acupuncture to help him with his knee pain during the race.
The 2014 Tour De France is underway. Hundreds of elite cyclists are racing through the picturesque mountains of France in an amazing feat of endurance. Although I am not a big cycling fan, I am a huge fan of acupuncture! So, I was thrilled to learn that super star cyclist Alberto Contador is using acupuncture to help him with his knee pain during the race. He injured his knee early in the race and uses acupuncture to combat the pain and inflammation. I also learned that Tyler Hamilton, who is now retired, also used acupuncture during the 2004 Tour.
From Cycling Weekly: Contador Receives Acupuncture for Knee
Back in 2004 Tyler Hamilton received acupuncture after a bike accident during the race injured his back and shoulder.
From the associated press during the 2004 Tour De France: Acupuncture Helped Rider with Back Pain in the Tour de France Race
Side note: I read Tyler Hamilton’s book ‘The Secret Race’ (written with Daniel Coyle) while on vacation and really enjoyed it.
Jennifer Dubowsky, LAc, is a licensed acupuncturist with a practice in downtown Chicago, Illinois, since 2002. Dubowsky earned her Bachelor of Science degree in Kinesiology from University of Illinois in Chicago and her Master of Science degree in Oriental Medicine from Southwest Acupuncture College in Boulder, Colorado. During her studies, she completed an internship at the Sino-Japanese Friendship Hospital in Beijing, China. Dubowsky has researched and written articles on Chinese medicine and has given talks on the topic. She maintains a popular blog about health and Chinese medicine at Acupuncture Blog Chicago. Adventures in Chinese Medicine is her first book. You can find her at www.tcm007.com.
*Image of “Tour de France”, Ian Taylor, via Wikimedia CommonsTags: acupuncturecycling
Acupuncture known to be an effective treatment for Piriformis Syndrome.
Acupuncture: An Effective Treatment for Painful Piriformis SyndromeBY PINEAPPLE • JULY 1, 2014
By Edward Scarlett
In my clinic I am continually amazed at how many patients come seeking relief from this very painful condition. This syndrome can occur in just about any one. For example elderly patients, athletes, people who sit a lot, weekend warrior types, people with trauma’s, pregnancy moms can all suffer from this Syndrome. The piriformis muscle is a small flat, band-like muscle located in the buttocks near the top of the hip joint. The Syndrome happens when the piriformis muscle compresses the sciatic nerve.
The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. The pain can be severe and extend down the length of the sciatic nerve (called sciatica). Many times it is difficult for the patient to sit or walk long distances. People can also have trouble experiencing restful sleep because of the pain.
The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle. Diagnosis of piriformis syndrome is made by the patient’s communication of symptoms and by a physical exam using a variety of movements to elicit pain to the piriformis muscle.
In most cases, a contracted or tender piriformis muscle can be found with palpating trigger points along the muscle itself. Sometimes I have found that a disk herniation in the lower lumbar spine and/or sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation can also coexist with the piriforis syndrome.
I have been able to achieve exceptional results treating these problems at my clinic over the last 23 years. I have found that using a combination of damp heat, blood moving liniments, advanced Acupressure and Acupuncture work just about always in getting the patient relief and correcting the dysfunction. Patients usually begin to feel relief right away with treatments.
The patient also needs to engage in a program of proper stretching, and exercise, depending on what stage of the syndrome there experiencing. For example whether the pain is being created by an acute or chronic situation would determine how active they should be or how much they should rest.
If they stay consistent with their treatments and follow the correct action plan they can most certainly expect positive results without taking pain meds or needing a cortisone injection. Many people are walking around out there with piriformis syndrome, hip, and low back pain not realizing it can be treated and resolved with a good treatment plan such as what we offer here at Alive and Acupuncture Clinic.
Tour de France 2011: All the latest Tour news in easily-digestible chunks: Kolobnev's positive, Geraint Thomas, Evans and more...
Contador receives acupuncture for knee
“The inflammation is bad,” he said yesterday. “To help take care of it I am using acupuncture.”
The Spaniard hopes that the acupuncture helps the inflammation and pain ahead of the first high-mountain stage, Thursday’s twelfth leg to Luz Ardiden.
“We are still here,” added general manager, Bjarne Riis, “to see if we can win the Tour de France. No matter what.”
Contador’s third crash on Sunday involved Russian Vladimir Karpets (Katusha). Rumours ran wild on Twitter that Karpets pushed Contador off the road.
Karpets apparently bumped against Contador. He told TV journalist Matt Rendell: “Yes, yes, he hit me with his wrist.”
“It was an accident,” said Contador, ending the rumours. “I got my handlebar tangled up with his seat.”
Judge for yourself here: http://www.youtube.com/watch?v=UKuJCGV8m-w
Chris Horner's acupuncture regime
Greg Bourque, Chris Horner's acupunturist since Horner's days at Francaise des Jeux in the 1990s, removes needles from Chris Horner's leg. Horner gets acupunture twice weekly.
Integrative Acupuncture & Oriental Medicine posted this photo on 2014-06-03. 10 likes. 0 comments. 4 shares.
Acupuncture Bedford's insight:
Jeremy Adams, sports star uses #acupuncture
Acupuncture - the most effective form of CAM for musculoskeletal conditions
Acupuncture is the most effective CAM for treating musculoskeletal conditions and one of only a few therapies that is supported by current medical evidence, according to a report commissioned by the charity Arthritis Research UK....
Via Bedford Acupuncture
Acupuncture - the most effective form of CAM for musculoskeletal conditions
Acupuncture is the most effective CAM for treating musculoskeletal conditions and one of only a few therapies that is supported by current medical evidence, according to a report commissioned by the charity Arthritis Research UK....
Via Bedford Acupuncture, Shaftesbury Clinic
Med Sci Sports Exerc. 2003 Aug;35(8):1296-302.Acupuncture and responses of immunologic and endocrine markers during competition.Akimoto T1, Nakahori C, Aizawa K, Kimura F, Fukubayashi T, Kono I.Author information
Acupuncture is used to modulate the physical well-being of athletes in Asian countries. However, there is little information on the immediate effects of acupuncture treatment on physiological or psychological responses to exercise.
The purpose of this study was to examine the effect of acupuncture treatment on the physical well-being of elite female soccer players during a competition period.
Subjects were divided into two groups: those who received acupuncture treatment (18.1 +/- 2.3 yr [+/-SD], N = 9) and a control group (17.7 +/- 2.8 yr, N = 12). In the treatment group, acupuncture stimulus was applied at LI 4 (Goukoku), ST 36 (Ashi-sanri) for 20 min, and ST 6 (Kyosya), LU 6 (Ko-sai) points for 15 min 4 h after the game every night during the competition period. The measured parameters included salivary secretory immunoglobulin A (SIgA) level, cortisol level in saliva, subjective rating of physical well-being, and profile of mood states (POMS).
The following were the main results: 1). Exercise-induced decrease of salivary SIgA and increase of salivary cortisol were inhibited by acupuncture. 2). Acupuncture improved subjective rating of muscle tension and fatigue. 3). The POMS score was modulated by acupuncture.
These results support the effectiveness of acupuncture for physical and mental well-being of athletes.
PMID: 12900681 [PubMed - indexed for MEDLINE]
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cupunct Med 1999;17:62-63 doi:10.1136/aim.17.1.62ContentsAcupuncture and alternative therapies in premiership football clubsRichard A Stacey
+Author AffiliationsMoorcroft Surgery, 646 King Lane, Alwoodley, Leeds LS77 7AN (UK)Summary
A survey was performed by postal questionnaire to assess the extent of use of acupuncture and other complementary treatment modalities amongst premier league football clubs. The physical therapies of acupuncture, osteopathy and chiropractic were used by over half the clubs that responded. Other therapies such as homoeopathy and aromatherapy were less commonly used.
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Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture's mechanism of action and suggests a potentially important integrative role for interstitial connective tissue. Anat Rec (New Anat) 269:257–265, 2002. © 2002 Wiley-Liss, Inc.
During acupuncture treatments, fine needles traditionally are inserted at specific locations of the body known as acupuncture points. According to classic Chinese theory, acupuncture points are linked together in a network of “meridians” running longitudinally along the surface of the body (Figure 1). Despite considerable efforts to understand the anatomy and physiology of acupuncture points and meridians, the definition and characterization of these structures remains elusive (NIH Consensus Statement, 1997).
The goal of this article is to present evidence supporting a conceptual model linking traditional Chinese acupuncture theory with conventional anatomy. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue and that this relationship is relevant to acupuncture's therapeutic mechanism.
Figure 1. Acupuncture meridians of the arm. Acupuncture points were located by palpation in a living subject, according to anatomical guidelines provided in a major reference acupuncture textbook (Cheng, 1987). Connective tissue planes associated with Yin meridians are more inward and deep, compared with the generally outward and superficial planes associated with Yang meridians.
Jump to…TRADITIONAL CONCEPTS
Acupuncture meridians are traditionally thought to represent “channels” through which flows “meridian qi” (Kaptchuk, 2000). Although the concept of meridian qi has no known physiological equivalent, terms used in acupuncture texts to describe the more general term “qi” evoke dynamic processes such as communication, movement, or energy exchange (O'Connor and Bensky, 1981). Disruption of the meridian channel network is believed to be associated with disease, and needling of acupuncture points is thought to be a way to access and influence this system (Cheng, 1987).
Charts representing acupuncture points and meridians date as far back as 300 B.C. (Veith, 1949). Modern acupuncture charts indicate 12 principal meridians “connecting” the limbs to the trunk and head. In addition, many other “accessory” meridians are also described, as well as deep “internal branches” starting at specific points on the principal meridians and reaching internal organs. The names of the principal meridians (e.g., lung, heart) represent physiological functions thought to be specifically related to each meridian, rather than the actual lung or heart organ itself. One meridian named Triple Heater is thought to be related to temperature balance between different parts of the body. Acupuncture points are mostly located along the meridians, although “extra” points outside the meridian system are also believed to exist. Although acupuncture texts and atlases generally agree on the location of the principal meridians, considerable variability exists as to the number and location of internal branches and extra points.
The Chinese character signifying acupuncture point also means “hole” (O'Connor and Bensky, 1981), conveying the impression that acupuncture points are locations where the needle can gain access to some deeper tissue components. Modern acupuncture textbooks contain visual charts as well as written guidelines for locating each acupuncture point. These guidelines refer to anatomical landmarks (such as bony prominences, muscles, or tendons) as well as proportional measurements (e.g., fraction of distance between elbow and wrist) (Cheng, 1987). During acupuncture treatments, acupuncturists use these landmarks and measurements to determine the location of each point within approximately 5 mm. Precise point location within this range is achieved by palpation, during which the acupuncturist searches for a slight depression or yielding of the tissues to light pressure.
Jump to…ARE ACUPUNCTURE POINTS DIFFERENT FROM SURROUNDING TISSUE?
Over the past 30 years, studies aimed at understanding the acupuncture point/meridian system from a “Western” perspective mainly have searched for distinct histological features that might differentiate acupuncture points from surrounding tissue. Seveal structures, such as neurovascular bundles (Rabischong et al., 1975; Senelar, 1979; Bossy, 1984), neuromuscular attachments (Liu et al., 1975; Gunn et al.,1976; Dung, 1984), and various types of sensory nerve endings (Shanghai Medical University, 1973; Ciczek et al., 1985), have been described at acupuncture points. However, none of these studies included statistical analyses comparing acupuncture points with appropriate “nonacupuncture” control points.
Other studies have turned their attention to possible physiological differences between acupuncture points and surrounding tissues. Skin conductance has been reported by several investigators to be greater at acupuncture points compared with control points (Reishmanis et al., 1975; Comunetti et al., 1995). Several factors, on the other hand, are known to affect skin conductance (e.g., pressure, moisture, skin abrasion; Noordegraaf and Silage, 1973; McCarroll and Rowley, 1979), and to date, no study has both controlled for these factors and included sufficient numbers of observations to confirm these findings. Attempts to identify anatomical and/or physiological characteristics of acupuncture points, therefore, have remained mostly inconclusive.
Ancient acupuncture texts contain several references to “fat, greasy membranes, fasciae and systems of connecting membranes” through which qi is believed to flow (Matsumoto and Birch, 1988), and several authors have suggested that a correspondence may exist between acupuncture meridians and connective tissue (Matsumoto and Birch, 1988; Oschman, 1993; Ho and Knight, 1998). Recent work done in our laboratory has begun to provide experimental evidence in support of this hypothesis. We have characterized a connective tissue response to acupuncture needling that is quantitatively different at acupuncture points compared with control points (Langevin et al.,2001b) and that may constitute an important clue to the nature of acupuncture points and meridians.
Jump to…BIOMECHANICAL RESPONSE TO NEEDLING: “NEEDLE GRASP”
An important aspect of traditional acupuncture treatments is that acupuncture needles are manually manipulated after their insertion into the body. Needle manipulation typically consists of rapid rotation (back-and-forth or one direction) and/or pistoning (up-and-down motion) of the needle (O'Connor and Bensky, 1981). During needle insertion and manipulation, acupuncturists aim to elicit a characteristic reaction to acupuncture needling known as “de qi” or “obtaining qi.” During de qi, the patient feels an aching sensation in the area surrounding the needle. Simultaneously with this sensation, the acupuncturist feels a “tug” on the needle, described in ancient Chinese texts as “like a fish biting on a fishing line” (Yang, 1601). We refer to this biomechanical phenomenon as “needle grasp.”
According to traditional teaching, de qi is essential to acupuncture's therapeutic effect (O'Connor and Bensky, 1981). One of the most fundamental principles underlying acupuncture is that acupuncture needling is thought to be a way to access and influence the meridian network. The characteristic de qi reaction, perceived by the patient as a needling sensation and by the acupuncturist as needle grasp, is thought to be an indication that this goal has been achieved (Cheng, 1987). The biomechanical phenomenon of needle grasp, therefore, is at the very core of acupuncture's theoretical construct.
Needle grasp is enhanced clinically by manipulation (rotation, pistoning) of the acupuncture needle. In previous human and animal studies using a computerized acupuncture-needling instrument (Langevin et al., 2001b, 2002), we have quantified needle grasp by measuring the force necessary to pull the acupuncture needle out of the skin (pullout force). We have shown that pullout force is indeed markedly enhanced by rotation of the needle. Needle grasp, therefore, is a measurable tissue phenomenon associated with acupuncture needle manipulation. In a quantitative study of needle grasp in 60 healthy human subjects (Langevin et al., 2001b), we measured pullout force at eight different acupuncture point locations, compared with corresponding control points located on the opposite side of the body, 2 cm away from each acupuncture point. We found that pullout force was on average 18% greater at acupuncture points than at corresponding control points. We also found that needle manipulation increased pullout force at control points as well as at acupuncture points. Needle grasp, therefore, is not unique to acupuncture points, but rather is enhanced at those points.
Jump to…ROLE OF CONNECTIVE TISSUE IN NEEDLE GRASP
Although previously attributed to a contraction of skeletal muscle, we have shown that needle grasp is not due to a muscle contraction but rather involves connective tissue (Langevin et al., 2001a, 2002). In both in vivo and in vitro experiments, we have found that, during acupuncture needle rotation, connective tissue winds around the acupuncture needle, creating a tight mechanical coupling between needle and tissue. This needle-tissue coupling allows further movements of the needle (either rotation or pistoning) to pull and deform the connective tissue surrounding the needle, delivering a mechanical signal into the tissue.
Observation under a microscope of an acupuncture needle inserted into dissected rat subcutaneous tissue reveals that a visible “whorl” of tissue can be produced with as little as one turn of the needle (Figure 2A). When the needle is placed flat onto the subcutaneous tissue surface and then rotated, the tissue tends to adhere to and follow the rotating needle for 180 degrees, at which point the tissue adheres to itself and further rotation results in formation of a whorl. This phenomenon can be observed to varying degrees with acupuncture needles of different materials (stainless steel, gold) as well as with other objects not customarily used as acupuncture tools such as regular hypodermic needles, glass micropipettes, siliconized glass, and Teflon-coated needles. An important factor appears to be the diameter of the rotating needle. Acupuncture needles are very fine (250–500 μm diameter). With needles greater than 1 mm in diameter, the tissue invariably follows the rotating needle for less than 90 degrees and then falls back, failing to stick to itself and initiate winding. Initial attractive forces between the rotating needle and tissue, thus, may be important to initiate the winding phenomenon. These may include surface tension and electrical forces and may be influenced by the material properties of the needle.
Figure 2. A: Formation of a connective tissue “whorl” with needle rotation. Rat subcutaneous connective tissue was dissected and placed in physiological buffer under a dissecting microscope. An acupuncture needle was inserted through the tissue and progressively rotated. Numbers 0 through 7 indicate numbers of needle revolutions. A visible whorl of connective tissue can be seen with as little as one revolution of the needle. B: Scanning electron microscopy imaging of reusable gold (left) and disposable stainless steel (right) acupuncture needles. Original magnification, 350×. C,D: Scanning electron microscopy of gold (C) and stainless steel (D) needles. Original magnification, 3,500×. The surface of the gold needle is visibly rougher than that made of stainless steel. Scale bars = 2.5 mm in A, 100 μm in B, 10 μm in C,D.
When we compared two equal diameter acupuncture needles, one reusable needle made of gold (ITO, Japan) and one disposable made of stainless steel (Seirin, Japan), the gold needle appeared to initiate winding more readily than the stainless steel one. Scanning electron microscopy images of the two needles (Figure 2B–D) showed that the gold needle had a rougher surface, which may have more successfully “engaged” the tissue during the initiation of winding. These observations also suggest that mechanical coupling between needle and tissue can occur even when the amplitude of needle rotation is very small (less than 360 degrees) as commonly used in clinical practice. We have also shown that, with back-and-forth needle rotation, which is generally preferred clinically over rotation in one direction, winding alternates with unwinding, but unwinding is incomplete, resulting in a gradual buildup of torque at the needle–tissue interface (Langevin et al., 2001b).
The importance of establishing a mechanical coupling between needle and tissue is that mechanical signals (1) are increasingly recognized as important mediators of information at the cellular level (Giancotti and Ruoslahti, 1999), (2) can be transduced into bioelectrical and/or biochemical signals (Banes et al., 1995; Lai et al., 2000), and (3) can lead to downstream effects, including cellular actin polymerization, signaling pathway activation, changes in gene expression, protein synthesis, and extracellular matrix modification (Chicurel et al., 1998; Chiquet, 1999). Changes in extracellular matrix composition, in turn, can modulate the transduction of future mechanical signals to and within cells (Brand, 1997). Recent evidence suggests that both tissue stiffness and stress-induced electrical potentials are affected by connective tissue matrix composition (Bonassar et al., 1996) and that changes in matrix composition in response to mechanical stress may be an important form of communication between different cell types (Swartz et al., 2001). Acupuncture needle manipulation, thus, may cause lasting modification of the extracellular matrix surrounding the needle, which may in turn influence the various cell populations sharing this connective tissue matrix (e.g., fibroblasts, sensory afferents, immune and vascular cells).
In addition, we have hypothesized previously that, in the vicinity of the needle, acupuncture-induced actin polymerization in connective tissue fibroblasts may cause these fibroblasts to contract, causing further pulling of collagen fibers and a “wave” of connective tissue contraction and cell activation spreading through connective tissue (Langevin et al., 2001a). This mechanism may explain the phenomenon of “propagated sensation,” i.e., the slow spreading of de qi sensation sometimes reported by patients along the course of an acupuncture meridian (Huan and Rose, 2001).
Jump to…CORRESPONDENCE OF ACUPUNCTURE POINTS AND MERIDIANS TO CONNECTIVE TISSUE PLANES
Acupuncture meridians tend to be located along fascial planes between muscles, or between a muscle and bone or tendon (Cheng,1987). A needle inserted at the site of a connective tissue cleavage plane will penetrate first through dermis and subcutaneous tissue, then through deeper interstitial connective tissue. In contrast, a needle inserted away from a connective tissue plane will penetrate dermis and subcutaneous tissue, then reach a structure such as muscle or bone. Because needle grasp involves interaction of the needle with connective tissue (Langevin et al., 2002), the enhanced needle grasp response at acupuncture points may be due to the needle coming into contact with more connective tissue (subcutaneous plus deeper fascia) at those points. The presence of needle grasp at control points as well as at acupuncture points is consistent with some amount of connective tissue (subcutaneous) being present at all points. This concept is illustrated in Figure 3, which shows ultrasound images of the same acupuncture point and corresponding control point in two normal human subjects. The acupuncture point is located on the skin overlying the fascial plane separating the vastus lateralis and biceps femoris muscles. The control point, located 3 cm away from the acupuncture point, is located over the belly of the vastus lateralis muscle.
Figure 3. Ultrasound imaging of acupuncture (AP) and control (CP) points. Acupuncture point GB32 was located by palpation in two normal human volunteers, as well as a control point located 3 cm away from the acupuncture point. After marking both points with a skin marker, ultrasound imaging was performed with an Acuson ultrasound machine equipped with a 7 MHz linear probe. A visible connective tissue intramuscular cleavage plane can be seen at acupuncture points but not at control points. V.Lat, vastus lateralis; B.Fem, biceps femoris; Sc, subcutaneous tissue.
To investigate the hypothesis that acupuncture points are preferentially located over fascial planes, we marked the location of all acupuncture points and meridians in a series of gross anatomical sections through the human arm (Research Systems Visible Human CD, Boulder, CO) (Figure 4). The interval between sections corresponded to one “cun” or anatomical inch (a proportional unit measurement used in acupuncture textbooks to locate acupuncture points) representing 1/9 of the distance between the elbow crease and the axially fold (in this case 2.5 cm). This section interval allowed us to include all acupuncture points located on the six principal meridians of the arm between the olecranon (Figure 4, section 0) and the superior edge of the humeral head (Figure 4, section 12). In each section, we marked all acupuncture points and the intersection of all meridians with the plane of section (meridian intersection).
Figure 4. Location of acupuncture points and meridians in serial gross anatomical sections through a human arm. The interval between sections corresponds to one “cun” or anatomical inch representing 1/9 of the distance between the elbow crease and the axially fold (in this case, 2.5 cm). Sections begin at the olecranon (0) and end at the superior edge of the humeral head (12). Acupuncture points, meridian intersections, and specific meridians are labeled according to the legend.
Acupuncture points and meridian intersections were located according to written guidelines (based on anatomical landmarks and proportional measurements) and acupuncture charts provided in a major textbook of traditional Chinese acupuncture (Cheng, 1987). Because connective tissue planes were visible on the anatomical sections, every attempt was made to minimize bias by adhering to these guidelines as objectively as possible. In a live subject, palpation is used to locate acupuncture points precisely once the approximate location has been determined by using anatomical landmarks and proportional measurements. For some points, body parts are manipulated and positioned in a specific way to perform this palpation. In the case of our postmortem sections, the points needed to be located in the anatomical position without the benefit of palpation. When written descriptions referred to anatomical landmarks palpable in the anatomical position (such as the olecranon or biceps tendon), we used the position of the bones, tendons, and muscles in the cross-sections to determine where these landmarks would have been palpable on the surface of the body. For those points where palpation is traditionally performed in a position other than the anatomical position, we guided ourselves on (1) charts from acupuncture textbooks drawn in the anatomical position, and (2) a live human model on which we located acupuncture points by palpating them in the position specified in the textbook, and then placed the model's arm in the anatomical position (Figure 1). Textbook guidelines referring to proportional measurements (such as a fraction of the distance between the elbow crease and axially fold) are traditionally defined in the anatomical position. We, therefore, were able to apply these measurements directly to the postmortem tissue sections by determining appropriate section numbers based on the section interval, and making measurements on individual cross-sections.
By using these guidelines, we marked three acupuncture points on the heart meridian (H3, H2, H1), two points on the pericardium meridian (P3, P2), five points on the lung meridian (L5, L4, L3, L2, L1), five points on the large intestine meridian (LI11, LI12, L113, LI14), five points on the triple heater meridian (SJ10, SJ11, SJ12, SJ13, SJ14), and four points on the small intestine meridian (SI8, SI9, SI10, SI11) for a total of 24 acupuncture points. Meridians intersected with the plane of section at 51 other sites that were not acupuncture points.
As shown in Figure 4, three of six meridians included portions that followed fascial planes between muscles (biceps/triceps [heart meridian, Figure 4, sections 2–7], biceps/brachialis [lung meridian, Figure 4, sections 4–5], and brachialis/triceps [large intestine meridian, Figure 4, sections 3–5]). Some points on those meridians (H2, LI14, H1) also appeared to be located at the intersection of two or more fascial planes. Two other meridians included portions that followed intramuscular cleavage planes [between heads of biceps (pericardium meridian, Figure 4, sections 5–7) and triceps (triple heater meridian, Figure 4, sections 2–6)]. One meridian (small intestine meridian) did not itself follow any recognizable inter- or intramuscular plane. However, three out of the four acupuncture points on this portion of the meridian (SI9, 10, and 11) clearly coincided with the intersection of multiple fascial planes. Overall, more that 80% of acupuncture points and 50% of meridian intersections of the arm appeared to coincide with intermuscular or intramuscular connective tissue planes.
To estimate the probability that such an event would be due to chance, we tested a model representing the middle portion of the arm (sections 2–7) approximated to a cylinder 12.5 cm long and 30 cm in circumference, and including eight acupuncture points and 28 meridian intersections. Assuming that the average width of the five major fascial planes of the arm (triceps/triceps, biceps/brachialis, brachialis/triceps, between heads of triceps, and between heads of biceps) is 1/60 of the circumference of the cylinder (or approximately 5 mm), 1/12 of the surface of the cylinder will intersect with a fascial plane. If we also assume that the “width” of an acupuncture point is 5 mm, the probability that a random point in any given section of the cylinder will fall on a fascial plane is 1/12 or 0.083. Using the hypergeometric distribution (sampling without replacement), the probability that either six or seven of eight points (75 or 87%) randomly distributed in six sections through the cylinder would fall on fascial planes is P < 0.001. Likewise, taking 5 mm as the “width” of a meridian, the probability of 14 of 28 meridian intersections (50%) falling on fascial planes is also P < 0.001.
These findings suggest that the location of acupuncture points, determined empirically by the ancient Chinese, was based on palpation of discrete locations or “holes” where the needle can access greater amounts of connective tissue. Some portions of meridians clearly follow one or more successive connective tissue planes, whereas others appear to simply “connect the dots” between points of interest. On the basis of these findings and our previous experimental results (Langevin et al., 2001b, 2002), we propose that acupuncture charts may serve as a guide to insert the needle into interstitial connective tissue planes where manipulation of the needle can result in a greater mechanical stimulus. A greater therapeutic effect at acupuncture points may be at least partly explained by more powerful mechanical signaling and downstream effects at those points.
We chose the arm for this study because it offers relatively simple anatomy and widely spaced fascial planes (compared with, for example, the forearm) and also because the arm illustrates how both meridians and connective tissue planes “connect” the arm with the shoulder girdle and chest (see below). We, however, expect that similar results would be obtained in other body regions. In the forearm, leg, and thigh, meridians also appear to generally follow connective tissue planes separating muscles or within muscles. On the trunk, meridians close to the midline (kidney, stomach, spleen, and bladder) run longitudinally in the front and back, whereas more laterally placed meridians (liver, gall bladder) run obliquely, paralleling the orientation of main muscle groups and the connective tissue planes separating them. On the face, meridians criss-cross each other in an intricate pattern compatible with the complexity of facial muscular and connective tissue structures.
Jump to…MERIDIAN/CONNECTIVE TISSUE NETWORK
Acupuncture meridians are believed to form a network throughout the body, connecting peripheral tissues to each other and to central viscera (Kaptchuk, 2000). Interstitial connective tissue also fits this description. Interstitial “loose” connective tissue (including subcutaneous tissue) constitutes a continuous network enveloping all limb muscles, bones, and tendons, extending into connective tissue planes of pelvic and shoulder girdles, abdominal and chest walls, neck, and head. This tissue network is also continuous with more specialized connective tissues such as periosteum, perimysium, perineurium, pleura, peritoneum, and meninges. A form of signaling (mechanical, bioelectrical, and/or biochemical) transmitted through interstitial connective tissue, therefore, may have potentially powerful integrative functions. Such integrative functions may be both spatial (“connecting” different parts of the body) as well as across physiological systems (connective tissue permeates all organs and surrounds all nerves, blood vessels, and lymphatics). In addition, because the structure and biochemical composition of interstitial connective tissue is responsive to mechanical stimuli, we propose that connective tissue plays a key role in the integration of several physiological functions (e.g., sensorineural, circulatory, immune) with ambient levels of mechanical stress.
One of the salient features of acupuncture theory is that the needling of appropriately selected acupuncture points has effects remote from the site of needle insertion, and that these effects are mediated by means of the acupuncture meridian system (O'Connor and Bensky,1981). To date, physiological models attempting to explain these remote effects have invoked systemic mechanisms involving the nervous system (Ulett et al., 1998; Pomeranz, 2001). A mechanism initially involving signal transduction through connective tissue, with secondary involvement of other systems including the nervous system, is potentially closer to traditional Chinese acupuncture theory, yet also compatible with previously proposed neurophysiological mechanisms.
Jump to…CONCEPTUAL MODEL FOR ACUPUNCTURE POINTS AND MERIDIANS
Rather than viewing acupuncture points as discrete entities, we propose that acupuncture points may correspond to sites of convergence in a network of connective tissue permeating the entire body, analogous to highway intersections in a network of primary and secondary roads. One of the most controversial issues in acupuncture research is whether the needling of acupuncture points has “specific” physiological and therapeutic effects compared with nonacupuncture points (NIH Consensus Statement, 1997). By using the road analogy, interaction of an acupuncture needle with connective tissue will occur even at the smallest connective tissue “secondary road.” Needling a major “highway intersection,” however, may have more powerful effects, perhaps due to collagen fiber alignment leading to more effective force transduction and signal propagation at those points.
In summary, the anatomical correspondence of acupuncture points and meridians to connective tissue planes in the arm suggests plausible physiological explanations for several important traditional Chinese medicine concepts summarized in Table 1. We propose that acupuncture needle manipulation produces cellular changes that propagate along connective tissue planes. These changes may occur no matter where the needle is placed but may be enhanced when the needle is placed at acupuncture points. This conceptual model would be further strengthened by an expanded investigation of the whole body, including lower extremity, trunk, and head. The anatomy of acupuncture points and meridians, thus, may be an important factor that will begin to unravel the veil of mystery surrounding acupuncture.
Table 1. Summary of proposed model of physiological effects seen in acupunctureTraditional Chinese medicine conceptsProposed anatomical/physiological equivalentsAcupuncture meridiansConnective tissue planesAcupuncture pointsConvergence of connective tissue planesQiSum of all body energetic phenomena (e.g. metabolism, movement, signaling, information exchange)Meridian qiConnective tissue biochemical/bioelectrical signalingBlockage of qiAltered connective tissue matrix composition leading to altered signal transductionNeedle graspTissue winding and/or contraction of fibroblasts surrounding the needleDe qi sensationStimulation of connective tissue sensory mechanoreceptorsPropagated de qi sensationWave of connective tissue contraction and sensory mechanoreceptor stimulation along connective tissue planesRestoration of flow of qiCellular activation/gene expression leading to restored connective tissue matrix composition and signal transductionJump to…Acknowledgements
We thank James R. Fox, M.S., Bruce J. Fonda, M.S., John P. Eylers, Ph.D., Gary M. Mawe, Ph.D., William L. Gottesman, M.D., Junru Wu, Ph,D., and Douglas J. Taatjes, Ph.D. for their valuable assistance. Data from the Visible Human Project Initiative was made available through the National Library of Medicine and the University of Colorado. This study was funded in part by National Institutes of Health Center for Complementary and Alternative Medicine Grant RO1AT-00133.
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