We have several physiotherapists who use acupuncture within the treatment/management plan of numerous conditions and also as an individual course of treatment by itself. All are physiotherapists using acupuncture are members of the Acupuncture Association of Chartered Physiotherapists (AACP) that ensures all members using acupuncture have received and maintain the necessary training to be able to use acupuncture effectively and competently. Please follow this link to find out more information on the AACP and acupuncture
Acupuncture Overview
Detailed below is a selection of evidence and information about our understanding of acupuncture and how some of its effects work, it is fairly in-depth but gives a good overview of the processes that take place as a result. |
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Acupuncture has been around in some form for over 2,500 years and involves the insertion of fine needles into specific points along meridians on the body (Hopwood et al 1997). The use of acupuncture within physiotherapy has increased substantially over the last 20-30 years as increased evidence and understanding of its mechanisms of action and effects has increased its integration and acceptance within western healthcare. The ability to utilise knowledge of anatomy, physiology and pathology with sound clinical reasoning enables physiotherapists to make more appropriate and effective use of acupuncture within treatment.
Three major categories of acupuncture mechanism of action have been described, which are peripheral, spinal and supra-spinal (Lundeburg 1998). The knowledge of these mechanisms in relation to pain mechanisms, anatomy and pathology are important to ensure sound clinical reasoning and appropriate treatment choice and progression during a patient’s management (Bradnam 2007).
The use of certain acupuncture points e.g. bilateral LI-4, combined with bilateral Liver-3 (4 gates) have been shown to maximise the descending inhibitory effect on pain at higher centres in the brain (they have been shown to have powerful central effects when used together (Carlsson 2002).
Recent Magnetic Resonance Imaging (MRI) studies have shown that manual acupuncture at LI-4 and Liv-3 caused deactivation of the prefrontal cortex and anterior cingulate cortex areas of the brain (Yan et al 2005). Creac’h et al (2000) showed that these areas of the brain were activated by mechanical nociceptive pain. It could therefore be suggested that stimulation of LI-4 and Liv-3 have pain modulating effects at higher centres within the brain. LI-11 and LI-14 (along with LI-4 and LIv-3) may have a powerful analgesic effect due to the larger effect on limbic and paralimbic structures involved in the modulation of pain that stimulation of peripheral points with a stronger De Qi have, that has been shown using fMRI (Hui et al 2005).
A trigger point is described as a taut band in the skeletal muscle or the muscle fascia. There are a variety of theories on the initial cause of ‘trigger points’, these include postural overload and trauma. Hong (1998) proposed that this can cause decreased circulation and local ischaemia due to sustained sarcomere shortening due to a dysfunctional motor end plate. Dysfunctional or over active motor end plates are associated with excessive acetylcholine production affecting the volted-gated sodium channels of the sarcoplasmic reticulum, increasing intracellular calcium levels. This creates low amplitude continuous action potentials maintaining contraction within a section of the muscle spindle and a cycle of local ischaemia with development of subsequent secondary local changes as a result (Hubbard and Berkoff, 1993). The secondary issues preventing resolution of nociceptive pain as described by Lundeburg et al (1988) are often associated with ongoing myo-fascial trigger points.
An active trigger point can also cause restriction of normal range of movement and weakness (Travell and Simon 1998). Trigger points are painful on compression and can give rise to characteristic referred pain. Myo-fascial trigger point pain referral patterns have been identified by Travell and Simon (1998). The use of acupuncture in the treatment of active trigger points is to insert the needle into the tissue to the level of the motor end plate to disrupt and de-activate the dysfunctional motor end plate (produce localized involuntary twitching and needle grab). This reaction has the effect of fatiguing the tight muscle through the over stimulation and subsequent depletion of acetylcholine to allow a full release of the sarcomere contraction. There is also needle induced afferent activity that blocks the trigger point’s C afferent input to the spinal cord by evoking activity in the enkephalinergic inhibitory neurons (Baldry 2001).
Acupuncture has been associated with release of endogenous endorphins (Clement-Jones et al 1980). The release of these endorphins in the Cerebro Spinal Fluid (CSF) via a neuronal network between the peri-aquaductal grey and hypothalamus in the brainstem (Clement-Jones et al 1980) which has a powerful analgesic effect and can have positive mood altering effects (Hopwood et al 1997). Endorphins are also released into the blood stream giving systemic pain inhibition as well as sympathetic nervous system inhibition (Ma 2004). Therefore acupuncture has the potential to inhibit the sympathetic components of pain and certain conditions through activation of higher centres in the brain.
There are numerous other reasons and processes that are involved in the way acupuncture works for the management of a variety of different conditions.
References
Baldry PE (2001) Myofascial pain and fibromyalgia syndromes. Churchill Livingstone. Edinburgh.
Bradnam L (2007) A proposed clinical reasoning model for western acupuncture, Journal of the Acupuncture association of chartered physiotherapists, Jan; 21-30.
Clement-Jones V, McLoughlin L, Tomlin S (1980) Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain Lancet: 2:8021:946-949.
Creac’h C, Henry P, Caille JM & Allard M (2000) Functional MR imaging analysis of pain-related brain activation after acute mechanical stimulation, American Journal of Neuro-radiology, 21: 1402-1406.
Greenwood MT, Leong Ta & Tan WC (1988) Traditional Acupuncture Treatment for Whiplash Syndrome, American Journal of Acupuncture, 16: 4: 305 – 318.
Hansson Y, Carlsson C & Olsson E (2007) Intramuscular and periosteal acupuncture for anxiety and sleep quality in patients with chronic musculoskeletal neck pain, Acupuncture in Medicine, 25: 40: 148-157.
Hong C J, Simons D G. (1998) Pathophysiologic and electrophysiologic mechanisms of myo-fascial trigger points. Archives of Physical medication and rehabilitation 79: 863-72.
Hopwood V, Lovesey M, Mokone S (1997) Acupuncture and related techniques in physical therapy. Churchill Livingstone, Edinburgh.
Hubbard D R and Berkoff G M (1993) Myo-fascial trigger points show spontaneous needle EMG activity, Spine, 18:1803-1807.
Hui K K S, Liu J, Makris N, Gollub RL, Chen AJW, Moore CI, Kennedy D N, Rosen B R & Kwong K K H (2000) Acupuncture Modulates the limbic system and subcortical gray structures of the human brain, Evidence from MRI studies in normal subjects, Brain Mapping, 9: 1: 13-25.
Hui KK, Liu J & Marina O (2005) The intergrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST36 as evidenced by fMRI, Neuroimage, 27: 3: 479-496.
James M G (1987) The Mechanisms of Acupuncture Analgesia, British Journal of Hospital Medicine (Oct):308-312.
Jones M (1995) Clinical reasoning and pain, Manual Therapy, 1, 17-24.
Lundeburg T (1998) The physiological basis of acupuncture, Paper presented at the MANZ/PAANZ Annual conference, Chistchurch, New Zealand, August 1998.
Lundeberg T & Ekholm J (2001) Pain - From Periphery to Brain, Journal of the Acupuncture Association of Chartered Physiotherapists, Feb, 13-19.
Lundeberg T, Hurtig T, Lundeburg S & Thomas M (1988) Long Term Results of Acupuncture in Chronic Head and Neck Pain, Pain Clinic, 2, 15-31.
Ma S (2004) Neurobiology of Acupuncture, Evidence based complementary Alternative Medicine, 1: 1: 41-47.
Sandberg M, Lundeberg T, Lindberg L & Gerdle B (2003) Effects of acupuncture on skin and muscle blood flow in healthy subjects, European journal of applied physiology, 90: 114-119.
Sjoland B, Terenius L & Eriksson M (1977) Increased cerebrospinal fluid levels of endorphins after electro-acupuncture, Acto Physiologica Scandinavia, 100; 3; 382-384.
Travell J, Simons G. (1998) Myofascial pain and dysfunction trigger point manual, Lippincott, Williams and Wilkins.
Vasavada AN, Brault JR, Siegmund GP (2007). Musculo-tendon and fascicle strains in anterior and posterior neck muscles during whiplash injury. Spine, 32: 7: 756-765.
Witt CM, Jena S, Brinkhaus Bl (2006). Acupuncture for patients with chronic neck pain. Pain. June 13; [abstract].
Yan B, Li K, Xu J, Wang W, Liu H, Shan B, Tang X (2005) Acupoint specific fMRI patterns in human brain, Neuroscience Letters, Vol 383, pp.236-240.
Acupuncture - Commonly asked questions
Does it hurt?!
The needles used in acupuncture are very different from those used to give an injection or take blood for instance. They are much thinner and the method of insertion means often nothing is felt as the needle is inserted. However in some cases you may feel a very small short lived scratch/sensation. Acupuncture aims to elicit a sensation called ‘De Qi’ which occurs when certain nerve endings/receptors are activated by the needle, at this point you will fell a mild ache but this might only last a few seconds. During the treatment the needles will be stimulated to recreate that sensation. If electro-acupuncture is used you will also feel a tingling tapping sensation at the needle during the treatment which are you are able to control the intensity of. These sensations are required to help stimulate the nerves spinal cord and higher centres in the brain to help achieve the pain relief from acupuncture.
How deep do the needles go?
This depends on the type of problem, area of needling, type of effect desired, style of needling and many other factors. Needles typically range from 10 mm to 100 mm in length. Most will go in somewhere between 10 to 30 mm (1 inch).
I give blood regularly, will I be able to continue doing this if I have acupuncture?
Yes - all are acupuncturists are registered to provide acupuncture using sterile safe sharps and conditions. If required you can be provided with a special form detailing this that you can take with you to the blood service.
Who should not have acupuncture?
There are certain groups of people and people with certain conditions/medications that are contraindicated or care needs to be taken if using acupuncture. In general acupuncture is not suitable for people with;
- Blood clotting problems e.g. haemophiliacs, those on warfarin
- Low blood pressure
- Infection in the area
- Pregnant women in the first and third trimester
- People with an allergy to metals
- People with severe needle phobia
Your physio will go through a checklist of questions to ensure you are suitable
How many sessions will I need?
This depends on your problem and response to treatment typically people receiving Acupuncture will have 6-10 sessions to achieve optimum results.
How long does each session last?
Treatment time for acupuncture typically lasts from 20-30 minutes
Will I be sitting or lying down?
This Depends on your problem and which points will be needled. Whatever the situation the physio will ensure that you are in a comfortable position.
How safe are the needles?
All needles we use are ONE USE only sterile disposable needles that are sourced from reputatable healthcare suppliers within the UK.
Should I drive after acupuncture?
Some people can feel drowsy or lethargic after acupuncture and it is recommended that anyone experiencing these symptoms in the 10 minutes after having acupuncture doesn’t drive or use machinery immediately and have someone drive them home.
Remember if you should have any questions please feel free to ask at any time.
Our physiotherapists using acupuncture are all members of the AACP (Acupuncutre association of Chartered Physiotherapists).
