Biomedical Acupuncture for Sports and Trauma Rehabilitation

Dry Needling Techniques

Yun-tao Ma

• Publisher: Churchill Livingstone
• Year: 2010
• ISBN:
  9781455701001
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Written by widely respected acupuncture expert Yun-tao Ma, PhD, LAc, Biomedical Acupuncture for Sports and Trauma Rehabilitation shows techniques that will enhance athletic performance, accelerate recovery after intensive workouts, and speed trauma rehabilitation after injuries or surgeries. Evidence-based research is used to support the best and most effective techniques, with over 100 illustrations showing anatomy, injury, and clinical procedures. Unlike many other acupuncture books, this book uses a Western approach to make it easier to understand rationales, master techniques, and integrate biomedical acupuncture into your practice.

"Finally, a well-referenced, common sense approach to dry needling in sports medicine that discusses maintenance, overtraining, and the effect of the stress response in athletes. This is a long-awaited book that will leave you feeling comfortable with a technique that is very useful not only for athletes, but for all patients of your practice."

Rey Ximenes, MD

The Pain and Stress Management Center

Austin, Texas

"For any clinician involved with assisting athletes recover from injury, as well as providing services to enhance physical performance, this text will be indispensable. This book is a major accomplishment in the field of sports injury and treatment of musculoskeletal and neurological pain."

Mark A. Kestner, DC, FIAMA, CCSP, CSCS

Kestner Chiropractic & Acupuncture Center

Murfreesboro, Tennessee

• Unique! Explores acupuncture treatments for sports injuries in the acute phase, rehabilitation, and prevention.
• Includes acupuncture for performance enhancement and injury prevention, emphasizing pre-event acupuncture used to help increase muscle output, assist with pre-competition stress, and prevent soft tissue injury.
• Provides evidence-based research to show the science behind the best and most effective techniques, based on the author's background in neuroscience and cell biology and his 35 years of clinical acupuncture experience.
• Offers an overview of the science of biomedical acupuncture including the mechanisms of acupuncture, anatomy and physiology of acupoints, and discussion of human healing potential.
• Uses terminology and concepts familiar to Western-trained health professionals, making the material easier to understand and incorporate into practice.
• Includes more than 100 illustrations showing anatomy, injury, and clinical procedures.
• Covers useful techniques including those that increase muscle force output, joint flexibility and stability; prevent sports injuries like muscle sprain, tendonitis, bone strain, stress/fatigue fracture and bone spurs; reinforce muscle output for specific sports; normalize physiology of dysfunctional soft tissues; predict treatment response; reduce physiological stress; use the new Vacuum Therapy for deep tissue dysfunctions; and balance the biomechanics of musculoskeletal system.

CHAPTER 1 Integrative Systemic Dry Needling

A New Modality for Athletes

All athletes experience injuries, as all people experience pain and disease in their lives. Some athletes are never completely able to recover from injuries that become chronic and make them more prone to new injuries. Some athletes come to believe that their performance is irreversibly impaired by injury while they are still in their prime, and some do have to face the reality that their athletic career is limited by chronic injuries. For many, however, this limitation is not inevitable. Some injuries can be successfully prevented, and it is possible to greatly improve recovery from both injury and surgery if the mechanisms of integrative systemic dry needling (ISDN) are understood by athletes themselves, their coaches, and their doctors.

Close examination of sports injuries indicates that most are related to soft tissue dysfunction. This is understandable, as soft tissue accounts for half of a human’s body weight. Even for injuries that necessitate surgery, the final stage of recovery from both the injury and the surgery still depends on restoring the physiologic function of soft tissue.

ISDN is a unique medical procedure that is designed to restore and normalize soft tissue dysfunction. It is a new development in clinical technique that is different from both conventional dry needling and classic acupuncture, although it shares the same physiologic mechanisms as both methods. ISDN incorporates the analytic approach of conventional dry needling represented by Travell and Simons’ trigger-point medicine¹ and Gunn’s intramuscular stimulation² and synthesizes them into a unified pathophysiologic system. The treatment emphasizes both local problems and systemic dysfunction, because local injuries definitely affect the entire physiologic and biomechanical system. ISDN is thus a systemic and synthetic approach.

The basic techniques used in ISDN can be traced to the acupuncture that was developed in the ancient Chinese civilization, but its theoretical systems and clinical practice are based on modern medical science. Although ISDN is a division of modern integrative and experimental biomedicine, it maintains the benefits of classical acupuncture, including some of the traditional point system. However, ISDN does not depend on the theory or interpretation of classical acupuncture. The theoretical background and many of the clinical techniques of classical acupuncture are part of an ancient belief system based on empirical data that were appropriate to a particular culture. The unscientific origin behind classical acupuncture has impeded its further development, and ISDN has already metamorphosed from empirical practice into science-based 21st-century medicine.

Although it is a new integrative approach, ISDN is built upon the general principles of biomedical science that are familiar to and accepted by all health care professionals.

ISDN AND ATHLETES

ISDN can help all athletes, from so-called weekend warriors to dedicated professionals. It can enhance their physical performance, prevent common injuries, accelerate recovery from overtraining stress, promote rehabilitation after injury and surgeries, and prolong athletic careers by providing systemic maintenance.

ISDN achieves these goals not only because it reduces or cures the local injuries that commonly occur in sports but also because it emphasizes systemic balance and the restoration of physiologic homeostasis in both injured and healthy athletes. Optimal homeostasis ensures that the musculoskeletal system is balanced and thus produces effective mechanical movement; physiologic integration of the nervous, cardiovascular, endocrine, and immune systems; and a harmonious interaction between body and mind that can maximally support mechanical movement.

This is not a promise or a theoretical expectation but the result of my clinical experience, beginning in the 1960s. Especially since I began practicing in Colorado in 2000, I have come to better understand the physiologic mechanisms of dry needling as applied to athletes, systematically formulating my clinical procedure by working with both elite and weekend athletes and their coaches. Experience alone is not enough to justify such methods, but advances in evidence-based sports medicine have revealed much data that support my approach. This approach is successful because it effectively manages both chronic and acute stress in the athlete’s musculoskeletal system. The term effectively is emphasized because athletes already have many techniques for minimizing chronic and acute stress, such as massage, physical therapy, warm-up stretching, and traditional acupuncture, and these techniques are effective, especially in young athletes whose physical adaptability is high. The majority of athletes, however, have passed their late 20s, and their musculoskeletal systems and other physiologic functions are changing. Chronic and acute stress slowly accumulate in the body, and physical deficiency gradually reveals itself. To restore physical capability, athletes need to restore homeostasis not only in local musculoskeletal structures such as a particular muscle group or joint, but also in the entire musculoskeletal system, and this must include balancing its physiologic and physical mechanics. Like all modalities in sports medicine, dry needling acupuncture or ISDN can be used by health care professionals to prevent and treat injuries, but in the context of sports, ISDN, as a nonspecific procedure, achieves these aims by reducing bodily stress and restoring and maintaining optimal homeostasis. With this homeostasis athletes can function better. They can better adjust to physical and psychologic challenges, and they can experience more rapid and more complete recovery from injuries.

The tenets of ISDN are to respect the human body and not interfere with it. It supports athletic activity in a natural way and never undermines the body with side effects.

ATHLETES EXPECT MORE THAN PAIN RELIEF

Working with athletes is a great pleasure for any health care professional. Because of their healthy bodies, positive emotion, strong willpower, good nutrition, and willingness to cooperate, they respond superbly to ISDN. With regular and well-designed maintenance procedures, patients can maintain optimal performance, and can even achieve better results than in previous years.

What is unique about working with athletes? Most seek medical attention at first for pain relief, which in most cases can be successfully accomplished because their well-trained bodies have maintained good self-healing potential. Whereas pain relief is enough for most nonathletic patients, athletes expect more than that. For them, pain relief is just a beginning. What they are seeking after suffering injury is to restore not only their original physical capability but also to acquire a level of good health that will minimize further injuries. I have has seen elite athletes whose physical pain has ended as a result of conventional medical intervention, but so has their sports career. Many of these athletes may have had brighter and longer sports careers if they were properly treated, and even the injuries they suffered could have been prevented if proper procedures had been adopted sufficiently early. It is clear that if clinicians focus only on pain relief for athletes, they risk ignoring their patients’ future performance and possibly prematurely ending their sports careers. ISDN aims to restore optimal homeostasis by reducing bodily stress so that the athlete’s own biologic system can take care of pain relief.

CHRONIC AND ACUTE STRESS IMPEDE PHYSICAL PERFORMANCE IN SPORTS AND EXERCISE

The following description is an example of the kind of situation that can be successfully managed if the appropriate methods are used. Dara Torres (aged 42 in 2008), the American Olympian swimmer and mother of a 2-year-old daughter, is a historic figure in modern competitive sports. She missed the gold medal by 0.01 seconds, 24.07 to 24.06, in the 50-meter freestyle in the Olympic Games of 2008 in Beijing, losing to Germany’s Britta Steffen—who was born 8 months before Torres won her first Olympic medal at Los Angeles in 1984. Australia’s Cate Campbell, 16, took the bronze.

CNN reported on August 30, 2008, that Torres had had three surgical procedures on one shoulder since November 2007, and according to this report, Torres admitted that she was competing in the games with shoulder pain.

The historic achievement of Dara Torres is more than can be measured just by her medals. If she had been competing with less shoulder pain, however, she may not have lost that 0.01 second. If her musculoskeletal system had been carrying less acute and chronic stress from precompetition training, she would have been able to swim even faster. From the perspective of sport and exercise physiology, Torres could still expect to perform beyond her current physical limit if the acute and chronic stress in her musculoskeletal system could be reduced to the lowest level. Using the de-stressing effects of ISDN and other proper procedures, Torres and other athletes could continue to surpass their physical barriers and achieve new records.

Michael Phelps, at the age of 22, won eight gold medals in the 2008 Olympic Games. Enormous acute stress accumulated in his musculoskeletal system during those few days in Beijing, and this was in addition to the stress of his precompetition training. But his young body and the excellent condition of his musculoskeletal structure and of his cardiovascular, pulmonary, and metabolic systems were well able to meet the challenge. If this acute musculoskeletal stress could be effectively reduced right after each competition to quickly restore his body to its optimal physical condition, it is very likely that Phelps could improve his performance even more.

Since the 1920s, records show that the performance of runners has improved by about 10%. The triple jump record has increased by 30%, the long jump by 41%, and the high jump by 35%. The current records in pole vault are 80% higher than in 1896, but this increase is attributable chiefly to the introduction of the fiberglass pole. A significant factor in the setting of new performance records is the application of scientific methods in training, including nutrition and an understanding of the physics of forces involved in the motion of the human body. Chinese and Cuban athletes, for example, have shown great improvement since the 1980s for this reason.

Competition today is more intense than ever, and as records are being broken by ever-narrower margins, many people believe that athletes are nearing the absolute limits of human performance. Some try to meet this challenge by using artificial performance-enhancing substances. Steroids are used for at least two reasons: to build up muscle mass and to reduce muscle pain and inflammation. This behavior is now spreading to include other drugs that are specific to the demands of a particular sport, such as drugs that help to eliminate trembling in archery and shooting and drugs that promote rapid water loss so that weightlifters can reduce weight. Doping has become a serious concern of governments and sports officials, and today any exceptional performance is followed by testing for performance-enhancing drugs. Medal winners are tested and retested, their DNA is examined, and their blood may even be frozen for years to come.

LIMITATIONS OF HUMAN PERFORMANCE IN SPORTS AND EXERCISE

Do athletes have to use drugs to break past their physical limits? According to clinical evidence and research on the limits of human physical performance, the answer must be “no”. Sports experts try to calculate the absolute limit of human performance by taking the highest value for each crucial physiologic factor such as maximal oxygen uptake, the greatest possible rate of burning energy, and the highest examples of physical stamina. A theoretical limit of human performance is then estimated by comparing these data with current performance records. Jamaican sprinter Usain Bolt lowered his own record in the 100-meter dash to 9.69 seconds in the Beijing Olympic Games, 0.03 seconds faster than the mark he set in May of the same year. Bolt knows that he could have achieved better; he visibly eased his pace when he saw that he already had secured the gold medal. According to research, the theoretical limit of the 100-meter dash could be as low as 9.2 seconds. The world record set by American athlete Jim Hines in 1968 was 9.95 seconds; thus, in four decades, the best performance improved by 0.26 seconds. Whether this research on performance limits can be considered reliable or not, it is beyond doubt that elite athletes will continue to break current records. This is because almost all athletes carry some level of both acute and chronic stress in their musculoskeletal systems as the effect of strenuous and often excessive long-term training. Younger athletes such as Michael Phelps can adjust and adapt to this stress, whereas older athletes are progressively less able to tolerate it and increasingly experience handicapped performance as a result of physical deficiency, soft tissue dysfunction, and chronic pain in their musculoskeletal system. ISDN can reduce this acute and chronic stress, and by improving and restoring the homeostasis of human movement, it can help athletes break through their current physical barriers to achieve better results, while prolonging their athletic careers for many years to come.

Many sports injuries are caused by repetitive overuse, which leads to soft tissue dysfunction and bone injuries such as stress fractures and bone spurs. The Chinese hurdler Liu Xiang was unable to compete in the Beijing Olympics because he injured his Achilles tendon right before the event. The world-famous Chinese basketball player, Yao Ming, suffered a stress fracture in his foot 8 months before the Beijing Games. The likelihood of such injuries can be greatly reduced if chronic and acute stress in the musculoskeletal systems are effectively managed.

ISDN AS AN EFFECTIVE TOOL IN CONVENTIONAL SPORTS MEDICINE

In addition to enhancing athletic performance and preventing injuries, ISDN can also be used to rehabilitate injured athletes. The most common injuries in sport...