Acupuncture During Rehabilitative Exercise
The following is an excerpt from the author’s textbook, Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine.
Among all the different tools of acupuncture, press needles, also known as intra-dermal needles, provide the practitioner with a unique and effective tool when it comes to combining acupuncture treatment with rehabilitative exercise. The combination of press needles and a home rehabilitative exercise program can reduce rehabilitation times. Intra-dermal needles can be inserted into specific points that will constantly stimulate the proprioceptive systems and promote the movement of qi and blood in the jing luo.
As discussed in Chapter One, there is evidence that afferent proprioceptive information from cutaneous proprioceptors assists in the perception of motion (Lephert, S. 1993, Reiman B. 2002). In fact, it was found that patients with anterior cruciate deficient knees and osteoarthritis relied more on the cutaneous proprioceptors for the perception of joint motion than did non-injured individuals (Callaghan, M. 2012). This field of research helps to explain why intra-dermal needles can have a profound effect on movement patterns.
Callison, M. Sports Medicine Acupuncture textbook. 2019
Figure 1. Pyonex press needles come in various sizes with 0.20mm x 1.2mm being the most popular size for use during exercise.
There are two types of intra-dermal needles—the press needle, commonly used in auricular acupuncture, and the closed head needle, referred to as hinaishin in Japanese acupuncture. For acupuncture during exercise, the author suggests using press needles (Pyonex brand made by SEIRIN and distributed in the United States by LhasaOMS).
There are many sizes available of press needles ranging from 0.20 mm x 1 mm to 0.26 mm x 1.8 mm. The Pyonex blue box size, 0.20 mm x 1.2 mm press needles are recommended to begin with because the size of the needle is large enough to signal cutaneous receptors and small enough that the patient is comfortable with the needle during exercise (Fig. 1). The press needles can be retained for 3-4 days. If the patient feels any pain or discomfort from the needles, they should be removed immediately and a smaller sized used.
Strategies for Press Needle Use
The practitioner can use press needles on a patient that is having difficulty performing the prescribed exercise due to mild pain or a lack of proprioceptive awareness. It is important to remember that if the patient experiences pain or discomfort that is more than mild during exercise, it is a sign that the exercise may be too difficult or inappropriate for that person. The goal of using press needles is not to enable the patient to perform inappropriate exercises, but it is to remove obstructions in the channels that may be causing mild discomfort and decreased proprioceptive communication.
The eight Extraordinary Vessel master points work very well to decrease pain and improve proprioception related to certain movement patterns. To review the discussion from earlier in this chapter in “Extraordinary Vessels and Movement Patterns,” the general guidelines are as follows—Mild pain or decreased proprioception that involves primarily flexion and/or adduction movements responds best to the use of the Ren Mai/Yin Qiao Mai or the Chong Mai/Yin Wei Mai; extension and/or abduction movements respond to the Du Mai/Yang Qiao Mai and rotational movements respond best to the Dai Mai/Yang Wei Mai pair.
The author will usually try a unilateral point combination on the side of the exercising limb first. If the results are not satisfactory, a unilateral treatment on the opposite side can be tried. In many cases, a quick palpatory assessment for tenderness of the master points of the vessel pair will usually lead to the correct Extraordinary Vessel combination.
The following are a examples of acute, recovery and functional phases of exercise for a shoulder injury. Specific Extraordinary Vessels are prescribed when the rehabilitative exercise induces mild discomfort for the patient or if the patient is having difficulty in sensing how to perform the exercise correctly (decreased proprioception = decreased qi and xue in the channels). For more information on acute, functional and recovery phases of exercises, refer to Pgs. 134-137 in Chapter Four “Acupuncture Treatment and Rehabilitative Exercise.”
Callison, M. Sports Medicine Acupuncture textbook. 2019
Figure 2. Isometric exercise for shoulder external rotation with Pyonex press needles applied to GB 41 and SJ 5.
Acute Phase
In the acute phase when signs and symptoms of acute stagnation are present, isometric exercises could be prescribed depending on the extent of tissue damage.
For example, with a patient starting physical therapy after surgical repair of the supraspinatus tendon, isometric shoulder external rotation exercises are commonly included in the rehabilitative exercise routine. When trying to perform the exercise, if the patient is having difficulty in feeling how to successfully engage the external rotators and instead recruits the other body segments such as the elbow flexors in order to accomplish the movement.
Because the exercise involves muscles that externally rotate the shoulder joint, the master points of the Dai Mai, GB 41 (zulinqi), and Yang Wei Mai, SJ 5 (waiguan), are treated with press needles (Fig. 2). After applying the press needles, it can be helpful for the practitioner to remind the patient of how to properly perform the exercise.
For more information in the stages of soft tissue healing, refer to Pgs. 86-90 “Acute Soft Tissue Injury: The Stages of Healing and the Eight Principles” in Chapter Three: Crossing from East to West—A Sports Medicine Assessment of the Patient’s Injury.
Callison, M. Sports Medicine Acupuncture textbook. 2019
Figure 3. Shoulder scaption exercise with Pyonex press needles applied to UB 62 and SI 3.
Recovery Phase
In the recovery phase, when the patient is progressing along in their rehabilitation or when the injury tearing of tissue, a shoulder scaption exercise, which involves a combination of shoulder flexion and abduction, is given to a patient with a rotator cuff injury. If the exercise induces mild discomfort for the patient, which can be helped by choosing the master points of the Du Mai, SI 3 (houxi) and Yang Qiao Mai, UB 62 (shenmai) (Fig. 3).
It is important for the practitioner to remember that if this point combination does not bring substantial relief, they can try the master points of the opposing Extraordinary Vessels: Ren Mai, LU 7 (lieque) and Yin Qiao Mai, K 6 (zhaohai).
A shoulder exercise that is often prescribed in later stages of this phase and into the following functional phase, involves scapular stabilization and shoulder joint rotation. If this exercise induces mild discomfort for the patient or if the patient is having difficulty in sensing how to perform the exercise correctly, using the master points of the Dai Mai/Yang Wei Mai can be treated with press needles that can substantially help the patient to perform the exercise effectively.
Callison, M. Sports Medicine Acupuncture textbook. 2019
Figure 4. Multi-plane exercises will have more than one pair of Extraordinary Vessels to assess for treatment.
Functional Phase
During the functional phase of exercise prescription, it can be difficult to assess the primary movement that causes the pain because in the functional phase the exercises are multi-planar.
For example, a patient recovering from bicipital tenosynovitis feels a wince of pain during the downward phase of a diagonal pattern exercise. This motion requires shoulder adduction, extension and internal rotation, which provides the practitioner with different options for Extraordinary Vessel treatment (Fig. 4). When there is more than one pair of Extraordinary Vessels to choose from and rotation is one of the motions of the exercise, the practitioner should try the Dai Mai/Yang Wei Mai first. If this combination does not relieve the patient’s pain, other master points from different Extraordinary Vessels can be applied until the patient can perform the exercise comfortably.
References
- Callaghan, M. J., McKie, S., Richardson, P., & Oldham, J. A. (2012). Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging. Physical therapy, 92(6), 821-830.
- Lephart S, Kocher M, Proprioception following ACL reconstruction. Journal of Sport Rehabilitation. 1992; 1: 188-196. 21.
- Reiman B, Lephart S., The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train. 2002; 37(1): 71-79.
- Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine. 2019. AcuSport Education. www.smatextbook.com
About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.
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About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.
