Jan 29, 2015Down the Meridian
As more athletes seek alternatives to Western medicine, a new discipline called sports acupuncture has emerged. This author combines his background in athletic training with the Eastern form of treatment.
By George Leung
George Leung, MAc, LAc, LAT, ATC, PTA, CKTP, is the practitioner and owner of East/West Sports Acupuncture & Orthopaedics in Brookline, Mass., and a former Head Athletic Trainer at Brookline, Danvers, and Lynn English high schools, all located in Massachusetts. He has treated athletes with the Boston Red Sox and New England Patriots, national- and world-level figure skaters and competitive runners, as well as youth athletes. He can be reached at: [email protected].
Like many athletic trainers, I was first drawn to the profession by a love of sports. I’ve played baseball and basketball competitively and have always led a very active lifestyle.
Like many Western acupuncturists, I got involved in this profession after seeking an alternative treatment for an injury. Ten years ago, while playing in a basketball game, I twisted my low back and felt immediate pain. Within the next few days I experienced sciatica, with radiating nerve pain down my left leg. As an athletic trainer, I knew that this type of injury usually takes a long time to heal and that surgery can be necessary. When my low back and sciatic nerve pain didn’t resolve, I decided to try acupuncture treatment in an effort to avoid surgery. I visited a veteran practitioner and, to my amazement, after three or four treatments the sciatica and low back pain disappeared altogether. I was both intrigued and inspired. A friend studying acupuncture suggested that with my background as an athletic trainer and physical therapist assistant, it might be useful to learn about the different ways acupuncture has been used to treat sports injuries. After years of working as an athletic trainer in schools and clinical settings and growing frustrated with seeing the same patients return for the same problems, while being unable to provide anything other than the same protocols–I finally decided to pursue a degree in acupuncture. In the years since, I’ve treated everyone from professional athletes to Olympic hopefuls to marathon runners. More and more athletes are seeking alternative, holistic therapies to treat their injuries in an effort to expedite recovery and enhance performance. I have found acupuncture to be a safe and effective option for a host of reasons.
To start, it focuses not only on the local symptoms but on the root cause. Secondly, each treatment is individualized based on the practitioner’s style, method, and approach to treating a condition, as well as the patient’s presentation, needs, and response. In addition, you are treating the mind and body all together. Acupuncture is also a natural healing treatment involving no medication. I’ve found acupuncture treatment remarkable for both its effectiveness in resolving all kind of sports and musculoskeletal injuries and the speed at which it produces results. For many athletes, timing is vital. Returning athletes to their sport safely and quickly can be the difference between them winning a championship or sitting on the sidelines as their dreams pass them by. To this end, we as sports medicine professionals have to be able to think outside the box, and help our athletes do the same.
HOW DOES IT WORK?
Traditional Chinese Medicine (TCM) acupuncture treatment focuses on needling various combinations of the 360 local acupuncture points located along 14 meridian lines, or channels, on the anterior and posterior of the body. The needling stimulates the nervous system, causing chemicals to be released and an unbalanced meridian to become unblocked. This allows the local blood and energy to reach the site of the injury, which produces healing. Needling also helps the body’s affected internal organs become balanced–resolving the underlying root problem of the injury. A fairly new discipline called sports acupuncture includes needling the motor points on an injured muscle, a treatment that causes the muscle to continually twitch (activate) and return to a normal, spasm-free state, thereby strengthening it. Another treatment involves needling the ashi points (trigger points) in TCM, which promotes localized blood flow to the injured area, eliminating pain and spasms. Also called orthopedic acupuncture or sports medicine acupuncture, sports acupuncture is used in conjunction with Western rehabilitative treatments in order to achieve the best possible outcomes. In some cases, heat modalities, electrical stimulation, cupping, or various manual techniques will be combined with acupuncture. These manual techniques can include joint mobilization, soft tissue mobilization, massage and stretching. For example, I may pair acupuncture with soft tissue manipulation to treat a specific imbalanced muscle group. In addition, I often have the athlete perform strengthening and proprioceptive therapeutic exercises.
Western sports medicine tends to use a protocol treatment format focused on resolving symptoms. Sports acupuncture treats both the local symptoms and the root cause of the injury. The treatment starts with the underlying problem and works its way up to the local symptoms, as opposed to treating the symptoms first and then working on the root of the problem. The goal of any sports-injury treatment is to eliminate pain, reduce inflammation, increase mobility by reducing muscle tightness and spasms, and re-activate the injured, weakened muscles. Sports acupuncture is successful because it enables the practitioner to directly access the site of the injury through the use of needles. Results can include immediate reduction of pain and muscle spasms, decrease in swelling and inflammation, increase in range of motion, restoration of mobility, strengthening of weakened parts of the injured body and the immune system, and quickened healing time. There is no limit to the types of injuries that can benefit from sports acupuncture, from plantar fasciitis to hamstring strains to meniscus tears, and many others.
WHAT IT LOOKS LIKE
A complete sports acupuncture treatment starts with both Eastern and Western intake examinations, including a comprehensive TCM evaluation and an orthopedic assessment, which take about an hour and a half. A treatment plan is then mapped out according to which meridians are involved and unbalanced, as well as any range of motion restrictions or muscle strength deficiencies. Sports acupuncture treatments last about an hour and fifteen minutes and take place in a relaxing environment, usually on a massage table in a quiet room or with gentle music playing. Relaxing the mind helps the patient focus their energy on the recovery process. The treatments employ various needling techniques using hair-thin, sterile and disposable needles applied to points identified during the intake process. Acupressure or tiny magnets can also be used. Electrical stimulation and various forms of heat are applied to promote greater blood circulation to the affected area and the needled points. This part of the treatment lasts about 30 minutes. After the needles are withdrawn, TCM and Western manual techniques are used to increase joint mobility, correct mechanical function, improve flexibility and range of motion, and strengthen muscles. TCM manual techniques include cupping, gwa-sha, and tuina. Cupping is used to create suction by placing glass or plastic cups on specific areas of the body, with or without needles or heat. This brings the internal toxins to the skin’s surface and creates an ecchymosis effect, which activates the inflammatory cycle and helps prevent muscle fatigue. Gwa-sha involves scrapping the skin to create redness and break up any scar tissue formation or adhesion. Tuina is a form of deep tissue massage and stretching used to enhance tissue mobility and range of motion. Western manual techniques used during treatments include joint and tissue mobilization, soft and deep tissue massage, manual stretching, and various therapeutic exercises. This active part of the treatment lasts about 30 minutes. The final part of a typical sports acupuncture treatment includes applying the Kinesio Taping Method to the affected area. The tape is worn for a few days following treatment to enhance and maintain the healing effect.
CASE STUDY ONE
Simon was a 23-year-old pairs figure skater with a history of chronic low back pain, or stress reaction syndrome, due to L5, S1 bulging discs and mild bilateral radiculopathy. When skating, jumping, or lifting his partner, Simon’s pain scale was 8-10, but he did not experience pain during general daily activities. A TCM and orthopedic assessment on Simon determined that the gall bladder (GB) and bladder (BL) meridians were affected and that he had restrictions on both sides of the quadratus lumborum, lumbar erector spinae, and gluteus medius and minimus muscles. He also had moderate-to-severe tenderness along the quadratus lumborum muscles.
The treatment goals for Simon were to resolve the inflammation, pain, and sciatica symptoms, reduce the internal swelling and muscle spasms, increase mobility, activate the weakened muscles, and calm the mind. Treatments were restricted to once a week due to physical therapy treatment he was undergoing and his ice conditioning work. Simon’s treatments began with needling points along the bladder (BL) and gall bladder (GB) meridians such as BL 23, 25, 40, 57 and 60, and GB 30 and 31. Motor points and trigger points were also needled. The quadratus lumborum muscles motor point was needled to reduce muscle tension and re-activate muscle function. Trigger points along the posterior iliac crest of the hip were needled to reduce tenderness and spasms in the gluteus medius and minimus muscles. Specific acupuncture needles were stimulated using electro-acupuncture to increase local blood circulation, decrease muscle spasms, and reduce pain. An infra-ray dry heat lamp was placed over the low back area to relax muscles and increase local blood circulation.
After the needles were withdrawn, Simon was given conventional rehabilitation, starting with deep tissue massage, manual lumbar traction, and stretching to help increase joint and muscle mobility. He was then instructed to perform home exercises to help him increase his flexibility and regain his strength and balance.
The Kinesio Taping Method was applied for L5, S1 bulging discs and the lumbar erector spinae muscles to maintain the treatment results. Simon was asked to keep the Kinesio tape on for a minimum of three to four days. The tape helped the injured back muscles continue to function appropriately and prevented them from cramping up when stressed. It also continued to reduce the swelling and inflammation. Depending on his schedule and how he was feeling, Simon was advised to return once or twice a week until significant improvement or a full recovery was achieved. The results were immediate. After a course of six sports acupuncture treatments, he experienced resolved pain, increased mobility, and an increase in energy and was soon able to return to the ice rink and skate without limitations. He resumed competing in national and world competitions and he and his partner won the gold medal in pairs skating at the 2013 Prudential U.S. Figure Skating Championships.
CASE STUDY TWO
Maddy, a 27-year-old competitive runner of half and full marathons, 50Ks, and 100-mile races had a history of right distal ilio-tibial band (IT-band) tendinitis and hip tightness. She experienced right distal IT-band clicking and pain when running for longer than 15 minutes, which got worse with descending activity. Maddy was in the process of training for back-to-back full marathons but the pain was hindering her preparation. She had never tried sports acupuncture.
Maddy’s TCM and orthopedic assessments determined that her stomach (ST), gall bladder (GB), and bladder (BL) meridians were affected and she tested positive for tightness in her hip flexor, IT-band, and hamstrings. She was also experiencing moderate-to-severe tenderness in the tensor fascia latae (TFL) and gluteus maximus muscles. The treatment goal for Maddy was to resolve the distal IT-band inflammation and increase mobility in the hip flexors, TFL, gluteus maximus, and hamstrings. Once a week treatments for six weeks were recommended. Maddy’s sports acupuncture treatment was carried out in two parts. The first placed her in a sidelying position for 20 minutes, with the second being in a prone position for 15 minutes. In the sidelying position, TCM acupuncture points ST 31 along the stomach meridian and GB 30, 31, and 32 along the gall bladder meridian were needled. The bladder meridian points were needled in the prone position. To reduce muscle tension and re-activate the muscle, the TFL and psoas motor points were used in both positions. Electro-acupuncture was initiated on all the points to increase local blood circulation and an infra-ray dry heat lamp was placed over both the hip and the distal IT-band for 20 minutes. After all needles were withdrawn, Maddy was again treated in the prone position. This portion of the treatment focused on the gluteus maximus and the hamstrings to increase mobility. TCM acupuncture points GB 30, BL 36 and 37 were needled along the gall bladder and bladder meridian, and the motor point used was the hamstring mp x2. Electro-acupuncture with an infra-ray dry heat lamp was again used for 15 minutes.
Following acupuncture, conventional and TCM manual techniques including tuina and deep tissue massage were applied to the hip and hamstrings to promote blood circulation and flexibility. The hamstrings and gluteus maximus were then stretched to increase mobility. Finally, Maddy was given the Kinesio Taping Method for patella tracking and to reduce tension on the IT-band. She was instructed to wear the tape for three to four days, including while running.
After three treatments, the IT-band tendinitis was completely resolved and Maddy was able to run her back-to-back marathons without limitations. She now regularly returns to acupuncture for maintenance work.
Acupuncture has been used for over 2,500 years and its success in treating various injuries and conditions is well documented with evidence-based research. It is recognized by the National Institutes of Health and World Health Organization to be an effective treatment for a host of conditions. Acupuncture treatments themselves are very safe. The needles used are sterilized and used only once. Because it is a medication-free treatment, it is free of the side effects that can be caused by conventional medications and injections. Acupuncturists are required to complete a three-year master’s degree program at an accredited school and they must pass three national board exams to become certified and licensed. A certification in the Clean Needle Technique is also required. I encourage athletic trainers to embrace sports acupuncture as a holistic way to help their athletes. Sports acupuncture can fill in the gaps where Western medicine may fall short.
SIDEBAR: BECOMING ONE
I have found that adding acupuncture to my sports medicine knowledge has resulted in a very rewarding practice. It did take extra schooling and training, but it’s been worth it. All accredited acupuncture schools offer at least a three-year master’s degree in acupuncture. Each program includes internships where students gain hands on, real-life experience before they graduate. Upon completion, students are required to pass three national board exams in Acupuncture, Point Location, Foundations of Oriental Medicine Module, and Biomedicine Module in order to be licensed and certified to practice acupuncture. In addition, there is a new advanced certification called Sports Medicine Acupuncture Certified (SMAC), which has a significant overlap with the requirements in athletic training programs.
What you have learned as an athletic trainer will be very complementary to what you learn in acupuncture school. Athletic trainers are well equipped to be very hands-on and multi-task oriented and therefore have a great advantage in the hands-on training of acupuncture. Having sports medicine knowledge in how to assess, evaluate, prevent, and treat sports-related injuries will help athletic trainers understand how to approach treating musculoskeletal conditions effectively. An added bonus is that being an acupuncturist and an athletic trainer can open more doors whether you’re an entrepreneur or even a team sports acupuncturist at the professional level. But most of all, working as a sports acupuncturist is particularly rewarding because it gives you the ability to help athletes return to competition as quickly as possible.