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Acupuncture and its Place in Sports Medicine

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Maria Fendrick

on 5 March 2013

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Transcript of Acupuncture and its Place in Sports Medicine

Is it in the right spot? On the Agenda Does it work? Randomized control trial for treating Osteoarthritis of the Knee. Do the acupuncturist's expectations have anything to do with the efficacy of the treatment? Brief over view of history of acupuncture

How acupuncture works

• From the eastern stand point : meridians, Qi, etc

• From the western stand point: measurable benefits

Acupuncture in sports - in the news

• who I using it

• what sports

• what is it being used to treat

Controversy with acupuncture

• between acup. and ATs

• is it even effective

• placebo effect

Efficacy of acupuncture

• clinical research?

• case studies Researchers goals:
- create convincing placebo
- find an answer to the question... Research Design - 6 licensed acupuncturists
- 560 people
Waiting list
High expectation treatment
Neutral expectation treatment
-Training for Acupuncturists
- Participants informed of "traditional
vs. non-traditional" acupuncture
treatment to Japan It all began 4,000 - 5,000 years ago In China and from there it spread Korea, and many other Asian countries. First got publicity in U.S. in 1971
James Reston, New York times reporter visited China and fell ill
Documented his experience in the Times. Results n=560 High Expectations
n=238 Wait List
n=72 Neutral Expectations
n=242 Sham
n=151 TCA
n=75 TCA
n=78 Sham
n=151 No significant difference between TCA and sham.
Significance existed in the difference between the satisfaction and pain relief of the high expectations versus the neutral expectations group.
Blinding was successful. Conclusions #1 - TCA was not better than the sham treatment at alleviating pain associated with osteoarthritis of the knee
#2 The communication style employed by the acupuncturist had a small but significant effect on patient satisfaction and pain reduction The Western World's Stab at Acupuncture Thermography to identify insertion points
Pain location is the focus
Mechanistic
Concrete physiological processes over meridian pathways
ie. neuropeptide, endorphine release, increased blood flow and oxygenation Functional MRI reveals... Decreased blood flow to limbic system Acupuncture affects Cerebral Blood Flow Increased perfusion to the areas associated with placebo analgesia and expectation regions A Brief History
How healing is encouraged
In the News
Review of the literature
The efficacy of acupuncture Thomas Herpen & Maria Fendrick
Bloomsburg University of Pennsylvania In recent news... New York Times:
Acupuncture, Real or Fake, Eases Pain Potential Problems Identified
Traditional acupuncture altered for study?
Standard mapping for needle insertion
Sham hits real points? Acupuncture 101 Qi - life force energy.
meridians - system of channels that Qi travels through.
points - places along meridans that Qi comes close to surface of the skin and can be easily accessed. Traditional Chinese Medicine (TCM) TCM - method of diagnosing and treating health problems using several modalities.
In TCM illness results from excessive or inadequate flow of Qi caused by blockages in the meridans.
Needles or other form of stimulation are used to restore Qi's natural flow and relieve symptoms. Ever heard of Qi (Chee)?
Ever had an
acupuncture treatment? TCM Diagnosis Localized Benefits of Acupuncture Increased
blood flow
white blood cell activity
decreased muscle tension
oxygen uptake
micro-inflammatory response
Analgesic effects Acupuncture's Effects on the Central Nervous System inhibitory to Sympathetic Nervous System
alters blood flow patterns in the brain Does acupuncture have a place in sports medicine? How Matt uses Acupuncture in Sport Decrease stress and anxiety
Increased flexibility
Enhanced proprioceiption
Acute trauma
bruising
swelling
muscle, tendon, and ligament injuries
Plus... Matt Callison, MS., L.Ac. Acupuncture used in conjunction with contemporary treatment for sports injuries.
Meets resistance from managers and athletic trainers
Short term vs. long term relief
cortisone injections
career duration Licensed Acupuncturist
Faculty member at Pacific College of Oriental Medicine
Treated players from numerous professional sports teams like... Chronic Injuries
low back
shoulder
knee
ankle James Farrior "I'm not the same if I don't have it. Its like getting the game plan. You can't go into the week without either one." Lisa Ripi, L.Ac. Experts in the Field
of Sports Acupuncture Howard Arbuthnot, MS., L.Ac. Masters in Acupuncture
Specializes in musculoskeletal and sports injury
Member of the Australian Olympic Medical team 1992, 1996, 2000, 2008
Deputy Head of Service for Soft Tissue to Austrailian Olympic team for London Olympics, 2012 His Application of Acupuncture in Sport Pain Management
Reduced muscular tone from fatigue or repetitive loading
Chronic overuse injuries
Local changes to circulation and the inflammatory response "It is estimated that more people have been treated with acupuncture than any other therapy (and probably all other therapies combined). It stands to reason that acupuncture has been used both effectively and not so effectively for any type of musculoskeletal injury you might imagine."
- Howard Arbuthnot "The players always report great results. They love it because they're always looking for that extra edge and since most of them are young, I find they're easier to treat because their bodies respond quickly."

-Matt Callison Visual observation
coloring of skin
tongue
eyes
Acuity of the 5 senses
Auscultation
Pulses Acupuncture and its Place
in Sports Medicine Friction Between Athletic Training Staff and Acupuncturists Exists Main Points in Acupuncture Research effects on specific health problems
cerebral activity during acupuncture
neurological properties of meridians and acupuncture points
methods and tools for improving research on acupuncture -U.S. Dept. Health & Human Services Licensed acupuncturist
Travels to treat N.F.L. players for 13 years
Jets
Giants
Steelers
Bengals
Dolphins "They always tell me I'm their little secret, I feel like the little mouse who takes the thorns out of their feet."
-Lisa Ripi Acupuncture and the Modern Pentathlete: A Case Study Male Olympian used stimulation of acupuncture points during 7 years of competition
Points to relieve pain associated with each event
Experienced major improvements in performance and pain relief
Some results were immediate
3000m run time: 10+ min. to < 9:25
Placebo effect's strength in elite athletes is discussed When acupuncture is used in this way - before, during, and after competition - can it possibly be considered a form of doping? World Anti-Doping Agency (WADA) Criteria 1. Scientific evidence that a method or substance has the potential to enhance performance.

2. Scientific evidence that a method or substance poses a threat to the health of an athlete.

3. WADA's determination that the method or substance is not in accordance with the spirit of sport. Study Design in Acupuncture research Unsuccessful Blinding
Inadequate Placebos
Poor quality/quantity of studies Do you think acupuncture's effectiveness as a method of healing that has been practiced for over 4,000 years can be based solely on the placebo effect? Did you know that
everyone can sense Qi? Do ethics come into play in the
decision to offer acupuncture as an
alternative to traditional sports medicine? Sam Querrey: Professional Tennis Player Career high singles ranking - 17 in world. http://www.pressdisplay.com/pressdisplay/viewer.aspx References Arbuthnot, H. (2012). Acupuncture: What does it do and what injuries can it treat? Modern Athlete & Coach, 16-17.

Bishop, G. (2010, November 29). Acupuncturist Treats 40 N.F.L. Players in 4 Cities. New York Times, http://www.nytimes.com/2010/11/30/sports/football/30acupuncture.html?_r=0

Cooper G., Kahn, S.B., and Zucker, P., (2009). Acupuncture for Musculoskeletal Medicine, Lippincott Williams & Wilkins. Philadelphia, PA.

From the Needle to the Field: A Look at Acupuncture in the World of Sports. (2012, July 13). Retrieved February 16, 2013, from Pacific College: http://www.pacificcollege.edu/acupuncture-massage-news/articles/1162-from-the-needle-to-the-field-a-look-at-acupuncture-in-the-world-of-sports.html

Hinman, R., McCrory, P., Pirotta, M., Relf, I., Crossley, K., Reddy, P., Forbes, A., Harris, A., Metcalf, B., Kyriakides, M., Bennell, K. (2012). Efficacy of acupuncture for chronic knee pain: protocol for a randomized controlled trial using a Zelen design. BMC Complementary and Alternative Medicines, 12:(161) 1-11.

Longbottom, J. (2010). Acupuncture in Manual Therapy, (Editor). Churchill Livingstone Elsevier, Europe.

Manheimer, E., Wieland, S., Kimbrough, E., Cheng, K. and Berman, B. M. (2009). Evidence from the Cochrane Collaboration for Traditional Chinese Medicine Therapies. The Journal of Alternative and Complementary Medicine, 15:(9) 1001-1014. doi: 10.1089=acm.2008.0414

NCCAM Clearinghouse. (2012). Acupuncture: An Introduction. backgrounder, D404 1-5.

Ohkubo, M., Hamaoka, T., Niwayama, M., Murase, N., Osada, ,T. Kime, R., Kurosawa, Y., Sakamoto, A., and Katsumura, T. (2009). Local increase in trapezius muscle oxygenation during and after acupuncture. Dynamic Medicine, 8:(2) 1-8. doi:10.1186/1476-5918-8-2

Parker-Pope, T. (2010, August 18). Acupuncture, Real or Fake, Eases Pain. New York Times, http://well.blogs.nytimes.com/2010/08/18/acupuncture-real-or-fake-eases-pain/

Sports Acupuncture Scores Points with Athletes. (2005, April 8). Retrieved February 16, 2013, from Pacific College of Oriental Medicine: http://www.pacificcollege.edu/acupuncture-massage-news/articles/593.html

Suarez-Almazor, M. E., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D. M. and Street, R. L. (2010). A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication. Arthritis Care Res, 62: 1229–1236. doi: 10.1002/acr.20225

Usiechenko, T. I., Gizhko, V., and Wendt, M. (2011). Goal-Directed Acupuncture in Sports-Placebo or Doping? Evidence Based Complimentary and Alternative Medicine, 2001:1-5. doi:10.1093/ecam/nep210 A few recurring problems have been identified:
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