As a physiotherapist who applies acupuncture in the assessment and treatment of various injuries and health problems, I am often asked by my clients and other caregivers whether I believe in acupuncture and how acupuncture works.
Coming from an evidence-based research background, and a lifelong learning approach to clinical assessment and treatment (thank-you McMaster University), I first approached acupuncture the way all clinicians should approach any modality or adjunct therapy: with scientific skepticism.
Two Schools of Acupuncture
My acupuncture journey began in 2014-2015 when I enrolled in McMaster University’s Contemporary Medical Acupuncture course. Here, I learned about the two basic schools to acupuncture: Traditional Chinese Medicine and Contemporary Medical Acupuncture.
The more I learned about each, the more overlap I saw between them — from anatomical points and physiological responses to the stimulation of the sympathetic and parasympathetic nervous system.
In Laymen’s terms, both approaches have their nuances and variances in explaining how the body works. Unfortunately, much of the text from a Traditional Chinese Medicine approach gets lost in translation and scientific explanation. The Contemporary Medical Acupuncture approach lends itself well to the nomenclature we use as health professionals. This is why I practice using the Contemporary Medical Acupuncture approach.
Do I Believe in Acupuncture?
Scientific skepticism guides much of my physiotherapy practice, and the practice of the physiotherapists, kinesiologists/exercise physiologists, and registered massage therapists I associate myself with at Propel Physiotherapy. I don’t “believe” in acupuncture because the connotation of “believing” in it would indicate a leap of faith that I like to leave for religion, love, hope, and other intangible qualities that do not hold ground in scientific rigor.
Acupuncture is the application of a stimulus to an anatomically relevant site on person’s body, which creates a physiological response. Focusing on acupuncture explicitly as a stimulus helps to explain this concept. A stimulus is being placed beyond the epidermis, dermis, and subcutaneous fat/fascia of your body and is now at a neuromuscular junction.
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How Acupuncture Works
From a contemporary medical acupuncture approach, acupuncture or needling works via five mechanisms, according to White et al. (2008). When an acupuncture needle is placed in the correct locations, these mechanisms are activated and our body responds accordingly:
- Local Response
The application of the acupuncture needle stimulates nerve fibres in the skin and muscle. At the local level, action potentials are set off and your body begins releasing calcitonin gene-related peptide (CGRP). This is a peptide that functions as a vasodilator (i.e. brings more blood flow to the area) and plays a role in pain mediation. In short, a micro-inflammatory cascade is created locally and blood flow, nutrients, and healing factors are brought to the local area.
- Segmental Response
Acupuncture applied to a specific segment of the body stimulates the afferent (i.e. sensory) nerve pathway. This nerve pathway corresponds to a specific spinal segment. This spinal segment is where a noxious signal enters the spinal cord and is interpreted in the brain as pain or noxious stimuli. Acupuncture helps to inhibit the noxious stimuli pathway at the same spinal level that corresponds to that part of the body.
Acupuncture acts as a pain inhibitor.
- Extrasegmental Response (Descending Inhibitory Pain Control)
Acupuncture has been shown to release naturally occurring opioid peptides (i.e. pain modulators) throughout our central nervous system. As you may know, our central nervous system (i.e., brain, spinal cord) is responsible for our systemic processes, including pain interpretation. Acupuncture also induces generalized analgesia (pain relief) throughout the body by inhibiting the sensory pathways at each spinal segment (hence the whole-body analgesic phenomena).
Beta-endorphin in the brain, enkaphalin in the spinal cord, dynorphin in the spinal cord and brain stem, and orphanin throughout the forebrain, midbrain, and spinal cord are released when acupuncture is applied appropriately. In addition, serotonin and noradrenaline area also released to modulate the nociception (i.e. noxious stimuli) pathways.
- Central Regulatory Effects
Acupuncture has demonstrated its ability to influence the affective component of pain via reduced neuronal activity in the limbic system of the brain. In Laymen’s terms, acupuncture decreases the activity in the brain responsible for the emotional component to pain. This helps to decrease the perception of pain throughout the body.
In addition, acupuncture has been cited to improve psychological states and is commonly associated with decreased anxiety, stress, and sleep disturbance. More recent literature demonstrates acupuncture’s ability to enhance the immune system’s function.
The mechanism of action for the central regulatory effects is still under investigation. An interpretation of the evidence suggests that the affective component of pain will respond to the application of acupuncture, however, the sensory component of pain would be better addressed through the other channels of segmental and extrasegmental effects.
- Myofascial Response
A common term established in the clinic setting is the Myofascial Trigger Point (MTrP). MTrP are hyperirritable points within a taught band of skeletal muscle caused by either acute or chronic muscle injury. The application of mechanical pressure on one’s MTrP replicates a person’s self-reported pain and MTrPs. The use of acupuncture has been shown to decrease the irritability of these points.
MTrP commonly have referred pain patterns, thereby allowing acupuncture practitioners the ability to work backwards from the site of reported pain. For instance, MTrPs in the upper fibres of trapezius (i.e. where neck meets shoulder) can refer pain to the anterior aspect of the cranium which becomes tension headache.
Acupuncture provides its effects by improving blood flow and mediating pain when applied locally to irritable tissues; by acting as a pain inhibitor when applied through nervous pathways associated with specific parts of the body; by releasing naturally occurring pain inhibitors through our central nervous system; by its holistic properties through areas of the brain like the limbic system; and by eliminating myofascial trigger points that cause referred pain patterns.
The dose, intensity of treatment, and specific points to use will vary depending on the chronicity of the injury, tissues effected, and client response.
I have approached acupuncture with scientific rigor and an appropriate amount of scientific skepticism. From a professional perspective, my clients have benefitted from the application of acupuncture as an adjunct to their physiotherapy sessions. As a referring healthcare professional or a client, it is important that you understand the mechanisms by which therapies are working and to ensure these are the right interventions for you or your clients.
White, Cummings, and Filshie (2008). An Introduction to Western Medical Acupuncture.