Sports Acupuncture's Roles in Innovation and Integration

It should come as no surprise that sports medicine practices—where disabling injuries are common, stakes are high, and competitions are won by fractions of a second, a mm, or a single point or hit—are open to experimentation with a diversity of techniques and modalities. Athletes, trainers, and coaches are naturally driven to try anything that might possibly restore and enhance functional capacity. This is not to imply that the efficacy of sports acupuncture is questionable or marginal. Rather, the incentives to experiment and innovate in sports medicine (Eastern or Western) stand in contrast to the profit-oriented caution with which insurers agree to cover novel therapeutics, and to the conservative culture of standard medical education, where a reductionist scientific model and avoiding accusations of bias or charlatanism are often valued over the needs of and experiences of individual patients and practitioners.

These dynamics of sports medicine perhaps explain its significant role in the integration of Eastern and Western acupuncture and the growing adoption of acupuncture (whether labeled as “traditional” or “dry needling”) by a broad spectrum of athletes, from professionals and elites to weekend warriors, casual recreationalists, and anyone seeking to recover physical capacity after injury, disability, or sedentarism.

Kendall's reinterpretation of the Nei Jing was among the first Western publications to argue that apparent differences between “meridian theory” and “anatomy and physiology” are accidents of mistranslation, and are culturally influenced divergences of emphasis in description, versus fundamentally incompatible paradigms regarding the nature of reality and the human organism. Whitfield Reeves, OMD, LAc, Matt Callison, LAc, and Drs. Hua Gu, PhD, LAc, Alon Marcus, DOM, LAc, and Poney Chiang, PhD, R.Ac, R.TCMP—and doubtless many others whose work I have yet to learn about—have also explored and elaborated both the consistencies, and the unique perspectives and contributions of Eastern and Western sports and orthoneuro medicine. I personally hope that the work of these pioneers will lead academicians to abandon attempts to prove or disprove clinical outcomes using methodologically suspect “placebo” and “sham acupuncture” controls and “cookbook” treatment protocols of negligible value in guiding clinical practice. Researchers, practitioners, and patients would all benefit from reorientation to the study of therapeutic mechanisms and observable effects of needling various tissues and locations in the human body.

Sports acupuncture's evolution from ancient roots in treating martial arts injuries (see Dr. Nietmzow's editorial (p. 207) is converging with emergent Western therapeutics, such as myofascial trigger-point needling and regenerative-injection therapies, which almost certainly have roots in ancient China, but have also been shaped by Western science. Clinicians, athletes, and patients generally can now benefit from crossfertilization among Eastern-trained acupuncturists merging ancient and contemporary orthopedic and neuroanatomical paradigms to select needling locations and techniques, and from Western physicians, physical therapists, and athletic trainers who are (re-) discovering the wisdom and utility of treating the longitudinal tracts or “meridians” described 2600 years ago in the seminal NeiJingSuWen and its descendent texts.

Paradoxically perhaps, for a field in which athletes, and their trainers and coaches, do not wait for modalities to receive gold seals of approval from multiple TBRCTs [triple blinded randomized controlled trials] and the Cochrane Database of Systematic Reviews, sports acupuncture may also contribute to the improvement of research quality and usefulness by shifting emphasis from notoriously subjective pain scores on visual analogue scales—with their plethora of subtle but potent external and uncontrollable variables—to more objectively verifiable measurements that are important in sports performance, such as joint range of motion, force output, sensory function, and other functional-capacity tests, all of which lend themselves well to triple-blinding.

This shift in emphasis from pain suppression to restoration of functional capacity will be recognized by experienced clinicians as valuable not only to satisfy the desires of academicians for objectivity, but also as a healthier and more-effective partnership between patients and practitioners than just “take this medication for your pain.” We see thus great public benefit in dissemination of techniques pioneered and refined in the context of treating elite athletes to alleviate the tragic suffering and socioeconomic costs of chronic pain and disability in the general population.

Yet, whatever the findings of research, acupuncture—like many, if not all, physical interventions—has always been and will always be a modality whose efficacy depends largely on the education, training, experience, and individual skills—including “bedside manner”—of the practitioners. All needles point in the same direction: There is great need for, and benefit to, continuing to expand the depth, breadth, quality, rigor, and consistency of training programs, and ongoing educational support for practitioners of all license types, backgrounds, and orientations to use needles to treat sports injuries as well as pain and disability generally. We hope that this special issue of Medical Acupuncture devoted to sports medicine acupuncture will help address that need through its inspirational survey of the many uses of acupuncture in sports medicine. And my personal guess is that Hua Tuo (circa 140–208 bce), an early acupuncture physician famous for his innovations, would feel pride, fascination, and delight to read this special issue and see these directions that acupuncture is now taking.