Practicing Outside the Lines: Using Acupuncture in the Athletic Training Room and on the Field

Abstract

Acupuncture can be used to treat athletes in an outpatient clinic setting, athletic training room, or even on a football field sideline. This article details 3 scenarios, in 3 illustrative cases, in which acupuncture was used for sports medicine in more unconventional settings. The author describes each case and shares his observations about them. First, acupuncture was used on a high-school football field sideline to help alleviate acute calf cramping in a player. Second, acupuncture was used in a division 2 college athletic training room to treat a player with subacute thoracic pain that was not improving with the usual treatments provided by the athletic trainers. Third, acupuncture was used to treat hamstring strain and tightness in a professional National Football League player to enhance his performance. These situations demonstrate the versatility of acupuncture in the realm of sports medicine. Acupuncture is an added-value service for athletes, and acupuncture providers should not be afraid to promote it in this population that is always looking for a competitive advantage.

INTRODUCTION

Acupuncture is typically practiced in an outpatient clinic setting. The best evidence supports acupuncture use in a clinic setting for conditions such as chronic, nonspecific low back and neck pain, osteoarthritis, headaches, and shoulder pain.¹ However, acupuncture can also be used in less conventional settings as well, such as in an athletic training room or on the sideline of a field. As both a physiatrist who is fellowship-trained in sports medicine and an acupuncturist, I have been able to use acupuncture to provide an added-value service to athletes. This article details a few uses of acupuncture in the sports-medicine realm that are less common, and that highlights the versatility of acupuncture.

3 ILLUSTRATIVE CASES

Case 1

This case involved using acupuncture on a high school football field sideline. Several years ago, I was covering a local high school football game, which was the first game of the season. The young athletes are often deconditioned at the beginning of the season, and so, during the game, multiple players were getting cramps in their legs. The game had to be stopped on multiple occasions with the athletic trainers going on the field to stretch the players. In particular, there was a player who had cramped up twice within ∼10 minutes, and, due to the cramping, he had to be pulled out of the game. He asked me if there was anything I could do to help, and expressed extreme frustration at the fact that he could not play.

I did not have the supplies to give him intravenous fluids, but I did happen to have my acupuncture bag with me. I asked him if he wanted to try something a little unconventional by getting acupuncture needling to his muscles to help loosen them up. He agreed eagerly. I then got verbal consent to treat him from his parents. I had him lying prone on a massage table and proceeded to identify trigger points in his gastrocsoleus. I performed ∼5 minutes of needling without needle retention to release multiple trigger points, with good twitch responses elicited. After treatment, the player returned to play in the game and did not have to be taken out again for cramps for the remainder of the game.

Comments

The etiology of exercise-associated muscle cramps is not entirely clear, but is thought be due to water and electrolyte imbalances or sustained abnormal spinal-reflex activity secondary to muscle fatigue.²

Muscle fatigue is implicated as a cause for cramping through an excitatory effect on the muscle spindle afferent activity (types Ia and II) and an inhibitory effect on the type Ib Golgi tendon organ afferent activity.³ There are several proposed mechanisms of action indicating that acupuncture can be useful to treat acute muscle cramps.

Acupuncture is thought to deactivate myofascial trigger points, and a local twitch response has been shown to change the local biochemical milieu of the trigger point immediately.⁴ Acupuncture is thought to reduce pain by influencing action potentials up to the spinal cord segment and depressing activity in the dorsal horn, thus diminishing subsequent painful stimuli.⁵ Acupuncture can stimulate local nerve fibers, which can cause release of local substances, such as calcitonin gene-related peptide, which causes blood vessels to dilate.⁶ Stimulation of nerves can also cause a release of pain inhibiting neuropeptides such as enkephalins and endorphins.⁷

Case 2

The second case involved using acupuncture in a college athletic training room. I go out to the training room routinely at a local division 2 university and will often see pathology there that is amenable to acupuncture treatment. In one particular instance, I saw a 20-year-old volleyball player with 2+ months history of right periscapular and thoracic-region pain. There was no inciting trauma or incident. He had seen the athletic trainers in an attempt to address his condition and also saw a chiropractor who “popped his ribs” but he only had minimal improvement of his condition. He had also tried some local cupping without any improvement. His medical history was significant for right-shoulder labral surgery 4 years prior, and he avoided excessive external rotation of the shoulder in order to protect it.

On physical examination, he had no reproduction of his pain when shoulder-provocative maneuvers, including rotator cuff tests, were performed. He had slightly restricted right shoulder, passive external rotation at the side and also when abducted to 90°, but this was not painful. He did have reproduction of his pain with thoracolumbar rotation to the right more than to the left. With performing single-leg stance on the right, he had a positive Trendelenburg sign with a hip drop, along with femoral medial rotation. He also had some restricted range of motion (ROM) and pulling on his back with passive right-hip ROM.

My impression of his condition was that myofascial dysfunctions in and around his right hip might be indirectly causing his right periscapular pain. He already had localized treatment to the area of pain without improvement. Therefore, needling treatment was provided to the right-hip adductors, tensor fascial lata (GB-29), gluteus medius, and gluteus maximus (GB-30), all with good local twitch responses elicited and without needle retention. This patient's pain resolved immediately after treatment, and his improvement was sustained.

Comments

This case highlights the importance of looking at a patient's whole-body biomechanics, as this can often be the key to relieving a more-difficult musculoskeletal pain complaint. Restricted ROM in the hip is known to be associated with low back pain.⁸ Thoracic posture is also known to affect scapular positioning and shoulder ROM.⁹ Acupuncture is a powerful treatment tool that releases myofascial trigger points (mTrPs) immediately, often with immediate improvement. These kinds of quick results are particularly desirable in the student-athlete population, for whom returning to play as soon as possible is a goal.

Case 3

The third case involved using acupuncture at a professional athletic training facility. When the Rams, a National Football League (NFL) team, were still in St. Louis, I would go routinely to the training room there to treat the players (Fig. 1). One of the most common complaints was hamstring strains and tightness. My treatments would involve local release of mTrPs in the hamstrings, but I would also usually release other trigger points along the Bladder meridian. The players would report that the needling helped their hamstrings feel looser, and these players often felt as if they could run more “freely.” They usually reported that, on the day of treatment and the day after, they would be quite sore. Then, 2 days later, these athletes would notice significant improvements. I had one particular player who would specifically request to see me 3 days before a game in order to maximize his performance.

FIG. 1.

Chi-Tsai Tang, MD, treating a St. Louis Rams player in a training-room setting.

Comments

Hamstring injuries are known to be a common problem in NFL players.¹⁰ Acupuncture has been shown to improve muscular performance. In particular, acupuncture can increase strength and this result can persist for 4 weeks.¹¹ Looking at functional activities, acupuncture has been shown to improve vertical jump.¹² Acupuncture can also improve flexibility, and possibly even reduce injuries sustained during a season.¹¹

DISCUSSION

Acupuncture can have many uses in sports medicine. This includes more-common indications, such as treatment of acute or chronic musculoskeletal injuries, but can also be used to aid sports recovery or enhance performance.¹³ Acupuncture can also be used in various settings outside the conventional clinic, such as the athletic training room. Athletic trainers are increasingly learning dry needling, so the use of needling therapies is no longer exclusively the practice of physicians or acupuncturists. However, I do believe we offer some distinct advantages. Our broad base of medical and acupuncture knowledge enables us to treat a wider variety of conditions. Our acupuncture experience enables us to needle more effectively and view patients more holistically. All of these factors anecdotally are responsible for improved patient outcomes and satisfaction. In addition, acupuncture is known to be exceedingly safe, when performed by qualified practitioners.¹⁴ Acceptance of needling therapies is generally good in the athletic population, and athletes who have had needling would recommend it to others.¹⁵

CONCLUSIONS

Acupuncture can be a distinctive addition to a sports-medicine physician's toolbox and we should not be afraid to use it in a variety of settings to help athletes.

AUTHOR DISCLOSURE STATEMENT

No financial conflicts of interest exist.

FUNDING INFORMATION

No funding was provided for work on this article.