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The present study investigated the immediate efficacy of acupuncture compared to sham acupuncture and placebo laser acupuncture on strength performance. A total of 33 recreational athletes (25.2 +/- 2.8 years; 13 women) were randomized to receive acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser acupuncture (deactivated laser device) in a double-blind crossover fashion with 1 week between trials. Assessment included bipedal drop jumps for maximum rebound height and quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface electromyography (EMG) was used to measure the EMG activity of the rectus femoris muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF) analysis was applied to characterize muscular endurance. Measurements were performed at baseline and immediately after treatment by a blinded investigator. Repeated measures ANOVA and post hoc paired-sample t test with Bonferroni-Holm correction were used for statistical analysis. The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N). ANOVA did not show statistically significant treatment effects for drop jump height or MPF. The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performance enhancement, but also for rehabilitation programs aimed at restoring neuromuscular function.
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ORIGINAL ARTICLE
Immediate effects of acupuncture on strength performance:
a randomized, controlled crossover trial
Markus Hu
¨bscher Lutz Vogt Thomas Ziebart
Winfried Banzer
Accepted: 11 May 2010 / Published online: 25 May 2010
ÓSpringer-Verlag 2010
Abstract The present study investigated the immediate
efficacy of acupuncture compared to sham acupuncture and
placebo laser acupuncture on strength performance. A total
of 33 recreational athletes (25.2 ±2.8 years; 13 women)
were randomized to receive acupuncture, sham acupunc-
ture (needling at non-acupuncture points) and placebo laser
acupuncture (deactivated laser device) in a double-blind
crossover fashion with 1 week between trials. Assessment
included bipedal drop jumps for maximum rebound height
and quadriceps maximum isometric voluntary force
(MIVF). Furthermore, surface electromyography (EMG)
was used to measure the EMG activity of the rectus femoris
muscle during a 30-s sustained MIVF of the knee exten-
sors. Mean power frequency (MPF) analysis was applied to
characterize muscular endurance. Measurements were
performed at baseline and immediately after treatment by a
blinded investigator. Repeated measures ANOVA and post
hoc paired-sample ttest with Bonferroni–Holm correction
were used for statistical analysis. The difference in the
mean change in MIVF from baseline between acupuncture
(46.6 N) and sham laser acupuncture (19.6 N) was statis-
tically significant (p\0.05), but no significant difference
was found between acupuncture (46.6 N) and sham acu-
puncture (28.8 N). ANOVA did not show statistically
significant treatment effects for drop jump height or MPF.
The present study shows that a single acupuncture treat-
ment was efficacious for improving isometric quadriceps
strength in recreational athletes. These results might have
implications not only for athletic performance enhance-
ment, but also for rehabilitation programs aimed at
restoring neuromuscular function.
Keywords Sham acupuncture Placebo laser
Muscle performance Athletes
Introduction
Acupuncture is one of the most frequently used therapies in
complementary and alternative medicine (CAM) (Astin
et al. 1998). Contemporary surveys from the USA and
Germany suggest that between 8 and 9% of the adult
population use acupuncture to prevent or treat a variety of
health problems (Ha
¨rtel and Volger 2004; Nahin et al.
2009). Furthermore, acupuncture has gained increased
attention in sports medicine and related disciplines
(Meleger and Borg-Stein 2000; Pelham et al. 2001;
Wadsworth 2006). Acupuncture usage is common among
collegiate athletes and the estimated prevalence of 12% is
apparently higher than in the general population (Nichols
and Harrigan 2006).
In sports medicine, acupuncture is preliminarily used to
control pain and relieve common ailments such as exercise-
induced muscle soreness (Hu
¨bscher et al. 2008), lateral
epicondylitis (tennis elbow) (Trinh et al. 2004), knee
osteoarthritis (Witt et al. 2005), low back and neck pain
(Manheimer et al. 2005; Trinh et al. 2006), anterior knee
pain (jumper’s knee) (Na
¨slund et al. 2002) or rotator cuff
tendinitis (Kleinhenz et al. 1999). In addition, acupuncture
treatment has been employed for performance enhancement
Communicated by Alain Martin.
M. Hu
¨bscher (&)L. Vogt W. Banzer
Department of Sports Medicine, Goethe-University Frankfurt,
Ginnheimer Landstraße 39, 60487 Frankfurt, Germany
e-mail: m.huebscher@sport.uni-frankfurt.de
T. Ziebart
Department of Oral and Maxillofacial Surgery,
Johannes Gutenberg-University Mainz, Mainz, Germany
123
Eur J Appl Physiol (2010) 110:353–358
DOI 10.1007/s00421-010-1510-y
in recreational and professional athletes (Akimoto et al.
2003; Huang et al. 2007; Dhillon 2008). Even though the
underlying mechanisms are largely unexplained, recent
studies demonstrating acupuncture-induced alterations in
the excitability of the motor system might provide a suitable
physiological basis for explaining the link between acu-
puncture and motor performance (Lo et al. 2005; Maioli
et al. 2006). However, there is no convincing evidence
either for or against a beneficial effect of acupuncture on
strength performance. The efficacy estimation is mainly
impeded by different acupuncture techniques, treatment
regimens, control conditions, multiple test procedures,
limitations in sample size and methodological study quality.
In considering acupuncture controls, it is crucial to evaluate
the physiological activity of the control intervention, as well
as the placebo response (White et al. 2006). Invasive needle
control (sham acupuncture) involves puncture of the skin at
non-acupuncture sites to test point specificity. However,
penetrating sham controls are not considered to be placebo
interventions given that they probably have some specific
physiological effects. The method of a placebo (deacti-
vated) laser acupuncture device has been shown to be
applicable for the evaluation of the placebo response
because this type of control is physiologically inert.
Furthermore, placebo laser acupuncture enables double-
blinding, which is another methodological problem of
acupuncture studies. The aim of this randomized, controlled
crossover study was to investigate the immediate efficacy of
acupuncture compared to sham acupuncture and placebo
laser acupuncture on muscular strength, power and endur-
ance in recreational athletes.
Methods
Subjects
The a priori power calculation (G*Power 3; Faul et al.
2007) revealed that, for the indented repeated measures
ANOVA, two-sided significance level of 5% and within-
subject correlation of q=0.4, a sample size of 28 would
have an 80% chance of detecting effects of medium size
(f=0.25). Assuming a 20% dropout rate, 36 healthy,
recreational athletes were recruited into the study. The
exclusion criteria were cardiovascular, pulmonary, meta-
bolic, neurological, psychiatric and musculoskeletal dis-
eases, hemophilia, muscle soreness, pain, acupuncture
treatment within the last 4 weeks and the use of any
medications. Subjects were instructed to maintain their
normal level of physical activity during the entire study
period and to refrain from any form of physical exercise for
at least 48 h prior to the tests. Food intake was restricted to
a light meal 3 h before the measurement procedure.
Beverages containing caffeine or alcohol were not allowed
for at least 12 h prior to the measurements.
All subjects provided written informed consent to the
protocol that had been approved by the Ethics Committee
of the Department of Medicine, Goethe-University Frankfurt,
Germany.
Study design and randomization
The study adopted a randomized, double-blind, crossover
design, in which all subjects were treated once with acu-
puncture, sham acupuncture and placebo laser acupuncture,
with 1 week between trials. A washout period of 1 week
has been shown to be adequate to avoid carryover effects
(Irnich et al. 2002). On the first day, baseline measure-
ments, including anthropometric data and strength testing,
were performed prior to random assignment of the subjects
to one of the six possible treatment orders. The random list
was generated by a computer program (BiAS for Windows
7.0; Department of Mathematics, Goethe-University
Frankfurt, Germany) and was retained by the principal
investigator until the end of the trial to ensure allocation
concealment.
Treatment
The subjects were blinded to the treatment. They were told
that the purpose of the study was to investigate the effects
of two different modes of needle acupuncture compared to
laser acupuncture, not mentioning terms such as ‘‘placebo’
or ‘‘sham’’ (Witt et al. 2005). Furthermore, placebo laser
acupuncture was performed double-blind: the subject and
the acupuncturist were not informed that the laser source
(laser diode) remained switched off (Irnich et al. 2002). All
treatments were performed by the same skilled and expe-
rienced acupuncturist (TZ) licensed by the German Medi-
cal Acupuncture Association. The treatment strategy,
including acupuncture points, sham points and needling
technique, was based on expert judgment of qualified and
experienced acupuncturists of the German Medical Acu-
puncture Association.
Acupuncture
The following classical acupuncture points were used in
the order: Zusanli (stomach 36), Sanyinjiao (spleen 6),
Qihai (conception vessel 6) and Shenmen (ear point 55)
(Hecker et al. 2008). Perpendicular needling was carried
out bilaterally (except Qihai) using sterile disposable nee-
dles (body points: Dongbang
Ò
0.3 930 mm; ear point:
Seirin
Ò
0.2 915 mm). The depth of needle insertion
depended on the anatomical location of the acupuncture
point and on the subjects’ constitution (e.g., skin thickness,
354 Eur J Appl Physiol (2010) 110:353–358
123
subcutaneous fat layer thickness) and varied from 1 to
2 mm at the ear point and from 5 to 30 mm at the body
points. De qi sensation was provoked by manual stimula-
tion (rotation) at the beginning of each session. De qi refers
to the sensations of the subject receiving acupuncture,
comprising soreness, numbness, heaviness and distention at
the site of needle insertion (Kong et al. 2007). Needles
were subsequently retained in place for 15 min while
subjects were lying in a supine position.
Sham acupuncture
Sham acupuncture comprised needling at the following
puncture sites that were at least 1 cun apart from the
classical acupuncture points and outside the corresponding
meridians: sham point 1, 1 cun cranial-ventral to San-
yinjiao; sham point 2, 3 cun caudal to a point located
midway between Zusanli and ventral-distal margin of the
head of the fibula; sham point 3, midway on the lateral
border between the iliac crest and 12th costal arch; sham
point 4, ear point at the ventral part of the auricular helix
with the same level of the inferior crus of the antihelix. A
cun is defined according to traditional acupuncture as the
width of the interphalangeal joint of the subject’s thumb
(Melchart et al. 2005). Subject position, needle type and
retention time were identical to those during acupuncture.
Placebo laser acupuncture
The Laserneedle
Ò
System (Laserneedle
Ò
Systems GmbH,
Germany) was used for placebo laser acupuncture. The
device consists of several optical fibers having a top section
that looks like a small needle. These ‘‘needles’’ were not
inserted into the skin, but were fixed onto the skin at the
above-defined sham points with special adhesive tape.
The main advantage of this method over a laser pen is that
the acupuncture points could be placebo-stimulated
simultaneously rather than consecutively, thus mimicking
the treatment regime of classical acupuncture. The laser
device was switched on to provide visual and acoustic
signals, but the laser diodes remained off-state. The subject
and the acupuncturist had to put on protective glasses
during the treatment and were told that the device emits
invisible infrared laser light. Subject position and treatment
duration were identical to those during acupuncture and
sham acupuncture.
Experimental procedures
Assessment of strength performance included bipedal drop
jumps, maximum isometric voluntary force (MIVF), and
isometric muscular endurance (IME). Measurements were
performed immediately (i.e., \5 min) after treatment, and
15 min recovery periods were allowed between the dif-
ferent tests. Assessors were blinded to the treatment.
Strength testing
Drop jumps from a 32-cm box were used to study power
performance during the stretch–shortening cycle. For this,
the subjects were instructed to drop down the box onto a
contact mat and, upon landing with bilateral foot contact,
perform a vertical jump while keeping their hands at their
hips. The primary goal of this test was to attain maximum
jump height. Before testing, each subject completed two
practice trials to ensure proper drop jumping technique.
After a 2-min rest period, three tests were performed,
separated by 1-min rest intervals, and the highest jump was
recorded for further analysis.
MIVF of the dominant knee extensors was measured
using a commercially available strain gauge force trans-
ducer (ASYS, SPOREG, Germany). The subjects were
seated upright with the knee and hip flexed at 90°and
performed maximum isometric contractions against an
inelastic strap, which was placed around the ankle and
connected to the force transducer (100 Hz sampling rate).
After a specific warmup (two submaximal practice trials),
three tests were performed with contractions lasting 5 s
separated by 2-min rest intervals. The subjects were
encouraged verbally to elicit their maximal effort, and
force was displayed on a screen in real time providing an
immediate feedback. Peak strength values were recorded in
Newtons, and the highest of the three trials was considered
to be representative of MIVF and used for statistical
analysis. Sufficient test–retest reliability of the device has
been shown by Pfeifer et al. (2002).
To assess IME, the subjects performed a 30-s sustained
MIVF of the dominant knee extensors (Halin et al. 2003).
Subject position was identical to that during the MIVF
measurements. The subjects were encouraged verbally to
elicit maximal effort during the entire contraction time.
EMG analysis
Bipolar surface electromyography (EMG) (BIOVISION
Ò
,
Wehrheim/Germany, differential instrumentation ampli-
fier; input impedance 10 GX, CMMR 130 db, RTI noise
8nVHHz, gain 2,500, filter 10 Hz low cutoff, 700 Hz high
cutoff) was used to measure the EMG activity of the rectus
femoris muscle during sustained MIVF (Pfeifer and Banzer
1999). The two electrodes were placed longitudinally in the
middle over the muscle belly after careful preparation of
the skin (cleaning with alcohol, shaving and abrasion)
(Hermens et al. 2000). For the detection of the signals,
Ag/AgCI electrodes (rectangular 4 95 mm embedded in
circular gel pad (diameter 10 mm), blue sensor N-00-S,
Eur J Appl Physiol (2010) 110:353–358 355
123
Medicotest GmbH, Andernach/Germany, 2 cm interelec-
trode distance) were used with preamplifiers no farther than
100 mm from the recording electrode. The reference
ground electrode was placed in a muscle-free area over the
tibia.
For data analysis (Watscope software, Northern Digital
Inc., Waterloo, Ontario), the first and last 5 s of the EMG
signal were selected, and the mean power frequency (MPF)
was calculated in each segment using the fast Fourier
transformation (FFT) (Hermens et al. 1999). Since during
fatiguing contractions the MPF shifts toward lower values,
the absolute change in MPF over time during sustained
MIVF was used to estimate muscular endurance (Arendt-
Nielsen et al. 1989).
Statistical analysis
A repeated measures ANOVA, with treatment type as a
within-subject factor and treatment order as a between-
subject factor, was used to analyze the mean change from
baseline. If the treatment effect was statistically significant
in the overall model, post hoc paired-sample ttests were
performed with Bonferroni–Holm correction. A two-sided
pvalue of less than 0.05 was considered as statistically
significant. All statistical computations were made with
SPSS 17.0 (SPSS Inc., Chicago, IL).
Results
A total of 33 subjects (13 women) completed the study and
were included in the analysis. The subject characteristics
(mean ±SD) were as follows: age 25.2 ±2.8 years;
height 179.1 ±11.2 cm; weight 74.7 ±14.2 kg; training
frequency per week 3.9 ±1.4; training duration per week
6.4 ±3.4 h. For unknown reasons, two subjects dropped
out before the baseline assessment and one person after the
first two treatments.
All outcome variables recorded at baseline and after
treatment are presented in Table 1. For the mean change
in MIVF (Fig. 1), ANOVA indicated a significant dif-
ference between the three treatments (p=0.04). No
significant treatment order effect was found, which could
have indicated a breakdown in randomization or carry-
over effects (p=0.13). Post hoc analysis revealed that
the difference in the mean change between acupuncture
and placebo laser acupuncture (27 N) was statistically
significant (p=0.04), but no significant difference
(p=0.05) was found between acupuncture and sham
acupuncture (17.8 N). ANOVA did not show statistically
significant treatment effects for jump height (p=0.22)
or MPF (p=0.38).
Discussion
This study aimed at investigating the immediate efficacy of
acupuncture compared to sham acupuncture and placebo
laser acupuncture on strength performance in recreational
athletes. Our main finding is that acupuncture was signifi-
cantly more efficacious in increasing MIVF of the knee
extensors than placebo laser acupuncture. After acupunc-
ture, MIVF increased by 8%, but only 5 and 3% after sham
acupuncture and placebo laser acupuncture, respectively.
However, although acupuncture tended to be superior to
sham acupuncture, this difference did not reach statistical
significance. The efficacy of sham acupuncture might be
explained by its invasiveness (Brinkhaus et al. 2006; Scharf
et al. 2006). Although our study used sham acupuncture at
non-acupuncture points, penetrating the skin could have
elicited physiological effects similar to those achieved
when needling specific acupuncture points. Therefore,
since penetrating sham controls should not be considered
as inert placebos, comparing acupuncture only with sham
acupuncture might underestimate the total treatment effect
(Paterson and Dieppe 2005). Thus, we decided to incor-
porate placebo laser acupuncture as a credible and physi-
ologically inert control condition that mimics the treatment
regime of classical acupuncture (Irnich et al. 2002; White
et al. 2006). An additional advantage of this method is that
it enables double blinding, since placebo laser treatment
cannot be distinguished from real laser treatment. In
summary, even though non-specific, generalized effects of
needling, evidenced by the insignificant difference between
acupuncture and sham acupuncture cannot be excluded, the
comparison of acupuncture and placebo laser acupuncture
suggests that acupuncture had efficacy beyond placebo.
Similar results were obtained by Huang et al. (2007)
demonstrating significant improvements in one repetition
maximum strength of the ankle dorsiflexors after repeated
electroacupuncture that was performed three times per
week for 4 weeks. However, this study included only one
control group receiving no intervention and was therefore
unable to identify whether the increase in muscle strength
was caused by a specific effect of electroacupuncture or
not. In contrast with the present results, Toma et al. (1998)
did not find immediate effects of a one-session acupuncture
treatment on isokinetic maximum strength of the knee and
wrist flexors when compared to superficial needling. Nev-
ertheless, the interpretation of this study is complicated by
the fact that only a single needle was inserted into the
muscle belly regardless of specific acupuncture points.
The physiological mechanisms underlying the beneficial
effects of acupuncture on muscular strength are largely
unexplained. The generation of muscle force relies on the
ability of the nervous system to activate muscles effec-
tively through motor unit recruitment and/or discharge,
356 Eur J Appl Physiol (2010) 110:353–358
123
whereas the regulation of motoneuron activity is accom-
plished by spinal as well as supraspinal inputs (Conwit
et al. 1999; Scaglioni et al. 2002). Short- and long-term
changes in neuromuscular excitability at spinal as well at
supraspinal levels may be induced by stimulating somato-
sensory afferents with acupuncture. Fink et al. (2004)
demonstrated a significant increase of spinal motoneuron
excitability after repeated acupuncture using soleus
H-reflex measurements. Several studies using transcranial
magnetic stimulation (TMS) and functional magnetic res-
onance imaging (fMRI) showed that a one-session acu-
puncture treatment led to enduring changes in corticomotor
excitability and plasticity, dependent on the mode and site
of stimulation as well as on the investigated muscle (Chae
et al. 2009; Lo et al. 2005; Maioli et al. 2006). These
findings imply that the increase in MIVF found in our study
might be triggered by acupuncture-induced modulations of
spinal and/or cortical motoneuron excitability. However,
the assessment of the physiological mechanism of acu-
puncture on strength performance was beyond the scope of
our study and should be addressed in future investigations.
Whereas acupuncture improved quadriceps strength, no
effects were observed with respect to drop jump perfor-
mance or muscular endurance. These results are partly in
line with previous investigations showing that a one-ses-
sion acupuncture treatment had no impact on drop jump
performance (Banzer et al. 2007) or muscular endurance of
the knee and wrist flexors (Toma et al. 1998).
In conclusion, the present study shows that a one-session
acupuncture treatment was efficacious for improving iso-
metric quadriceps strength in recreational athletes. Future
prospective studies should evaluate whether acupuncture-
induced strength gains would carry over to athletic per-
formance. Furthermore, the present findings may have
potential implications for rehabilitation programs aimed at
restoring neuromuscular function. For example, it may be
possible to facilitate muscle strength in patients who
exhibit long-term weakness of the quadriceps and func-
tional disability (e.g., total knee arthroplasty, knee osteo-
arthritis, anterior cruciate ligament injury). Therefore, the
short- and long-term efficacy of acupuncture as an adjunct
to exercise therapy in the treatment of musculoskeletal
disorders associated with neuromuscular deficits should be
investigated.
Acknowledgments This study was supported by a grant from the
German Medical Association of Acupuncture.
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... It is widely recognized that acupuncture is a treatment for several health disorders, including pain, migraine, and arthritis (11,37,47). Acupuncture has also been applied to enhance sports performance and recovery in professional and recreational athletes (1,2,10,12,18,21,42). ...
... The potential of acupuncture to benefit muscle strength and recovery is of interest in sports and athletic performance (27). In a cross-over design research study by Hü bscher et al., 33 recreational athletes were assessed for bipedal drop jumps and maximum isometric voluntary force (MIVF) after needle acupuncture, sham acupuncture, and placebo laser acupuncture (18). The results revealed an 8% increase in the MIVF after acupuncture. ...
... Although acupuncture practice usually requires a series of treatments, there has been research on the acute effects of acupuncture on performance. In the randomized controlled cross-over trial by Hü bscher et al. (18), a single treatment of acupuncture was shown to significantly enhance maximum isometric muscle strength. However, research by Toma et al. investigated the effects of a single treatment acupuncture session on muscle strength and endurance during a hand-grip and knee flexion task (40). ...
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... After a preliminary medical examination, three athletes were excluded from the study. Therefore, the actual number of participants observed was 17 (nonathletes; age: 20.1 ± 2.6 years; body mass: 74.5 ± 14.8 kg; height: 177.5 ± 5.0 cm; body mass index (BMI): 22.3 ± 3.1 kg/m 2 ; length of their upper arms: 33.6 ± 1.69 cm) participated and completed this study, any neuromusculoskeletal disease, a recent history of acupuncture treatment or use of drugs; drink caffeine or alcohol within 12 h; have not done strenuous physical exercise in 48 years [21]. In addition, participants had no history of musculoskeletal injury to the lateral shoulder joint and their range of motion was within the normal range (adduction-abduction: 0-180 • , flexion: 0-170 • , extension: 0-40 • ). ...
... Average work flexion, average work adduction/abduction, total work flexion and total work adduction/abduction at Post 1, Post 2 and Post 3 were all higher than baseline and the flexor, adductor and abductor muscle strength increased approximately 23 min after acupuncture. Previous studies have shown that acupuncture at the points around the shoulder joint can trigger the PAP phenomenon and increase the power value after exercise [6]; acupuncture at the Xiaohai and Jianwaishu points for 20 min can activate the trapezius muscle and increase the strength performance of bilateral trapezius muscles [30]; acupuncture at the Zusanli, Sanyinjiao, Qihai and Shenmen points for 15 min can strengthen the quadriceps muscles of recreational athletes [21]. Therefore, acupuncture around the shoulder joint of LI14, SJ14 SJ13, LU1, LU4, LU3 and SJ12 holes can cause the PAP phenomenon to be enhanced in healthy male subjects around the shoulder joint muscle strength and acupuncture can improve the shoulder joint muscle strength endurance at approximately 13-23 min of the average work and the total work increases. ...
... The study found that the parameter values increased after the completion of the isokinetic motor of the shoulder joint at Post 1, indicating that acupuncture had an immediate effect on improving shoulder muscle strength. Past research has found that needling receptors on the skin cause nerve reflexes to set up the body's communication mechanism [31], which is transmitted to the brain to regulate muscle activity and increase the recruitment of motor units to increase muscle strength [21]. The brain, cerebellum and limbic regions showed the same activity as the increased muscle activity after acupuncture termination [13]. ...
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Acupuncture as a traditional and commonly used treatment has been used to improve the performance of athletes. In the improvement of female shoulder joint explosive force and muscle endurance also has an immediate effect. However, whether the effect of acupuncture therapy can be maintained after improving athletic performance still worth further discussion. The purpose of this study was to explore the timeless of the physical neurophysiological response induced by acupuncture at specific acupoints in improving endurance performance. Seventeen healthy male participants completed six groups of shoulder joint isokinetic exercises. The isokinetic exercise completed in the first group was taken as the baseline. After acupuncture for 15 min, the following 5 isokinetic experiments were completed. Acupuncture acupoints included Binao (LI14), Jianliao (SJ14), Naohui (SJ13), Zhongfu (LU1), Xiabai (LU4), Tianfu (LU3) and Xiaoluo (SJ12). The results show that acupuncture can improve physical performance for 10–20 min. After acupuncture, the maximum torque, average power, average work and total work values significantly increased (p < 0.05). Stimulation of acupoints can effectively improve the performance of periarticular muscle endurance around the shoulder, but this improvement is limited by time.
... e average torque and average speed of elbow extension/flexion at post1 were higher than pre after RA. Motoneuron activity is regulated through the spinal and supraspinal level inputs, and the recruitment of motoneuron is the basis for the production of muscle strength [23]. Past studies have shown that increased reflex excitability in the spinal and supraspinal level may induce the generation of dorsiflexion to plantar flexion peak torque and increase the rate of torque development in isokinetic ankle movements [24]; neurophysiological evidence of H reflex indicates that acupuncture can increase the excitability of spinal motoneurons [25]. ...
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Immediate characteristics of acupuncture have been confirmed by relevant studies; however, the current study on the time effect of acupuncture in improving upper limb forearm muscle endurance is still limited. The aims of this study are to explore: (1) whether real acupuncture (RA) can improve female forearm muscle endurance compared to sham acupuncture (SA) and (2) whether the changes in forearm muscle endurance after RA are time-dependent. Thirty-six healthy female students were recruited to participate in isokinetic tests of elbow flexion/extension (Flex/Ext) from maximum flexion to maximum extension as much as possible using an isokinetic dynamometer at a speed rate of 60°/sec. Participants in the RA group were stimulated at Quchi (LI11), Shousanli (LI10), Hegu (LI4), Xiaohai (SI8), Tianjing (SJ10), and Waiguan (SJ5) acupoints for 20 min, while the SA group needling was near at these acupoints. The values of the isokinetic parameters and surface electromyography (sEMG) signals were recorded before and after acupuncture. After RA, the isokinetic parameters values (average torque, work, power, and speed), the sEMG values at four major muscles, and the joint stiffness of elbow Flex/Ext were significantly increased p < 0.05 . The enhancement of forearm muscle endurance lasted approximately 7–21 min (from post1 to post3/post4), indicating that the effect of RA to improve elbow Flex/Ext muscle endurance is time-dependent. Therefore, this study found that RA can immediately improve the forearm muscle endurance of healthy women compared with SA, and this effect can last approximately 7–21 min until the acupuncture efficacy decreased or disappeared.
... In addition, acupuncture treatment can improve the walking speed and knee flexion moment of patients with knee osteoarthritis (OA), which has an immediate effect on transforming the gait control strategy into a normal mode [6]. Acupuncture can effectively improve the strength of the quadriceps femoris of athletes in sports competitions, which is conducive to improving sports performance and restoring neuromuscular function [7]. Therefore, acupuncture is an alternative therapy useful for improving sports performance and competition results in sports medicine. ...
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Acupuncture can improve explosive force production and affect joint stiffness by affecting muscle activation levels. This study aims to explore the effects of true acupuncture (TA) compared with sham acupuncture (SA) on the explosive force production and stiffness of the knee joint in healthy male subjects. Twenty subjects were randomly divided into the TA group (n = 10) and SA group (n = 10) to complete isokinetic movement of the right knee joint at a speed of 240°/s before and after acupuncture. Futu (ST32), Liangqiu (ST34), Zusanli (ST36), Xuehai (SP10), and Chengshan (BL57) were selected for acupuncture. The intervention of SA is that needles with a blunt tip were pushed against the skin, giving an illusion of insertion. The results showed that acupuncture and the intervention time had a significant interaction effect on knee joint explosive force and joint stiffness (p < 0.05). The average maximum (max) torque, average work, average power, average peak power and total work of the TA group increased significantly after acupuncture (p < 0.05), while the SA group did not (p > 0.05). Therefore, true acupuncture can immediately improve the explosive force and joint stiffness of the male knee joint by inducing post-activation potentiation (PAP) and/or De-Qi.
... erefore, this study aims to explore the effect of acupuncture in explosive force production by the forearm muscles in females. Previous studies have found that acupuncture therapy has a direct effect on effectively improving the quadriceps muscle strength scale of recreational athletes [17]. e purpose of this study was to investigate the immediate effect of a single acupuncture session on strength improvement. ...
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Background: Acupuncture can effectively enhance musculoskeletal rehabilitation, with effects such as reduced pain intensity and muscle tension and decreased disability. Objective: The purpose of this study was to determine the efficacy of traditional Chinese acupuncture (TCA) compared with sham acupuncture (SA) in explosive force production by the forearm muscles in females. Methods: A total of 32 subjects were included and randomly assigned to two groups: TCA group (n = 16): stimulated specific acupoints including Quchi (LI11), Shousanli (LI10), Hegu (LI4), Xiaohai (SI8), Tianjing (SJ10), and Waiguan (SJ5) for 15 minutes; SA group (n = 16): using superficial needle insertion at nonacupoints without stimulation. The subjects warmed up for the 3-time isokinetic test with an angular velocity of 30°/s and then performed a set of 15 full flexion (Flex) and extension (Ext) with an angular velocity of 180°/s using the CON-TREX isokinetic test training system recorded as the pretest. After acupuncture for 15 min, perform a set of the same isokinetic movement isokinetic records as the posttest. The average max torque, average work, average power, average peak power, average max speed, and total work were collected to evaluate the forearm explosive force changes. Use two-way repeated measures ANOVA to compare the difference before and after acupuncture between two groups. Results: The results showed that acupuncture conditions (sham acupuncture as well as true acupuncture) and the intervention times (not acupuncture or acupuncture for 15 min) have a significant interaction effect on forearm explosive force and joint stiffness (P < 0.05). The simple main effect showed that the selected parameters of the TCA group increased significantly after acupuncture (P < 0.05), while the SA group did not (P > 0.05). We speculate that the activation of muscle may be related to the selected acupuncture points. Conclusion: Acupuncture can produce excitation in motor nerves and muscles, and nerve stimulation increases the recruitment of motor units, thus improving the muscle explosive force.
... Notably, the analgesic effect, mechanism of acupuncture, and improvement of muscle function have been well established in many studies. [35][36][37][38] However, since these effects are limited in duration after needle removal, TEA has been attempted as an alternative for diseases requiring long-term management. Furthermore, TEA has been reported to promote connective tissue repair by activating fibroblasts in experimental studies. ...
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Purpose: This study aims to determine the feasibility of thread-embedding acupuncture (TEA) for the treatment of shoulder instability. Patients and methods: This is a patient-assessor blinded, randomized, sham-controlled trial with two parallel arms. A total of 40 patients with shoulder instability aged between 13 and 43 years will be recruited and screened using set inclusion and exclusion criteria. After screening, they will be randomly allocated to the TEA or sham TEA group. Patients in both groups will then receive TEA or sham TEA treatment on six acupoints once a week for 8 weeks, which will be followed by additional follow-up assessments at 4 and 8 weeks after the end of treatment. Changes in shoulder pain and disability will be assessed as the primary outcome, whereas 100-mm pain visual analogue scale, shoulder range of motion, rotator cuff quality of life index, EuroQol 5-dimension 5-levels, treatment satisfaction, economic evaluation, and safety will all be measured as secondary outcomes of the study. Outcome assessment will be conducted at baseline and at 4, 8, and 16 weeks after screening. Conclusion: The results from this trial will help to design further clinical trials on the efficacy, safety, and cost-effectiveness of performing TEA for shoulder instability. Trial registration number: KCT0005921 (Clinical Research Information Service of the Republic of Korea).
... Applying needles at points PC6 and E36, the latter also used in the present study, was shown to reduce heart rate and lactate levels after 60 minutes (Lin et al., 2009), suggesting that the technique accelerated the recovery of athletes, similarly to that demonstrated here, where the physiological variables under study recovered in less time than those of the group submitted to acupuncture before exercise. Applying one acupuncture session seems to maximize athletic exertion by decreasing pain perception, as previously reported by Hübscher, Vogt, Ziebart, & Banzer, (2010). These authors concluded that a single session of manual acupuncture can significantly increase the level of isometric exertion in relation to controls. ...
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Studies have demonstrated the positive effects of acupuncture on athletic performance. The aim of this study was to determine the acute effects of acupuncture on heart rate, the perceived exertion scale and lactate levels in recreational athletes. Seven competitive male engaged in HIIT. The characteristic was 31.61+7.02 years old, heart rate reserve 59.71+4.10, lactate 3.31+0.63 mM/DL. The subjects were submitted to two exercise sessions. Both training sessions consisted of 10 burpees, 12 thrusters and 14 box jumps (75 cm high) for 12 minutes. Activity intensity was between 85 and 95% of maximum heart rate. Acupuncture points: ST36, L3, LI11. The student’s t-test was adopted, Shapiro-Wilk test was applied for normality, and Pearson correlation. There was a positive correlation of r = 0.69 between lactate levels and heart rate. Lactate: P2 15.00±1.18 - P3 19.59±1.46 p= 0.0004; Heart rate: P2 163.71±7.27 - P3 177.60±6.99 p=0.0007; Blood pressure: P2 174.86±1.57 - P3 180.86±1.77 p= 0.0001. Acupuncture increased lactate accumulation, heart rate and blood pressure, suggesting that the exertion reached after acupuncture is higher than without acupuncture. The acupuncture technics will improve the athlete performance. On this case, we suggest use this practice thirty minutes before the work out or race. It will allow the effects of acupuncture during the activity.
Article
Acupuncture and dry needling share many similarities in their proposed mechanisms of action and their sports medicine-related applications. Pain is the most common indication for these needling treatments, but there also are some limited studies on their use for ergogenic purposes. Needling can likely improve muscular strength and power, including increasing jump height, and it also can increase flexibility. In terms of sports recovery, acupuncture can not only be used for pain relief after injury, but also can help with routine recovery, such as in delayed onset muscle soreness. There are numerous case reports of acupuncture and dry needling being used to treat athletes for various diagnoses and conditions, however more high quality studies are needed in order to make more specific evidence-based recommendations. Given the high degree of safety and limited adverse events associated with needling treatments, it can likely be promoted in athletes.
Article
O movimento de plantiflexão e dorsiflexão do tornozelo tem uma importância funcional na sustentação da postura bípede e no caminhar, assumindo relevância em atividades diárias e no contexto desportivo. A ACP tem sido estudada como possível recurso coadjuvante às técnicas convencionais de recuperação a cargas de treinamento. O objetivo foi avaliar a influência da intervenção aguda por ACP na resistência física em sujeitos submetidos a exercício repetitivo de plantiflexão e dorsiflexão de tornozelo. O estudo foi do tipo ensaio clínico-experimental cego por parte do voluntário e avaliador com avaliação quantitativa e grupo controle. A amostra foi composta por 47 voluntários do sexo feminino, com idades de 18 a 55 anos (média 36,3 ± 10,6). Os voluntários foram separados por alocação determinística em alternância sequencial em três grupos: acupuntura (GACP n=16), acupuntura sham (Gsham n=16) e controle (GCRT=15). Todos os grupos realizaram o exercício de planti e dorsiflexão no equipamento reformer do método Pilates, antes e após a intervenção. Utilizou-se no GACP o acuponto E36 (Zusanli). O Gsham recebeu agulhamento superficial, fora do ponto de ACP, e o GCRT não recebeu intervenção. Todos os três grupos permaneceram em repouso por 20 minutos, durante a aplicação. Foram utilizadas agulhas filiformes descartáveis 0,25x40mm. Após 24 horas todos os voluntários foram reavaliados no número de repetições. Houve diferenças significativas na variação no número máximo de repetições no pré-tratamento para o pós-imediato (p= 0,004), porém não entre os momentos pré tratamento comparado ao pós 24 horas. Concluiu-se que houve aumento no número máximo de repetições em todos os grupos, sendo no GACP o responsável pelo maior aumento (31,5%).
Article
Background: The ability to produce force is critical to several daily activities. Strategies to reduce delayed onsent muscle soreness (DOMS) and restore force-generating properties that occur in response to training and impair physical performance have been proposed. Acupuncture has been proposed to accelerate recovery and optimize muscle functioning. It was to determine the effects of acupuncture on DOMS and on the muscle force production capacity. Methods: Thirty physically active volunteers (26.3 ± 3.1 years old, 1.70 ± 0.08 m, 66.5 ± 12.6 kg) were allocated in a control (CG; n = 10), placebo (PG; n = 10), and acupuncture (AG; n = 10) groups. The groups were subjected to an exercise protocol to induce DOMS and were assessed for muscle force, threshold, and rate of perceived pain and activation of the biceps brachialis muscle before (PRE) and 20 minutes after (POST) a single acupuncture session using a mixed model analysis. Results: The threshold and rate of perceived pain were reduced in the AG (P < 0.05) but remained unchanged in the other groups (P > 0.05). Muscle activation also showed larger changes in the AG in comparison with the other groups (P < 0.05). No changes in the ability to produce force were found after acupuncture in any groups (P > 0.05). Conclusions: Acupuncture may reduce discomfort and improve muscle activation but was not effective to promote force improvement and/or restore the force-generating properties. It may be speculated that muscle disruption may have played a role and did not allow participants to restore their muscular performance. Rebec Number; RBR-8bh5k7 (www.ensaiosclinicos.gov.br/rg/RBR-8bh5k7); Clinical Trial Registry (UTN No.: U1111-1234-9553).
Article
Background: Low back pain limits activity and is the second most frequent reason for physicians visits. Previous research shows widespread use of acupuncture for low back pain. Purpose: To assess acupuncture's effectiveness for treating low back pain. Data Sources: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. Study Selection: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. Data Extraction: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. Data Synthesis: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. Limitations: The quantity and quality of the included trials varied. Conclusions: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.
Article
Background: Acupuncture is widely used by patients with low back pain, although its effectiveness is unclear. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain.Methods: Patients were randomized to treatment with acupuncture, minimal acupuncture (superficial needling at nonacupuncture points), or a waiting list control. Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers, and consisted of 12 sessions per patient over 8 weeks. Patients completed standardized questionnaires at baseline and at 8, 26, and 52 weeks after randomization. The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8, as determined on a visual analog scale (range, 0-100 mm).Results: A total of 298 patients (67.8% female; mean ± SD age, 59 ± 9 years) were included. Between baseline and week 8, pain intensity decreased by a mean ± SD of 28.7 ± 30.3 mm in the acupuncture group, 23.6 ± 31.0 mm in the minimal acupuncture group, and 6.9 ± 22.0 mm in the waiting list group. The difference for the acupuncture vs minimal acupuncture group was 5.1 mm (95% confidence interval, −3.7 to 13.9 mm; P = .26), and the difference for the acupuncture vs waiting list group was 21.7 mm (95% confidence interval, 13.9-30.0 mm; P<.001). Also, at 26 (P=.96) and 52 (P=.61) weeks, pain did not differ significantly between the acupuncture and the minimal acupuncture groups.Conclusion: Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain, whereas there were no significant differences between acupuncture and minimal acupuncture.
Article
The effects of acupuncture needle stimulation on skeletal muscle activity and exercise performance were studied in 17 healthy men. Each subject underwent maximal strength and muscular endurance force-generation tests of the nondominant hand and leg with EMG activity simultaneously recorded using a hand dynamometer and the Cybex II dynamometer. After a pretest evaluation of exercise performance and EMG activity, an acupuncture needle was inserted in the semitendinosus m. and either the flexor digitorum superficialis m. or flexor digitorum profundus m.; posttest evaluation was conducted following needle insertion. Results indicated no significant difference in exercise performance. However, there was a significant difference in EMG responses during maximum knee flexion on stimulated muscle and during endurance knee flexion on nonstimulated muscle (p = 0.044 and 0.05, respectively, in repeated measures ANOVA). No significant difference was noted in EMG for maximal hand grip. It may be concluded that single acupuncture stimulation affects neuromuscular function.
Article
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
Article
Some studies have shown beneficial effects of needle acupuncture on physical performance. Objective: To evaluate immediate effects of a standardized acupuncture treatment on vertical jumping performance. Subjects and Methods: 12 healthy sport students participated in the study. A randomized crossover design was used to investigate specific effects of real acupuncture, sham acupuncture and a no-acupuncture waiting list condition on myoelectric activity and kinematic parameters (duration of ground contact, maximum jumping height) in one-legged drop jumps. Results: The results of the present study do not demonstrate significant treatment effects on myoelectric and kinematic parameters. However, real acupuncture tends to result in a relative decrease in the duration of ground contact accompanied by increased muscular innervation. Conclusion: Acupuncture treatment had no significant impact on muscular performance of lower leg in stretch-shortening cycle under the present conditions. As to further research, the potential efficacy of acupuncture for improving reactive strength should be investigated in terms of controlled trials with stratified randomization according to physical performance capacity.
Article
Summary Use and Acceptance of Classical Natural and Alternative Medicine in Germany - Findings of a Representative Population-Based Survey Background: The use of classical natural therapies and alternative medicine is becoming increasingly popular in Germany and other European countries. Only few population-based studies in Germany have investigated the use and acceptance of a variety of classical and alternative methods, including their possible determinants. Methods: Cross-sectional survey of a nationally representative sample of men and women aged 18 to 69 years, applying a standardized self-administered questionnaire, that included questions on 21 different healing methods, on personal reasons for use, on individual attitudes to natural therapies, and on the socioeconomic background. Results: Overall, 70% of women and 54% of men had used at least one classical natural or alternative healing method (including homeopathic and anthroposophic medicine) during the 12 months preceding the study. The most frequently used methods were classical therapies such as exercise therapy (32% of women, 26% of men), herbal medicine (33% of women, 20% of men), hydrotherapy (24% of women, 17% of men), and medical massage (22% of women, 15% of men). About 20% of women and 10% of men had applied homeopathic therapies, and about 9% (11% women, 6% men) had used acupuncture. In multivariate logistic regression analyses gender and education were the best predictors of classical and alternative medicine use. Women and persons with at least high-school education used these methods significantly more often than men and persons with lower education. Age-stratified analyses revealed that the age-group of the 40-49-year-old people used classical and alternative methods significantly more often than younger or older age-groups. The most frequently reported health problems for which natural therapies had been applied were back pain (57%), cold (29%), headaches (19%), strain (15%) and gastrointestinal ailments (12%). Overall, the efficacy and usefulness of natural healing methods was evaluated positive by the majority of the study population. 58% would appreciate it if physicians would more often prescribe such therapies, and 48% would like to have more information about the benefit of natural healing methods. Conclusions: The prevalence of use of natural medicine varies substantially across different types of healing methods. The observed overall acceptance together with the marked need for more information should be used more intensively for the development of health promotion strategies and underpins the necessity of reinforced research activities in this field.
Article
Acupuncture, a common treatment modality within complementary and alternative medicine, has been widely used for Parkinson's disease (PD). Using functional magnetic resonance imaging (fMRI), we explored the neural mechanisms underlying the effect of specific and genuine acupuncture treatment on the motor function in patients with PD. Three fMRI scans were performed in random order in a block design, one for verum acupuncture (VA) treatment, another one for a covert placebo (CP), and the third one for an overt placebo (OP) at the motor function implicated acupoint GB34 on the left foot of 10 patients with PD. We calculated the contrast that subtracts the blood-oxygen-level dependent (BOLD) response for the acupuncture effect (VA vs. CP) and the placebo effect (CP vs. OP). We found a significant improvement in the motor function of the affected hand after acupuncture treatment. The putamen and the primary motor cortex were activated when patients with PD received the acupuncture treatment (VA vs. CP) and these activations correlated with individual enhanced motor function. Expectation towards acupuncture modality (CP vs. OP) elicited activation over the anterior cingulate gyrus, the superior frontal gyrus, and the superior temporal gyrus. These findings suggest that acupuncture treatment might facilitate improvement in the motor functioning of patients with PD via the basal ganglia-thalamocortical circuit. © 2009 Movement Disorder Society