All About Acupuncture – A Physio's Perspective

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Acupuncture is one of the many tools in my tool box. As a physiotherapist, I use acupuncture as part of my integrated approach to pain management. I don’t use it with every client that walks though my door, but based on my clinical judgement, it may come up as a valuable option.
I often get questions about acupuncture, so this is my best attempt to answer all of those questions. Let’s start with: What is Acupuncture?
Acupuncture is an ancient system of medicine part of Traditional Chinese Medicine (TCM) dating back approximately 2000 years. It is based on the concept that ill health is derived from an imbalance of the body’s energy. This energy is referred to as Qi (pronounced chee) and can be stimulated via channels called meridians in the body. Perhaps you have heard this energy in terms of Yin and Yang energy. Yin energy is quiet and calm while yang energy is more energetic and exciting. In a healthy individual these two opposite energies complement one another to create balance.
Practitioners of TCM use certain acupuncture points on the body to help restore balance in the energy systems. TCM looks at the whole body and environment to diagnose and treat an ailment. For example, they may relate your diagnoses to elements such as fire, earth, metal, water and wood. They may also include a thorough skin and tongue examination, as well as a discussion about the timing and cycles of your illness or pain.
Although I completely love and respect TCM, I learned acupuncture from a Western approach. I was taught that the knowledge and practice of acupuncture spread to the Western world via trading in the 17th century. Rumor has it that its popularity grew after president Nixon’s visit to Chinese clinics. Western acupuncture was born with the focus on pain mechanisms, and its influence on the nervous system. With that being said, my training was based on scientific research and clinical evidence that suggests acupuncture can reduce pain and promote healing. In fact, Physiotherapists are one of the largest medical professions practicing acupuncture.
Acupuncture works by stimulating the brain and spinal cord to produce natural pain relieving chemicals. For example it triggers the release of endorphins, serotonin and melatonin. These chemicals assist in the body’s ability to heal itself. I often use acupuncture before or after other physio treatments like manual therapy or exercise in order to speed recovery.
I have three different techniques for applying the acupuncture needles.  In each approach I use single-use, pre-sterilized disposable needles. They vary in width and length depending on the area of the body I am focusing on. I determine the points, which I often call ‘the recipe’ based on my assessment of the cause of the imbalance. While TCM has 700-800 points, I use approximately 100 points in my physio scope of practice. For example I wouldn’t treat someone’s digestive issues, as that isn’t something physiotherapists typically address. My clients may complain of pain, stiffness or loss of strength in a specific area.
The first approach is what I call conventional acupuncture. I typically use a recipe with 7 to 10 points, with more points being used for bilateral treatments – like central back and neck pain. The needles stay in for approximately 20 minutes to complete a conventional acupuncture session.
I also use trigger point acupuncture to facilitate relaxation in a specific muscle. This often comes up after longer term unresolved muscle pain, post trauma, or a very tight muscle. With this technique the needle goes into the trigger point of the muscle and I look for the desired effect. I move the needle up and down for a few seconds until the trigger point releases, thus treatment time is much shorter.

Lastly, I use electroacupunture, this is when I pair needles with electrodes, which are connected to my transcutaneous electrical nerves (TENS) machine. The unit delivers amplitudes and frequencies of electrical signals based on the settings I choose. There is evidence to support its use with chronic pain conditions.
 
I am often asked, does it hurt? Acupuncture should not be painful. The sensations felt is called Deqi – and sometimes it is described as a warm, tingling, dull ache or weird sensation. If it is a sharp pain, the needle may be in too shallow. It can also be nauseating if the needle is too close to a blood vessel or nerve. If my client is uncomfortable I simple reposition the needle, and if that doesn’t work I just remove it completely.
Overall, acupuncture is a valuable tool in my tool box. There are a few different approaches to this ancient traditional Chinese medicine and all of them are beneficial and specific to what a person is suffering from or looking to optimize. I think acupuncture is something everyone should experience – especially if you are suffering from chronic pain.
In Health,
Beth Hollis

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