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Dry Needling: Explained

Dry Needling: Explained

Trigger Point Dry Needling and Acupuncture can seem to refer to the exact same practice. An outside observer sees the insertion of thin needles in a sterile but tranquil environment and assumes the results, methods, and treatments are the same.

 

This, however, is not true. Trigger point dry needling (aka: TDN) is actually quite different from the traditional practice of acupuncture. Although it is true that both practices use essentially the same tools — both TDN and acupuncture use very small, thin needles — they aim to treat different ailments in different ways.

 

Let’s remove some of the mystery associated with the relationship between Trigger point dry needling and acupuncture by explaining the differences between the two practices.

 

Practice

 

Trigger Point Dry Needling is a method used to treat pain resulting from neuromuscular skeletal conditions. Acupuncture can also be used to fight chronic pain (along with other ailments) but the issues addressed are different. Acupuncture aims to align the meridians of the body, while dry needling addresses trigger points. These trigger points are associated with specific points of pain within the muscular system. Needles are inserted into these trigger points, essentially releasing them and easing the pain that previously emanated from them.

 

Learn more about Trigger Point Needling in Nashville, TN today!

 

Origin

 

The origins of acupuncture and dry needling happened quite a long time away from each other. Acupuncture is dated back to ancient China over 4,000 years ago. Dry needling, however, dates back to the 1940’s and was coined by Dr. Janet Travell in the United States. She and Dr. David G. Simon identified most of the trigger points located throughout the human body. This is considered to be the first generation of the practice.

 

The second generation came in the 1970’s through the work of Dr. C. Gunn. He developed a treatment for myofascial pain called Intramuscular Stimulation (IMS). This work didn’t directly reference the first generation of dry needling, but the combination of these two fields of work are what informs the current practice.

 

This practice is continuing to evolve as we learn more about how trigger points affect our bodies and more research is conducted. Aspects of dry needling are being incorporated into other forms of physical therapy. Innovations are improving the results seen through TDN and expanding upon its current use.

 

Methods of Treatment

 

Insertion of thin needles might look similar when comparing dry needling to acupuncture, but the actual practice has some differences. First of all, acupuncture is generally performed by strategically placing needles along specific points in the body at a fairly shallow depth.

 

Dry needling is also performed with strategic placement, although as we said earlier the aim is to address trigger points and not meridians. The needles are also placed a little deeper for dry needling than they are for acupuncture and for shorter periods of time.

 

The depth at which the needles are placed depends on the specific trigger points and muscles that are to be addressed.

 

Uses for Trigger Point Needling

 

The application of needles to target specific trigger points can have a wide range of benefits for the patient. Although, it should be noted that trigger point dry needling is but one part of a larger physical therapy treatment plan to address a particular issue. A consultation with a trained acupuncturist will help put together a plan to treat the issue.

 

Trigger point dry needling can be used to treat a wide range of conditions such as repetitive stress injuries, neck pain, headaches, muscle tendonitis, frozen shoulder, carpal tunnel syndrome, sciatica, muscle strains, plantar fasciitis, rotator cuff impingement, and sacroiliac joint dysfunction.

 

What to Expect from Dry Needling?

 

Patients seeking dry needling can do a little preparation beforehand to help the treatment along. First, patients should eat a light meal between one and two hours before the appointment. Wear loose and comfortable clothing that can be rolled up if necessary to reach certain parts of the body.

 

The depth of the needles isn’t generally a concern for many patients. However, there is a possibility that the patient will feel the insertion of the needle. The goal is to elicit a local twitch response in the muscle which can occasionally result in brief pain that feels similar to a deep ache. However, these responses are generally very short.

 

It’s common to see benefits very soon after treatment. Depending on the issue being addressed, patients see improvements in range of motion and a decrease in previous symptoms. There can occasionally be bruising around the treated area as well as some soreness that clears up anywhere between a few hours a couple days after treatment.

 

 

 

Contact Affinity Acupuncture for dry needling treatment in Nashville!

 

Acupuncture: Natural Back Pain Treatment

Acupuncture: Natural Back Pain Treatment

Lower back pain affects just about everybody at some point in their life. Maybe you spent the weekend doing yard work and now it’s difficult to tie your shoes. Or perhaps you have chronic issues that have been following you for a while. Whatever the case, lower back pain can be a great hindrance in not only performing daily tasks, but being able to enjoy yourself.

There’s a growing backlash against pain medication. There has been an unfortunate tendency for doctors to overprescribe these medications, which can lead to addiction and other negative consequences.

So what is a person to do if they want to find relief from pain while also avoiding costly and dangerous medications? They start looking for a natural means of alleviating this pain.

Acupuncture has been used for thousands of years as a back pain treatment. However, there are still people that dismiss the practice as ineffective without actually looking into the research or trying it themselves.

The Research

The largest scientific study involving acupuncture’s efficacy in back pain treatment was performed in 2007. It used data from 1,162 patients with ages ranging from 18 to 86 years old. These patients all suffered from chronic lower back pain. The average length of their back pain was eight years.

The patients were split into three groups. The first received acupuncture in an attempt to treat their lower back pain. The second received what they called “sham acupuncture,” which is the insertion of needles but without strategic placement. The third group received conventional treatments for the back pain which included medication, physical therapy, and exercise.

The results were collected after six months of treatment. They were recorded using interviews with the patients in order to determine their pain levels. Both the Von Korff Chronic Pain Grade Scale questionnaire and the back-specific Hanover Functional Ability Questionnaire were used to compile the data

The results of the study were pretty surprising to anybody that didn’t have previous knowledge of acupuncture. 

47.6% improvement in pain was reported by the patients that received acupuncture. This is quite an achievement when compared to the 27.4% improvement for those who received conventional therapies.

The “sham acupuncture” group, however, reported a 44.2% improvement in pain which has caused some to muddy the waters of success for acupuncture. There are a variety of theories as to why this would happen, including the placebo effect as well as the difficulty in truly creating a neutral version of acupuncture.

But when you compare this singular study against the 2,500 year history of using acupuncture as a back pain treatment, it’s easy to see there’s more to the practice than a simple placebo effect.

Visit Affinity Acupuncture for back pain treatment in the Nashville, TN area today!

How It Works

Traditional Chinese medicine bases acupuncture around the idea of energy within your body. This energy needs to be balanced. 

Acupuncture is performed through the strategic insertion of needles into specific points in the body. These points are connected through a series of pathways — called meridians — which creates the open flow of energy. 

The insertion of these needles helps to stimulate these points. This stimulation opens the pathways and creates the balanced flow of energy along the body’s meridians.

This improved flow of energy helps the body to fight off sickness and pain.

Scientific studies are difficult to perform on the practice so those in the medical community aren’t able to definitively state why acupuncture works. However, many doctors recommend their patients use acupuncture to treat their pain. So even if they can’t specifically state why acupuncture works, it is widely touted for its ability to treat back pain.

Those in the medical community do have their theories, though. Some think acupuncture needles stimulate the central nervous system which releases chemicals to the brain, blood, and muscles. Others think it increases the speed of electromagnetic signals in the body which increases the flow of endorphins.

But despite their varying theories as to why it works, it’s widely accepted that acupuncture is a legitimate method for back pain treatment. 

Seeking Back Pain Treatment in Nashville

Those seeking back pain treatment in the Nashville area can visit Affinity Acupuncture for natural pain relief. We aim to help the Nashville and surrounding communities by offering individualized care through traditional Chinese methods that have been used for thousands of years. We offer acupuncture for back pain treatment as well as many other conditions. In fact, the World Health Organization recommends acupuncture as treatment for neck pain, depression, headaches, sciatica, and more.

Contact Affinity acupuncture to learn more about their back pain treatment options in Nashville, TN today!

Acupuncture Soothes Cervical Spinal Nerves, Reduces Pain

Researchers find acupuncture effective for the relief of cervical spinal syndrome. This condition involves irritation of the spinal nerves located in the neck. Spinal nerves transmit sensory, motor, and autonomic nervous system signals between the spinal cord and the body. Inflammation and impingement present in cervical spinal syndrome results in head, neck, chest, shoulder, or arm pain and dysfunction. The results of the research demonstrates that acupuncture plus moxibustion yields a high total recovery rate. In addition, nearly every patient receiving acupuncture plus moxibustion demonstrated significant improvements.

Researchers from the Hubei Hongan Traditional Chinese Medicine Hospital examined 200 cervical syndrome patients in a controlled investigation. The research team discovered that targeted acupuncture treatments produce an extremely high total effective rate and a high complete recovery rate. Targeting involved the application of a primary acupuncture point prescription for all patients plus an additional set of secondary acupuncture points based upon diagnostic variations in clinical presentations. Using this semi-protocolized targeted approach to patient care, the research team achieved a 97% total effective rate across all tiers of improvement. The breakdown into levels of efficaciousness produced surprising results. The total recovery rate was 64%, the significant improvement rate was 17%, the minimal improvement rate was 16%, and 3% had no improvement. 

Dr. Ruth Jackson, MD, notes, “The nerve roots leave the spinal cord at an angle which approximates a right angle, and they fill fairly snugly the foramina through which they pass. This makes them very vulnerable to irritation from any mechanical derangement of the cervical spine.” Cervical syndrome is often triggered by a small event, such as leaning over a sink while brushing teeth or turning the head. However, the initial cause may have been prior, including whiplash injuries, mechanical deformities, or other chronic irritations. The tight spacing of the intervertebral foramina (IVF) through which the nerves pass is easily encroached by both chronic and acute conditions that produce inflammation and morphological changes.

A primary set of acupoints was administered to all patients in this acupuncture continuing education study. A total of 3 – 4 acupoints from the primary set were applied during each acupuncture session. Each acupoint, including customized secondary acupoints, were needled with standard manual acupuncture protocols for insertion and manipulation. Total needle retention time during each acupuncture session was 20 minutes. One acupuncture session was applied daily for a total of 10 days, followed by a two day break and then another 10 days of acupuncture therapy. For moxibustion, a moxa cigar was used to warm the cervical Jiaji acupoints for 30 minutes per day. One 30 minute moxibustion treatment was conducted daily for 10 consecutive days. The next treatment cycle of an additional 10 days of moxibustion care commenced after a 2 day break from treatment. The primary acupoints were selected from the following selection:

Fengchi (GB20)
Dazhui (GV14)
Jianjing (GB21)
Tianzong (SI11)
Lieque (LU7)
Zhongzhu (TB3)
Houxi (SI3)
Ashi (located beside spinous processes)
Secondary acupoints were selected based on the type of cervical syndrome presentation for each patient. For nerve root compression cervical syndrome affecting the shoulders and arms, the following points were applied:

Jianyu (LI15)
Tianzong (SI11)
Binao (LI14)
Yanglao (SI6)
For vertebral artery related cervical syndrome, the following acupoints were applied:

Taiyang (MHN9)
Touwei (ST8)
Baihui (GV20)
Sishencong (MHN1)
Neiguan (PC6)
Sanyinjiao (SP6)
Taichong (LV3)
Zusanli (ST36)
For sympathicus cervical syndrome involving excess stimulation of the sympathetic division of the autonomic nervous system, the following acupoints were applied:

Taiyang (MHN9)
Jingming (BL1)
Qiuhou (MHN8)
Yifeng (TB17)
Neiguan (PC6)
Zusanli (ST36)
Sanyinjiao (SP6)
Jiaoxin (KD8)
Yinjiao (CV7)
Patients were evaluated before and after the treatment course of care. The treatment efficacy for each patient was categorized into 1 of 4 tiers:

Recovery: Complete recovery of neck function. Complete absence of clinical symptoms.
Significantly effective: Alleviation of localized pain. Clinical symptoms largely absent.
Effective: Localized pain present. Basic physiological function achieved. Main clinical symptoms absent.
Not effective: No improvement.
The total treatment effective rate was derived as the percentage of patients who achieved at least an effective tier. The data shows that acupuncture combined with moxibustion benefits nearly every cervical syndrome patient to some degree, with a 97% total effective rate across all tiers of improvement. The 64% complete recovery rate is equally important.

The researchers gave a Traditional Chinese Medicine (TCM) background to the treatment of cervical syndrome, often manifesting as cervical spondylosis. According to TCM, cervical syndrome is common starting in middle-aged individuals and older. Often, cervical nerve impingement is due to osteoarthritis and cervical disc protrusions or extrusions. Radiculitis is common in all cases. According to TCM principles, left untreated, cervical syndrome is a degenerative disorder. Calcification of related ligaments due to chronic strain and inflammation may lead to oppression of the cervical vertebrae, nerve roots, and blood vessels. There may also be pressure onto the spinal cord in more serious cases. These conditions lead to cervical dysfunction and pain.

In TCM, cervical syndrome is often categorized in the class of Bi Zheng. External pernicious influences giving rise to cervical syndrome include external injury, exhaustion, wind, cold, and dampness. Zang-Fu and deficiency related conditions include deficiency of the liver and kidneys or tendon and bone malnutrition. The aforementioned conditions result in poor qi and blood circulation in the Taiyang meridians and imbalances of the Ying and Wei. Symptoms such as severe neck pain, shoulder pain, numbness, headache, dizziness, and nausea ensue as a result of the condition. The results of the research demonstrates that acupuncture combined with moxibustion is effective for the relief of cervical syndrome.

References:
Li HX & Zhao L. (2013). Efficacy observation on treating 200 cases of cervical syndrome with acupuncture and moxibustion. Clinical Journal of Chinese Medicine. 5(3).

Jackson, Ruth. “The Classic: The Cervical Syndrome.” Clinical Orthopaedics and Related Research. 468, no. 7 (2010): 1739-1745.

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1699-acupuncture-soothes-cervical-spinal-nerves-stops-pain

Report Finds Acupuncture Reverses Lower Back Pain

Report Finds Acupuncture Reverses Lower Back Pain

Qi-guiding acupuncture relieves disc herniation pain and a special intensive silver acupuncture needle protocol relieves chronic lower back myofascial pain.

Researchers find acupuncture effective for the treatment of lower back pain disorders. In a protocolized study from the Shanghai Jiaotong University Sixth People’s Hospital, researchers determined that a special type of manual acupuncture therapy, known as qi-guiding acupuncture, produces significant positive patient outcomes for lumbar intervertebral disc herniation patients. In related research from Xinping Hospital of Traditional Chinese Medicine, investigators find acupuncture combined with moxibustion effective for the alleviation of lower back pain due to lumbodorsal myofascial pain syndrome. A special application of silver acupuncture needles produced superior patient outcomes. Let’s start with a look at the Shanghai Jiaotang University research and then we’ll see how the silver needle protocol boosts treatment efficacy for the treatment of lower back pain.

Acupuncture is effective for the treatment of lumbar intervertebral disc herniations. Wu et al. (Shanghai Jiaotong University Sixth People’s Hospital) investigated the treatment results of qi-guiding acupuncture with meridian differentiated acupoint selections and determined that it produces significant positive treatment outcomes for lumbar intervertebral disc herniation patients. Wu et al. also find electroacupuncture with meridian differentiated acupoint selections effective; however, qi-guiding acupuncture had a slightly higher rate of producing positive patient outcomes. Qi-guiding acupuncture had an 87.5% total treatment effective rate and electroacupuncture achieved an 86.6% total treatment effective rate. Qi-guiding acupuncture also had better outcomes for increases in nerve conduction velocity. The results are definitive given the large sample size of 549 patients with lumbar disc herniations evaluated in this study. 

Lumbar disc herniation patients experience lower back pain and radiculopathy (radiating pain and numbness) as a result of anulus fibrosis damage, IVF encroachment, and other issues associated with disc damage (Hu et al.). Acupuncture, as one of the most common non-surgical treatment methods for lumbar disc herniation, has a high treatment effective rate and no significant adverse effects (Cheng).

Qi-guiding acupuncture was first documented in ancient literature, including The Systematic Classic of Acupuncture & Moxibustion by Huang-fu Mi. In qi-guiding acupuncture, needle entry and removal is controlled and slow. To direct qi upward, the acupuncture needle is oriented upward; similarly, to direct qi downward, the needle is pointed downward. Subsequently, the needle is frequently rotated, lifted, and thrust to regulate the flow of qi in the body. Additional manipulation techniques may be intermittently applied. In modern use, qi-guiding acupuncture repairs ultramicroscopic structures of damaged nerve roots and accelerates other aspects of nerve repair, thereby increasing nerve conduction.

In this study, lumbar disc herniation patients receiving qi-guiding acupuncture achieved an 87.5% total treatment effective rate. Patients receiving electroacupuncture achieved an 86.6% total treatment effective rate. Both qi-guiding acupuncture and electroacupuncture significantly increased nerve conduction velocity. Qi-guiding acupuncture had a slightly greater improvement in common peroneal nerve conduction velocity and superficial fibular nerve conduction velocity. Common peroneal nerve conduction velocity increased from 38.26 ± 12.8 to 44.75 ± 5.24 after the application of qi-guiding acupuncture, and increased from 39.11 ± 3.64 to 39.86 ± 10.95 after electroacupuncture. Superficial fibular nerve conduction velocity increased from 41.63 ± 4.37 to 42.55 ± 6.43 after the application of qi-guiding acupuncture, and increased from 40.71 ± 9.56 to 40.43 ± 4.01 after electroacupuncture.

A total of 549 patients with lumbar disc herniations were treated and evaluated in this study. These patients were diagnosed with lumbar disc herniations between December 2012 and March 2014. They were randomly divided into a treatment group and a control group, with 280 patients in the treatment group and 269 patients in the control group. The treatment group underwent qi-guiding acupuncture therapy, while the control group received electroacupuncture. Acupoint selection for both groups was based on meridian differentiation. Identical acupoints were selected for both patient groups.

For Taiyang meridian lumbago and leg pain (scelalgia):

Shenshu (BL23) Dachangshu (BL25) Zhibian (BL54) Huantiao (GB30) Juliao (GB29) Yinmen (BL37) Weizhong (BL40) Chengshan (BL57) Kunlun (BL60) For Yangming meridian lumbago and leg pain:

Shenshu (BL23) Dachangshu (BL25) Qichong (ST30) Biguan (ST31) Futu (ST32) Tiaokou (ST38) Zusanli (ST36) For Shaoyang meridian lumbago and leg pain:

Shenshu (BL23) Dachangshu (BL25) Huantiao (GB30) Fengshi (GB31) Yanglingquan (GB34) For qi-guiding acupuncture, the following protocol was administered. Upon disinfection with 75% ethanol, a 0.30 mm x 40 mm filiform acupuncture needle was inserted into each selected acupoint. Huantiao and Juliao were needle to a depth of 2.5 inches. The remaining acupoints were needled to a depth of 1.2 inches. When a deqi sensation was achieved for all acupoints, qi-guiding needling with the Xie (reducing) manipulation technique was applied to Weizhong, Tiaokou, and Yanglingquan to transmit the needling sensation upward and toward the hip or waist. The same technique was applied to Huantiao, Juliao, and Biguan, instead transmitting the needle sensation downward and toward the legs. Subsequently, qi-guiding needling with the Bu (tonification) manipulation technique was applied on Dachangshu to transmit the needle sensation toward the lumbosacral area. The same technique was used on Shenshu until a deqi sensation of soreness or swelling was perceived at the lumbar region. A needle retention time of 20 minutes was observed during which the needles were rotated, lifted, and thrusted every 5 minutes to facilitate the flow of qi. One qi-guiding acupuncture session was conducted every other day for a total of 10 treatments.

Electroacupuncture for the control group was administered with the same aforementioned protocol. Before needle retention, the needles were connected to an electroacupuncture device. The device was then set to a continuous wave at 4 Hz with a 2mA current. A 20 minute needle retention time was subsequently observed. One electroacupuncture session was conducted every other day for a total of 10 treatments. The clinical results the Wu et al. study demonstrate that both qi-guiding acupuncture and electroacupuncture, when combined with meridian-differentiated acupoint selection, are suitable and effective therapies for lumbar disc herniation patients. However, qi-guiding acupuncture produces slightly better treatment outcomes in terms of nerve conduction velocity improvements.

In a related study, Wang H.D. (Xinping Hospital of Traditional Chinese Medicine) finds acupuncture combined with moxibustion therapy effective for the treatment of lumbodorsal myofascial pain syndrome. The study also finds that a silver needle protocol produces preferable treatment outcomes to conventional acupuncture. Lumbodorsal myofascial pain syndrome causes chronic lumbago and commonly occurs in young adults. Intensive acupuncture combined with moxibustion using silver needles was famously used by Professor Xuan Zhe Ren, a renowned Chinese orthopedist.

Acupoints were selected based on the degree of soft tissue damage, area of muscular tissue involved, and size of tendon contracture. In this approach, acupoints are 2 cm apart from each other and are mainly located on the lumbosacral region. Results from Wang’s study demonstrate that lumbodorsal myofascial pain syndrome patients receiving intensive acupuncture combined with moxibustion using silver needles achieved a 90% total treatment effective rate. Conventional acupuncture with moxibustion achieved an 83.3% total treatment effective rate.

Wang’s study involved a total of 60 patients with lumbodorsal myofascial pain syndrome. They were divided into a treatment group and a control group, with 30 patients in each group. The treatment group underwent intensive acupuncture-moxibustion therapy with silver needles. The control group received conventional acupuncture-moxibustion.

Intensive acupuncture-moxibustion with silver needles was applied to the T12 – L4 Jiaji acupoints and the acupoints located at the midpoint between each Jiaji acupoint. In addition, acupoints located 2 cm lateral to the Jiaji acupoints were needled. Finally, moxibustion applied with one Zhuang of 3 cm moxa cigar. One session was conducted daily for a total of 7 days. For conventional acupuncture-moxibustion therapy, the following primary acupoints were selected:

Shenshu (BL23) Mingmen (GV4) Weizhong (BL40) Ashi Additional acupoints were selected based on individual symptoms. For lumbago with chill-dampness:

Yaoyangguan (GV3) For lumbago due to exhaustion:

Yanglingquan (GB34) Sanyinjiao (SP6) For lumbago with kidney deficiency:

Zhishi (BL52) Taixi (KD3) A needle retention time of 30 minutes was observed. Subsequently, moxibustion was applied using either a 4 hole or 6 hole moxa box on the lumbar acupoints. One session was conducted daily for a total of 7 days. The treatment efficacy for each patient was evaluated and categorized into 1 of 3 tiers:

Recovery: Complete elimination of symptoms. Physical movement regained completely. No pain points. Significantly effective: Elimination of symptoms. Physical movement regained. Discomfort reoccurs only under exhaustion or change in weather. No pain or numbness. Effective: Symptoms relieved. Pain or numbness present. Not effective: No improvement in symptoms. The total treatment effective rate for each patient group was derived as the percentage of patients who achieved at least an effective tier of improvement. The intensive acupuncture-moxibustion with silver needles protocol outperformed conventional acupuncture. However, both approaches produced significant positive patient outcomes.

Both aforementioned studies indicate that acupuncture is effective for the alleviation of lower back pain. These studies highlight the differences in therapeutic effects between various forms of acupuncture. As a result, qi-guiding acupuncture and intensive acupuncture-moxibustion with silver needles are found clinically effective for the relief of lower back pain.

 

References: Wu YC, Sun YJ, Zhang JF, Li Y, Zhang YY & Wang CM. (2014). Clinical Study of Qi-guiding Acupuncture at Points Selected According to Meridian Differentiation for Treatment of Lumbar Intervertebral Disc Herniation. Shanghai Journal of Acupuncture and Moxibustion. 33(12).

Cheng XN. (1987). The study of Chinese acupuncture-moxibustion. Volume 1, Beijing: People’s medical publishing house. 192-284.

Hu YG. (1995). Prolapse of lumbar intervertebral disc. Volume 2, Beijing: People’s medical publishing house. 226-228.

Zhu WM, Wu YC, Zhang JF, et al. (2010). Tuina combined with acupoint injection in treating prolapse of lumbar intervertebral disc. Chinese Journal of Sports Medicine. 29(6): 708-709.

Wang HD. (2013). Clinical Observation on Intensive Acupuncture-moxibustion with Silver Needles for Lumbodorsal Myofascial Pain Syndrome. Shanghai J Acu-mox. 32(8).

 

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1690-acupuncture-reverses-lower-back-pain

 

Report Finds Acupuncture Reverses Lower Back Pain

How Acupuncture is Effective For Lumbar Disc Herniation

Acupuncture is Leading the Way in Pain Management

Researchers demonstrate excellent clinical results using acupuncture for the treatment of lumbar disc herniations.

Researchers find acupuncture safe and effective for the treatment of lumbar disc herniations across multiple independent clinical trials. A meta-analysis of investigations reveals that Jiaji acupoints yield significant positive patient outcomes when combined with manual and electroacupuncture techniques. Distal and abdominal acupuncture also demonstrated significant positive patient outcomes. This research review covers rare acupuncture points demonstrating clinical efficacy and details a powerful manual acupuncture technique proven effective for relief of lumbar disc herniation symptoms. We’ll start with primary research by Song et al. and then take a close look at a meta-analysis by Wang et al., including specific approaches to clinical care proven to deliver excellent results.

Researchers find both electroacupuncture and manual acupuncture effective for the treatment of lumbar disc herniations. Song et al. conducted a clinical trial at the Xixiang People’s Hospital in Guangdong, China. Electroacupuncture and manual acupuncture significantly reduced patients’ pain levels. Outstanding positive patient outcomes were recorded for the electroacupuncture treatment group. Patients with lumbar disc herniations receiving electroacupuncture had a 91.8% total treatment effective rate. Improvements included pain reductions, increases in range of motion, and improved straight leg lift testing. 

A sample size of 123 patients was randomly divided into two groups. In group one, 61 patients received electroacupuncture therapy. In group two, 62 patients received manual acupuncture. For the electroacupuncture patients, the Jiaji acupoints at the specific vertebra corresponding to the herniated lumbar disc, as well as on the two adjacent vertebrae, were selected as the primary acupoints and treated on both sides. Additional secondary acupoints were selected based on individual patient symptoms. For hip pain, the following acupoints were chosen:

Huantiao (GB30)
Chengfu (BL36)
For calf pain:

Weizhong (BL40)
Chengshan (BL57)
For lateral calf pain, the following acupoint were chosen:

Yanglingquan (GB34)
Zusanli (ST36)
Kunlun (BL60)
Xuanzhong (GB39)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was reported. Next, an electroacupuncture device was connected to the needles in the Jiaji acupoints. A continuous waveform was selected at an initial 0.8 Hz frequency. The intensity was then gradually increased until both sides of the lumbar muscle were twitching rhythmically at a tolerable rate for the patient. Subsequently, a 30 minute needle retention time was observed. One electroacupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. For the manual acupuncture patients, the following acupoints were selected according to the affected area:

Ganshu (BL18)
Shenshu (BL23)
Yaoyan (MBW24)
Huantiao (GB30)
Zhibian (BL54)
Chengfu (BL36)
Weizhong (BL40)
Weiyang (BL39)
Yanglingquan (GB34)
Feiyang (BL58)
Guangming (GB37)
Kunlun (BL60)
Tonggu (BL66)
Jinggu (BL64)
Houxi (SI3)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was felt. During the subsequent 30 minute needle retention time, the acupuncture needle was manipulated once every 10 minutes. One acupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. The total treatment efficacy was measured based on the TCM Treatment Efficacy Guidelines issued by the TCM Governing Board. Efficacy was categorized into 1 of 3 possible tiers:

Effective: Waist and leg pain ceased. Straightened leg lift of 70° and above. Normal waist and leg activity regained.
Improvement: Waist and leg pain relieved. Improvement in extent of waist movement.
Not effective: No improvement in symptoms.
The total treatment effective rate was measured as a percentage of patients who achieved at least the “improvement” tier. Electroacupuncture produced a 91.8% total treatment effective rate including pain reductions, increases in range of motion, and improved straight leg lift testing. Song et al. conclude that acupuncture is effective for the treatment of lumbar disc herniations.

The research team prefaced their study with background information. Lumbar disc herniation is a common disease among adults. Pain, numbness, or weakness arises due to damage or compression of the nerve root caused by herniation of the nucleus pulposus. This is the soft inner core of the vertebral disc that helps absorb compression and torsion. A herniation occurs when the soft material from the inner core escapes through the outer rings of the disc. This stubborn disease is usually characterized by an abrupt onset with a prolonged or repetitive course of symptomatic flare-ups. Main symptoms include leg and lumbar region pain, and also lower limb motor dysfunction. Lower limb paralysis is possible in severe cases.

Song et al. note that acupuncture is a relatively non-invasive treatment for disc herniations that dredges meridians, promotes qi circulation, eliminates blood stasis, and expels wind-dampness. Pain is thereby relieved when blood and qi circulation is restored. In modern terms, acupuncture stimulates parasympathetic tone and downregulates excess sympathetic nervous system activity. Resulting decreases in the inflammatory cascade of endogenous biochemicals results from the regulation of the autonomic nervous system.

Song et al. add that acupuncture regulates nerve activity, facilitates muscles relaxation, mitigates muscular spasms, dilates blood vessels, improves blood circulation, and also reduces both edema and inflammation. The Jiaji acupoints, located on the back beside the Du meridian, are used to treat diseases related to the corresponding affected nerve segments. Electroacupuncture utilizes electrical stimulation to facilitate the regeneration of damaged nerves by improving nerve cell metabolism and nerve cell enzyme activity. The basis of this is that electroacupuncture forms a localized, stable, and subtle electric current that boosts the electrophysiological properties of nerve cells (Sun, 1996).

In a related study, Wang et al. conducted a meta-analysis on the efficaciousness of acupuncture for the treatment of lumbar disc herniations. Without exception, the clinical investigations demonstrate that acupuncture is a safe and effective treatment modality for lumbar disc herniation patients. The following are examples of studies included in the meta-analysis.

Liu et al. investigated the efficacy of conventional acupuncture therapy. Conventional acupuncture treatment was administered by first identifying the vertebrae with lumbar disc herniations. Corresponding Du meridian acupoints and the two adjacent Jiaji acupoints were needled. The identified acupoints were treated with the Shao Shan Huo (Setting the Mountain on Fire) needling technique. Patients were treated for 10 consecutive days and achieved a 95% total treatment effective rate.

Shao Shan Huo is a powerful tonification needling technique in Traditional Chinese Medicine (TCM). Needles are inserted and stimulated to elicit the arrival of deqi for purposes of reinforcing qi. When applied properly, the patient feels a warm sensation at the needle region. In addition, the skin will be flush red as a result of enhanced micro-circulation of blood.

Initially, the needle is inserted slowly to superficial depth beneath the skin. During the procedure, lifting and thrusting is applied to three levels of depth beneath the skin, starting with the most superficial level at approximately a 0.5 cun depth. This is followed by lifting and thrusting at the middle level at approximately 1.0 cun and the deep level at approximately 1.5 cun. Depth varies according to patient size and acupoint location.

At each of the three depths of insertion, the needle motion combines quick and forceful thrusting with slow and gentle lifting for a total of nine times. Rotation may also be applied with the same techniques. After stimulation at all three levels is complete, the needle is lifted to the superficial level and the procedure is repeated, often three times, to ensure elicitation of a qi sensation producing heat and redness of the skin. The patient may also sweat in the region of the needle or throughout the body as a result of the heat sensation produced by this tonification method. Liu et al. achieved a 95% total treatment effective rate using the Setting the Mountain on Fire technique using the Du and Jiajia (Huatuojiaji) acupuncture points at correlated regions to lumbar disc herniations. Notably, acupuncture was applied for 10 consecutive days.

Deng and Cai’s investigation also examined application of the Jiaji acupoints for the treatment of lumbar disc herniations. In a different approach to needle stimulation, Deng and Cai applied electroacupuncture stimulation to the needles. They achieved significant levels of positive patient outcomes in their clinical trial. In their investigation, patients were treated every other day. Short-term results and a three month follow-up confirm significant clinical improvements.

He et al. had an entirely different approach to acupuncture therapy for the treatment of lumbar disc herniations. Their approach focused on abdominal acupuncture and anterior acupoints. The clinical investigation yielded significant positive patient outcomes. In their semi-protocolized investigation, a set of primary acupoints were applied plus secondary acupoints were added for specific diagnostic concerns. The primary acupoints for all patients were the following:

Shuifen (CV9)
Qihai (CV6)
Guanyuan (CV4)
Next, secondary acupoints were added based on diagnostic criteria. For acute lumbar disc herniations, the following acupoints were added:

Shuigou (GV26)
Yintang (MHN3)
For prolonged lumbar disc herniation, the following acupuncture point was added:

Qixue (KD13)
For generalized lumbago, the following acupoints were added:

Wailing (ST26)
Qixue (KD13)
Siman (KD14)
For sciatica occurring when sitting, the following acupuncture points were added:

Qipang
Wailing (ST26), affected side only
Xiafengshidian
Xiafengshixiadian
He et al. measured improvement rates after three weeks of acupuncture therapy. Patients achieved significant improvements. The researchers conclude that the protocol is effective for the treatment of lumbar disc herniation symptoms. He et al. used several acupoints termed ‘extra’ points including Xiafengshidian, Xiafengshixiadian, and Qipang. The acupoints demonstrate that the researchers focused on abdominal acupuncture as a means of treating lumbar concerns.

Xia Feng Shi Dian (Xia Feng Shi Dian, Lower Wind-Damp Point) is located 2.5 cun lateral to CV6 and is indicated for the treatment of knee disorders, including postoperative swelling and pain. Xiafengshixiadian (Xia Feng Shi Xia Dian, Below Wind-Damp Point) is located 3 cun lateral to CV5 and is used for leg, ankle, and foot disorders. Qipang (Qi Pang, Beside Qi) is located 0.5 cun lateral to CV6 and is indicated for lower back and leg pain, swelling, and weakness; including postoperative disorders.

The meta-analysis included the clinical research of Zhang et al. Manual acupuncture was applied to acupoints surrounding the afflicted area. All needles were directed towards the center of the afflicted region. Zhang et al. achieved a 97.5% total treatment effective rate.

Overall, the metal-analysis by Wang et al. documents that acupuncture is a safe and effective treatment modality for patients with lumbar disc herniations. Implementation of Jiaji acupoints was common across several studies. Other techniques including abdominal acupuncture and local Ashi acupoint acupuncture also demonstrated clinical effectiveness. Both electroacupuncture and specialized manual acupuncture demonstrated effectiveness as well. As a result of the findings, the researchers conclude that acupuncture is an important treatment option for patients with lumbar disc herniations.

 

References:
Song YJ, Yu MJ, Li L, Huang WX, Cai ZW, Su DP. (2013). Clinical Observation of Electro-acupuncture in Treatment of Lumbar Disc Herniation. Chinese Manipulation & Rehabilitation Medicne.

Sun ZR. Mechanism of acupuncture in the regeneration of surrounding damaged nerves. 1996(02).

Wang FM, Sun H, Zhang YM. (2014). Advance of Clinical Research in Intervention of Lumbar Disc Herniation(LDH) with Acupuncture Moxibustion. Journal of Clinical Acupuncture and Moxibustion.
30(3).

Deng W & Cai LH. (2011). Electroacupuncture on Jiaji acupoint in treating lumbar disc herniation. Journal of Clinical Acupuncture. (7).

He JX, Lin WR, Chen JQ, Huang Y, Wang SX, Lin HH & Chen HX. Abdominal acupuncture in treating lumbar disc herniation. Shanghai Journal of Acupuncture. 2012. (7).

Liu YZ, Sun XW & Zou W. (2012). Shao Shan Huo acupuncture technique on lumbar Jiaji acupoint in treating lumber disc herniation. Journal of Clinical Acupuncture. (6).

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1670-acupuncture-found-effective-for-lumbar-disc-herniations