Spinal stenosis is the term used to describe a narrowing spine. Treatments vary because everybody’s case is different. Some individuals experience mild symptoms, while others experience severe symptoms. Can knowing treatment options help the patient and healthcare team customize and personalize a treatment plan to the individual’s condition?
Spinal Stenosis Treatments
Spaces within the spine can become narrower than they’re supposed to be, which can cause pressure on nerve roots and the spinal cord. Anywhere along the spine can be affected. The narrowing can cause pain, burning, and/or aching in the back and weakness in the legs and feet. Spinal stenosis has several primary treatments. When working through spinal stenosis treatments, a healthcare provider will assess symptoms and start treatment with first-line therapy, such as pain medication and/or physical therapy. These are often the first among individuals with the disease.
Medication
Chronic pain is one of the main symptoms. The first-line treatment often involves using pain-relieving medication/s. Commonly prescribed medications are nonsteroidal anti-inflammatories or NSAIDs. These medications reduce pain and inflammation. However, NSAIDs are not recommended for long-term use, and other medications may need to be used to relieve pain that includes: (Sudhir Diwan et al., 2019)
Tylenol – acetaminophen
Gabapentin
Pregabalin
Opioids for severe cases
Exercise
Exercise can reduce spinal stenosis symptoms by taking pressure off the nerves, which can reduce pain and improve mobility. (Andrée-Anne Marchand et al., 2021) Healthcare providers will recommend the most effective exercises for the individual. Examples include:
Another primary spinal stenosis treatment is physical therapy, which is often used alongside pain medications. Typically, individuals undergo six to eight weeks of physical therapy, with sessions two to three times a week. Utilizing physical therapy has been shown to (Sudhir Diwan et al., 2019)
Reduce pain
Increase mobility
Reduce pain medications.
Reduce mental health symptoms like anger, depression, and mood changes.
For severe cases, physical therapy following surgery can reduce recovery times.
Back Braces
Back braces can help reduce movement and pressure on the spine. This is helpful because even small spinal movements can lead to nerve irritation, pain, and worsening symptoms. Over time, the bracing can lead to a positive increase in mobility. (Carlo Ammendolia et al., 2019)
Injections
Epidural steroid injections may be recommended to relieve severe symptoms. Steroids act as anti-inflammatories to reduce pain and swelling caused by inflammation and irritation of the spinal nerves. They are considered nonsurgical medical procedures. According to research, injections can effectively manage pain for two weeks and up to six months, and some research has found that after a spinal injection, relief can last 24 months. (Sudhir Diwan et al., 2019)
Thickened Ligaments Decompression Procedure
Some individuals may be recommended to undergo a decompression procedure. This procedure involves using a thin needle tool inserted into the back. The thickened ligament tissue is removed to reduce the pressure on the spine and nerves. Research has found that the procedure can reduce symptoms and the need for more invasive surgery. (Nagy Mekhail et al., 2021)
Alternative Treatments
In addition to first-line treatments, individuals may be referred to alternative therapies for symptom management, including:
Acupuncture
This involves the insertion of thin-tipped needles into various acupoints to relieve symptoms.
Some research has found that acupuncture may be more effective at reducing symptoms than physical therapy alone. Both options are viable and can improve mobility and pain. (Hiroyuki Oka et al., 2018)
Chiropractic
This therapy reduces pressure on nerves, maintains spinal alignment, and helps to improve mobility.
Massage
Massage helps to increase circulation, relax the muscles, and reduce pain and stiffness.
New Treatment Options
As spinal stenosis research continues, new therapies are emerging to help relieve and manage symptoms in individuals who don’t respond to traditional medicine or cannot partake in conventional therapies for various reasons. However, some evidence presented is promising; medical insurers may consider them experimental and not offer coverage until their safety has been proven. Some new treatments include:
Acupotomy
Acupotomy is a form of acupuncture that uses thin needles with a small, flat, scalpel-type tip to relieve tension in painful areas. Research on its effects is still limited, but preliminary data shows it could be an effective complementary treatment. (Ji Hoon Han et al., 2021)
Stem Cell Therapy
Stem cells are the cells from which all other cells originate. They act as the raw material for the body to create specialized cells with specific functions. (National Institutes of Health. 2016)
Individuals with spinal stenosis can develop soft tissue damage.
Stem cell therapy uses stem cells to help repair injured or diseased tissues.
Stem cell therapy can help repair or improve the damaged areas and provide symptom relief.
Clinical studies for spinal stenosis report that it could be a viable treatment option for some.
However, more research is needed to confirm whether the therapy is effective enough to be widely used. (Hideki Sudo et al., 2023)
Dynamic Stabilization Devices
LimiFlex is a medical device undergoing research and analysis for its ability to restore mobility and stability in the spine. It is implanted into the back through a surgical procedure. According to research, individuals with spinal stenosis who receive the LimiFlex often experience a higher reduction in pain and symptoms than with other forms of treatment. (T Jansen et al., 2015)
Lumbar Interspinous Distraction Decompression
Lumbar interspinous distraction decompression is another surgical procedure for spinal stenosis. The surgery is performed with an incision above the spine and places a device between two vertebrae to create space. This reduces movement and pressure on the nerves. Preliminary results show positive short-term relief from symptoms; long-term data is not yet available as it is a relatively new spinal stenosis treatment option. (UK National Health Service, 2022)
Surgical Procedures
There are several surgical procedures are available for spinal stenosis. Some include: (NYU Langone Health. 2024) Surgery for spinal stenosis is often reserved for individuals with severe symptoms, like numbness in the arms or legs. When these symptoms develop, it indicates a more notable compression of the spinal nerves and the need for a more invasive treatment. (NYU Langone Health. 2024)
Laminectomy
A laminectomy removes part or all of the lamina, the vertebral bone covering the spinal canal.
The procedure is designed to reduce pressure on nerves and the spinal cord.
Laminotomy and Foraminotomy
Both surgeries are used if an individual’s spinal stenosis negatively affects an opening in the vertebral foramen.
Ligaments, cartilage, or other tissues that constrict the nerves are removed.
Both reduce pressure on the nerves traveling through the foramen.
Laminoplasty
A laminoplasty relieves pressure on the spinal cord by removing parts of the spinal canal’s lamina.
This surgical procedure involves removing herniated or bulging discs that are placing pressure on the spinal cord and nerves.
Spinal fusion
Spinal fusion involves joining two vertebrae using metal pieces like rods and screws.
The vertebrae are more stable because the rods and screws act as a brace.
Which Treatment Is The Right One?
Because all treatment plans differ, determining the most effective is best suited for a healthcare provider. Each approach will be personalized to the individual. To decide what therapy is best, healthcare providers will assess: (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)
The severity of symptoms.
The current level of overall health.
The level of damage that’s occurring in the spine.
The level of disability and how mobility and quality of life are affected.
Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual’s primary healthcare provider and/or specialists to help determine the best treatment options and concerns regarding medications or other forms of treatment.
Unlocking Wellness
References
Diwan, S., Sayed, D., Deer, T. R., Salomons, A., & Liang, K. (2019). An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain medicine (Malden, Mass.), 20(Suppl 2), S23–S31. doi.org/10.1093/pm/pnz133
Marchand, A. A., Houle, M., O’Shaughnessy, J., Châtillon, C. É., Cantin, V., & Descarreaux, M. (2021). Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial. Scientific reports, 11(1), 11080. doi.org/10.1038/s41598-021-90537-4
Ammendolia, C., Rampersaud, Y. R., Southerst, D., Ahmed, A., Schneider, M., Hawker, G., Bombardier, C., & Côté, P. (2019). Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 19(3), 386–394. doi.org/10.1016/j.spinee.2018.07.012
Mekhail, N., Costandi, S., Nageeb, G., Ekladios, C., & Saied, O. (2021). The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain practice : the official journal of World Institute of Pain, 21(8), 826–835. doi.org/10.1111/papr.13020
Oka, H., Matsudaira, K., Takano, Y., Kasuya, D., Niiya, M., Tonosu, J., Fukushima, M., Oshima, Y., Fujii, T., Tanaka, S., & Inanami, H. (2018). A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC complementary and alternative medicine, 18(1), 19. doi.org/10.1186/s12906-018-2087-y
Han, J. H., Lee, H. J., Woo, S. H., Park, Y. K., Choi, G. Y., Heo, E. S., Kim, J. S., Lee, J. H., Park, C. A., Lee, W. D., Yang, C. S., Kim, A. R., & Han, C. H. (2021). Effectiveness and safety of acupotomy on lumbar spinal stenosis: A pragmatic randomized, controlled, pilot clinical trial: A study protocol. Medicine, 100(51), e28175. doi.org/10.1097/MD.0000000000028175
Sudo, H., Miyakoshi, T., Watanabe, Y., Ito, Y. M., Kahata, K., Tha, K. K., Yokota, N., Kato, H., Terada, T., Iwasaki, N., Arato, T., Sato, N., & Isoe, T. (2023). Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ open, 13(2), e065476. doi.org/10.1136/bmjopen-2022-065476
Jansen, T., Bornemann, R., Otten, L., Sander, K., Wirtz, D., & Pflugmacher, R. (2015). Vergleich dorsaler Dekompression nicht stabilisiert und dynamisch stabilisiert mit LimiFlex™ [A Comparison of Dorsal Decompression and Dorsal Decompression Combined with the Dynamic Stabilisation Device LimiFlex™]. Zeitschrift fur Orthopadie und Unfallchirurgie, 153(4), 415–422. doi.org/10.1055/s-0035-1545990
Those experiencing neck pain, stiffness, headache, shoulder and back pain may suffer from a whiplash injury. Can knowing whiplash signs and symptoms help individuals recognize the injury and help healthcare providers develop an effective treatment plan?
Whiplash Signs and Symptoms
Whiplash is a neck injury that typically occurs after a motor vehicle collision or accident but can happen with any injury that rapidly whips the neck forward and backward. It is a mild to moderate injury of the neck muscles. Common whiplash signs and symptoms include:
Some individuals can develop chronic pain and headaches.
The symptoms and treatment depend on the severity of the injury. Treatment can include over-the-counter pain medicines, ice and heat therapy, chiropractic, physical therapy, and stretching exercises.
Frequent Signs and Symptoms
The sudden whipping movement of the head can affect several structures within the neck. These structures include:
Muscles
Bones
Joints
Tendons
Ligaments
Intervertebral discs
Blood vessels
Nerves.
Any or all of these can be affected by a whiplash injury. (MedlinePlus, 2017)
Statistics
Whiplash is a neck sprain that occurs from a fast neck-jerking motion. Whiplash injuries account for more than half of vehicle traffic collision injuries. (Michele Sterling, 2014) Even with a minor injury, the most frequent symptoms include: (Nobuhiro Tanaka et al., 2018)
Neck pain
Next stiffness
Neck tenderness
Limited range of motion of the neck
Individuals can develop neck discomfort and pain shortly after an injury; however, the more intense pain and stiffness typically do not occur right after the injury. Symptoms tend to worsen the next day or 24 hours later. (Nobuhiro Tanaka et al., 2018)
Beginning Symptoms
Researchers have found that approximately more than half of individuals with whiplash develop symptoms within six hours of the injury. Around 90% develop symptoms within 24 hours, and 100% develop symptoms within 72 hours. (Nobuhiro Tanaka et al., 2018)
Whiplash vs. Traumatic Cervical Spine Injury
Whiplash describes a mild to moderate neck injury without significant skeletal or neurological symptoms. Significant neck injuries can lead to fractures and dislocations of the spine that can affect the nerves and spinal cord. Once an individual develops neurological problems associated with a neck injury, the diagnosis changes from whiplash to traumatic cervical spine injury. These differences can be confusing as they are on the same spectrum. To better understand the severity of a neck sprain, the Quebec classification system divides neck injury into the following grades (Nobuhiro Tanaka et al., 2018)
Grade 0
This means there are no neck symptoms or physical examination signs.
Grade 1
There is neck pain and stiffness.
Very few findings from the physical examination.
Grade 2
Indicates neck pain and stiffness
Neck tenderness
Decreased mobility or neck range of motion on physical examination.
Grade 3
Involves muscle pain and stiffness.
Neurologic symptoms include:
Numbness
Tingling
Weakness in the arms
Decreased reflexes
Grade 4
Involves a fracture or dislocation of the bones of the spinal column.
Other Symptoms
Other whiplash signs and symptoms that can be associated with the injury but are less common or only occur with a severe injury include (Nobuhiro Tanaka et al., 2018)
Tension headache
Jaw pain
Sleep problems
Migraine headache
Difficulty concentrating
Reading difficulties
Blurred vision
Dizziness
Driving difficulties
Rare Symptoms
Individuals with severe injuries can develop rare symptoms that often indicate traumatic cervical spine injury and include: (Nobuhiro Tanaka et al., 2018)
Amnesia
Tremor
Voice changes
Torticollis – painful muscle spasms that keep the head turned to one side.
Bleeding in the brain
Complications
Most individual generally recover from their symptoms within a few weeks to a few months. (Michele Sterling, 2014) However, whiplash complications can occur, especially with severe grade 3 or grade 4 injuries. The most common complications of a whiplash injury include chronic/long-term pain and headaches. (Michele Sterling, 2014) Traumatic cervical spine injury can affect the spinal cord and be associated with chronic neurological problems, including numbness, weakness, and difficulty walking. (Luc van Den Hauwe et al., 2020)
Treatment
The pain is typically more severe the next day than after the injury. Whiplash musculoskeletal injury treatment depends on whether it is an acute injury or the individual has developed chronic neck pain and stiffness.
Acute pain can be treated with over-the-counter medicines like Tylenol and Advil, which effectively treat the pain.
Advil is a nonsteroidal anti-inflammatory that can be taken with the pain reliever Tylenol, which works in different ways.
The mainstay of treatment is encouraging regular activity with stretching and exercise. (Michele Sterling, 2014)
Physical therapy uses various range of motion exercises to strengthen the neck muscles and relieve the pain.
Chiropractic adjustments and non-surgical decompression can help realign and nourish the spine.
Acupuncture can cause the body to release natural hormones that provide pain relief, help relax the soft tissues, increase circulation, and reduce inflammation. The cervical spine can return to alignment when the soft tissues are no longer inflamed and spasming. (Tae-Woong Moon et al., 2014)
Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of physiotherapy, 60(1), 5–12. doi.org/10.1016/j.jphys.2013.12.004
Tanaka, N., Atesok, K., Nakanishi, K., Kamei, N., Nakamae, T., Kotaka, S., & Adachi, N. (2018). Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics, 2018, 4765050. doi.org/10.1155/2018/4765050
van Den Hauwe L, Sundgren PC, Flanders AE. (2020). Spinal Trauma and Spinal Cord Injury (SCI). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19
Moon, T. W., Posadzki, P., Choi, T. Y., Park, T. Y., Kim, H. J., Lee, M. S., & Ernst, E. (2014). Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials. Evidence-based complementary and alternative medicine : eCAM, 2014, 870271. doi.org/10.1155/2014/870271
For individuals living with cyclical or chronic endometriosis symptoms, can incorporating support therapies help in disease management?
Support Therapies
Endometriosis is a disorder in which tissue similar to the uterine lining begins to grow outside the uterus where it does not belong. Endometriosis support therapies involve a comprehensive approach to treatment. It involves non-invasive treatments to help manage symptoms that can include:
A physical therapist uses various pressures, stretching, and/or trigger point release. This helps: (Sylvia Mechsner, 2022)
Release muscle tension
Lower cortisol – stress hormone
Improve circulation
Release endorphins – the body’s natural painkillers
Medications
Nonsteroidal anti-inflammatory drugs or NSAIDs and hormonal contraceptives – birth control are the first line of treatment. Advil and Motrin are over-the-counter NSAIDs. If those don’t manage pain effectively, a healthcare provider may recommend prescription NSAIDs. (Sylvia Mechsner, 2022) Hormonal suppression agents or estrogen modulators are a second line of treatment for endometriosis and can include: (Christian M. Becker et al., 2022)
Hormonal contraceptives suppress or regulate periods. They are effective for management, but not everyone can take them because of medical history, side effects, or fertility disorders and conditions. (Mert Ilhan et al., 2019) A healthcare provider can recommend alternative support therapies.
Transcutaneous Electrical Nerve Stimulation
A transcutaneous electrical nerve stimulation utilizes a battery-operated device that delivers low-voltage electrical stimulation to nerve fibers through electrodes placed on the skin.
Sessions are usually 15 to 30 minutes and work by disrupting pain signals. (Sylvia Mechsner, 2022)
Acupuncture
Acupuncture is a therapy in which a practitioner inserts thin needles into specific acupoints on the body to promote the flow of energy and alleviate pain. (Nora Giese et al., 2023)
Chiropractic
Chiropractic care focuses on spinal adjustments and alignment to enhance nervous system function, help alleviate pelvic discomfort and nerve pain – sciatica – and improve overall well-being. (Robert J. Trager et al., 2021)
Non-surgical decompression could be recommended to gently stretch the spine, relieve pressure, and flood the spine with added nutrients.
Movement Medicine: Chiropractic Care
References
Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., & Appiah, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children’s Hospital: A Case Series. Journal of pediatric and adolescent gynecology, 35(6), 722–727. doi.org/10.1016/j.jpag.2022.07.004
Mechsner S. (2022). Endometriosis, an Ongoing Pain-Step-by-Step Treatment. Journal of clinical medicine, 11(2), 467. doi.org/10.3390/jcm11020467
Ilhan, M., Gürağaç Dereli, F. T., & Akkol, E. K. (2019). Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis. Current drug delivery, 16(5), 386–399. doi.org/10.2174/1567201816666181227112421
Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., Saridogan, E., Tomassetti, C., van Hanegem, N., Vulliemoz, N., Vermeulen, N., & ESHRE Endometriosis Guideline Group (2022). ESHRE guideline: endometriosis. Human reproduction open, 2022(2), hoac009. doi.org/10.1093/hropen/hoac009
Pereira, A., Herrero-Trujillano, M., Vaquero, G., Fuentes, L., Gonzalez, S., Mendiola, A., & Perez-Medina, T. (2022). Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. Journal of personalized medicine, 12(1), 101. doi.org/10.3390/jpm12010101
Giese, N., Kwon, K. K., & Armour, M. (2023). Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative medicine research, 12(4), 101003. doi.org/10.1016/j.imr.2023.101003
Trager, R.J., Prosak, S.E., Leonard, K.A. et al. (2021). Diagnosis and management of sciatic endometriosis at the greater sciatic foramen: a case report. SN Comprehensive Clinical Medicine, 3. doi.org/doi:10.1007/s42399-021-00941-0
For individuals dealing with ulcerative colitis, can acupuncture treatment benefit those with UC and other GI-related issues?
Acupuncture For Ulcerative Colitis
Acupuncture has been used to treat symptoms related to pain and inflammation. Studies suggest it may help reduce inflammation and symptoms like diarrhea and abdominal pain, which could benefit individuals with inflammatory bowel disease. Individuals with ulcerative colitis, an inflammatory bowel disease/IBD affecting the large intestine, may find acupuncture beneficial in managing symptoms, including pain and gastrointestinal symptoms. (Crohn’s and Colitis Foundation, 2019)
The pathways connecting the acupoints generate energy, which contributes to overall health.
A disruption to the energy flow can cause injury, illness, or disease.
When acupuncture needles are inserted, energy flow and health are improved.
Benefits
Acupuncture can be used for the relief of various conditions. Studies have shown that acupuncture can reduce inflammation and disease activity in individuals with an IBD, like UC and Crohn’s disease. It can help with: (Gengqing Song et al., 2019)
Pain symptoms
Gut microbiome imbalances
Gut motor dysfunction
Intestinal barrier function
Anxiety
Depression
Studies suggest the use of acupuncture with heat, known as moxibustion, can improve several GI symptoms including (Crohn’s and Colitis Foundation, 2019)
Studies found the use of acupuncture along with moxibustion reduced inflammation in individuals with Crohn’s disease and ulcerative colitis. (Crohn’s and Colitis Foundation, 2019)
Stress and Mood
Chronic conditions like ulcerative colitis can cause feelings of depression and/or anxiety. Acupuncture may be used to address symptoms related to stress and mood and can benefit emotional health issues that include: (Johns Hopkins Medicine. 2024)
Insomnia
Anxiety
Nervousness
Depression
Neurosis – mental health condition characterized by chronic distress and anxiety.
Side Effects
Acupuncture is considered a safe practice. The most common side effects are: (GI Society. 2024)
Needle shock is rare but more common in individuals:
Who are regularly nervous.
Who are nervous around needles.
Who are new to acupuncture.
Who have a history of fainting.
Who are extremely fatigued.
Who have low blood sugar.
For some, GI symptoms may worsen before they improve. It is recommended to try at least five sessions as this is part of the healing process. (Cleveland Clinic. 2023) However, individuals should contact their doctor if symptoms become severe or last more than two days. (GI Society. 2024) Individuals considering acupuncture to help manage symptoms of ulcerative colitis should speak with their healthcare provider to help determine the appropriate treatment and where to start.
Wilkinson J, Faleiro R. (2007). Acupuncture in pain management. Continuing Education in Anaesthesia, Critical Care and Pain. 7(4), 135-138. doi.org/10.1093/bjaceaccp/mkm021
For fitness and sports enthusiasts, weekend warriors, and athletes looking to improve physical performance, can incorporating acupuncture for sports performance be effective?
Acupuncture For Sports Performance
Acupuncture for sports performance follows the same needle insertion for specific points to treat pain symptoms, alleviate inflammation and fatigue, and enhance blood circulation to improve physical and athletic performance. Acupuncture is based on traditional Chinese medicine principles that focus on restoring the balance of the nervous system and body to activate natural healing and increase energy circulation. (Johns Hopkins Medicine. 2024).
Acupuncture has become a popular alternative treatment for sports injuries as it has shown positive outcomes and recovery from injuries. (George G. A. Pujalte et al., 2023)
The body’s blood and energy pathways, known as meridians, become blocked by inflammation because of illness, injury, or overuse, resulting in pain, stress, and various symptoms. The acupuncture needles stimulate the pathways to clear the blockages, allowing optimal circulation of energy and blood to reduce inflammation and restore balance. (Jiajie Zhu et al., 2021)
Sports acupuncture works by maintaining optimal circulation of blood and energy through meridians through the arteries, tendons, muscles, and organs for enhanced productivity and ability. (Liang Kang et al., 2021)
Electroacupuncture involves connecting electrical stimulation from a tens machine to specific points over an area to enhance the needle treatment. (Keitaro Kubo et al., 2020)
Acupuncture Can Help
Ways that acupuncture can help include:
Increase Range of Motion
Acupuncture can help loosen tight muscles, tendons, and ligaments overused during training or games.(Chi-Tsai Tang, 2023)
This allows athletes to perform at peak levels without risking worsening or causing further injury.
Increase Flexibility
Acupuncture helps increase elasticity in joints by releasing adhesions within connective tissue for increased mobility.
Improve Reflexes
Targeting key points stimulates nerve activity, which can improve quicker reflexes and improve coordination.(Chi-Tsai Tang, Bo Song. 2022)
Increase Circulation
Acupuncture increases blood circulation to areas lacking oxygen.
Acupuncture releases endorphins, which reduce pain and also provide an overall sense of calmness and relaxation.
This enables athletes to stay focused and motivated throughout training and games. (Chi-Tsai Tang, 2023)
Reduce Fatigue
Regular acupuncture for sports performance can help maintain energy levels to help prevent burnout and maintain optimal performance during practice and games. (George G. A. Pujalte et al., 2023)
Relieve Muscle Tension
Acupuncture treatment can help relax tense muscles caused by repetitive use as well as from stress tension that could be caused by anxiety before a game or tournament.
For individuals who want to improve their physical performance, sports acupuncture can provide a natural, non-invasive alternative that can help improve athletic performance mentally and physically.
Lumbar Spine Injuries in Sports: Chiropractic Healing
Zhu, J., Li, J., Yang, L., & Liu, S. (2021). Acupuncture, from the ancient to the current. Anatomical record (Hoboken, N.J. : 2007), 304(11), 2365–2371. doi.org/10.1002/ar.24625
Kang, L., Liu, P., Peng, A., Sun, B., He, Y., Huang, Z., Wang, M., Hu, Y., & He, B. (2021). Application of traditional Chinese therapy in sports medicine. Sports medicine and health science, 3(1), 11–20. doi.org/10.1016/j.smhs.2021.02.006
Tang, C. T., & Song, B. (2022). Acupuncture and Dry Needling for Sports Performance and Recovery. Current sports medicine reports, 21(6), 213–218. doi.org/10.1249/JSR.0000000000000968
Kubo, K., Iizuka, Y., Yajima, H., Takayama, M., & Takakura, N. (2020). Changes in Blood Circulation of the Tendons and Heart Rate Variability During and After Acupuncture. Medical acupuncture, 32(2), 99–107. doi.org/10.1089/acu.2019.1397
Tang C. T. (2023). Practicing Outside the Lines: Using Acupuncture in the Athletic Training Room and on the Field. Medical acupuncture, 35(5), 266–269. doi.org/10.1089/acu.2023.0043
For individuals with arthritis, can incorporating acupuncture with other therapies help manage pain and other symptoms?
Acupuncture For Arthritis
Acupuncture has been around for thousands of years and is a form of traditional Chinese medicine that utilizes needles inserted into various parts of the body to relieve pain and inflammation. The practice is based on the concept of life energy that flows throughout the body along pathways called meridians. When the energy flow becomes disrupted, blocked, or injured, pain or illness can present. (Arthritis Foundation. N.D.) Further research is needed to determine how the acupuncture therapeutic mechanisms work and the overall effectiveness. However, there is emerging evidence suggesting that acupuncture can provide symptom relief for individuals with joint pain, especially those with osteoarthritis and rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Benefits
The actual method that reduces the pain and inflammation is still unclear. Theories include that the needles suppress inflammatory responses, improve blood flow, and relax muscles. Although acupuncture cannot cure or reverse arthritis, it may be useful for managing pain and decreasing associated symptoms, especially in combination with other therapies. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Rheumatoid Arthritis
A systematic review of 43 studies, including humans and animals with rheumatoid arthritis, demonstrated varied results. Several studies showed improvement in symptoms and decreased biological markers of rheumatoid arthritis following one to three sessions of acupuncture for four weeks or more. (Sharon L. Kolasinski et al., 2020) Beneficial outcomes following acupuncture treatment for rheumatoid arthritis include:
Reduced pain
Reduced joint stiffness
Improved physical function
The results of the human and animal studies suggested that acupuncture has the potential to down-regulate:
Levels of interleukins
Levels of tumor necrosis factor
Specific cell signaling proteins/cytokines involved in the inflammatory response, which become elevated in autoimmune conditions like rheumatoid arthritis. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Most of the study subjects were also receiving other forms of treatment, especially medication. Therefore, it is difficult to conclude how beneficial acupuncture is alone or as a supplemental addition to other medical treatments. (Pei-Chi Chou, Heng-Yi Chu. 2018)
Osteoarthritis
Acupuncture for osteoarthritis of the hand, hip, and knee is recommended, according to the American College of Rheumatology and Arthritis Foundation, meaning that it may be worth trying, although more research is needed to confirm its effectiveness. However, since the risk is relatively minor, acupuncture is generally considered a safe alternative treatment option for managing the symptoms. (Sharon L. Kolasinski et al., 2020)
Chronic Pain
As clinical trials suggest that acupuncture may be effective in providing pain relief, it may be a recommended option for individuals suffering from chronic pain. A recent systematic review of 20,827 patients and 39 trials concluded that acupuncture is effective for the treatment of chronic musculoskeletal pain, headache, and osteoarthritis pain. (Andrew J. Vickers et al., 2018)
Triggering the release of endorphins/hormones that help reduce pain.
Safety
Acupuncture is considered a safe procedure by a licensed and certified professional.
To practice acupuncture in the United States, an acupuncturist needs a minimum of a master’s degree from a program accredited by the American Academy of Acupuncture and Oriental Medicine and a license in the state where they received their acupuncture treatment.
Doctors with an MD or DO degree licensed in the United States to practice medicine can also be licensed by the American Academy of Medical Acupuncture after additional training.
Risks
Risks associated with acupuncture are bleeding and bruising, especially for individuals who have a bleeding disorder like hemophilia or take a blood thinning medication. Individuals are recommended to talk to their healthcare provider to determine if acupuncture is a safe option.
Side Effects
Most individuals do not experience any side effects, although possible reactions can include: (Shifen Xu et al., 2013)
Soreness
Bruising
Scarring
Needle shock: a vasovagal response that presents as feeling faint, clammy hands, chills, and slight nausea.
Acupuncture Session
During the initial treatment, individuals will discuss their medical history and what joints and areas of their bodies are presenting with symptoms.
After a physical exam, the individual will lie on a treatment table.
Individuals may be face up or down depending on what areas of the body the acupuncturist needs to access.
It is recommended to wear loose clothing that can be rolled up or moved out of the way to access different areas easily.
Depending on what areas need to be accessed, individuals may be asked to change into a medical gown.
The acupuncturist will use alcohol swabs to disinfect the area before inserting the needles.
The needles are made of stainless steel and are extremely thin.
Individuals may feel a slight pinch in sensitive areas like the hands and feet, but needle insertion should be comfortable and well-tolerated without significant discomfort.
For electroacupuncture, the acupuncturist will pass a mild electric current through the needles, typically 40 to 80 volts.
The needles stay in place for 20 to 30 minutes.
After the treatment is finished, the acupuncturist will remove the needles and dispose of them.
Frequency
The frequency of acupuncture sessions will vary depending on the severity of the symptoms and whether the visits are approved and reimbursed by the health insurance company.
Cost and Insurance
Costs for acupuncture can vary from $75 to $200 per session.
The first session, which involves an initial assessment and evaluation, usually costs more than follow-up visits.
Whether the health insurance will cover some or all of the costs of acupuncture sessions depends on the individual insurance company and the condition being treated.
Medicare currently covers acupuncture services up to 12 visits within a 90-day period for chronic low back pain only.
Medicare will not cover acupuncture for other conditions. (Medicare.gov. N.D.)
Acupuncture is not a cure for arthritis, but it may be a useful tool to help manage pain and other symptoms. Make sure to consult a healthcare provider if acupuncture is safe to try based on medical history.
Chou, P. C., & Chu, H. Y. (2018). Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review. Evidence-based complementary and alternative medicine : eCAM, 2018, 8596918. doi.org/10.1155/2018/8596918
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., Wise, B., … Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis care & research, 72(2), 149–162. doi.org/10.1002/acr.24131
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. doi.org/10.1016/j.jpain.2017.11.005
Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., & Lao, L. (2013). Adverse events of acupuncture: a systematic review of case reports. Evidence-based complementary and alternative medicine : eCAM, 2013, 581203. doi.org/10.1155/2013/581203
For individuals dealing with injuries and pain conditions, can incorporating acupuncture into a treatment plan help alleviate and manage pain?
Acupuncture Pain Management
Pain management techniques include physical therapy, medications, cold therapies, chiropractic, and massages. One method that is growing is acupuncture. (World Health Organization. 2021) According to a report by the World Health Organization, acupuncture is the most commonly used form of traditional medicine practiced globally. (World Health Organization. 2021) More than 10 million acupuncture treatments are administered annually in the U.S. (Jason Jishun Hao, Michele Mittelman. 2014)
What Is It?
Acupuncture is a medical practice that involves placing solid but super thin needles at specific points in the body to treat certain health issues. They can be used on their own or stimulated with electric currents, called electroacupuncture. Acupuncture originated in China about 3,000 years ago and is known as traditional Chinese medicine or TCM. In more recent years, the practice has gained acceptance and demand worldwide. (Jason Jishun Hao, Michele Mittelman. 2014)
How Does It Work?
Acupuncture pain management works by balancing the flow of qi/chi/energy, which moves through meridians, or channels in the body. By inserting needles into specific points along these channels, balance is reestablished for overall health and well-being. When the energy is imbalanced due to internal and external stressors that can include injuries, underlying conditions, unhealthy diet, and stress, individuals can present with symptoms and illness. Using diagnostic techniques and comprehensive interviews, practitioners can determine which organ systems and meridian channels need addressing to restore function. There are more than 2,000 acupoints in the body. (Johns Hopkins Medicine. 2024) Each point has its own purpose and function: some increase energy, others decrease it, helping balance the body to support healing and recovery. Acupuncture pain management goes beyond energy healing and can help alleviate pain by stimulating nerves, muscles, and fascia/connective tissue, regulating immune response, nervous system response, lymphatic flow, and increasing muscle relaxation.
Types
Different types of acupuncture have been modified in training and styles, but all involve needling into certain points and include:
Orthopedic/Dry Needling
This technique combines Traditional Chinese Medicine and structure manipulation to treat pain, tissue injuries, imbalances in the body, and other general systemic disorders.
Five Element Style
This is a spiritual and emotional technique that uses the five elements of nature, including wood, fire, earth, metal, and water, to transfer energy, creating balance in the body.
Japanese Style
uses similar techniques to TCM but uses a more subtle approach, such as using fewer needles or inserting them at lower depths in the body.
Korean
This technique uses both techniques from Chinese and Japanese acupuncture.
Practitioners may use more needles and different kinds of needles, like a copper variety, instead of the standard stainless steel type.
This type of acupuncture uses only acupoints on the hand to treat different areas of the body.
Auricular
This is similar to Korean acupuncture but relies on certain points in the ear to treat other areas of the body.
The goal is to overcome imbalances and disharmonies.
Distal
This technique treats pain indirectly.
Practitioners place needles in spots other than the area of discomfort.
For example, practitioners may place needles around the elbows for knee pain or the lower legs for shoulder pain.
Acupressure
This form of therapy stimulates different acupoints without using needles.
Practitioners use precise finger placements, hands, or other tools and essential oils to apply pressure over specific points to enhance energy flow.
Providers can combine and use various forms based on an individual’s needs.
Conditions
One analysis of more than 2,000 scientific reviews of acupuncture therapies found it to be effective for post-stroke aphasia, neck, shoulder, lower back pain, muscle pain, fibromyalgia pain, lactation issues after delivery, vascular dementia symptoms, and allergy symptoms. (Liming Lu et al., 2022) A study on mice by neuroscientists found that electroacupuncture can decrease inflammation. (Shenbin Liu et al., 2020) The National Center for Complementary and Integrative Health found that acupuncture can be helpful for: (National Center for Complementary and Integrative Health. 2022)
Nausea and vomiting in cancer patients undergoing treatment
Chronic prostatitis
Digestion
Irritable bowel syndrome
Seasonal allergies
Urinary incontinence
Infertility
Asthma
Quitting smoking
Depression
Safety
When the treatment is performed by a highly trained, licensed, and certified acupuncturist, it is very safe. The most common serious adverse events were pneumothorax/collapsed lung, cardiovascular problems, and fainting, which in some cases caused trauma, like fractures. (Petra Bäumler et al., 2021) There are some short-term risks associated with acupuncture, including:
Pain
Bleeding
Bruising
Drowsiness
Dizziness for individuals that have not eaten or fear of needles.
Serious side effects associated with acupuncture, like a punctured lung or infection, are very rare. For individuals that have a metal allergy, infection, or open wound in the area where the needles will be inserted, it is recommended to avoid acupuncture. Individuals who have a bleeding disorder, are taking any medicines like an anticoagulant, or are pregnant, should talk to the acupuncturist before beginning a treatment plan.
What to Expect
Everyone’s visit will be tailored to their specific needs, and the first visit will likely last an hour or two. The initial evaluation will include a full medical/health history. The individual will spend a few minutes discussing concerns and health goals with the acupuncturist. Individuals will be asked to lie on the treatment table so the practitioner can access their limbs, back, and abdomen. After inserting needles, they will stay in place for about 20 to 30 minutes. At this time, individuals can relax, meditate, sleep, listen to music, etc. The practitioner may monitor if and how the pulse has changed and add or remove needles. After the needles are removed, the practitioner will determine the course of treatment. Depending on how chronic or severe the condition is, they may recommend several acupuncture pain management treatments over the course of several weeks.
Chiropractic Care For Healing After Trauma
References
World Health Organization. (2021). WHO benchmarks for the practice of acupuncture.
Hao, J. J., & Mittelman, M. (2014). Acupuncture: past, present, and future. Global advances in health and medicine, 3(4), 6–8. doi.org/10.7453/gahmj.2014.042
Johns Hopkins Medicine. (2024). Acupuncture.
Lu, L., Zhang, Y., Tang, X., Ge, S., Wen, H., Zeng, J., Wang, L., Zeng, Z., Rada, G., Ávila, C., Vergara, C., Tang, Y., Zhang, P., Chen, R., Dong, Y., Wei, X., Luo, W., Wang, L., Guyatt, G., Tang, C., … Xu, N. (2022). Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ (Clinical research ed.), 376, e067475. doi.org/10.1136/bmj-2021-067475
Liu, S., Wang, Z. F., Su, Y. S., Ray, R. S., Jing, X. H., Wang, Y. Q., & Ma, Q. (2020). Somatotopic Organization and Intensity Dependence in Driving Distinct NPY-Expressing Sympathetic Pathways by Electroacupuncture. Neuron, 108(3), 436–450.e7. doi.org/10.1016/j.neuron.2020.07.015
National Center for Complementary and Integrative Health. (2022). Acupuncture: what you need to know.
Bäumler, P., Zhang, W., Stübinger, T., & Irnich, D. (2021). Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ open, 11(9), e045961. doi.org/10.1136/bmjopen-2020-045961
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