Can individuals managing facet arthropathy treat the condition with over-the-counter pain relievers, prescription muscle relaxers, exercise, and chiropractic spinal manipulation?
Facet Arthropathy
Facet arthropathy, or facet osteoarthritis, is arthritis that affects the facet joints in the spine. It causes pain and stiffness due to cartilage degeneration within these joints, often resulting from wear and tear associated with aging. Essentially, it occurs when the small joints in the back of the spine become arthritic and rub against each other painfully.
It affects the bony protrusions, called facet joints, that connect the spine’s bones.
Symptoms include neck and back pain that can worsen with standing, bending, or twisting.
Facet arthropathy is diagnosed using X-rays and other imaging studies.
Severe cases may require surgery.
Facet Joints
Twenty-four vertebrae form the spine, with two facet joints between each. Facet joints are small joints located at the back of each vertebra in the spine. They allow movement and stability, help maintain the alignment of the spinal bones/vertebrae, and limit excessive motion. The joints and the cushioning intervertebral disc form a three-joint complex between each vertebra.
The three-joint complex allows the spine to move, including bending, rotating, and extending.
Synovial fluid lubricates the joints so they can move.
The intervertebral disc provides flexibility and dissipates compressive loads.
The facet joints stabilize the spine by constraining rotation and bending.
Symptoms
Arthropathy refers to any disease affecting a joint, including arthritis. Osteoarthritis, also known as arthrosis, is a specific type of arthropathy. It is a non-inflammatory, degenerative arthritis. Pain is the main symptom that is typically worse in the morning when awakening, and in the evening, the pain can also get worse when twisting or bending backward. The symptoms can vary based on the part of the affected spine. Low back pain is the most common, a condition referred to as lumbar facet arthropathy because it affects the lumbar spine of the lower back. (Perolat R. et al., 2018) Common Symptoms include:
Muscle spasms or cramps.
Pain that may come in periodic flare-ups
Pain that worsens with standing or inactivity.
Dull pain on both sides of the spine.
Aching pain on both sides of the spine.
Pain in the lower back, buttocks, shoulders, or back of the skull
Radiating pain to the buttocks and legs.
Pain that improves with sitting, leaning forward, or changing positions.
Pins-and-needles sensations in the hands or feet.
Clicking sounds when moving the spine.
Catching sensations when moving the spine.
Muscle weakness.
Causes
Facet arthropathy causes progressive damage to the spine. Spinal osteoarthritis, aka spondylosis, is the most common cause, but it can also occur with a severe form of spinal arthritis known as ankylosing spondylitis. It is primarily due to age-related wear and tear, but injuries or repetitive stress on the spine can also cause it. Arthritis in the facet joints can develop due to:
Aging-related wear and tear
Disc problems
A previous back injury
Torn ligaments
Spinal fractures
Deterioration of facet joints can also cause bony overgrowths called osteophytes or bone spurs, which can cause radiating pain and restrict the spine’s range of motion.
Degeneration
The facet joints and intervertebral discs degenerate due to age-related wear and tear.
The cartilage in the facet joints can dry out, crack, and wear down.
The joint capsule and synovial membrane can inflame or tear, affecting synovial fluid production.
The loss of cartilage can lead to hypermobility, and the joint can stiffen over time.
Diagnosis
Imaging studies are important to the diagnosis. Several types confirm the diagnosis and also characterize the nature and severity of the condition:
X-rays provide a plain, black-and-white image of the spinal column.
CT scan composites multiple X-rays to create a three-dimensional image of the spinal column.
MRI uses magnetic and radio waves to generate images of soft tissues like ligaments and cartilage.
To confirm the diagnosis, a diagnostic block, which is a small amount of local anesthetic, is injected into a facet joint. The needle placement is directed either with an ultrasound or a CT scan. Facet arthroplasty is confirmed if the injection provides immediate relief (American Academy of Orthopaedic Surgeons, 2022). The healthcare provider will want to exclude other possible causes as part of the differential diagnosis. Conditions that mimic facet arthropathy include:
Herniated disc
Psoriatic arthritis
Reactive arthritis
Spinal gout
Spinal compression fracture
Treatment
The treatment varies depending on the location and severity of the condition. Generally, conservative treatments are used before more invasive procedures are considered.
Lifestyle Changes
Initially, a healthcare provider may recommend rest and avoiding aggravating movements, including any activity that involves bending or twisting.
Activities that take the weight off the facet joint, such as sitting, leaning forward, or changing positions, may help ease the pain.
Patients may also be advised to adjust their sleep positions to take the pressure off facet joints.
Options included curling up on your side or lying on your back with the knees supported with pillows.
Medications
If a diagnostic block is used, a patient may not need medications immediately. However, as the anesthetic starts to wear off, the patient may be prescribed over-the-counter or prescription pain relievers based on the severity of the pain. These can include:
Analgesics like Tylenol
Nonsteroidal anti-inflammatory drugs like Advil or Aleve
Muscle relaxants like Lloresal for acute back pain
Antidepressants like Cymbalta for chronic back pain
Physical Therapy
Physical therapy is a major part of the treatment of lower back pain. The treatment plan will include personalized exercises to strengthen the core muscles and avoid stress on the spine. Examples include:
Knee-to-chest stretches, hugging your knees for 30 to 60 seconds.
Walking 10 to 20 minutes per day.
Aquatic therapy to alleviate pressure on the spine.
Surgery
If conservative measures don’t work or provide sufficient relief, a healthcare provider may recommend specialist procedures or surgeries that include:
Lumbar intra-articular injections deliver an anesthetic or corticosteroid into the spine for longer-lasting pain relief.
Sinuvertebral nerve ablation destroys spinal nerves with a strong electrical current.
Extracorporeal shockwave therapy ESWT delivers low- or high-energy electrical pulses to help ease pain.
Spinal fusion surgery involves fusing two or more vertebrae to eliminate movement and pain in the facet joints.
Facet rhizotomy is a surgical procedure used to sever one of the nerves supplying the facet joint.
Stem cell regeneration is an experimental procedure in which stem cells are harvested and injected into damaged joints to restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Facet Syndrome Pain Treatment
References
Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. https://doi.org/10.1007/s13244-018-0638-x
American Academy of Orthopaedic Surgeons. (2022). Spinal injections. https://orthoinfo.aaos.org/en/treatment/spinal-injections/
For individuals who injure their neck or back, the muscles may spasm or seize up, making it difficult to get through the day, exercises, physical activities, etc. Can skeletal muscle relaxers help relieve pain and reduce frequency?
Back Spasms Muscle Relaxers
Back muscle spasms are common back pain that feels like a sudden tightness or contraction in the back muscles. They can range from minor twinges to severe pain.
Causes
Poor posture: Sitting or standing with bad posture can strain the back muscles.
Overuse: Picking something up, bending, or lifting can cause a spasm.
Dehydration: Not drinking enough water can cause electrolyte imbalances, leading to spasms.
Underlying conditions: A herniated disc or degenerative disc disease can cause back spasms.
Muscle imbalances: Weak muscles or muscles that are too tight can cause spasms.
Treatments
Home treatments: You can apply heat or ice, take over-the-counter pain medication, try gentle stretching, or massage the area.
Exercise: Improve your back’s strength and flexibility with exercise or physical therapy.
Hydration and nutrition: Drink enough water and eat foods rich in magnesium and calcium.
Chiropractic Adjustments: These can realign the spine to the correct position and muscles to relax.
Non-surgical Decompression: Decompression of the spine will allow more blood and nutrients to heal painful areas.
Skeletal Muscle Relaxers
A healthcare provider may prescribe skeletal muscle relaxers. These medications are not available over the counter and must be prescribed by a healthcare provider.
Skeletal muscle relaxers will probably cause drowsiness.
Individuals should not drive, operate heavy machinery, or engage in other physical activities while taking back spasm muscle relaxers.
Skeletal muscle relaxers are not recommended for 65 or older because safer, effective alternatives exist.
Also, women who are pregnant or breastfeeding should not take these medications.
Discuss these issues with your healthcare provider.
Carisoprodol
Carisoprodol is available generically and as Soma and Vanadom brands. It works by suppressing nerve impulses located in the brain and spinal cord. Healthcare providers prescribe this medication in combination with physical therapy for the healing release of any muscle spasm and management of musculoskeletal injuries and/or pain. (Witenko C. et al., 2014) It’s not about having to continue taking the medication to feel better but more as a jump start to help with the physical therapy program.
Back muscle spasms are a perfect example of a condition that may benefit from carisoprodol in the short term.
Carisoprodol can be habit-forming.
Be sure to talk to a healthcare provider before suddenly going off this medication.
Carisoprodol can cause side effects that may impair thinking or reactions.
Inform your healthcare provider of any drug allergies, kidney disease, or liver disease, or if you get seizures.
Cyclobenzaprine
Cyclobenzaprine is available as Amrix and in generic form. Like other muscle relaxers, cyclobenzaprine may cause dizziness or drowsiness. The sedation effects are how it works on painful, tension-filled muscles. Cyclobenzaprine is used together with physical therapy to treat skeletal muscle-related conditions and/or injuries, especially when pain or spasm is involved. When used in conjunction with physical therapy, it can help expedite recovery.
Cyclobenzaprine is chemically related to tricyclic antidepressants.
Although it is considered a derivative of the tricyclic antidepressant class, it does not pose the same risk to liver health.
According to the National Institutes of Health, reasons not to take this medication include having a thyroid disorder, heart block, congestive heart failure, a heart rhythm disorder, or having recently had a heart attack. (Witenko C. et al., 2014)
Metaxalone
Skelaxin is the brand name for metaxalone. As with the other muscle relaxers, metaxalone is used in combination with physical therapy and rest when muscles get too tight. (Witenko C. et al., 2014) It works by suppressing nerve impulses in the brain and spinal cord. In addition to older individuals and pregnant women, metaxalone is usually not prescribed for those with kidney disease, liver disease, seizures, or blood disorders.
Injury Medical Chiropractic and Functional Medicine Clinic
Back spasms: Muscle relaxers could help individuals, along with a personalized physical therapy treatment program. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Thoracic Spine Pain
References
Witenko, C., Moorman-Li, R., Motycka, C., Duane, K., Hincapie-Castillo, J., Leonard, P., & Valaer, C. (2014). Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P & T: a peer-reviewed journal for formulary management, 39(6), 427–435.
Zacny, J. P., Paice, J. A., & Coalson, D. W. (2012). Subjective and psychomotor effects of carisoprodol in combination with oxycodone in healthy volunteers. Drug and alcohol dependence, 120(1-3), 229–232. https://doi.org/10.1016/j.drugalcdep.2011.07.006
Can acupuncture be an effective treatment for anxiety and panic disorders in addition to other treatments, like therapy and/or medication?
Acupuncture For Anxiety and Panic Disorders
Considered one of the most popular types of alternative medicine, acupuncture has grown in popularity as a way to treat a variety of mental health conditions, including depression, post-traumatic stress disorder (PTSD), and other anxiety disorders. With the growth in popularity, more research has been focused on treatment for panic and anxiety symptoms. (Pilkington K. 2010)
Acupuncture can enhance personal wellness.
Acupuncture is generally safe and has few side effects.
It can help reduce physical and mental symptoms like tension, pain, and rapid heart rate.
Other alternative medicine practices include yoga, therapeutic massage, herbal medicines, and aromatherapy.
Traditional Chinese Medicine
Acupuncture is a healing technique originating from traditional Chinese medicine (TCM). The practice is based on the concept that medical conditions and mental health disorders are caused by an imbalance in the energy and circulation of the body’s vital life energy, known as chi or qi (National Institute for Complementary and Integrative Health, 2022). When the body and mind function properly, energy flows optimally through the channels/meridians at certain points throughout the body. Like tight or spasming muscles, energy or circulation becomes congested in different meridian pathways, leading to disease or disorders. The goal of acupuncture is to restore the health and balance of these channels.
How It Works
During acupuncture treatment sessions, small needles are placed along specific body areas, known as acupuncture points. These areas are thought to be where energy blockage occurs. The needles, which come in various thicknesses and lengths, stimulate and open blocked energy channels. Experts have conceptualized acupuncture from a neuroscience perspective, where nerves, muscles, and connective tissues are stimulated, and neurochemicals are released.
Acupuncture can help regulate the nervous system.
It can stimulate the body’s feel-good hormones and reduce stress hormones.
It can help deactivate the analytical brain, which is responsible for anxiety and worries.
Clinical trials examining acupuncture for anxiety and panic disorders have shown some positive results. (Pilkington K. 2010) Acupuncturists and medical professionals are still not clear exactly why it may help with anxiety, but some research has noted that acupuncture appears to have a calming effect. More research studies are needed to prove the effectiveness of acupuncture for anxiety disorders. (Kim Y. K. 2019)
Getting Treated
What it can help with:
Agoraphobia
Generalized anxiety disorder (GAD)
Panic disorder
Phobias
Selective mutism
Separation anxiety disorder
Social anxiety disorder
If you are interested in treating your anxiety and panic symptoms through acupuncture, the first step is to consult your main healthcare provider. Professional acupuncture practitioners are on websites, including the National Certification Commission for Acupuncture and Oriental Medicine and the American Academy of Medical Acupuncture. The use of acupuncture continues to rise, making it more readily available. Since it has been evaluated for effectiveness and is available through many hospitals, some insurance policies may cover some acupuncture treatments.
Injury Medical Chiropractic and Functional Medicine Clinic
Acupuncture can help relieve symptoms of anxiety, stress, pain, discomfort, tightness, and poor circulation. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and build optimal health and wellness solutions with primary healthcare providers and specialists. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Discovering The Benefits of Chiropractic Care
References
Pilkington K. (2010). Anxiety, depression, and acupuncture: A review of the clinical research. Autonomic neuroscience : basic & clinical, 157(1-2), 91–95. https://doi.org/10.1016/j.autneu.2010.04.002
National Institute for Complementary and Integrative Health. (2022). Acupuncture: Effectiveness and Safety. Retrieved from https://www.nccih.nih.gov/health/acupuncture-effectiveness-and-safety
Kim Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08
Can understanding how nociceptors function and their role in processing pain signals help individuals who are managing injuries and/or living with chronic pain conditions?
Nociceptors
Nociceptors are nerve endings that detect harmful stimuli, such as extreme temperatures, pressure, and chemicals, and signal pain. They are the body’s first defense against potentially damaging environmental inputs.
Nociceptors are in the skin, muscles, joints, bones, internal organs, deep tissues, and cornea.
They detect harmful stimuli and convert them into electrical signals.
These signals are sent to the brain’s higher centers.
The brain interprets the signals as pain, which prompts the body to avoid the harmful stimulus.
Nociceptors, often called pain receptors, are free nerve endings all over the body. They play a pivotal role in how the body feels and reacts to pain. The main purpose of a nociceptor is to respond to damage to the body by transmitting signals to the spinal cord and brain. (Purves D, Augustine GJ, Fitzpatrick D, et al., editors. 2001) If you bang your foot, the nociceptors on the skin are activated, sending a signal to the brain via the peripheral nerves to the spinal cord. Pain resulting from any cause is transmitted this way. Pain signals are complex, carrying information about the stimuli’s location and intensity. This causes the brain to fully process the pain and send communication back to block further pain signals.
Thermal nociceptors respond to extreme hot or cold temperatures.
For instance, when touching a hot stove, the nociceptors, which signal pain, are activated immediately, sometimes before you know what you’ve done.
Mechanical
Mechanical nociceptors respond to intense stretching or strain, such as pulling a hamstring or straining a tendon.
The muscles or tendons are stretched beyond their ability, stimulating nociceptors and sending pain signals to the brain.
Chemical
Chemical nociceptors respond to chemicals released from tissue damage.
For example, prostaglandins and substance P or external chemicals like topical capsaicin pain creams.
Silent
Silent nociceptors must be first activated by tissue inflammation before responding to a mechanical, thermal, or chemical stimulus.
Most visceral nociceptors are located on organs in the body.
Polymodal
Polymodal nociceptors respond to mechanical, thermal, and chemical stimuli.
Mechano-thermal
Mechano-thermal nociceptors respond to mechanical and thermal stimuli.
Pain Transmission
Nociceptors are also classified by how fast they transmit pain signals. Transmission speed is determined by the type of nerve fiber known as an axon a nociceptor has. There are two main types.
The first type is A fiber axon, fibers surrounded by a fatty, protective sheath called myelin.
Myelin allows nerve signals/action potentials to travel rapidly.
Because of the difference in transmission speed, the pain signals from the A fibers reach the spinal cord first. As a result, after an acute injury, an individual experiences pain in two phases, one from the A fibers and one from the C fibers. (Ngassapa D. N. 1996)
Pain Perception Phases
When an injury occurs, the stimulated nociceptors activate the A fibers, causing a person to experience sharp, prickling pain.
This is the first phase of pain, known as fast pain, because it is not especially intense but comes right after the stimulus.
During the second phase of pain, the C fibers are activated, causing an intense, burning pain that persists even after the stimulus has stopped.
The fact that the C fibers carry burning pain explains why there is a short delay before feeling the sensation.
The C fibers also carry aching, sore pain caused by organs within the body, such as a sore muscle or stomachache. (Ngassapa D. N. 1996)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
From Injury To Recovery With Chiropractic Care
References
Purves D, A. G., Fitzpatrick D, et al., editors. (2001). Nociceptors. In Neuroscience. 2nd edition. (2nd ed.). Sunderland (MA): Sinauer Associates. https://www.ncbi.nlm.nih.gov/books/NBK10965/
University of Texas McGovern Medical School. (2020). Chapter 6: Pain Principles. https://nba.uth.tmc.edu/neuroscience/m/s2/chapter06.html
Ngassapa D. N. (1996). Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain. East African medical journal, 73(3), 207–209.
Can knowing about wrist sprains—their types, symptoms, causes, and diagnoses—help develop an effective treatment program?
Wrist Sprain
Wrist sprains are injuries that affect ligaments that attach bone to bone. They occur after a fall from work overuse, house tasks, during sports activities, or with other direct trauma. Symptoms of a wrist sprain include:
Pain
Swelling
Bruising
Decreased range of motion
Weakness
Tingling
The injury affects the ligaments and soft tissue structures connecting bone to bone. Mild wrist sprains typically heal within a few weeks; most heal without complications in six to 12 weeks. (National Health Service, 2020) However, severe injuries can require surgery, physical therapy, and months to recover fully.
This joint is between the radius and three small bones in the base of the hand.
The scaphoid
The triquetrum
The lunate
Ulnocarpal
This joint is between the ulna and the articular disc and cushions it from the carpal bones, the lunate, and the triquetrum.
Wrist sprains can affect any of these joints but more commonly affect the ligament between the scaphoid and lunate bone or the triangular fibrocartilage complex/TFCC on the pinky side of the wrist.
Sports include skateboarding, gymnastics, basketball, snowboarding, hockey, and contact sports.
Diagnosis
A healthcare provider will diagnose a wrist sprain based on symptoms and injury causes. X-rays are the first imaging to rule out fractures. Other tests can include:
Magnetic resonance imaging – MRI
Computed tomography – CT scan
Arthrogram -X-rays with contrast dye
Treatment
Nonsteroidal anti-inflammatory drugs, such as Aleve, Advil, Motrin, and aspirin, can treat pain and inflammation. The severity of the wrist sprain determines whether additional treatment is needed. Sprains should initially be treated with the RICE protocol (American Academy of Orthopaedic Surgeons, 2024)
Rest
Minimize using the injured wrist for at least two days.
Wear a splint for support.
Avoid sudden movements.
Avoid placing too much pressure on the wrist.
Ice
Cold packs are recommended several times daily for 20 minutes to decrease pain and swelling.
Compression
Wrap the wrist with an elastic bandage or Kinesio tape to help reduce swelling.
Elevation
To decrease swelling, use pillows to elevate the wrist as much as possible above the level of your heart.
Grade 1 sprains usually heal with basic care within a week or two.
Individuals may need the brace for a week or more.
A healthcare provider may also recommend stretching exercises to overcome stiffness and regain mobility. (American Academy of Orthopaedic Surgeons, 2024) Physical therapy, occupational therapy, or treatment by a certified hand therapist can also reduce pain and improve range of motion and strength.
Treatment for grade 3 sprains often requires surgery. Grade 3 sprains, including avulsion fractures, often require a six-week cast for bones to heal. In some cases, the bones might also need a screw or temporary wires to hold them in the proper position. (Vannabouathong, C. et al., 2018) Severe wrist sprains may also require surgery to repair the injured ligament. If the original ligament cannot be repaired, a piece of the tendon can be used to reconstruct it. (American Society for Surgery of the Hand, 2020)
Healing Time
Mild to moderate sprains usually recover within a few weeks without long-term complications. (American Society for Surgery of the Hand, 2018) The prognosis for severe wrist sprains improves with early diagnosis and treatment. After surgery, ligaments usually heal within eight to 12 weeks but can take six to 12 months for function to return to normal. (American Academy of Orthopaedic Surgeons, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
The Path to Healing Personal Injury
References
National Health Service. (2020). Advice after spraining your wrist. https://www.ruh.nhs.uk/patients/patient_information/ORT_057_Advice_after_a_wrist_sprain.pdf
American Academy of Orthopaedic Surgeons. (2024). Wrist sprains. https://orthoinfo.aaos.org/en/diseases–conditions/wrist-sprains
Mass General Brigham. (2025). Wrist sprains. https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/sports-medicine/conditions/hand-arm/wrist-sprain
American Society for Surgery of the Hand. (2017). Anatomy 101: Wrist joints. https://www.assh.org/handcare/blog/anatomy-101-wrist-joints
National Library of Medicine. (2021). Wrist injuries and disorders. Retrieved from https://medlineplus.gov/wristinjuriesanddisorders.html
American Society for Surgery of the Hand. (2018). Sprained wrist. https://www.assh.org/handcare/condition/sprained-wrist
Vannabouathong, C., Ayeni, O. R., & Bhandari, M. (2018). A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. Clinical medicine insights. Arthritis and musculoskeletal disorders, 11, 1179544118809050. https://doi.org/10.1177/1179544118809050
American Society for Surgery of the Hand. (2020). Scapholunate torn ligament. https://www.assh.org/handcare/condition/scapholunate-torn-ligament
For individuals wanting to try acupuncture for various health conditions but aren’t sure?
Is Acupuncture Painful?
Acupuncture is a procedure where extremely fine needles are inserted into pressure points in the body. A traditional Chinese medicine technique used to alleviate pain and enhance physical and emotional well-being. (Harvard Health, 2023) It can be beneficial for anyone dealing with persistent painful conditions, such as back pain, sciatica, arthritis-related discomfort, headaches, and post-surgery pain. It’s also a supportive option for individuals experiencing hot flashes and generalized inflammation, making it a versatile choice for holistic health. People undergoing acupuncture experience minimal pain, usually mild pressure or soreness during or after. However, choosing an experienced practitioner and communicating with them during the treatment is the best way to avoid increased pain.
When Performed Correctly, It Should Not Hurt
Many fear that acupuncture will be painful. However, this is not the case because the procedure uses extremely fine needles. One study of pediatric patients found that 87% reported minimal to no pain while having the treatment (Gold J. I. et al., 2023). Improper needle placement is one of the most common reasons that patients experience pain during or after treatment (Johns Hopkins Medicine, 2025). This is why it is important to be treated by a licensed practitioner who is well-versed in treating specific conditions.
Soreness After Treatment
It is relatively uncommon to experience pain after receiving acupuncture. About 10% of individuals experience minor soreness after the treatment (Kelly R. B. & Willis J. 2019). The soreness is typically felt in the areas where the needles were inserted.
Situations When Pain Can Present
A small group of those who undergo acupuncture may experience some pain. It is most frequently seen in the following: (Harvard Health, 2023)
The acupuncturist is inexperienced and inserts the needle incorrectly or not in the right area.
The needles are inserted more deeply than normal or with too much pressure.
The patient has a lower pain threshold and/or is more sensitive to needles.
The practitioner uses higher gauge/thicker needles.
It is important for individuals who have not had acupuncture before to discuss the procedure and any concerns with their provider beforehand. The acupuncturist may be able to perform a trial needle insertion to provide a preview of the treatment. During the initial session, they may use fewer needles or target a smaller area. Constantly communicate with the acupuncturist during the treatment. This allows them to adjust the needles causing soreness or discontinue the procedure if there is increased pain.
Acupuncture Process
Modern medicine explains acupuncture’s benefits. When the needles are inserted, they stimulate the release of endorphins, opioids, immune system cells, and neurohormones. These chemicals help reduce and relieve pain and modify how the body perceives it. They may also impact blood pressure, body temperature, and central nervous system function. (Harvard Health, 2023)
Pressure Points: Is Acupuncture Painful On Certain Body Parts?
Acupuncture can cause some increased soreness in certain body areas. This is especially true when needles are inserted into less muscle or fat regions. For example, hand or foot acupuncture can occasionally cause increased pain (Kaiser Permanente, 2021). Thin individuals with less soft tissue may also experience a stinging sensation as needles are inserted. Communication with the provider is the key to making the acupuncture sessions as comfortable as possible.
During A Session
The first acupuncture session may consist of the following:
The practitioner goes over medical history and current symptoms.
The practitioner examines the body and may also examine the tongue to assess for any present imbalances.
The patient will lie or sit on a table.
Sterilized needles are inserted into the affected areas one at a time.
In some situations, heat or electrical stimulation may also be used to enhance its effects. (Johns Hopkins Medicine, 2025)
Most cases of soreness after treatment will resolve in one to three days. During this time, here are a few recommendations to alleviate any soreness symptoms:
Apply ice to the areas of soreness.
Gently stretch the sore areas.
Increase fluid intake.
Soak in a warm bath with Epsom salts or magnesium oil.
Perform light aerobic exercise.
Take over-the-counter anti-inflammatory medication if recommended by a physician. (University of Georgia, N.D.)
Find a Licensed Acupuncturist
Most states have an online directory of licensed acupuncturists that can help find a local provider. Some national acupuncture associations also maintain lists of members who are board-certified. For example, this directory searches for certified acupuncturists through the National Certification Commission for Acupuncture and Oriental Medicine. (National Certification Commission for Acupuncture and Oriental Medicine, 2024)
Injury Medical Chiropractic and Functional Medicine Clinic
Therefore, acupuncture is not painful and can help relieve symptoms such as anxiety, stress, pain, discomfort, tightness, and poor circulation. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and build optimal health and wellness solutions with primary healthcare providers and specialists. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Beyond Adjustments: Chiropractic and Integrative Healthcare
References
Harvard Health Publishing. (2023). Acupuncture. https://www.health.harvard.edu/a_to_z/acupuncture-a-to-z
Gold, J. I., Kobylecka, M., Ngo, N. H., Lin, C. T., & Hurray, C. N. (2023). Does Acupuncture Hurt? A Retrospective Study on Pain and Satisfaction during Pediatric Acupuncture. Children (Basel, Switzerland), 10(11), 1774. https://doi.org/10.3390/children10111774
Kelly, R. B., & Willis, J. (2019). Acupuncture for Pain. American family physician, 100(2), 89–96.
Kaiser Permanente. (2021). Acupuncture 101: here’s what you can expect. https://healthy.kaiserpermanente.org/health-wellness/healtharticle.acupuncture-101
University of Georgia. (N.D.). Dry needling. https://healthcenter.uga.edu/healthtopics/dryneedling/
National Certification Commission for Acupuncture and Oriental Medicine. (2024). Directory: Feel Confident About Finding a Qualified Practitioner. https://directory.nccaom.org/#
Can incorporating an exercise program like the Alfredson Protocol help athletes and individuals who have hurt their Achilles tendon find pain relief and healing so they can return to regular physical activities?
Exercise Protocol Achilles Tendonitis
Achilles tendonitis occurs when the tendon at the back of the ankle gets injured. It is common in runners. For individuals who have Achilles tendonitis, walking and running can be painful. You might have to stop engaging in exercise and physical activities like sports. Depending on your job, having the condition may make working harder. Here are a few of the signs and symptoms of the condition:
Pain in the back of the lower leg, just above the heel.
Pain with running, jumping, or pointing the toes.
A small lump on the Achilles tendon just above the heel.
The first line of treatment is to rest and ice the tendon. Anti-inflammatory medications can help reduce pain. (American Academy of Orthopaedic Surgeons, 2022) Physical therapy can include strengthening exercises, ultrasound heat therapy, and deep massage. Exercises stretching the nearby muscles will help gradually increase the stress the tendon can handle, eventually reducing inflammation and swelling. Stretching and flexibility exercises will help an Achilles tendon heal. (University of Michigan, 2023)
The only way to determine if an individual has injured their Achilles tendon is to see a doctor. If the injury is Achilles tendonitis, a physical therapist may be recommended. A physical therapist can train individuals on the Alfredson protocol, an exercise protocol program for those with Achilles tendonitis (tendinopathy) that research has shown is helpful for those with the condition. The therapist will train on how to exercise to strengthen the tendon. The exercises stretch the Achilles tendon to help it handle forces and stress, known as eccentric loading. (Stevens M., & Tan C. W. 2014)
Inflammation
Tendonitis is inflammation of a tendon. However, studies have shown that the tendon might not be inflamed in those with the condition. When an area of the body is inflamed, inflammatory cells are present. Individuals usually feel pain in the inflamed area. For those with Achilles tendonitis, the tendon will present with pain, but not necessarily because the tendon is inflamed. Under a microscope, researchers examined tissue from the tendons of those with Achilles tendonitis. They did not find inflammatory cells in the tissue. (Stevens M., & Tan C. W. 2014) This means that although individuals felt pain, they were not inflamed. If there are no inflammatory cells in the tendon, this could explain why those with Achilles tendonitis often do not find relief from the anti-inflammatory treatment of non-steroidal anti-inflammatory drugs (NSAIDs). Studies have shown that gentle exercise protocols for the tendon are more helpful. However, researchers are not sure why these exercises are so beneficial. (O’Neill S., Watson P. J., & Barry S. 2015)
Eccentric Exercise
A chiropractic physical therapy team can help individuals heal the injury with eccentric loading exercises. Eccentric loading exercises work the muscles and tendons to help them get stronger. Once healing has begun, they can help strengthen the tendon. Individuals start slowly with easy exercises and then work up to harder ones. They will have the patient lengthen or stretch out the muscle. As the patient moves, the muscles and tendons contract or shorten. The Alfredson protocol consists of eccentric loading exercises for the Achilles and the muscles that support it.
Alfredson Protocol
Before exercising, talk to a doctor or physical therapist to know if it’s safe. How to do the Alfredson protocol:
First, stand on a small step or curb.
Stand with the balls of your feet on the edge.
Your heels should hang over the edge.
Hold onto something for balance.
Keep the knees straight.
This will load a muscle part of the Achilles tendon called the gastrocnemius.
Using both feet, lift the heels and rise onto the balls of the feet.
Keep the foot with the painful Achilles tendon on the step.
Lift the non-injured foot off the step.
Slowly lower down using the injured ankle.
The heel should move towards the floor.
The ball of the foot should remain in contact with the edge of the step.
Return the non-injured foot to the step.
Repeat the exercise.
Do three sets of 15 reps with the knees straight. Then, do the Alfredson protocol again with the knees slightly bent. This will work a muscle called the soleus, which connects to the gastrocnemius. Perform three sets of 15 repetitions. Perform both exercises twice a day. This could be in the morning and the evening. The Alfredson protocol is most beneficial when done for about 12 weeks. (Stevens M., & Tan C. W. 2014)
Injury Medical Chiropractic and Functional Medicine Clinic
The Alfredson exercise protocol can be done at home with a step or raised platform to put the feet on safely. Individuals should consider working with a personal trainer to ensure safety and get the most out of the workouts. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
American Academy of Orthopaedic Surgeons. OrthoInfo. (2022). Achilles Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/
University of Michigan. (2023). Achilles Tendon Injury: Physical Therapy and Rehab. https://www.uofmhealth.org/health-library/tr2261
Stevens, M., & Tan, C. W. (2014). Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. The Journal of orthopaedic and sports physical therapy, 44(2), 59–67. https://doi.org/10.2519/jospt.2014.4720
O’Neill, S., Watson, P. J., & Barry, S. (2015). WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?. International journal of sports physical therapy, 10(4), 552–562.
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