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Sports injuries are common, and vary from minor toe injuries to major complex trauma. Usually, only soft tissue is damaged, but there can also be fracturing of bone. Soft tissue injuries include sprains, strains and bruising. A sprain is a partial or complete rupture of a ligament, a strain is a partial tear of muscles and a bruise is a rupture of tissue leading to a haematoma. Any soft-tissue injury can lead to a tenderness, swelling, haematoma, scarring, fibrosis and loss of function.
Most commonly, sports injuries affect the lower limb, particularly the ankle (e.g. Achilles tendinopathy, sprains) and knee (e.g. patellofemoral pain syndrome, ligament injuries).(Murray 2004) Other common sporting injuries include those of the shoulder (e.g. dislocations, acromioclavicular joint injuries, rotator cuff injuries); elbow (e.g. tennis, golfer’s); wrist (e.g. strains, sprains, breaks); leg (e.g. shin splints, stress fractures, hamstring injuries); foot (e.g. plantar fasciitis); groin (strain); and back (e.g. acute lumbar sprain).(Andres 2008; Arthritis Research Campaign 2004; Jarvninen 2000, McGriff-Lee 2003; Mitchell 2005; Wolfe 2001) Injuries can be caused by trauma as a result of a sudden impact or awkward movement, or can develop over time often due to continual use of the same joints or muscle groups. Contributing factors can be not warming, using inadequate equipment or training too hard for current level of fitness.
The aims of therapy are to relieve pain, control inflammation, hasten resolution of a haematoma, and accelerate repair. Also, there should be restoration of function and recovery of muscle power. Conventional approaches to sports injuries include RICE (rest, ice, compression and elevation), anti-inflammatory drugs and analgesics, immobilisation, corticosteroid injections, physiotherapy and surgery.
How acupuncture can help
One systematic review found strong evidence suggesting that acupuncture is effective in the short-term relief of lateral epicondyle pain (Trinh 2004). This updated an earlier review on the same subject where there was insufficient evidence to either support or refute the use of acupuncture (Green 2002). The only other systematic review on sports injuries found that, based on the results of trials exhibiting a sufficient level of quality, treatments that were effective in decreasing pain and improving function in patients with patellofemoral pain syndrome were acupuncture, quadriceps strengthening, and the use of a resistive brace (Bizzini 2003). There is also positive evidence from individual randomised controlled trials, showing that:
- acupuncture reduced pain in patients with plantar fasciitis (Zhang 2001);
- electroacupuncture had better therapeutic effects than medication, both in the short and long term, in patients with acute lumbar strain (Yao-chi 2007);
- acupuncture plus warmed needle relieved the pain of chondromalacia patella (Qui 2006);
- acupuncture reduced NSAID intake and relieved pain in patients with shin splints (Callison 2002);
- acupuncture reduced the pain of patellofemoral pain syndromes (Jensen 1999);
- acupuncture was effective for soft tissue disease (Yuan 1989).
Altogether, there is a paucity of controlled trials of acupuncture for sports injuries, so we also refer to some of the uncontrolled studies. Case series suggest acupuncture might be helpful in the treatment of shoulder injuries (Osborne 2010), medial collateral ligament injuries of the knee (Yan 2008) and plantar fasciitis (Tillu 1998), but these results need confirming.(See Table below).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety (Wu 1999).
Acupuncture may help relieve symptoms of sports injuries, such as pain and inflammation by:
- stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);
- delivering analgesia via alpha-adrenoceptor mechanisms (Koo 2008);
- increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
- modulating the limbic-paralimbic-neocortical network (Hui 2009);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
- improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.
- Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clinical Orthopaedics and Related Research 2008; 466: 1539-54.
- Arthritis Research Campaign, 2004. Plantar fasciitis. Information and exercise sheet (H02). [online]. Available: www.arc.org.ukICSI.
- Jarvinen TA et al. Muscle strain injuries. Current Opinion in Rheumatology 2000; 12: 155-61.
- McGriff-Lee N. Management of acute soft tissue injuries. Journal of Pharmacy Practice 2003; 16: 51-8.
- Mitchell C et al. Shoulder pain: diagnosis and management in primary care. BMJ 2005; 331: 1124-8.
- Murray IR et al. How evidence based is the management of two common sports injuries in a sports injury clinic? Br J Sports Med 2005; 39: 912-6.
- Wolfe MW et al. (2001) Management of ankle sprains. American Family Physician 2001; 63: 93-104.