Preventive measures are the best way to decrease the incidence and severity of injury in sports, and many research programs and treatment methods have been developed for this purpose. However, the potential of dry needling acupuncture for preventing sports injuries has not yet been seriously recognized by sports medicine professionals.
Dry needling therapy is a specific modality for soft tissue dysfunction. Needling and needling-induced lesions activate built-in biologic self-regulatory mechanisms to normalize pathophysiology of soft tissues. Soft tissue accounts for about 50% of human body mass and is a part of every anatomic entity as either a structural or functional element; any pathologic insult, internal or external, can cause or be manifested as soft tissue dysfunction. Therefore dry needling acupuncture is a modality that can be used in almost every clinical condition that involves soft tissue dysfunction, ranging from postexercise syndrome, delayed-onset muscle soreness, precompetition stress, and myofascial pain to cancer in patients who are undergoing chemotherapy, radiotherapy, or both. If an injury necessitates surgical intervention, dry needling acupuncture can be used before and after surgery for improving rehabilitation.
The best practical way to prevent sports injury is to restore musculoskeletal homeostasis, which accelerates recovery from postexercise syndrome, delayed-onset muscle soreness, and soft tissue inflammation and rebalances musculoskeletal pathomechanics so as to enhance the efficiency and ease of movement.
INJURY PREVENTION: TREATING ASYMPTOMATIC ATHLETES
Preventing injury in asymptomatic athletes is of utmost importance. Injury prevention and performance enhancement are in fact the same issue.
Many injuries occur because the soft tissues—the muscles, fascia, tendons, and ligaments—are loaded with accumulated stress so that they are in a physical and physiologic state of "preinjury." Under these conditions, any overtraining, unusual movement or posture, or physical impact can cause an injury that would not happen, or would be less severe, in a healthy body. Examples of this would be different kinds of tendinitis, tendon avulsion, abnormal bone growth such as bone spurs caused by chronic muscle hypertension, and even bone breakage resulting from sudden contraction of tight muscles. All these conditions are caused by soft tissue dysfunction. If such dysfunctions were eliminated and if the chronic stress in the affected tissues were regularly treated, such injuries could be prevented.
In investigating the medical histories of several world-class athletes, the author has found that many of their injuries and surgical procedures could have been prevented if they had received proper regular preventive treatment to remove accumulated mus-culoskeletal stress or to alleviate hidden symptoms. In fact, he found that most athletes, professional and nonprofessional, have symptoms that are hidden to a greater or lesser degree. Even those who claimed to be symptom-free reported after treatment that they felt their musculoskeletal systems were much better coordinated and their muscles were stronger. Injuries resulting from musculoskeletal stress are often hidden, unknown in their early stages to both athletes and their physicians.
Many athletes and medical professionals understand the importance and necessity of injury prevention, and many programs have been developed for this purpose. The First World Congress on Sports Injury Prevention, which was convened in Oslo, Norway, in June 2005, is an example of the progress made in this field. Is it possible to prevent sports injuries? The answer is definitely "yes." Systematic research suggests that sports injuries can be reduced by 54% to 65%, depending on the type of sport and type of intervention (see later discussion in this chapter).
The use of dry needling acupuncture for sports injury prevention is a new approach that the author and colleagues have developed since the late 1990s. Their experience demonstrated that needling is very effective in restoring musculosk-eletal homeostasis, which enhances efficiency of movement; accelerates recovery from postexercise syndrome, delayed-onset muscle soreness, and soft tissue inflammation; and rebalances musculoskel-etal mechanics.
The author and colleagues have found that all healthy athletes benefit from a session of preventive dry needling acupuncture once a week, combined with a treatment 3 days before competition and another immediately after competition. This protocol enhances physical performance and prevents soft tissue injury by accelerating recovery from overtraining.
CLINICAL PROCEDURE FOR PREVENTING INJURY AND ENHANCING PERFORMANCE
A general procedure for asymptomatic athletes may follow these steps:
• Collection of an accurate history of sports career, including all injuries
• Recording of any current complaint
• A musculoskeletal screening examination
• Systemic or subsystemic treatment
A well-designed general musculoskeletal screening examination ( Table 13-1) is suggested to identify possible pathology.1 In this examination, asymmetry or mechanical imbalance can be identified. Any pathologic condition or imbalance that seems to be local can affect systemic physiology, function, or structure. In the author's experience, all athletes, professional
TABLE 13-1 Musculoskeletal Screening Examination
Look at ceiling, floor, over both shoulders, touch ears to shoulders Shrug shoulders (resistance) Abduct shoulders Full external rotation of arms Flex and extend elbows Arms at sides, elbow at 90 degrees: ilex, pronate, and supinate wrist Spread fingers, make fist Tighten (contract) quadriceps; relax quadriceps "Duck walk" away and toward examiner Stand with back to examiner
Knee straight, touch toes
Raise up on toes, heels
Arms at sides, anteroposterior positions of both arms and hips Stand with side to examiner
Acromioclavicular joints; general habitus Cervical spine motion
Trapezius strength Deltoid strength Shoulder motion Elbow motion Elbow and wrist motion
Hand and finger motion, strength, deformities Symmetry of knee and ankle joints
Hip, knee, and ankle motions
Symmetry: ear and shoulder levels, hips, popliteal creases, malleoli, scoliosis Scoliosis, hip motion, tightness of lumbar muscles, hamstring and calf muscles Calf symmetry, leg strength Body rotation about superior-inferior axis
Neck position and anterior-posterior skeletal alignment
CHAPTER 13 Using Dry Needling Acupuncture for and amateur, are living with hidden musculoskeletal stress that can become symptomatic at any time during training or competition if it is not properly treated. The treatment should be provided in a systemic way with emphasis on any symptoms that have been revealed in the screening examination. There is a difference that should be noted between those with previous injuries and those without: Athletes with previous injuries are more vulnerable to recurring symptoms because their injuries or surgical procedures may have changed their anatomic structure to some degree, which can create an imbalance in their natural musculoskeletal biomechanics.
The following cases, from the author's own patients, serve as examples of preventive treatment for asymptomatic athletes or those with only minor musculoskeletal symptoms.
case study i
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