Effects Of Acupuncture On Delayed-Onset Muscle Soreness: A .
HindawiEvidence-Based Complementary and Alternative MedicineVolume 2020, Article ID 5864057, 11 pageshttps://doi.org/10.1155/2020/5864057Review ArticleEffects of Acupuncture on Delayed-Onset Muscle Soreness: ASystematic Review and Meta-AnalysisWen-Dien Chang ,1 Nai-Jen Chang ,2 Hung-Yu Lin ,3 and Jih-Huah ofof4Sport Performance, National Taiwan University of Sport, Taichung, TaiwanSports Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanOccupational Therapy, Asia University, Taichung, TaiwanBiomedical Engineering, Ming Chuan University, Taoyuan, TaiwanCorrespondence should be addressed to Jih-Huah Wu; wujh@mail.mcu.edu.twReceived 13 April 2020; Accepted 8 June 2020; Published 27 June 2020Academic Editor: Albert MoraskaCopyright 2020 Wen-Dien Chang et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.Objectives. Evidence for the effects of acupuncture on delayed-onset muscle soreness (DOMS) is inconsistent. The aim of thisstudy was to explore the effects of acupuncture on DOMS. Methods. Studies investigating the effect of acupuncture on DOMSin humans that were published before March 2020 were obtained from eight electronic databases. The affected muscles,groups, acupuncture points, treatment sessions, assessments, assessment times, and outcomes of the included articles werereviewed. The data were extracted and analyzed via a meta-analysis. Results. A total of 15 articles were included, and relief ofDOMS-related pain was the primary outcome. The statistical meta-analysis showed that there were no significant differencesbetween acupuncture and sham/control groups, except for acupuncture for DOMS on day 1 (total SMD 0.62; 95%CI 1.12 0.11, P 0.05) by comparing with control groups. Conclusion. Acupuncture for DOMS exhibited very-small-tosmall and small-to-moderate effects on pain relief for the sham and no acupuncture conditions, respectively. Evidenceindicating the effects of acupuncture on DOMS was little because the outcome data during the follow-up were insufficient toperform an effective meta-analysis.1. IntroductionDelayed-onset muscle soreness (DOMS) is a commonmyogenic pain that occurs after strenuous exercise training,especially after eccentric muscle contraction exercise [1]. Theclinical signs of DOMS include muscle soreness, tenderness,and decreased joint range of motion [2]. In clinical diagnosis, DOMS symptoms progressively increase after exercise, peak at 2-3 days after exercise, and then dissipate by 5–7days later [3]. The visual analog scale (VAS) is commonlyused to quantify DOMS pain in many studies [4]. Thepressure pain threshold (PPT) was demonstrated as reliablefor measuring the pain threshold [5] and was also a clinicalmarker to assess DOMS [6]. Other assessments, such asmuscle strength or hematology analysis, were also used toassess the recovery of DOMS [3].Although the progression of DOMS is not a seriousproblem, the discomfort can affect exercise participation forathletes. Exercise professionals must take particular care duringperiods of DOMS, as muscle injuries and functional deficienciesmay augment the risk of sports injuries, particularly whenreturning to sports, or advancing training practices [7]. Thus,strategies to minimize DOMS symptoms and facilitating musclerecovery are of great interest to athletes and athletic trainers,with recovery interventions playing a key role in optimizingsport performance [8]. Many conservative treatments, includingmassage, cryotherapy, ultrasound, and transcutaneous electricalnerve stimulation, are used to decrease DOMS symptoms, buttheir effects are inconsistent [9]. If necessary, analgesics are used,but they have short-term effects and there is a risk of abuse [10].Therefore, nonmedicated, complementary therapies for DOMSrelated pain relief have gained popularity in recent times.
2Acupuncture is a medical procedure of traditionalChinese medicine and is a common complementary therapyfor treating DOMS. A previous systematic review hasprovided evidence for the effects of acupuncture on musculoskeletal disorders [11]. The therapeutic mechanism ofacupuncture has been explained, and it is commonly usedfor musculoskeletal conditions in clinical practice [12]. Theapplication of needle acupuncture to tender points (i.e., AhShi acupuncture point) or other acupuncture points to reduce DOMS symptoms is feasible [9]. However, the evidencefor the effects of acupuncture on DOMS is inconsistent.Therefore, the aim of this study was to conduct a systematicreview and a meta-analysis to explore the effects of acupuncture on DOMS.2. Methods2.1. Search Strategy and Data Extraction. We conducted thesystematic review and meta-analysis in accordance withstandard guideline and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement[13, 14]. The searching strategy was based on patient, intervention, comparison, outcome, and study type (PICOs) inTable 1. The keywords “DOMS,” “acupuncture,” “therapy,”“muscle soreness,” and “acupuncture” were used to search inthe PubMed, EMBASE, Chinese Electronic Periodical Services, Scopus, Google Scholar, and Cochrane Library electronic databases. The search strategy in PubMed was that #1(“delayed onset muscle soreness” [All Fields] OR “musclesoreness” [All Fields]); #2 (“acupuncture” [ MeSH Terms]OR “acupuncture therapy” [MeSH Terms]); and #3 (#1 AND#2). The search strategy in EMBASE was that #1 (“delayedonset muscle soreness”/exp OR “muscle soreness”); #2(“acupuncture” OR “delayed onset muscle soreness”); and#3 (#1 AND #2). Experimental studies related to humansubjects and published in journals before March 2020 wereincluded. The inclusion criteria were as follows: controlstudy design articles; the participant has received the procedure for inducing DOMS; intervention was acupunctureapplying on acupuncture points after inducing DOMS; andthe controls used were sham or no acupuncture, and theoutcomes in the follow-up were recorded. The exclusioncriteria were as follows: articles of case reports, reviewstudies, and experimental groups received interventions oflaser acupuncture, electroacupuncture, or another traditional Chinese medicine intervention.First, the included abstracts were reviewed and screenedby two specialists in sports medicine with more than 5 yearsof experience. Second, suitable articles were selected, and thefull texts were collected and reviewed carefully by the twospecialists. The detailed data from each article were independently extracted. The author’s name, year of publication,number of participants, intervention, and results werereviewed and collected. The items (i.e., affected muscles,groups, acupuncture points, treatment sessions, assessments, assessment times, and outcomes) in the includedarticles were collated and analyzed on the basis of the datarecorded by the two specialists. Finally, the data from theEvidence-Based Complementary and Alternative MedicineTable 1: Items of PICOs in our study.ItemsPatient or problemInterventionComparisonOutcomeStudy typeDescriptionHuman subjects with DOMSAcupunctureSham or no acupuncturePain or physiological recoveryControl study designPICOs: patient, intervention, comparison, outcome, and study type.included articles were analyzed by meta-analysis in accordance with outcome data integrity.2.2. Methodological Quality Assessment. The Jadad scale,which included questionnaire items of randomization,blinding, withdrawals, and dropouts, was used to assess themethodological quality of articles [15]. The scale was scoredbetween 0 and 5, with higher scores indicting higher articlequality. For each study, the score was assessed independentlywith the advice of the two specialists.2.3. Quality Assessment. The Cochrane risk of bias tool wasused to assess the bias risk in each included study and judgethe methodological quality of the article via seven individualelements. The results of “low bias,” “unclear,” or “high bias”were presented for each element. For each study, the scorewas assessed independently with the advice of the twospecialists.2.4. Statistical Analysis. The outcomes of the included articleswere collected and meta-analyzed using MedCalc software(MedCalc, Mariakerke, Belgium). The results of the acupuncture group were compared with those of the shamacupuncture and control groups. The assessments and assessment times were subgrouped to compare the standardizedmean differences (SMDs) between the groups. The SMDs and95% confidence intervals (CIs) were estimated from the meansand standard deviations of the results of the included articles.The VAS decrease of DOMS was represented as the improvement of pain. When the acupuncture group was compared with the sham and control groups, a negative SMDfavoured the acupuncture group, and the outcomes of theacupuncture group were proved. Heterogeneity was tested bythe Q-statistic test. The result was considered a significantheterogeneity for P 0.05 or I2 50%, and a total randomeffects model was used to predict the total effects of theacupuncture, sham acupuncture, and control groups. A totalfixed-effects model was used when significant homogeneityoccurred, and a total random-effects model was used in asignificant heterogeneity.A file drawer analysis was used to assess the publicationbias of the included articles. The total effects of variousassessments and the effects in various assessment times wereused for subgroup analysis to identify the effects of acupuncture on DOMS. Cohen’s rule was used to grade theeffect size; SMDs of 0.01–0.2, 0.2–0.5, 0.5–0.8, and 0.8
Evidence-Based Complementary and Alternative Medicineindicated very small, small, moderate, and large effect sizes,respectively [16].3. ResultsAfter searching the electronic databases, 58 abstracts wereincluded. Following discussions with the specialists, 1 studyprotocol, 8 case reports, and 15 review studies were excluded. Thus, 34 studies of interventions for DOMS inhumans remained, and the full texts were reviewed. Amongthese 34 studies, 14 articles researched other nontraditionaltypes of acupuncture or interventions in traditional Chinesemedicine, and five articles used acupuncture before DOMSin an experimental group were excluded. Finally, 15 studiesabout acupuncture for DOMS were reviewed (Figure 1)[17–31]. The studies included seven English and three nonEnglish articles. The risk of bias for all the 15 articles assessedand the results are summarized in Figure 2. In the includedarticles, there were 7 two-arm trials, 7 three-arm trials, and 1four-arm trial. Sixteen acupuncture groups (n 192), 10sham groups (n 132), and 13 control groups (n 153) wereanalyzed, as reported in Table 2.3.1. Acupuncture Treatment. In the acupuncture group, theacupuncture points were chosen in accordance with theinduced DOMS muscle and tenderness symptoms.However, Barlas et al. [28] applied needles to acupuncturepoints for one group and to tender points (Ah-Shi acupuncture points) for another group. Benito-de-Pedroet al. and Martı́n-Pintado-Zugasti et al. used dry needlingon tender points via the Ah-Shi acupuncture point procedure for DOMS [18, 20]. Itoh et al. [25] applied needleson tender points via the Ah-Shi acupuncture point procedure, which is based on clinical acupuncture manipulation. Based on the meridian theory of traditionalChinese medicine, needles were inserted into the acupuncture points for 3–30 mins, and the participants feltthe “de-qi” sensation. The acupuncture treatment sessionswere 1 time per day, or among 1 day to 2 weeks (Table 2).For the sham acupuncture groups in all the reviewedstudies, acupuncture was applied to a sham acupuncturepoint (near the correct acupuncture point). The controlgroups did not receive any treatments. Both groups werecompared with the acupuncture groups to analyze theeffects.3.2. Assessment Tools3.2.1. Pain. The VAS was used to assess the intensity ofmuscle pain [17, 19–21, 25, 26, 28]. No pain received a scoreof 0, and maximum pain received a score of 10. The sorenesslevel of DOMS muscle during preforming functional activitywas assessed by VAS. The PPT was also measured to assesspain, with a minimum force applied to the affected musclewith DOMS [17–19, 23, 26, 28, 29, 31]. PPT was applied toselected points with a pressure increase rate of 1 kg/cm2/suntil participants felt tenderness.33.2.2. Muscle Strength. Maximum isometric voluntary forcewas assessed by the strain-gauge force transducer (ASYSSporeg, Offenbach, Germany) and was defined as isometricmuscle strength [19, 26]. Isokinetic muscle strength, including eccentric and concentric muscle contractions, wasevaluated using a Kin-Com dynamometer (Chattecx Corporation, Chattanooga, TN) [31].3.2.3. Biochemical Analysis. Blood samples of the participants were taken, and their serums were separated. Thelevels of luteinizing hormone, testosterone, cortisol, andserum creatine kinase were analyzed [24, 27, 29–31].3.2.4. Joint Range of Motion. Joint range of motion wasmeasured using a goniometer via passive joint motion,which was limited by antagonist muscle of DOMS [28].3.2.5. Psychophysiological Response. Thermographic measurement was performed with a thermographic camera toassess skin temperature and blood circulation, originated byautonomic nervous system stimulation [18]. Psychologicalfactors, such fear and anxiety for pain or kinesiophobia, onthe outcomes of acupuncture for DOMS were also measuredby psychological questionnaires [20]. In the study byPaulson et al., skin conductance and skin temperature wereused as indicators of sympathetic nervous system activation.They were assessed using FlexComp Infiniti SC-Flex/Pro SCsensors (Thought Technology, New York, USA) [22].3.3. Study Outcomes. In Table 3, analyses of all the includedarticles revealed that the decrease of VAS appeared afteracupuncture and then gradually declined during the treatment sessions. In particular, pain was significantly decreasedon day 3 (P 0.05) [17, 20, 21, 25, 26, 29]. Joint motion andmuscle strength were also improved during acupuncturetreatment sessions, but there were no significant differences[19, 26, 28, 31]. Four of the included articles had found thatPPT in the acupuncture group was significantly improvedcompared to sham or control groups (P 0.05)[18, 23, 29, 31]. But, in the four articles, the outcomes on PPTdid improve significantly (P 0.05) [17, 19, 26, 28]. Paulsonet al. [22] observed increased skin conductance and decreased skin temperature after acupuncture, and the differences were significant (P 0.05). However, biochemicalanalysis of blood (i.e., luteinizing hormone, testosterone,cortisol, and serum creatine kinase) revealed no significantdifferences between acupuncture and control groups[24, 27, 29–31]. Barlas et al. [28] noted no increase in jointmotion in the acupuncture group after treatment. Thechanges on psychological measure and skin temperaturewere also noted at postacupuncture for DOMS [18, 20, 22].3.4. Results of Meta-Analysis. When inducing DOMS, theVAS data from the articles were integrated after acupuncture. In the follow-up, VAS was collected to perform subgroup analysis. Nine articles were excluded with the reason
4Evidence-Based Complementary and Alternative MedicineAbstracts screened in PubMed, EMBASE, ChineseElectronic Periodical Services, and Cochrane Libraryelectronic databases (n 58)Articles excluded with reasons:Review study (n 15)Case reports (n 8)Study protocol (n 1)Full texts retrieved for evaluation (n 34)Articles excluded with reasons:Other types of acupuncture or interventions (n 14)Acupuncture before DOMS (n 5)All articles retrieved for detailed review (n 15)Articles excluded with the reason that theydid not clearly report outcome data (n 9)Articles included in meta-analysis (n 6)Figure 1: Flow diagram of article selection process.that they did not clearly report outcome data, i.e., unavailable data [18, 22–24, 27, 29, 30], and missing data[26, 31]. Therefore, the data from the six articles were included for meta-analysis. The Jadad scales of the studies werein the range of 2–5, and they had moderate methodologicalquality (average score 3.13 1.18, Table 2).Rosenthal’s fail-safe number was used to analyze thepublication bias in meta-analysis [32]. Based on the outcomesof the included articles, the tolerance level of 85 was lower thanthe fail-safe number of 225. Therefore, the publication biascould not affect the results of meta-analysis. In three articles,the VAS was reported on days 1–3 after inducing DOMS. Theeffects of acupuncture on DOMS could be inferred by comparing the SMDs of the acupuncture groups with those of thesham acupuncture or control groups. The VASs on days 1–3were compared with acupuncture and sham acupuncturegroups in Figure 3. The results of meta-analyses revealed thatthere were homogeneity in VAS on day 1 (95% CI forI2 0.01 76.07, Pheterogeneity 0.14) and heterogeneity on days 2and 3 between the groups (95% CI for I2 20.48 87.94,Pheterogeneity 0.01;95%CIforI2 18.10 89.92,Pheterogeneity 0.01, respectively). The result of meta-analysis fordecrease of VAS on days 1–3 was in favour of acupuncture, andthe total effects demonstrated very-small-to-small effect sizeson day 1 (total SMD 0.26, 95% CI 0.55 0.02, P 0.07),day 2 (total SMD 0.26, 95% CI 0.85 0.33, P 0.38), andday 3 (total SMD 0.02; 95% CI 0.78 0.75, P 0.95).Compared with sham acupuncture, the effects of pain relieffrom acupuncture on DOMS were very small to small, withnonsignificant differences between the two groups (P 0.05).The effects of VAS decrease were observed by comparingthe acupuncture and control groups in Figure 4. Decrease ofVAS on days 1 and 2 (95% CI for I2 25.17 84.99,Pheterogeneity 0.006; 95% CI for I2 38.40 89.86,Pheterogeneity 0.003, respectively) had significant heterogeneity in both groups, but those on day 3 did not haveheterogeneity (Pheterogeneity 0.08). Comparing both groups,the SMD on day 1 was significant for VAS decrease in favourof acupuncture (total SMD 0.62; 95% CI 1.12 0.11,P 0.01), but there were no significant differences on day 2and 3 (total SMD 0,22; 95% CI 0.88 0.45, P 0.51;total SMD 0.27; 95% CI 0.69 0.16, P 0.18, respectively). The effect on pain relief of DOMS was in favour ofacupuncture, and the meta-analysis on day 1 revealed thatthe acupuncture group had a moderate effect when compared to the control group (P 0.05). The acupuncturegroup also had small effect for DOMS pain relief on days 2and 3, but there were no significant differences (P 0.05).4. DiscussionThe onset of DOMS occurred between 2 and 3 days after theexercise and decreased progressively by 5–7 days, indicatingthe utility of DOMS as a method of determining the effects ofacupuncture on muscle pain. Athletes incorporate musclestrength to optimise sport performance and gain a
Allocation concealment (selection bias)Blinding of participants and personnel (performance bias)Blinding of outcome assessment (detection bias)Incomplete outcome data (attrition bias)Selective reporting (reporting bias)Other bias5Random sequence generation (selection bias)Evidence-Based Complementary and Alternative MedicineBarlas (2000) ? Benito-de-Pedro (2020) ? Cardoso (2020)? ?Fleckenstein (2016) –? Hübscher (2008) ? Itoh (2008) ?– Itoh (2011) ? Jui (1994)––? Li (2006) ?–? Lin (1999)?–? Martín-Pintado-Zugasti (2017) ? Paulson (2013) ? Wang (2009) ? Xiang (1998)–? Yang (2016) ? Random sequence generation (selection bias)Allocation concealment (selection bias)Blinding of participants and personnel (performance bias)Blinding of outcome assessment (detection bias)Incomplete outcome data (attrition bias)Selective reporting (reporting bias)Other bias0%25%Low risk of biasUnclear risk of biasHigh risk of biasFigure 2: Summary of bias risk.50%75%100%
6Evidence-Based Complementary and Alternative MedicineTable 2: Summary of affected muscles, treatment programs, and study quality in the included articles.Author (years)Cardoso et al. (2020) [17]Affected musclesQuadricepsBenito-de-Pedro et al.(2020) [18]Triceps suraeFleckenstein et al. (2016)[19]Biceps brachiiMartı́n-Pintado-Zugastiet al. (2017) [20]Yang (2016) [21]Paulson and Shay (2013)[22]Itoh et al. (2011) [23]Wang (2009) [24]Upper trapeziusQuadricepsBiceps brachiiExtensor digitalQuadricepsItoh et al. (2008) [25]Biceps brachiiHübscher et al. (2008)[26]Biceps brachiiLi and Zhai (2006) [27]Quadriceps,gastrocnemius, solusBarlas et al. (2000) [28]Biceps brachiiLin and Yang (1999) [29]Biceps brachiiXiang et al. (1998) [30]QuadricepsJui (1994) [31]QuadricepsGroups (n)Acupuncture pointsAcupunctureLR3, ST34, ST36(n 15)Sham (n 15)Sham acupuncture pointsControl (n 15)No acupunctureAcupunctureAh-Shi(n 17)Sham (n 17)Sham acupuncture pointsAcupuncture LI4, LI11, LU3, LU5, GB34, SP10,(n 12)Ah-ShiSham (n 12)Sham acupuncture pointsTreatment sessionQuality5 insertions; 1 time5 insertions; 1 timeNo treatment8–10 insertions; 1time90 secDe-qi; 15 mins;1time/day; 3 days15 mins; 1time/day; 3daysNo treatmentControl (n 12)No acupunctureAcupunctureAh-Shi4 mins, 1 time(n 30)Sham (n 30)Sham acupuncture points4 mins, 1 timeControl (n 30)No acupunctureNo treatmentAcupunctureAh-Shi, SP10, SP6, GB34, GB30,25 mins; 1 time(n 10)BL23Control (n 10)No acupunctureNo treatmentDe-qi; 15 mins; 1AcupunctureLI4, LI10, LI11, TE5time(n 12)Sham (n 12)Sham acupuncture points15 mins; 1 timeControl (n 12)No acupunctureNo treatmentAcupunctureAh-Shi5 mins; 3 times(n 6)Sham (n 6)Sham acupuncture points5 mins; 3 timesControl (n 6)No acupunctureNo treatmentAcupuncture20 mins, 1 time/day, 2ST36, RN8(n 5)weeksControl (n 5)No acupunctureNo treatmentDe-qi; 10 mins; 1AcupunctureAh-Shitime(n 10)Sham (n 10)Sham acupuncture points10 mins; 1 timeControl (n 10)No acupunctureNo treatment3 mins, 1 time/day; 4Sham (n 10)Sham acupuncture pointsdaysAcupuncture GB34, LU3, LU5, LI11, SP10, Ah- De-qi; 15 mins; 1(n 7)Shitime/day; 3 days15 mins; 1 time/day; 3Sham (n 8)Sham acupuncture pointsdaysControl (n 7)No acupunctureNo treatmentAcupunctureST36, GB34, BL20, BL23, BL11,De-qi; 30 mins, 1(n 14)BL12, BL25, BL57, Ah-Shitime/day, 1 weekControl (n 14)No acupunctureNon-treatmentDe-qi; 5 mins; 1 time/AcupunctureP2, CO11, LU5,CO4day; 5 days(n 12)De-qi; 5 mins; 1 time/AcupunctureAh-Shiday; 5 days(n 12)5 mins; 1 time/day; 5Sham (n 12)Sham acupuncture pointsdaysControl (n 12)No acupunctureNo treatmentAcupunctureDe-qi; 20 mins; 1GB34, LU3, LU5, LI11, Ah-Shi(n 10)time/day; 5 daysControl (n 10)No acupunctureNo treatmentAcupuncturePC6, GB30, ST36, GB34, BL5730 mins; 1 time(n 10)Control (n 10)No acupunctureNo treatment3 mins, 1 time/day; 4AcupunctureSP10, GB31, ST36days(n 10)3 mins, 1 time/day; 4Sham (n 10)Sham acupuncture pointsdays455233325423222BL11, Dazhu; BL12, Fengmen; BL20, Pishu; BL23, Shenshu; BL25, Dachangshu; BL56, Chengjin; BL57, Chengshan; CO4, Wei; CO11, Yidan; GB30, Huantiao;GB31, Fengshi; GB34, Yanglingquan; LI4, Hegu; LI10, Shousanli; LI11, Quchi; LR3, Taichong; LU3, Tianfu; LU5, Chize; P2, Erbeifei; PC6, Neiguan; RN8,Shengue; SP6, Sanyinjiao; SP9, Yinlingquan; SP10, Xuehai; ST34, Liangqiu; ST36, Zusanli; and TE5, Waiguan.
Evidence-Based Complementary and Alternative Medicine7Table 3: Summary of assessments, assessment times, and outcomes in the included articles.Author (years)AssessmentsCardoso et al. (2020)VAS, PPT[17]Benito-de-Pedro et al.PPT, thermographic(2020) [18]measurementFleckenstein et al.VAS, PPT, muscle strength(2016) [19]Martı́n-Pintado-ZugastiVAS, psychologicalet al. (2017) [20]measureYang (2016) [21]VASPaulson and Shay (2013)Sympathetic nervous[22]system responsesItoh et al. (2011) [23]PPTAssessment timesPre-post acupuncture, day 1Pre-post acupuncturePreacupuncture, days 1, 2,and 3Postacupuncture, days 0.5,1, and 2Postacupuncture, day 1Pre-post acupuncturePre-post acupuncture, day 2Serum creatine kinase,testosteronePre-post treatment sessionItoh et al. (2008) [25]VASPre-post acupuncture, days1, 2, 3, and 7Hübscher et al. (2008)[26]VAS, PPT, muscle strengthPre-post acupuncture, days1, 2, and 3Li and Zhai (2006) [27]Luteinizing hormone,testosterone, cortisolPre-post treatment sessionBarlas et al. (2000) [28]VAS, PPT, joint range ofmotionWang (2009) [24]Lin and Yang (1999)[29]Pre-post acupuncture, days1, 2, 3, 4, and 5Preacupuncture, days 1, 2,PPT, serum creatine kinaseand 3Xiang et al. (1998) [30]Serum creatine kinasePre-post treatment sessionJui (1994) [31]PPT, muscle strength,serum creatine kinasePreacupuncture, days 1, 2,and 3 OutcomesSignificant decrease in VAS at postacupunctureamong the groups Improved PPT at postacupuncture A significant difference in PPT between the groupsNo significant differences in all assessments at days1–3 among the groupsSignificant decrease in VAS over time among thegroups Significant differences in VAS between the groups Increased skin conductance and decreased skintemperature at postacupuncture Increased PPT at postacupuncture and day 2 Increased level of serum creatine kinase atposttreatment sessionNo significant differences in testosterone levelbetween the groupsDecreased VAS at postacupuncture A significant decrease in VAS at day 3 among thegroups Decreased VAS and increased PPT and musclestrength at days 2-3A significant decrease in VAS at day 3 among thegroups No significant differences in levels of luteinizinghormone, testosterone, and cortisol between thegroupsA significant decrease in VAS at days 1–5 among thegroups A significant decrease in VAS at day 3 among thegroups Decreased levels of serum creatine kinase atpostacupuncture A significant improvement in muscle strength at day3 and in PPT at day 2 between the groups No significant differences in the levels of serumcreatine kinase between the groupsP 0.05, comparison between group differences.competitive edge [33]. However, intensified training mayalso cause DOMS that can last for several days after exercise, which may affect neuromuscular control, leading toa decreased explosive muscular force and resulting in anincreased risk of sports injuries [34]. Garlanger et al. [35]found that athletes with DOMS often recommendedacupuncture to other athletes after receiving it. Theacupuncture in traditional Chinese medicine could be acomplementary therapy, and the acupuncture experiencewas accepted in athletes. However, the effects of acupuncture on pain relief for DOMS require further evidence. Through our systematic review, we found thatacupuncture reduced the level of DOMS in twelve studies[17, 18, 20–23, 25, 26, 28–31], but three studies did notreport any benefits of acupuncture on DOMS [19, 24, 27].Although the improvement of PPT and muscle strength onDOMS after receiving acupuncture was found, a reasonfor insufficient data leads to the difficultly conductingmeta-analysis. So, only the effect sizes of VAS were analyzed at days 1–3 between acupuncture and shamacupuncture or control. The meta-analysis revealed noevidence that acupuncture decreased pain more effectivelythan sham acupuncture. When comparing DOMS measures between acupuncture and control, the effect size onpain relief was small to moderate at days 1–3. It impliesthat acupuncture for DOMS seems to be used in pain reliefat post-DOMS compared to nonuse of acupuncture.Three of the included articles supported the analgesiceffect of acupuncture on DOMS, suggesting that acupuncture is effective in managing pain in DOMS[25, 26, 29]. Although the mechanism of acupuncture onDOMS remains unknown, the neurostimulation andChinese meridian theory were used to explain the analgesiceffect. Okada and Kawakita [36] argued that the pain-relieving mechanism of acupuncture is a diffuse noxiousinhibitory control phenomenon, which is why acupuncturecan decrease the muscle pain associated with DOMS.Fleckenstein [37] indicated that acupuncture on skinsurface caused physical stimulation (i.e., the “de-qi” sensation). This neural stimulation could activate the spino-
8Evidence-Based Complementary and Alternative MedicinenSMD95% CICardoso (2020) [17]Fleckenstein (2016) [19]3024–0.350.22–1.08 to 0.39–0.60 to 1.03Martín-Pintado-Zugasti (2017) [20]60–0.71–1.24 to –0.18Itoh (2008) [25]20–0.67–1.59 to 0.25Barlas (2000)a [28]240.31–0.51 to 1.13Barlas (2000)b [28]240.13–0.69 to 0.94Total fixed effects182–0.26–0.55 to 0.02Authors (years)SubgroupsSMD, 95% CIDay 1Test of heterogeneity: Q 8.29, df 5, P 0.14, I 39.69%2Day 2Fleckenstein (2016) [19]Martín-Pintado-Zugasti (2017) [20]Itoh (2008) [25]Barlas (2000)a [28]Barlas (2000)b [28]Total random ��0.26Test of heterogeneity: Q 12.91, df 4, P 0.01, I2 69.03%Day 3Fleckenstein (2016) [19]24–0.5820Itoh (2008) [25]–0.78Barlas (2000)a [28]240.36Barlas (2000)b [28]240.8892–0.22Total random effectsTest of heterogeneity: Q 9.60, df 3, P 0.02, I2 68.75%–0.91 to 0.72–1.50 to –0.42–1.78 to 0.10–0.43 to 1.22–0.53 to 1.11–0.85 to –0.33–1.45 to –0.29–1.76 to 0.21–0.50 to 1.20–0.01 to 1.77–0.78 to 0.75–2 –1 012FavoursFavours shamacupuncture acupunctureFigure 3: Forest plots; subgroup analysis of pain at days 1, 2, and 3 (acupuncture vs. sham acupuncture groups; aacupuncture on P2, CO11,LU5, and CO4 acupuncture points; bacupuncture on Ah-Shi acupuncture point).bulbo-spinal circuit and inhibit wide-dynamic-rangeneurons, resulting in a short-term analgesic effect [38].Barlas et al. [28] thought that the manual twisting ofneedles at approximately 1 Hz is used to obtain a “de-qi”sensation. The physical stimulation with low frequenciescould stimulate active endogenous opioid systems andreduce the pain sensation after acupuncture [39]. Wang[24] supported that acupuncture for DOMS could relaxmuscles and have an analgesic effect. It
Apr 13, 2020 · ReviewArticle Effects of Acupuncture on Delayed-Onset Muscle Soreness: A Systematic Review and Meta-Analysis Wen-Dien Chang
1. Acupuncture treatment: Boby acupuncture Ear acupuncture Scalp acupuncture Facial acupuncture Hand and Foot acupuncture Electro-acupuncture 2. Chinese herbal medicine 3. Cupping 4. Moxibustion 5. Chinese Tui Na ( massage) and acupressure 6. Foot therapy 7. Exercise
Teaching acupuncture 53 Acupuncture organisations 57 National guidelines for acupuncture training 60 Summary 61 5 Acupuncture in primary care 63 Introduction 63 Provision of CAM by general practitioners 64 GPs' knowledge about acupuncture 65 BMA survey—The use of acupuncture in primary care services 67 Discussion 77 6 Future developments 83
the Acupuncture Licensure Act. Additional copies of this publication are available from Department of Consumer Affairs CALIFORNIA ACUPUNCTURE BOARD 444 North 3rd Street, Suite 260 Sacramento, CA 95811. For more information call 916/445-3021, or visit the California Acupuncture Board Web site at www.acupuncture.ca.gov. 07-043 (04/08)
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THE THREE-LEVEL ACUPUNCTURE BALANCE Integrating Japanese Acupuncture with AcuGraph Computer Diagnosis Jake Paul Fratkin, OMD, L.c. PART 1 ANTECEDENTS TO 3-LEVEL PROTOCOL A. Overview and Introduction p. 2 B. Schools of Acupuncture Practiced in the West 5 C. Acupuncture: General Considerations 6 D. Level One: The Primary Channels 8
Acupuncture involves the puncturing of the skin with thin sterile needles, at defined acupuncture points, that are then stimulated either manually or electrically. In manual acupuncture (MA) the needles are twisted back and forth by hand until a sensation of DeQi is achieved. In electro-acupuncture the needles are connected to a
strated that acupuncture is beneficial for relieving dyspep-sia symptoms and associated negative emotions, thus improving patient quality of life [4–6]. The acupoints and acupuncture stimulus such as manual acupuncture (MA) manipulations are the key elements inducing the effect. Related research studies on treating FD with acupuncture
American Academy of Medical Acupuncture Primarily a physician acupuncture association -medicalacupuncture.org American Board of Medical Acupuncture confers board certification on eligible MD and DO members who have completed all requirements: DABMA.org Not all courses in medical acupuncture teach strictly scientificmedical acupuncture
