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What is Contemporary Medical Acupuncture
Contemporary medical acupuncture (also known as functional integrated acupuncture or biomedical acupuncture) takes the traditional form of Chinese acupuncture and modifies it using modern day scientific understandings of human physiology and anatomy. At first glance contemporary medical acupuncture appears very similar to the traditional Chinese approach, as the same small, thin needles are placed in specific points on the body for a period of 5 to 30 minutes and removed. However, there are considerable differences between the approaches.
Contemporary vs. Traditional
In contemporary medical acupuncture, treatment is given after a conventional medical/neuro-functional diagnosis. This diagnosis is made based on established methods of a medical history taking and physical examination. After the diagnosis is established, the practitioner will use acupuncture needles to influence the physiology of specific structures that were identified in the initial examination. Needle placement will be determined based on specific goals to affect local tissue structures, target specific spinal segmental outflow, as well as influence central regulatory effects on the nervous system. In summary the points used in this form of acupuncture are chosen based on their specific neuroanatomical and neuromuscular location related to your specific pain or dysfunction. The practitioner will typically use contemporary medical acupuncture as another treatment tool along with other therapeutic approaches such as: manual joint manipulation and mobilization, soft tissue techniques, stretching and rehabilitation exercises.
On the other hand, a traditional Chinese acupuncturist or Naturopathic Doctor will also do a very comprehensive history/physical examination but make a diagnosis based on complex theories regarding disturbance in the body’s balance (energy) that need to be addressed with treatment. This traditional form of acupuncture involves the similar use of small needles inserted at specific points on the body, but aimed to help to regulate the flow of energy or Qi. Dysregulation of this energy in the body is stated to be at the root of all ailments and disease. By regulating the state of qi with the needles, traditional acupuncturists aim to help guide the body back into homeostasis. While modern science may find it difficult to explain in conventional medical terms, traditional Chinese acupuncture has been around for more than 2500 years and has produced positive results for centuries.
Since contemporary medical acupuncture lends itself to the same method of understanding musculoskeletal complaints, it makes for an excellent clinical tool for many modern day manual practitioners to add to their current toolkit, including chiropractors, physiotherapists, massage therapists and more.
Mechanisms of Effect
There are a number of mechanisms that help to understand why acupuncture can be so effective at treating musculoskeletal conditions. Some involve the nervous system and one involves the muscles. In clinical practice there can be considerable overlap between these mechanisms, and treatment often activates more than one mechanism.
- Local Effects – Acupuncture promotes local healing by increasing blood flow to the area where the needles were inserted.
- Segmental Analgesia – Acupuncture reduces pain in the segment where the needles are inserted. This is accomplished by the stimulation of sensory nerves which send signals to its particular segment in the spinal cord where it acts to lower the body’s response to painful stimuli that are supplied by the same segmental spinal nerve. This is most likely the main mechanism that acupuncture relieves pain.
- Extrasegmental Analgesia – Acupuncture reduces pain in the entire body. The signals from sensory nerves that are sent to the spinal cord then travel upwards to the brainstem, and here they stimulate the body’s own pain suppressing mechanisms. This effect is felt beyond the segment where acupuncture was applied and is felt throughout the whole body, known as extrasegmental analgesia.
- Central Regulatory Effects – Acupuncture has a calming effect and improves wellbeing. After reaching the brainstem, signals then go on to influence various parts of the brain. Stimulation of these regulatory brain structures can have a general calming affect as many patients report various positive effects such as improved mood, decreased sensitivity to pain, reduced nausea in pregnant women, regulating the autonomic nervous system and hormone regulation. (such as hormones that control the menstrual cycles).
- Myofascial Trigger Points – Acupuncture inactivates mysofascial trigger points. Recent or past injury to muscles and the soft tissue structures around them can develop small areas of damage that take longer to heal and cause persistent pain. Known as myofascial trigger points, they typically present as a taut band with an acutely tender spot that can sometimes refer some distance away and often inhibit normal movement due to pain.
General Treatment Considerations
- What is a treatment like?
- Contemporary medical acupuncture is generally used in combination with other manual therapy treatment techniques such as joint mobilization, soft tissue techniques, rehabilitation exercises and other methods. With this in mind, acupuncture will often be performed at the beginning of the treatment with the practitioner then using his or her other clinical tools to effectively treat your specific diagnosis.
- Length of time?
- The length depends on the goal of the treatment and the mechanisms that we intend to influence. For many local uncomplicated injures the needles can be inserted and removed almost immediately and is sufficient to produce local effects. If the goal is to stimulate the central nervous system needles will typically be left in for up to 15 to 20 minutes to produce an appropriate effect.
- How many needles?
- The amount depends on your specific diagnosis and goals of treatment. For example, when treating fairly uncomplicated knee pain there may be fewer needles (as few as 4 needles) inserted only into some of the local structures. However, if the diagnosis was instead chronic in nature and included multiple areas of the body it may be worthwhile to use mechanisms that influence the central nervous system, which would require placing needles across the body in a widespread fashion to promote sufficient nervous system stimulation.
- Is it painful?
- In general, most people report that they barely feel an acupuncture needle being inserted with no pain reported. A short and minor feeling of sharpness occasionally happens when a needle is inserted but it is nothing to worry about. Acupuncture is generally a comfortable experience for most.
- When will I feel the positive effects?
- Based on the multiple mechanisms mentioned above, the timing of effects after acupuncture range from having an immediate effect, hours and even days after treatment. Typically the practitioner will perform a test/retest method to assess the effect of any treatment performed on that day and determine any immediate effects then and there. In the next visit the practitioner will ask you about any positive effects that may have taken hours or a few days to occur.
Commonly Treated Conditions (based on current evidence):
- Neck pain
- Upper limb pain, (especially rotator cuff tendonitis, tennis elbow and golfer’s elbow)
- Lower limb pain
- Low back pain
- Chronic knee pain
- Myofascial pain – including myofascial trigger points
- Osteoarthritis (especially knee, ankle, hip, AC joint, and cervical spine)
- Migraine headache
- Tension-type headache
- Jaw Pain
- Chronic pain
- Plantar fasciitis
- Athletic injuries