ACUPUNCTURE IN PHYSIOTHERAPY

What is acupuncture?

Acupuncture is one of the many skills employed within physiotherapy as

part of an integrated approach to the management of pain and
inflammation. Physiotherapists base their treatments on scientific research
and clinical evidence that Acupuncture can reduce pain by stimulating the
brain and spinal cord to produce natural pain-relieving chemicals such as
endorphins, melatonin (which promotes sleep) and serotonin (to promote
well-being), to name but a few. These chemicals assist the body's healing
processes and offer pain relief as a precursor to other treatments such as
manual therapy or exercise in order to aid recovery.

Acupuncture forms part of traditional Chinese medicine (TCM). This

ancient system of medicine dates back as far as 1000 years BC and is based
on a holistic concept of treatment which regards ill health as a manifestation
of imbalance in the bodys energy. Re-establishing a correct balance is the
aim of TCM. Energy is referred to as Qi, (pronounced chee) and is
described in terms of Yin energy quiet and calm and Yang energy
vigorous and exciting. They are complementary opposites and in health exist
in a dynamic but balanced state in the body. Practitioners of TCM believe
that stimulating certain Acupuncture points on the body can help to restore
the balance between Yin and Yang that becomes disturbed in illness.

AACP members combine TCM principles with scientific evidence as a

means of reducing pain and promoting healing, always with the aim of
enhancing physiotherapy treatments such as exercise and rehabilitation
techniques to promote recovery and improve quality of life.

Conventional acupuncture

Conventional acupuncture involves the use of single-use, pre-sterilised

disposable needles of varying widths, lengths and materials that pierce the
skin at the acupuncture points. The physiotherapist will determine the
locations of these points on the basis of an assessment of the cause of the
imbalance. A number of needles may be used during each treatment, and
these are typically left in position for between 20 and 30 minutes before
being removed.
Trigger point acupuncture may also be used to facilitate relaxation in
specific muscles following traumas, for longer-term unresolved muscle pain,
or as a means of increasing muscle length in order to aid stretch and
rehabilitation. In the latter case, the needle is inserted into the affected
muscle until the tissue is felt to relax under the needle, which is then
removed. Trigger point needling often produces an effect much more
quickly, and therefore, does not require the 2030-minute treatment time.
Acupressure
In acupressure treatment, physiotherapists use their hands to activate
acupuncture or trigger points in order to relieve muscle tightness, or to
stimulate Qi flow and balance the body. It is a healing art in which the
fingers are applied to key acupuncture points. The amount of pressure used
varies according to the condition and requires trained, sensitive hands. It is
often used to treat patients who are sensitive, those with a phobia of
needles, children and frail people.

Laser acupuncture
Laser is an acronym of "light amplification by stimulated emission of
radiation", and the use of these beams in treatment is known as low-level
laser therapy (LLT). Laser stimulation may be used to perform any
acupuncture treatment for which needles are typically used. It is particularly
suited for nervous patients, children, sports injuries, sensitive areas and ears.
This form of acupuncture may be available from physiotherapists who are
fully trained in the correct application of this treatment and its
contraindications.

Moxabustion and cupping

Moxabustion and cupping are techniques used to introduce warmth into the
acupuncture points, either at the end of theacupuncture needle in the case
of moxabustion, or to areas that require increased stimulation of Qi flow in
the case of cupping. These enhancements have the effect of increasing the
circulation, removing waste products, and reducing muscle spasm and pain.
Moxabustion and cupping may also be used as precursors to the
physiotherapist stretching the damaged tissue or mobilising a joint.
Conditions treated with these techniques include osteoarthritis, areas of
poor Qi flow and cold conditions.

Electroacupuncture
Following a detailed physiotherapy assessment, inserted needles can be
coupled to the electrodes of an electroacupuncture machine. These units are
designed to deliver variable amplitudes and frequencies of electrical
impulses. Low-frequency electroacupuncture is intended to contribute to the
mechanism of pain reduction, especially by stimulating chemicals in the
brain that aid analgesia, relaxation and sleep.
This technique is particularly useful in chronic pain problems and solid
research to supports its use. Your physiotherapist may use transcutaneous
electrical nerve stimulation (TENS) machines over specific acupuncture
points in order to help this mechanism and enhance pain modulation.

Why do physiotherapists do acupuncture?

Scientific research has examined the effectiveness of acupuncture for

various conditions. In recent years large studies have begun to emerge which
have helped to support the benefits of acupuncture treatment. For example
it is accepted that acupuncture can help tension-type headaches and pain of
osteoarthritis, for example osteoarthritis of the knee, especially when it is
used in conjunction with other treatments such as physiotherapy.
Physiotherapists use acupuncture to treat musculoskeletal disorders and
pain. Most courses do not teach you to treat other disorders such as
allergies, conception issues and addictions. However, acupuncture
treatment is holistic and during some treatment for pain you may find that
you aid in treating other problems.

Meridians and acupuncture points

There are about 400 acupuncture points and 20 meridians connecting most
of the points, however by the 2nd Century CE, 649 acupuncture points
were recognized in China. These 20 meridians include the "twelve regular
channels" or "twelve regular meridians", with each meridian corresponding
to each organ; nourishing it and extending to an extremity. There are also
"Eight Extraordinary Channels" or meridians, two of which have their own
sets of points, and the remaining ones connecting points on other channels.

Twelve standard meridians

Meridians are divided into Yin and Yang groups. The Yin meridians of the
arm are: Lung, Heart, and Pericardium. The Yang meridians of the arm are:
Large Intestine, Small Intestine, and Triple Warmer. The Yin Meridians of
the leg are Spleen, Kidney, and Liver. The Yang meridians of the leg are
Stomach, Bladder, and Gall Bladder.

Eight extraordinary meridians

The eight extraordinary meridians are of pivotal importance in the study of
Qigong, T'ai chi ch'uan and Chinese alchemy.[ These eight extra meridians
are different to the standard twelve organ meridians in that they are
considered to be storage vessels or reservoirs of energy and are not
associated directly with the Zang Fu or internal organs. These channels were
first systematically referred to in the "Spiritual Axis"

Contraindications and precautions to Acupuncture

Pregnant patients -should not be given acupuncture during the first

trimester if the wrong points are used there is a risk of miscarriage. Careful
selection of points should be used throughout the rest of pregnancy.
Diabetics- Care should be taken when needling the diabetic patient because
of a danger of poor peripheral circulation and the effects that acupuncture
can have on blood sugar levels.

Pacemakers- electroacupuncture should not be used on patients with a

pacemaker.

Confused patients- Acupuncture should not be used with confused

patients as they will be unable to o-operate with treatment.

Anti-coagulant medication- patients receiving anti-coagulant medication

are at risk of bleeding therefore extra care must be taken when treating these
patients.

Needle phobia this is a contraindication.

Known allergy to metal -this s a contraindication.

Infection infection to the area that requires treatment is a

contraindication.

PRACTICAL SESSION

1. Location of points
2. Inserting a needle

Large intestinal meridian

Gall Bladder meridian
Stomach meridian