Acupuncture, medical acupuncture, dry needling...call it what you want...has been shown to activate proprioceptive afferent receptors in muscle tissue, in particular the type 11 (flower spray type) which which contribute to numbing feeling associated with the needle sensation or ‘de qi’.1,2 Given the pain modulatory benefits of acupuncture are mainly attributed to sensory effects, the activation of these proprioceptors may be important from a mechanisms point of view.2
Manual therapy also activates proprioceptors (sometimes referred to as ergo or mechanoreceptors) about the muscle spindles and articular structures.3 When looking at the manual therapy literature and listening to experts4 discuss the proposed mechanisms which underpin its benefits, the role of proprioceptor activation is considered not only in terms of contribution to pain modulation, but also from functional point of view. In other words, manual therapy is associated with pain modulation, but can also be used to facilitate movement and exercise, help normalise faulty movement patterns etc.
So, my musing for this morning is should acupuncture research be focussing more on functional effects? i.e to what extent may acupuncture impact on specific functional outcomes which assess mobility, strength and control etc? Is acupuncture when combined with specific exercise more effective than one or the other on it’s own? What happens when manual therapy, exercise and acupuncture are combined?
From my own clinical experience, acupuncture, often in conjunction with manual therapy, is very helpful in modulating pain and normalising muscle tone which facilitates improved control of movement and exercise.
For me more of this type of research would be more interesting and clinically relevant than arguing over whether a needle inserted at point A vs point B is more effective on pain scores in an effort to show efficacy. Functional effectiveness studies are perhaps the way forward?
1. Wang KM, Yao SM, Xian YL, Hou ZL. A study on the receptive field of acupoints and the relationship between characteristics of needling sensation and groups of afferent fibres. Scientia Sinica. Series B, Chemical, biological, agricultural, medical & earth sciences. 1985 Sep;28(9):963-71.
2. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesthesia & Analgesia. 2008 Feb 1;106(2):602-10.
3. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual therapy. 2009 Oct 1;14(5):531-8.