Big Game, Little Needles: Acupuncture in Professional Football

Note from the Karim Khan, Editor BJSM: 

I expect this blog to generate a lot of discussion. On the one hand will be the folks who argue that if there are no RCTs for a treatment then it shouldn’t be discussed on the BJSM blog. If we extend that argument then Jenny McConnell’s taping for knee pain should have been banned from its birth in 1989 until the RCT that proved its value 20 years later. Similarly we wouldn’t have knee arthroscopy for meniscal tears or arthroscopic ACL reconstruction. No RCT, no treatment. 

On the other hand, there are clinicians who treat patients and who swear by a technique that provides patient-reported benefits. In many cases the clinician has no incentive to conjure up a treatment effect and the patient is entering the clinical contract in good faith. You’ll see example of that abounding in the piece below. 

BJSM revels in criticism so if you have an opinion about this fire away – via letters, your favourite social media channels; feel free to submit a’discussion’ or an ‘editorial’ submitted to the BJSM.  Instructions for authors here

Press Release emailed to BJSM (among others) by The Acupuncture Association of Chartered Physiotherapists

Football is the most internationally recognised sport of our era with the FIFA World Cup one of the most watched events worldwide, reaching a global in-home television audience of 3.2 billion in 2014. Due to the strenuous, repetitive movements and physical contact they endure on a regular basis, professional footballers are rarely short on injuries needing treatment. Given the detrimental effect on training and results, clubs need to focus on prevention and treatment for such injuries to ensure success. Football teams increasingly employ acupuncture to treat musculoskeletal injuries and long term conditions. Acupuncture is used both on its own and in conjunction with other therapies such as physiotherapy.

One team that has utilised acupuncture to support its players is Notts County FC who recently let the Acupuncture Association of Chartered Physiotherapists (AACP) film inside their treatment room. Watch full video here:

<iframe width=”560″ height=”315″ src=”https://www.youtube.com/embed/sxbMACk9lGk” frameborder=”0″ allowfullscreen></iframe>

Head of Sports Medicine Johnny Wilson advocates for players’ autonomy of care and as such always gives his players the option of acupuncture, many of whom have seen benefits to their fitness and performance. Wilson sees acupuncture’s value as one part of a multi-model approach to footballer’s physiotherapy. He often uses it as an additional method to more standard treatment regimes. Wilson states:

“We have three aspects to our philosophy; reduce their risk of injury, improve their athletic performance and help them tolerate the demands of the game . . . we look at how we can enable the players to run economically and efficiently”.

Notts County Player-Manager Kevin Nolan highlights acupuncture’s role within professional football:

“Acupuncture has become a part of everyday modern football. You see it used often, there wouldn’t be a day go by that I wouldn’t see the needles come out. It’s something, if we’re going to be moving forward as a medical department, that we need to study and know about and make sure we don’t get left behind and we can give our athletes the best possible rehab.”

Notts County Midfielder Curtis Thomson, who receives acupuncture within the video, comments that as a midfielder he amounts a lot of running time during matches and training which causes his back and legs to cease up “I find that the acupuncture helps release [the tension] and gives me more mobility on the pitch”. Within the video we see Wilson acupuncture three points to treat Curtis’s acute hamstring pain alongside the exercise and stretches that make up the holistic approach championed at the club.

There are many proposed theories of how acupuncture works. One western medical theory discussed by Wilson within the video puts forward that acupuncture modulates spinal signal transmission and the brains perception of pain. Wilson summarises how Acupuncture does this in a three-fold effect:

  • Local tissue – the inserted needle provides the initial stimulus which creates a local trauma around the needle. This causes a release of calcitonin gene peptides (thought to play a role in the transmission of pain) and histamines which causes a local flammatory response around the needle.
  • Spinal segmental approach – following the initial response from the insertion of the needle delta fibres are excited, they in turn excite beta endorphins and encephalons. These neurotransmitters work to decrease the input of pain by asking the brain to attend to the needle rather than the pain that the patient was originally experiencing.
  • Supraspinal – cells within the spinal cord communicate with specific areas of the brain, in response, further neurotransmitters are released which help block the sensation and perception of pain.

Wilson concludes “you’re almost taking your own painkillers.”

Ex-England Striker Alan Smith also credits acupuncture for a quick recovery before a Champion’s League quarter finale against Deportivo de La Coruña. “The Saturday before the Tuesday evening game I had a bad effusion on my right calf . . . I got to Tuesday mid-afternoon and I was still struggling to make any progress. The physio said to me do you want to try acupuncture. That was my first experience and with great results . . . it just dispersed of all the hematoma that I had around that area, the initial reaction was great, I managed to play a full game. I was probably a major doubt for the game beforehand.”

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The Acupuncture Association of Chartered Physiotherapists (AACP) is a professional network representing physiotherapists who are interested in integrating Western Evidence Based Acupuncture into mainstream Physiotherapy for the management of pain and systemic conditions. The AACP represents over 6,000 members making it the largest professional body for acupuncture in the UK. AACP members are all qualified and chartered physiotherapists who have successfully completed acupuncture training at a postgraduate level. Acupuncture combined with physiotherapy is widely accepted within both the National Health Service (NHS) and private practice. Your local AACP acupuncture-physiotherapist can be found by visiting aacp.org.uk

Full references on file at the AACP.
Organization contact: jennifer@aacp.uk.com

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  • The Sp⚽️rts Physio

    Very interesting reading, thanks Jonny and Karim for posting.

    I fully agree and support that treatments such as knee taping, scopes and ligament reconstructions need a chance to establish evidence of their effect and worth. However, we can not say that acupuncture hasn’t had its chance to prove its effect and worth.

    There has been decades of research, and multiple systematic reviews that show its effects are nothing more than placebo. It doesn’t matter how or where you place these needles, it doesn’t even matter if you puncture the skin or not. The effects are comparable to sham and placebo.

    So the question is are we telling athletes and players that we are treating them with placebos? And are we happy to offer placebo treatments? If so where do we draw the line?

    Maybe prescriptions of lucky pants and sugar pills will be next?

    Cheers

    Adam Meakins

  • Hugo Silva Pinto

    Maybe we should really learn what is called sham or placebo acupuncture or at least tell the truth to athletes and health professionals about the so called placebo or sham acupuncture!

    Placebo or sham acupuncture on any type of study, is called to the puncture of any tissue (skin, muscle, fascia, joints or periosteum) 1-5 cm besides what is considered to be an acupuncture point, based on Tradicional Chinese Medicine approach.

    No matter the approach with needling, TCM or not, if you puncture the same tissues with the same innervation can you actually expect a different outcome?

    Those who compare Acupuncture with Sham/Placebo Acupuncture but don’t elucidate what sham is, actually are comparing Acupuncture with Acupuncture.
    So how can you expect a different result?

    If you stimulate the same nerve, neurological segments and motor points and expect a different result, that means that you do not know anatomy and neuroanatomy or even neurophysiology!
    That means that you haven’t been reading the last 30 years of research in neurophysiology of pain!!!
    That is a serious bias in learning and transmiting knowledge.