The Background of Sports Performance
Sports performance can be defined by the level of an athlete’s physiological, psychological/social, tactical, and technical characteristics (Bangsbo, 2015). Physiological characteristics are the body's functional and structural responses to physical exercise, which are separated into four components: skill, muscle strength, endurance, and recovery (Larry Kenney et al., 2012). Assessing the level of an athlete’s physiological characteristics consists of methods such as the motor skill test (Paillard, 2019), the one-rep-max test to measure strength (Bryzcki, 2013), the Vo2 max test for endurance (Bundy and Leave, 2010), and the visual analogue scale to gauge levels of delayed onset muscle soreness (DOMS) within recovery (Delgado, 2018). Improving this characteristic involves extensive practice and repetition, strength and conditioning programs specific to the desired athlete’s needs, appropriate recovery methods, and time between training. A repercussion of athletes not meeting their required level of recovery may cause physical and psychological stress and can harm the athlete's performance (Braun-Trocchio et al., 2022).
A substantial body of literature has provided compelling evidence of the positive correlation between increased levels of anxiety, low levels of performance, and increased risk of physical injury (Ford et al., 2017). Furthermore, Burns et al. (2022) reported that more than 80% of athletes consider psychological/social characteristics related to their sporting success. Due to psychological/social characteristics being important in sporting performance, various tests have been created to measure multiple psychological/social factors such as motivation levels, self-confidence, somatic anxiety, cognitive anxiety, psychological preparation, and social support (Diaz-Tendero et al., 2020). In a study conducted by Rowland and Van Lankveld (2019), their findings suggest that approximately 30-60% of sporting participants suffer from sporting-induced anxiety.
Traditional Chinese Medicine Understanding of Sports Performance
Traditional Chinese Medicine (TCM) has a holistic approach to sports performance, rooted in balance and harmony within the body. Treatment may involve acupuncture needles inserted into specific acupuncture points along the body's meridians. Adapting TCM to an athlete’s sporting routine can strengthen their vitality, allowing them to achieve peak physical and mental performance (Yance and Tabachnik, 2007).
Optimal performance in TCM is obtained when the body's Qi, also known as vital force, is balanced and circulates smoothly throughout the body's meridians. Qi is a vital substance with many functions, such as warming, protecting, transforming, transporting, holding, and raising. It is also responsible for a person’s energy levels. Additionally, the Chinese proposed that Blood is the mother of Qi (Maciocia, 2015). Therefore, a sufficient flow of Blood is crucial for an athlete to maintain high energy levels and obtain optimal functioning of the body’s tissues, muscles, and organs during their performance and reduce the risk of injury (Chan and Wong, 2022). Additionally, the Blood in TCM houses the spirit, which is critical because psychological characteristics are crucial to sports performance.
Furthermore, Maciocia (2015) states that vigorous exercise can deplete the body's Qi and Blood. In 2018, Saavedra et al. reported that elite athletes participate in this form of exercise for around 5 – 8 hours per day. Physical overexertion is widely known to be a cause of disease in TCM (Chen-Tek Tai, 2012), and Wimmer (2004) states that it can have detrimental effects on an athlete's ability to perform and can lead to the athlete sustaining physical injuries. Therefore, re-establishing the smooth flow of Qi and Blood is crucial for an athlete to achieve their peak performance (Keji and Hao, 2003).
To What Extent Is Acupuncture Used for Sports Performance?
Yu et al. (2023) state that the use of TCM to enhance sporting capabilities can be traced back over 2,000 years. An increasing number of studies provide evidence of the ability of acupuncture to improve an athlete's physiological and psychological characteristics. Usichenko et al. (2009) documented a case of an athlete who adapted acupuncture into his athletic routine for specific symptoms impacting his performance. This resulted in him achieving a 5.8% decrease in his cross-country running time, improving from 10 minutes and 0 seconds to 9 minutes and 25 seconds. This case highlights the benefits that acupuncture can bring to an athlete's performance because it is tailored to their needs.
Watts (2005) found that over 70% of China’s top athletes incorporate acupuncture to reduce physical fatigue and prevent injury. Although this is an old citation, you can’t dismiss the fact that acupuncture may influence their success in sports. Furthermore, big names in the sporting world, such as David Beckham (football star), Vincenzo Nibali (recent winner of the Tour de France), Aaron Rodgers (one of the most respected quarterbacks in the NFL), and Kobe Bryant (NBA star) have all praised acupuncture for the benefits it brought to their athletic performance.
Research on Acupuncture Enhancing Sports Performance
Over the past two decades, various researchers have studied the effect of acupuncture on an athlete's recovery time. Delayed onset muscle soreness (DOMS) is a pain experienced, usually peaking at 24-48 hours, due to intense physical exertion. It can inhibit an athlete's motor performance and increase the risk of injury (Vickers, 2001). Data from several sources has found evidence that acupuncture can successfully reduce the intensity of an athlete's level of DOMS (Satpal, 2008; Hubscher et al., 2008; Itoh et al., 2008; Garlanger et al., 2016; Luetmer, 2019; Cardoso et al., 2020; Antonassi et al., 2021; Bailey, 2022). Other researchers, however, reported little evidence to support this claim (Barlas et al., 2000; Fleckenstein et al., 2015). An evaluation of the study conducted by Fleckenstein et al. (2015) highlighted failed components such as not placing acupuncture needles locally in the muscles that performed the task and failure to complete a total pain pressure threshold due to the researchers avoiding the chance of causing bruising to the participants. Their testing was completed 72 hours after exercise when evidence suggests the peak of DOMS can be felt at 24-48 hours.
Various studies have found a positive correlation between acupuncture and aerobic capabilities. Ehrlich and Klinkik (1992) conducted a single-blind study with thirty-six healthy men, and their findings reported a significant increase in the group that received acupuncture, establishing a 6.6% increase in anaerobic threshold compared to the 0.9% and 3.4% in the sham and control groups. Additionally, they discovered acupuncture could reduce the time of an athlete's HRR after exertion. Further investigation has been carried out by Zen-Pin et al. (2009), Pernambuco et al. (2020), and Tsopanidau et al. (2020) on this topic, and their studies all reported similar results. This is a remarkable finding for football players as Reinhardt et al. (2020) conducted a study on eighteen semi-professional footballers and found a strong correlation between their heart rate recovery (HRR) and their level of physical aerobic performance.
There is a growing body of literature documenting the benefits that acupuncture can provide for psychological factors in sporting performance, such as reducing pre-competition anxiety. The first recorded study in this area was in 2003 by Akimoto et al. and has been investigated a further four times by Shayestehfar et al. (2015), Shu et al. (2017), Zarei et al. (2017), Khojastefar et al. (2021), which all reported positive results, adding to the growing evidence that it is plausible acupuncture can aid in reducing pre-competition anxiety.
Akiomoto et al. conducted a study in 2003 with elite female football players to research the benefits that acupuncture treatment could bring to the players' physical well-being. The results showed an improvement in muscle tension and fatigue, a decrease in the production of stress hormones, and regulation of their mood.
References:
Akimoto, T. Nakahori, C. Aizawa, K. Kimura, F. Fukubayashi, T. Kono, I. (2003) Acupuncture and Responses of Immulogic and Endocrine Markers During Competition Medical Science Sports Exercise [Online] 35(8) pp.1296-1302 Available from: https://pubmed.ncbi.nlm.nih.gov/12900681/
Antonassi, D. Rodacki, C. Lodovico, A. Ugrinowitsch, C. Rodacki, A. (2021) Immediate Effects of Acupuncture on Force and Delayed Onset of Muscle Soreness Medical Acupuncture [Online] 33(3) pp. 203-2011 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236298/
Bailey, S. (2022) The Effect of Acupuncture on Reducing Pain and Stiffness of Delayed Onset Muscle Soreness (DOMS) Following Eccentric Loading Exercise International Journal of Sport Exercise Medicine [Online] Available from: https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise- medicine-ijsem-8-239.php?jid=ijsem
Bangsbo, J. (2015) Performance in sports--With a specific emphasis on the effect of intensified training Journal of Medical Science Sports [Online] 4 pp.88–99 Available from: https://pubmed.ncbi.nlm.nih.gov/26589122/
Barlas, P. Robinson, J. Allen, J. Baxter, G. (2000) Lack of Effect of Acupuncture Upon Signs and Symptoms of Delayed Onset Muscle Soreness Clinical Physiology [Online] 20(6) pp. 449-56. Available from: https://pubmed.ncbi.nlm.nih.gov/11100392/
Braun-Trocchio, R. Graybeal, A. Kreutzer, A. Warfield, E. Renteria, J. Harrison, K. Williams, A. Moss, K. Shah, M. (2022) Recovery Strategies in Endurance Athletes Journal of Functional Morphology and Kinesiology [Online] 7(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883945/
Bryzcki, M. (2013) Strength Testing – Predicting a One-rep Max from Reps-to-fatigue Journal of Physical Education [Online] 64(1) pp.222-236 Available from: https://www.tandfonline.com/doi/abs/10.1080/07303084.1993.10606684?journalCod e=ujrd20
Bundy, M. Leave, A. (2010) Training and Conditioning A Guide to Sports Injury and Management [Online] Available from: https://www.sciencedirect.com/science/article/abs/pii/B9780443068133000041
Burns, L. Weissensteiner, J. Cohen, M. Bird, S. (2022) A Survey of Elite and Pre- elite Athletes’ Perceptions of Key Support, Lifestyle and Performance Factors BMC sports science, medicine and rehabilitation [Online] Available from: https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-021- 00393-y#Tab3
Cardoso, R. Lumini-Oliveria, J. Santos, M. Ramos, B. Matos, L. Machado, J. Greten, H. Franconi, G. (2019) Acupuncture Can Be Beneficial for Exercise-Induced Muscle Soreness: A Randomised Controlled Trial Journal of Bodywork and Movement Therapies [Online] 24(1) pp. 8-14 Available from: https://pubmed.ncbi.nlm.nih.gov/31987567/
Chan, T. Wong, Y. (2022) Dynamic Balance: Integrating Principles of Traditional Chinese Medicine into Strength and Conditioning [Online] Available from: https://books.google.co.uk/books?id=REFXEAAAQBAJ&lpg=PT11&ots=YcXcDc6t_ A&dq=%22Qi%22%20%22athlete%22%20%22performance%22%20%22Chinese% 20Medicine%22&lr&pg=PT12#v=onepage&q=%22Qi%22%20%22athlete%22%20% 22performance%22%20%22Chinese%20Medicine%22&f=false [Accessed: 7, September 2023]
Cheng-Tek Tai, M. (2012) An Oriental Understanding of Health. Tzu Chi Medical Journal [Online] 24(2) pp. 92-95 Available from: https://www.sciencedirect.com/science/article/pii/S1016319012000122
Delgado, D. Lambert, B. Boutris, N. McCulloch, P. Robbins, A. Moreno, M. Harris, J. (2018) Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-Based Visual Analog Scale in Adults Academy Orthopaedic Surgeons Global [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132313/#:~:text=The%20visual%20 analog%20scale%20(VAS,%E2%80%9D%20and%20%E2%80%9Cworst%20pain. %E2%80%9D
Diaz-Tendero, P. Perez-Llantada, M. Llave, A. (2020) Psychometric Properties of the Psychological State Test for Athletes Front psychology [Online] Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.566828/full
Ehrlich, D. Haber, P. (1992) Influence of Acupuncture on Physical Performance Capacity and Haemodynamic Parameters International Journey Sports Medicine [Online] Available from: https://pubmed.ncbi.nlm.nih.gov/1428381/
Fleckenstein, J. Niederer, D. Aurbach, K. Bernhorster, M. Hubscher, M. Vogt, L. Banzer. (2015) No Effect of Acupuncture in the Relief of Delayed-Onset Muscle Soreness: Results of a Randomized Controlled Trial [Online] Available from: https://boris.unibe.ch/73388/1/00042752-900000000-99611.pdf
Ford, J. Iidenfonso, K. Jones, M. Arvinen-Barrow, M. (2017) Sport-related Anxiety: Current Insights Journal of Sports medicine [Online] 8(1) pp. 205-212 [Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667788/
Garlanger. K Fredricks, W. Aloc, A. Bauer, B. Laskowski, E. (2016) The Feasibility of Effects of Acupuncture in an Adolescent Nordic Ski Population The Journal of injury, function and rehabilitation [Online] 9(8) pp.795-803 Available from: https://onlinelibrary.wiley.com/doi/abs/10.1016/j.pmrj.2016.11.010
Hubscher, M. Vogt, L. Bernhorster, M. Rosenhagen, A. Banzer, W. (2008) Effects of Acupuncture on Symptoms and Muscle Function in Delayed-Onset Muscle Soreness The Journal of Alternative And Complementary Medicine [Online] 14(8) pp.1011- 1016 Available from: https://www.researchgate.net/profile/Markus- Huebscher/publication/23457253_Effects_of_Acupuncture_on_Symptoms_and_Mus cle_Function_in_Delayed- Onset_Muscle_Soreness/links/5567a96808aeccd777378bf6/Effects-of-Acupuncture- on-Symptoms-and-Muscle-Function-in-Delayed-Onset-Muscle-Soreness.pdf
Itoh, K. Ochi, H. Kitakoji, H. (2008) Effects of Tender Point Acupuncture on Delayed Onset Muscle Soreness (DOMS) – A Pragmatic Trial Chinese Medicine [Online] 3(14) Available from: https://link.springer.com/article/10.1186/1749-8546-3-14
Keji, C. Hao, X. (2003) The integration of traditional Chinese medicine and Western medicine. Cambridge University Press. [Online] Available from: https://www.cambridge.org/core/journals/european-review/article/abs/integration-of- traditional-chinese-medicine-and-western- medicine/2CE830CB634D7AB0F21928BD1C4C840A
Khojastefar, M. Self-Ghaffari, M. Memari, A-H. Halabachi, F. Seif-Barghi, T. (2021) A Randomized Crossover, Pilot Study Examining the Effect of Acupuncture in the Management of Competitive Anxiety in Athletes Journal of Acupuncture Meridian Study [Online] 14(4) pp.149-156 Available from: https://www.journal- jams.org/journal/view.html?uid=1060&vmd=Full
Larry Kenney, W. Wilcome, J. Costill, D. (2012) Physiology of Sport and Exercise 5th edition. [Online] Available from: https://www.mdthinducollege.org/ebooks/exercise_Physiology/Physiology_of_Sport_ and_Exercise_5th_Edition.pdf
Luetmer, M Do, A. Canzanello, N. Bauer, B. Edward, L. (2019) The Feasibility and Effects of Acupuncture on Muscle Soreness and Sense of Wellbeing in an Adolescent Football Population American Journal of Physical Medicine and Rehabilitation [Online] 98(11)pp. 964-970 Available from: https://journals.lww.com/ajpmr/abstract/2019/11000/the_feasibility_and_effects_of_a cupuncture_on.4.aspx
Maciocia, G. (2015) The Foundations of Chinese Medicine: A Comprehensive Text. Edinburgh: Churchill Livingstone.
Paillard, T. (2019) Relationship between Sport Expertise and Postural Skills Movement science and sports psychology [Online] Available from: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01428/full
Pernambuco, C. Vale, R. Valentim-Silva, J. Filho, C. Jesus, V. Borges, E. Cardoso, L. Regazzi, I. Dantas, E. (2020) Acupuncture on Lactate, Perceived Exertion in Recreational Athletes Submitted to HIIT Orthopaedics and Sports Medicine [Online] Available from: https://www.preprints.org/manuscript/202008.0034/v1
Reinhardt, L. Schulze, S. Kurz, E. Schwesig, R. (2020) An Investigation into the Relationship between Heart Rate Recovery in Small-Sided Games and Endurance Performance in Male, Semi-professional Soccer Players. Sports Medicine – Open. [Online] 6(43) Available from: https://sportsmedicine- open.springeropen.com/articles/10.1186/s40798-020-00273- 8#:~:text=The%20ability%20to%20recover%20in,on%20the%20short%2Dterm%20r ecovery.
Rowland, D. Van Lankveld, J. (2019) Anxiety and Performance in Sex, Sport and Stage: Identify Common Ground Front psychology [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646850/
Saavedra, J. Borgeirsson, S. Kristjandottir, H. Halldorsson, K. Gudmunsdottir, L. Einarsson, I. (2018) Comparison of Training Volumes in Different Elite Sportspersons According to Sex, Age and Sport Practised Journal of Sports Science
Medicine [Online] pp.37-42 Available from: https://www.mjssm.me/clanci/MJSSM_Sept_2018_Saavedra_37-42.pdf
Satpal, D. (2008) The Acute Effect of Acupuncture on 20-km Cycling Performance Clinical Journal of Sports Medicine [Online] 18(1) pp. 76-80 Available from: https://journals.lww.com/cjsportsmed/abstract/2008/01000/the_acute_effect_of_acup uncture_on_20_km_cycling.14.aspx
Shayestehfar, M. Seif-Barhi, T. Zarei, S. Mehran, A. (2015) Acupuncture Anxiolytic Effects on Physiological and Psychological Assessments for a Clinical Trial. [Online] Available from: https://www.hindawi.com/journals/scientifica/2016/4016952/
Shu, S. Yuan, Y. You, Y. Qian, X. Gu, W. Zhou, S. (2017) Wrist-Ankle Acupuncture for Precompetition Nervous Syndrome: A Randomized Controlled Trial Neuropsychiatry Neuropsychiatry [Online] 7(6): 1053-1060 Available from: https://www.jneuropsychiatry.org/peer-review/wristankle-acupuncture-for- precompetition-nervous-syndrome-a-randomized-controlled-trial.pdf
Tsopanidau, A. Chatzakis, P. Drimalas, P. Stavridis, I. Dallas, G. Zacharogiannis, E. (2020) Effect of Acupuncture in Physiological Parameters and Endurance Running Performance Sports Medical Physical Fitness [Online] 60(6) pp.841-847 Available from: https://pubmed.ncbi.nlm.nih.gov/32253895/
Usichenko, T. Gizhko, V. Wendt, M. (2011) Goal-Directed Acupuncture in Sports- Placebo or Doping Evidence-Based Complementary Alternative Medicine [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096472/#:~:text=Especially%20the %20placebo%20effect%20might,extraordinary%20sensitive%20to%20placebo%20ef fects.
Vickers, A. (2001) Time Course of Muscle Soreness Following Different Types of Exercise BMC Musculoskeletal Discord 2(5) [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC59671/
Watts, J. (2005) Feature: Olympian Pins and Needles Supplement [Online] 336(1)pp. 62-63 Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(05)67857-9/fulltext
Wimmer, R. (2004) Athletes and Overtraining: A Traditional Chinese Medicine Perspective. Acupuncture today. [Online] Available from: https://acupuncturetoday.com/article/28455-athletes-and-overtraining-a-traditional- chinese-medicine-perspective
Yance, D. Tabachnik, B. (2007) Breakthrough Solutions in Herbal Medicine Apoptogenic Formulas: The Way to Vitality Townsend letter: The examiner of Alternative medicine [Online] Available from: https://go.gale.com/ps/i.do?id=GALE%7CA157081507&sid=googleScholar&v=2.1&it =r&linkaccess=abs&issn=&p=AONE&sw=w&userGroupName=anon%7E873f041e& aty=open-web-entry
Yu, Z. Wang, W. Yang, K. Gou, J. Jiang, Y. Yu, Z. (2023) Sports and Chinese herbal medicine Pharmacological research – modern Chinese medicine [Online] Available from: https://www.sciencedirect.com/science/article/pii/S2667142523000763
Zarei, S. Shayesterhfar, M. Memari, A-H. SeifBarghi, T. Sobhani, V. (2017) Acupuncture Decreases Competitive Anxiety Prior to a Competition in Young Athletes: A Randomized Control Trial Pilot Study Journal of Complementary and Integrative Medicine [Online] Available from: https://www.degruyter.com/document/doi/10.1515/jcim-2015-0085/html
Zen-Pin, L. Chung-Yuan, W. Tsong-Rong, J. Tso-Chiang, M. Fan, C. Juang-Geng, L, Jen-Jeng, H. Tsung-Jung, H. (2009) Effect of Auricular Acupuncture on Oxygen Consumption of Boxing Athletes Chinese Medical Journal [Online] 122(13)pp. 1587- 1590 Available from: https://journals.lww.com/cmj/fulltext/2009/07010/effect_of_auricular_acupuncture_on _oxygen.22.aspx
Comments