J Appl Physiol

91: 2471–2478, 2001.

Biomechanical response to acupuncture
needling in humans

HELENE M. LANGEVIN,1 DAVID L. CHURCHILL,1 JAMES R. FOX,2 GARY J. BADGER,3
BRIAN S. GARRA,4 AND MARTIN H. KRAG2
1
Departments of Neurology, 2Orthopaedics and Rehabilitation, 3Medical Biostatistics, and
4
Radiology, University of Vermont College of Medicine, Burlington, Vermont 05405
Received 23 March 2001; accepted in final form 25 July 2001

Langevin, Helene M., David L. Churchill, James R. and/or pistoning (up-and-down motion) of the needle.
Fox, Gary J. Badger, Brian S. Garra, and Martin H. Needle manipulation can be brief (a few seconds), pro-
Krag. Biomechanical response to acupuncture needling in longed (several minutes), or intermittent depending on
humans. J Appl Physiol 91: 2471–2478, 2001.—During acu- the clinical situation (33). Even when electrical stimu-
puncture treatments, acupuncture needles are manipulated
lation is used (a relatively recent development in the
to elicit the characteristic “de qi” reaction widely viewed as
essential to acupuncture’s therapeutic effect. De qi has a
history of acupuncture), a certain amount of manual
biomechanical component, “needle grasp,” which we have needle manipulation is usually performed immediately
quantified by measuring the force necessary to pull an acu- after needle insertion (6, 40).
puncture needle out of the skin (pullout force) in 60 human Traditionally, manipulation is performed to elicit the
subjects. We hypothesized that pullout force is greater with characteristic reaction to acupuncture needling known
both bidirectional needle rotation (BI) and unidirectional as “de qi.” De qi has a sensory component perceived by
rotation (UNI) than no rotation (NO). Acupuncture needles the patient as an ache or heaviness in the area sur-
were inserted, manipulated, and pulled out by using a com- rounding the needle and a simultaneously occurring
puter-controlled acupuncture needling instrument at eight biomechanical component that can be perceived by the
acupuncture points and eight control points. We found 167 acupuncturist (3, 6, 10, 16, 33). We refer to this com-
and 52% increases in mean pullout force with UNI and BI, ponent as “needle grasp.” During needle grasp, the
respectively, compared with NO (repeated-measures ANOVA,
acupuncturist feels as if the tissue is grasping the
P ⬍ 0.001). Pullout force was on average 18% greater at
acupuncture points than at control points (P ⬍ 0.001). Needle needle such that there is increased resistance to fur-
grasp is therefore a measurable biomechanical phenomenon ther motion of the manipulated needle (6, 10, 38, 40).
associated with acupuncture needle manipulation. This “tug” on the needle is classically described as “like
a fish biting on a fishing line” (48). Needle grasp can
acupuncture meridians; connective tissue range from subtle to very strong, with pulling back on
the needle resulting in visible tenting of the skin (16,
21). During acupuncture treatments, needle manipu-
ALTHOUGH ACUPUNCTURE IS INCREASINGLY USED for the lation is used to elicit and enhance de qi, and de qi is
treatment of pain and other conditions (27, 37), the used as feedback to confirm that the proper amount of
rational basis underlying its use remains unclear (2). needle stimulation has been used.
Western medical experts have been inherently skepti- De qi is widely viewed as essential to acupuncture’s
cal of acupuncture’s therapeutic value. One reason is therapeutic effectiveness (6, 10, 16, 23, 33, 40). Docu-
that it seems very unlikely that the simple act of mentation of de qi has been used as a criterion for
inserting fine needles into tissue could elicit any effect evaluating the adequacy of both manual and electrical
at all, let alone wide-ranging and long-lasting thera- acupuncture treatments in clinical trials (13, 46). Nee-
peutic effects. Hypodermic needles are routinely used dle manipulation, de qi, and needle grasp, therefore,
in Western medicine, and their insertion into the body are potentially important components of acupuncture’s
is not considered therapeutic. Acupuncture needles are therapeutic effect, yet the mechanisms underlying de
of a finer gauge than even the finest needles used for qi and needle grasp are unknown.
intradermal injections, and acupuncture rarely results As a first step toward understanding the physiolog-
in a single drop of blood being discharged. ical and therapeutic significance of de qi, we have
What is not widely appreciated by nonacupunctur- quantified needle grasp by measuring the force neces-
ists, however, is that acupuncture typically involves sary to pull an inserted acupuncture needle out of the
manual needle manipulation after needle insertion (3, tissues (pullout force). We hypothesized that pullout
6, 16, 33, 40). Manual needle manipulation consists of force is greater with two different types of needle
rapidly rotating (back-and-forth or one direction)
The costs of publication of this article were defrayed in part by the
Address for reprint requests and other correspondence: H. M. payment of page charges. The article must therefore be hereby
Langevin, Dept. of Neurology, Given C423, Univ. of Vermont College marked ‘‘advertisement’’ in accordance with 18 U.S.C. Section 1734
of Medicine, Burlington, VT 05405 (E-mail: hlangevi@zoo.uvm.edu). solely to indicate this fact.

http://www.jap.org 8750-7587/01 $5.00 Copyright © 2001 the American Physiological Society 2471

used for both acupuncture point and corresponding control puncture point was determined by palpation. Sanyinjiao (Sp6). Langevin) according to pressibility (subcutaneous tissue vs. fraction of the distance linear array transducer. With ultrasound im- were identified and marked with a skin marker (16 acupunc. These groups differed only Determination of Needle Insertion Depth in type of needle manipulation used (BI. CA) equipped with a 7-MHz proportional measurements (e. Zhongdu (GB32). Healthy volunteers aged 18–55 yr were invited to participate. Each acupuncture point was therefore Study Protocol paired with a corresponding control point on the opposite side Study protocol was approved by the University of Vermont of the body. METHODS Fig. Volunteers taking anti-inflammatory or anti. the nearest bone and joint. General Clinical Research Center between June 2000 and December 2000. together with the historical importance of this technique. For each location.” we also hypothesized that pullout force is greater at classically defined acupuncture points than at nonacu- puncture control points. where S was the slight depression or yielding of tissues. Approximate position was determined aging was performed with an Acuson 128 ultrasound ma- in relation to anatomic landmarks (e. Each enrolled volunteer Throughout testing. Testing was not scheduled during menstru. 1. a similar “dummy” procedure was performed and then disregarded. will suggest that needle manipulation may indeed play an impor- tant role in acupuncture therapy. For each location.org . A computer-controlled acupuncture needling instrument was fabricated and used to perform all needling procedures (needle insertion. during see or hear any indication of which side was used for each which a total of 16 points on the body received acupuncture point (acupuncture and control) and which needle manipula- needling. On the side selected for acupunc- inflammatory medication. located on the forearm and lower leg and 3 cm in radius for histamine medications were asked to discontinue their use 3 points located on the upper arm and thigh. On the side selected vascular disease. the perimuscular fascia is visible as an echogenic line ture points total). acute or chronic corticosteroid therapy. the acupuncture point’s meridian and as far as possible from ation to avoid possible discomfort due to cessation of anti. a disk-shaped template was centered on the extensive scarring or dermatological abnormalities in the acupuncture point. one of three experimental groups. Mountain View. aging. the precise position of each acu.g.jap. After consenting. Zusanli (St36). The transducer was always held between wrist and elbow creases) (6).. and for control point. neuromuscular disease. bleeding disorder. or NO). subjects were neither told nor able to participated in one testing session lasting 2–3 h. muscle). M. Acupuncture points were identified by an separating two tissues of different echogenicity and com- experienced acupuncturist (H. feeling for a point and was calculated as: D ⫽ S ⫹ 1. To test these hypotheses.5 cm. Kongzui (Lu6). These measurable effects. and Chengshan (B57). The term “acupuncture/control location” is here- Institutional Review Board. informed consent was control points. The control point days before testing. The same needle depth (D) was eated by these landmarks. Eight traditional acupuncture point locations were inves. a pair of corresponding tion depth was determined based on ultrasound measure- acupuncture points on the right and left sides of the body ment of subcutaneous tissue thickness. or UNI) was being performed. Abbre- viations in parentheses correspond to acupuncture meridians and The study was conducted at the University of Vermont point numbers (6). The disk was 2 cm in radius for points areas tested.2472 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING manipulation commonly used in acupuncture practice [bidirectional (BI) and unidirectional (UNI) needle ro- tation] than with needle insertion with no manipula- tion (NO). Since de qi is tradi- tionally believed to be greater at “acupuncture points. collagen for acupuncture point and control point. Exclusion criteria were a history of right and left sides of the body were then randomly selected diabetes. tendons) and chine (Acuson. 1). ture point. Female volunteers were excluded if they was marked on the perimeter of the disk at a 45° angle from were pregnant. Qinling Study Site and Participants (Ht2). For each acupuncture/control location. UNI. Needle-insertion depth was standardized and based on tissue measurements made by ultrasound. manipulation. subcutaneous tissue thickness measured by ultrasound at J Appl Physiol • VOL 91 • DECEMBER 2001 • www. bones. BI.g. perpendicular to the skin. target needle inser- tigated (Fig. each subject was randomized into tion type (NO. The following acupuncture points were used in this study: Hoku (LI4). Ultrasound im- traditional methods. this will demonstrate that needle manipulation has measurable biomechanical effects.. If proven true. Protocol summaries were mailed after used to refer to a corresponding pair of acupuncture and to volunteers for review. and pullout) as well as measurement of pullout force. Quchi (LI11). Within the area delin. and written. obtained on the day of the study. we carried out an experi- ment in which normal human subjects received differ- ent types of acupuncture needle manipulation at eight acupuncture points and eight corresponding control points.

and. pullout. 12. This is necessary eliminated many potential sources of investigator bias. cutaway view with needle retracted. This ensured consistent experimental conditions and initiated.org . grip (which are mounted to the loadcell’s live side) is signif- a personal computer fitted with a servomotor controller. the needle is robotically advanced into the tissue tissue on the needle. This because the weight of the needle rotation motor and needle system consists of a hand-held needling instrument (Fig. nipulation. From left to right: cutaway view with needle extended. Inset shows needle in extended position. significant tissue compression artifact was found. Just enough force is applied acupuncture points from seven different acupuncture text. inset). B: needling instrument in use. This formula for needle depth was against a subject’s skin in the appropriate location and ori- based on compiling needle depth guidelines for the listed ented perpendicular to the skin. Fig.jap. to maintain light contact with the skin. A 500-g capacity tared. and custom-written control and data acquisition software. pulled out of the tissue. rotated to perform manipulation (if called for). we found that the investigator could easily Acupuncture Needling maintain skin contact without causing visible skin compres- sion throughout a pullout test. side view. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2473 the acupuncture point. To perform a pullout test. and therefore upper and lower limits of the listed ranges for each point. evaluation tests. Taring the system needling instrument contains two miniature servomotors. the loadcell reading is tared. 33. In loadcell readings are not affected by pressure against the a pilot study of subcutaneous tissue measurements in 16 skin by the foot of the instrument. The icant compared with typical pullout force. the system operates in the 2. All needling procedures (insertion. 2). 6. with the instrument in its final orientation compensates for both of which are controlled by the computer. The loadcell is phys- books (1. needle depth determination sure. ma. 47) and averaging the suggested ically isolated from the skin-contacting foot. A: design schematic of acupuncture needling instrument. and within this range no Needling system. 3. 39. motion (needle insertion and pullout). and pullout-force measurement) were After the instrument has been properly positioned and performed by a computer-controlled acupuncture needling oriented but just before the needling procedure has been system. Applying too much pres- subjects (8 men and 8 women). In at each acupuncture point in all subjects. The investigator holds the instrument after a 10-s delay. however. needling procedure is initiated. through a hole in the instrument’s skin-contacting foot (Fig. can compress the underlying tissue and could using the above formula fell within the recommended ranges potentially influence how the tissue responds to needling. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. 2. The first motor this gravity-induced loadcell signal such that only those is coupled to a ball leadscrew and generates linear needle forces exerted by the tissue on the needle are recorded. Under the computer’s strain-gauge loadcell measures all axial forces exerted by the control. The second motor Once the instrument has been positioned and the loadcell generates needle rotation (manipulation). following manner.

direction of rota- tion. unidirectional rotation. Subjects randomized to the three needle-manipulation lation to rapid and forceful needle movements. Pullout- rotations each for BI. amount of rotation. All other needling parameters with the force outcome measure quantifies the force required to over- exception of needle insertion depth (see above) were held come the attractive forces between needle and tissue. Fig. After ultrasound imaging was per. Approximate (verified by an observer). a new sterile disposable needle appropriate. cal software. Pairwise comparisons among means. the number of needle rotations for needle manipulation was 16 clockwise for UNI and 16 The needle-grasp component of de qi is an increase in the alternating clockwise and counterclockwise cycles of four gripping of the acupuncture needle by local tissues. In this study. the instrument was (18). 40. Shimizu. Data corresponding to pullout mm in diameter was mounted in the needling instrument. bidirectional rota- tion.org . 3.25 cant difference (LSD) test. Because across the three needle-manipulation types. For each point. ized to right or left side for each acupuncture/control location dled before control points within each acupuncture/control within subjects. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. Experimental needle insertion depth at each control point was set according design was treated similar to a split-plot with subjects ran- to ultrasound measurements at the corresponding acupunc.g. the data acquisition system insertion speed was 10 mm/s. which correspond to the antilog of the avoid any visible compression of skin by the instrument arithmetic means of the log-transformed data.. Activation of a push-button switch standard errors associated with geometric means were com- initiated the needling procedure as described above. used to assess differences in mean pullout force and needle- formed. the appropriate insertion depth for each acupunc. M. needle dwell time was 2 s before manipulation and cell. Graphical descriptions of needling procedure types and examples of corre- sponding pullout force measurements. NO. ␹2-tests. ranging from almost no manipu. Wallis tests. or 50 mm in length and 0. In this study. 3): needle the entire needling procedure. rotation speed. respectively.2474 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING Needling parameters. all motion parameters (e. types were compared with respect to age. 3). The peak force occurring during the pullout phase was 10 s after manipulation. plot) and acupuncture and control points (subplot) random- tween marking and needling. insertion depth between acupuncture and control points and ture/control location was entered into the computer. acupuncture points were nee. Needle-manipulation techniques vary widely in clinical practice. Statistical analyses were performed using SAS statisti- disinfected by submerging in isopropyl alcohol for 30 s. BI. continuously recorded the needle force detected by the load- tions/s. insertion speed. During constant across all points and all subjects (Fig. Outcome Measure pendently set. pullout speed) can be inde. no nee- dle manipulation. when location. Between puted based on the method described by Kendall and Stuart test points within the same subject. UNI. Repeated-measures ANOVA was Needling protocol.jap. Langevin). Be. Peak force detected during needle pullout was taken as the pullout force. Top: programmed linear insertion/retrac- tion (dashed line) and rotary manipula- tion (solid line) motion of acupuncture needle for the three experimental groups. gender. and Kruskal- were chosen for BI and UNI. all parts of the instrument that came in computer controlled. insertion contact with the subject or the needle were steam sterilized. needle manipulations performed by an acupuncturist trained in a variety of different acupuncture needling techniques Statistical Methods (H. dwell time. These automatically identified and saved as the pullout-force out- parameters were determined by observing and simulating come measure (Fig. domized to one of the three needle-manipulation types (whole ture point and to minimize repositioning of the subject be. depth. Because the needling instrument is tween subjects. All means presented for pullout force enough pressure to maintain light contact with the skin to are geometric means. The needling normality and homogeneity of variance assumptions associ- instrument was then held by hand against the skin using just ated with ANOVA (5). and body needle manipulations corresponding to “moderate” practice mass index (BMI) by using ANOVA. were performed by using Fishers least signifi- (Seirin. rotation speed was 8 revolu. pullout speed was 5 mm/s. These differed only in the needle manipu- lation used. force were log transformed before analysis to satisfy the Skin at each point was disinfected with alcohol. Japan) 30. Needle-motion parameters are listed in text. Bottom: examples of the re- sulting axial force on the needle.

with three (Ht2. Secondary analyses were performed comparing pull- out force within needle-manipulation types and within point types (acupuncture vs. a greater types [NO: 21.e.2 ⫾ 0. BI [acupuncture point: 60. Mean pullout force was also significantly greater at acupuncture points than at corresponding control points [F(1. Fig.19) ⫽ 9.3 g compared with 53.4. 4C). P ⫽ 0.05).05). There was no evidence that differences between nee- dle-manipulation types were dependent on point type (i. F(1. Height of bars represents geometric means.8 g) (Fishers LSD.001) different between needle-manipulation types (A) and between icantly different from the others (Fishers LSD.4 g. 4. control) [F(2.4 g. point: 51.0 g. Our measurements of pullout force are the first tical significance (P ⬍ 0. Means and SD for age and BMI of participants that completed the study were 37. Fig. LI4.001. points than at control points in seven out of the eight DISCUSSION locations tested (Ht2.2 ⫾ 7. F(1. LI11. Means are also signifi- cantly different between acupuncture and control points with NO. Mean pullout force (⫾SE) for UNI (97.41 mm.19) ⫽ 4. completed the testing protocol.5.001 for control points].6 ⫾ 0.3 kg/m2. 4. P ⫽ 0. Fig. and the latter was significantly greater than that for NO (36.5 ⫾ 5. Pairwise compari. significant differences were found among the manipulation types [F(2. acupuncture vs. P ⬍ acupuncture points and control points (B).8. P ⬍ BI.5 ⫾ 5.2 yr and 26. quantification of needle grasp.48 for needle manipulation by point-type interaction].57) ⫽ 0. St36. P ⬍ 0. consisting of 38 women and 22 men. P ⬍ 0. differences in pullout force between acu- puncture and control points not were dependent on the type of needle manipulation.5 ⫾ 2. Within acupuncture and control points.50 mm.3 ⫾ 8. Error 0.73. insertion depth across the three needle-manipulation trol locations was not the aim of our study. P ⬍ 0. the primary outcome measure. and UNI (C).0 g at control points. Fig.001].7 ⫾ 1.2 g. P ⫽ 0. UNI: average pullout force was observed at acupuncture 22. LI11. BI: 22..57) ⫽ 1. 4A]. Means are significantly (P ⬍ sons indicated that each manipulation type was signif.9 ⫾ 2.7 ⫾ 1.9 ⫾ 0.37 mm. control point: 87.5 ⫾ 2.0. Significant differences in pullout force were observed across the three needle- manipulation types [F(2. Lu6.35]. control bars represent SE. 4B]. Conversely.07. a biomechanical aspect J Appl Physiol • VOL 91 • DECEMBER 2001 • www.57) ⫽ 18. respectively. and Sp6) achieving statis. F(1. P ⫽ 0. There was no significant difference in mean needle- Although the testing of individual acupuncture/con.1 g.19) ⫽ 26.5 ⫾ 0.9. Sp6.8 ⫾ 2.7 g).jap.001 for acupuncture points and F(2.007] and UNI [acupuncture point: 109.57) ⫽ 75.3 g. P ⬍ 0. F(2.57) ⫽ 62.039]. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2475 RESULTS Study Participants Sixty-one volunteers were enrolled in the study.001. is graphically displayed in Fig. The remaining 60. There were no significant differences with respect to these subject characteristics between the groups of subjects randomized to the three needle-manipulation types.5.57) ⫽ 49.5 g) was significantly greater than that for BI (55. 0. Pullout force measurements. Acupuncture and control points also differed different across the three needle-manipulation types within both significantly within NO [acupuncture point: 38. 1. Means are significantly 0. P ⬍ 0. One female participant withdrew during testing because of discomfort associated with the testing procedure.1 ⫾ 10.org .05). control. Mean pullout force at acupuncture points was 63.7 ⫾ control points and acupuncture points (C). and B57). Pullout-Force Measurements Pullout force. control point: 34.0.

In an electron microscopy Fig. A mechanism involving ture points and control points. Pullout forces of grasping the needle (21. and removal. we observed a pronounced increase in the nipulation increased pullout force at both acupuncture thickness of subcutaneous tissue surrounding the nee- points and control points. With BI. whereas needle grasp is ob- served within seconds of inserting and manipulating the needle. Needle grasp can be observed at locations winding alternates with unwinding. Example of the amount of torque developing at the needle- study of debris found on acupuncture needles after tissue interface during UNI (A) and BI (B) in a human volunteer. once the needle has involving these tissues include increased turgidity. It is therefore likely that. gen around the needle (21). Figure 5 shows the amount of torque nonquantitative evaluation of electromyographic activ. muscle contraction is not the primary mech. A frequently stated opinion is that needle continuously as needle rotation proceeds. Con- traction of fibroblasts. manipulation. Be- dle grasp. the magnitude of this winding of connective tissue is consistent with our difference was much smaller than the difference finding of greater pullout force with UNI than with BI. 45). is well documented in vitro (20). caused by manipulation of the needle. Increased tissue turgidity. we propose that needle grasp. Together. 5B). a mechanism in- anism responsible for this phenomenon. 16). Whether such rapid cytoskeletal changes in connective tissue fibroblasts can themselves result in measurable contractile forces at the tissue level is at the present unknown. is likely to occur as a compo- nent of the triple inflammatory response to the injury created by the acupuncture needle. in which needle grasp (Fig. 5A) and BI (Fig. human subjects by measuring the electrical current enced by needle manipulation and that this effect is not delivered to the motor during the different manipula- unique to acupuncture points. Tenting of skin observed A mechanism involving winding of tissue is attrac- during needle grasp when the needle is pulled back tive because this would greatly amplify the friction also suggests that layers superficial to muscle are force between tissue and needle (17). 5A). but unwinding is where no skeletal muscle is present (such as at the incomplete. the only published study supporting this view is a sively increased. Needle ma. resulting from extravasa- tion of protein-rich fluid. Contraction of connective tissue has not been studied in relation to acupuncture but is a potentially impor- tant component of the needle-grasp phenomenon. 40). The potential subcutaneous connective tissues. Increased tissue turgidity because of the triple inflammatory response is therefore unlikely to be the mechanism underlying needle grasp. 5B). compared with NO. However. final torque at the end of each rotation cycle progres- ever. several hundred grams represent substantial loads although contraction of muscle may occur during nee. The continuously increasing was subjectively rated by the acupuncturist (34).2476 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING of the characteristic de qi reaction widely viewed as insertion. with UNI. Kimura et al. developing at the needle-tissue interface during UNI ity during acupuncture needling. tion procedures.jap. Winding of connective tissue around the needle dur- ing needle rotation is another possible mechanism con- tributing to needle grasp. Although we also found an dle after needle rotation.org . With BI. the grasp is caused by a muscle contraction (15. We (19) observed elastic and collagen fibers that were found 167 and 52% increases in pullout force with UNI entwined around the needle. and winding of tissue around the needle during needle rotation. resulting in a gradual build up of torque in wrist) and on palms and soles where there are no the tissue (Fig. explants. cause of its self-amplifying nature. the ear- liest evidence of arteriolar dilation leading to protein extravasation during the triple response occurs 10–15 min after injury (9. 5. Tissues likely volving winding quickly can result in strong mechani- involved in needle grasp are therefore the skin and/or cal coupling between needle and tissue. essential to the therapeutic effect of acupuncture. arrector pili smooth muscles. The mechanism underlying needle grasp is currently the torque required to rotate the needle increased unknown. Possible mechanisms importance of this effect is that. with visible winding of colla- 18% difference in mean pullout force between acupunc. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. In a study using rat tissue and BI. How. We typically observed that. contraction. these An estimate of needle torque could be obtained in our results indicate that needle grasp is strongly influ. We torque during UNI is consistent with tissue winding believe that muscle contraction is not the source of around the needle (Fig. occurring over seconds to min- utes and involving polymerization of soluble actin and formation of actin stress fibers. respectively. given the small diameter (250 ␮m) of the needle.

The technique of practice. Apparent therapeutic effects acupuncture needle manipulation and biomechanical observed at control points were attributed to the “non. This study constitutes a differences in therapeutic response between acupunc. tendon) (6. Some differences nevertheless necessarily ex- needle manipulation appears to have pronounced ef. nonacupuncture points. with illustrations. Elim- would be expected to occur wherever connective tissue ination of feedback-driven adjustments in needling is present but may also vary depending on local qual- technique was necessary in our study to test our hy- itative or quantitative tissue differences. Attempts to identify unique anatomical and/or We thank Jason A. and sensa- of connective tissue in response to needle rotation tions obtained during the needling itself (6. and Adam D. unteers. sistent with available evidence from clinical trials. events in the tissue. The difference in the magnitude of these effects form all acupuncture needling procedures is an impor- may correspond to the difference between the impact of tant and novel aspect of our study. These clinical be used in clinical trials of acupuncture. NIH Center for Research Resources Grant M01RR-00109. Reviews of these studies concluded that. secretion of paracrine or autocrine factors. 44). needle placement (acupuncture vs. 35) have been reported at This study was funded by the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine Grant no. In the clinical situation. and acupuncturists The difference between these two levels of effects fits modify these techniques according to the patient’s age. subsequent Skin electrical conductance has been found to be needle manipulation (either rotation or pistoning) may lower at acupuncture points than at control points in pull on collagen fibers. nonacupuncture The use of a computer-controlled instrument to per- point). also provide important biological markers that can lation at nonacupuncture points (24.Weld for recruitment of vol- meridians so far have been mostly unconvincing.” or to the gen. These biomechanical events are specific physiological effect of needling.org . This needling acupuncture points and that of nonneedle study for the first time demonstrates a link between placebos (2. 31) but not in others (28. of these effects in future studies may eventually lead controlled clinical trials have compared the needling of to insights into acupuncture’s therapeutic mecha- acupuncture points with sham procedures using no nisms. the impact of the insertion and manipulation of needles. the therapeutic effects lasting days to weeks and even same amount of needle grasp may have more power- permanently. Doran for assistance Various histological structures such as neurovascu. with a mechanism involving tissue winding. This matrix de. connective tissue can wind around the needle at These effects may be prolonged and explain the per. 36). these same effects may needling or minimal needle insertion without manipu. on the other hand. although many of these trials were puncture would be valuable in future studies. Yandow for assistance in conducting the study physiological properties of acupuncture points and and preparing the manuscript. since neurovascular bun- plexing claim that acupuncture treatments can have dles are located along connective tissue planes. resulting in deformation of some studies (8. (between muscles or between muscle and bone or stream effects ranging from cell contraction. Riesner and Richard A. potentially associated with long-lasting cellular and eralized effect of noxious stimulation (“diffuse noxious extracellular effects. 33). We chose our substrate on which this technique is applied (the tissue needling parameters to be consistent with acupuncture into which the needle is inserted). 29). R. This is con- potheses objectively but might. poorly controlled. 11. no histological study RO1AT-00133 and conducted at the University of Vermont General so far has compared acupuncture points with control Clinical Research Center at Fletcher Allen Health Care supported by points by using quantitative morphometric methods. Substrate ture. Needle trials showed the effectiveness of acupuncture vs. 43). Gale A. 39. Developing an understanding inhibitory controls or DNIC”) (42. a wide variety of nee- effect. 25. Hamill is also lar bundles (4. 14. endings (7. first step toward determining the biological and clin- ture points and nonacupuncture points. Compar- number of early clinical trials of acupuncture com- ison of clinical outcomes obtained with acupuncture pared clinical outcomes with needling of acupuncture needling performed by our instrument vs. those points. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2477 become mechanically coupled to the tissue. palpation of tissues. manual acu- vs. A remove an important therapeutic component.jap. However. stimulation of these structures by the mechanical ulation on pullout force dominates over the effect of matrix deformation caused by tissue winding. slightly greater at acupuncture points because more and neuromodulation of afferent sensory input (21). ist between our study protocol and clinical acupunc- fects no matter where the needle is placed. 42. other hand. allowing controlled a technique (needle manipulation) vs. in a clinical setting. 26. In addition. ical significance of this phenomenon. Recent well. 47). the therapeutic effect of needling An important limitation of this study is that a nonacupuncture points appeared either equal to that of cause and effect relationship between pullout force acupuncture points or intermediate between that of and therapeutic effect has not been established. acupuncture points. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. W. ful downstream effects at acupuncture points via Our results indicate that the effect of needle manip. In the shorter term. Winding underlying condition. On the extracellular connective tissue matrix. gene ex. acupuncture points and meridians are formation may be transduced into local cells present frequently located along connective tissue planes within connective tissue with a wide variety of down. dling techniques are used (22). 30.000 years (27a). Needle grasp may therefore be pression. appears to be more subtle. 32) and various types of nerve gratefully acknowledged. a grasp has been described in acupuncture textbooks credible sham procedure but did not aim to test for for over 2. The ongoing support of Dr.

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