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

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

grip (which are mounted to the loadcell’s live side) is signif- a personal computer fitted with a servomotor controller. Fig. In at each acupuncture point in all subjects. Taring the system needling instrument contains two miniature servomotors. Inset shows needle in extended position. 2. motion (needle insertion and pullout). Applying too much pres- subjects (8 men and 8 women). and. 6. evaluation tests. 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. the loadcell reading is tared. however.org . significant tissue compression artifact was found. 39. side view. Just enough force is applied acupuncture points from seven different acupuncture text. nipulation. needle depth determination sure. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2473 the acupuncture point. From left to right: cutaway view with needle extended. All needling procedures (insertion. 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. ma. 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. The loadcell is phys- books (1. following manner. the system operates in the 2. Under the computer’s strain-gauge loadcell measures all axial forces exerted by the control. pulled out of the tissue. This because the weight of the needle rotation motor and needle system consists of a hand-held needling instrument (Fig. with the instrument in its final orientation compensates for both of which are controlled by the computer. and custom-written control and data acquisition software. rotated to perform manipulation (if called for). To perform a pullout test. A: design schematic of acupuncture needling instrument. the needle is robotically advanced into the tissue tissue on the needle. The icant compared with typical pullout force. can compress the underlying tissue and could using the above formula fell within the recommended ranges potentially influence how the tissue responds to needling.jap. and within this range no Needling system. 2). 12. inset). This is necessary eliminated many potential sources of investigator bias. 47) and averaging the suggested ically isolated from the skin-contacting foot. 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. pullout. 3. and therefore upper and lower limits of the listed ranges for each point. needling procedure is initiated. through a hole in the instrument’s skin-contacting foot (Fig. cutaway view with needle retracted. A 500-g capacity tared. B: needling instrument in use. The investigator holds the instrument after a 10-s delay. The second motor Once the instrument has been positioned and the loadcell generates needle rotation (manipulation). to maintain light contact with the skin. 33. This ensured consistent experimental conditions and initiated. we found that the investigator could easily Acupuncture Needling maintain skin contact without causing visible skin compres- sion throughout a pullout test.

bidirectional rota- tion. Because across the three needle-manipulation types. types were compared with respect to age. Approximate (verified by an observer). no nee- dle manipulation. 3. Shimizu. Between puted based on the method described by Kendall and Stuart test points within the same subject. were performed by using Fishers least signifi- (Seirin. 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. Activation of a push-button switch standard errors associated with geometric means were com- initiated the needling procedure as described above. ␹2-tests. plot) and acupuncture and control points (subplot) random- tween marking and needling. amount of rotation. Be. pullout speed) can be inde. gender. NO. respectively. Langevin).org . Peak force detected during needle pullout was taken as the pullout force. and Kruskal- were chosen for BI and UNI. BI. all parts of the instrument that came in computer controlled. All means presented for pullout force enough pressure to maintain light contact with the skin to are geometric means. ized to right or left side for each acupuncture/control location dled before control points within each acupuncture/control within subjects.2474 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING Needling parameters. Pairwise comparisons among means. In this study. Wallis tests. For each point. Needle-manipulation techniques vary widely in clinical practice. the appropriate insertion depth for each acupunc. acupuncture points were nee. In this study. domized to one of the three needle-manipulation types (whole ture point and to minimize repositioning of the subject be. 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. UNI. needle manipulations performed by an acupuncturist trained in a variety of different acupuncture needling techniques Statistical Methods (H. the instrument was (18). J Appl Physiol • VOL 91 • DECEMBER 2001 • www. Top: programmed linear insertion/retrac- tion (dashed line) and rotary manipula- tion (solid line) motion of acupuncture needle for the three experimental groups. a new sterile disposable needle appropriate. The peak force occurring during the pullout phase was 10 s after manipulation. During constant across all points and all subjects (Fig. insertion speed. These automatically identified and saved as the pullout-force out- parameters were determined by observing and simulating come measure (Fig. These differed only in the needle manipu- lation used. pullout speed was 5 mm/s. and body needle manipulations corresponding to “moderate” practice mass index (BMI) by using ANOVA. Japan) 30. needle dwell time was 2 s before manipulation and cell. Fig. Statistical analyses were performed using SAS statisti- disinfected by submerging in isopropyl alcohol for 30 s. Needle-motion parameters are listed in text. unidirectional rotation. dwell time. all motion parameters (e. Graphical descriptions of needling procedure types and examples of corre- sponding pullout force measurements. Data corresponding to pullout mm in diameter was mounted in the needling instrument. cal software. 40. ranging from almost no manipu. rotation speed was 8 revolu. direction of rota- tion.g. The needling normality and homogeneity of variance assumptions associ- instrument was then held by hand against the skin using just ated with ANOVA (5)..25 cant difference (LSD) test. After ultrasound imaging was per. Repeated-measures ANOVA was Needling protocol. M. Outcome Measure pendently set. insertion depth between acupuncture and control points and ture/control location was entered into the computer. Subjects randomized to the three needle-manipulation lation to rapid and forceful needle movements. or 50 mm in length and 0. the data acquisition system insertion speed was 10 mm/s. depth. 3). continuously recorded the needle force detected by the load- tions/s. 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. Bottom: examples of the re- sulting axial force on the needle. when location. 3): needle the entire needling procedure. which correspond to the antilog of the avoid any visible compression of skin by the instrument arithmetic means of the log-transformed data. insertion contact with the subject or the needle were steam sterilized. force were log transformed before analysis to satisfy the Skin at each point was disinfected with alcohol. Because the needling instrument is tween subjects.jap. used to assess differences in mean pullout force and needle- formed. rotation speed. Pullout- rotations each for BI.

significant differences were found among the manipulation types [F(2. Significant differences in pullout force were observed across the three needle- manipulation types [F(2. Pairwise compari. 4A].50 mm.org .5 ⫾ 2.4 g. F(1. F(1.2 g. a biomechanical aspect J Appl Physiol • VOL 91 • DECEMBER 2001 • www.5 g) was significantly greater than that for BI (55. There was no evidence that differences between nee- dle-manipulation types were dependent on point type (i. a greater types [NO: 21. One female participant withdrew during testing because of discomfort associated with the testing procedure. control point: 87. and B57). LI11. Secondary analyses were performed comparing pull- out force within needle-manipulation types and within point types (acupuncture vs. UNI: average pullout force was observed at acupuncture 22.2 ⫾ 7. F(1. Lu6.007] and UNI [acupuncture point: 109.e.1 g. control) [F(2.1 ⫾ 10. Fig. BI: 22.2 ⫾ 0. is graphically displayed in Fig..48 for needle manipulation by point-type interaction].3 g compared with 53. Height of bars represents geometric means. P ⬍ 0. the primary outcome measure.0 g. and UNI (C). Conversely.7 g). and the latter was significantly greater than that for NO (36.5. Pullout-Force Measurements Pullout force. quantification of needle grasp.5. insertion depth across the three needle-manipulation trol locations was not the aim of our study. LI11. Fig.9.jap. point: 51. Acupuncture and control points also differed different across the three needle-manipulation types within both significantly within NO [acupuncture point: 38.57) ⫽ 49.57) ⫽ 0.6 ⫾ 0.5 ⫾ 2. Our measurements of pullout force are the first tical significance (P ⬍ 0.57) ⫽ 62. Error 0.0.07. completed the testing protocol. 4C).0. respectively. Fig. 4.7 ⫾ control points and acupuncture points (C). Means are significantly (P ⬍ sons indicated that each manipulation type was signif.8 g) (Fishers LSD. P ⫽ 0. P ⫽ 0. P ⬍ BI.9 ⫾ 2.4.4 g. consisting of 38 women and 22 men.2 yr and 26.19) ⫽ 9.3 ⫾ 8. Pullout force measurements.001.3 kg/m2.8 ⫾ 2. P ⬍ 0.5 ⫾ 0. control bars represent SE. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2475 RESULTS Study Participants Sixty-one volunteers were enrolled in the study. control point: 34.57) ⫽ 1. P ⬍ 0.19) ⫽ 4. P ⫽ 0. Sp6. 4B].001]. The remaining 60.05).57) ⫽ 75. points than at control points in seven out of the eight DISCUSSION locations tested (Ht2. P ⬍ acupuncture points and control points (B).7 ⫾ 1.0 g at control points. Means and SD for age and BMI of participants that completed the study were 37.05). Mean pullout force (⫾SE) for UNI (97.001 for acupuncture points and F(2.41 mm. 1. Mean pullout force at acupuncture points was 63. St36. Mean pullout force was also significantly greater at acupuncture points than at corresponding control points [F(1. with three (Ht2. Means are significantly 0. Within acupuncture and control points.37 mm.05).9 ⫾ 0.5 ⫾ 5. F(2.039]. control. 0. Means are also signifi- cantly different between acupuncture and control points with NO. P ⬍ 0. P ⫽ 0.35].7 ⫾ 1. differences in pullout force between acu- puncture and control points not were dependent on the type of needle manipulation. LI4.19) ⫽ 26.001 for control points]. There were no significant differences with respect to these subject characteristics between the groups of subjects randomized to the three needle-manipulation types. BI [acupuncture point: 60. Fig.5 ⫾ 5.57) ⫽ 18. P ⬍ 0. 4. There was no significant difference in mean needle- Although the testing of individual acupuncture/con.3 g. acupuncture vs.001) different between needle-manipulation types (A) and between icantly different from the others (Fishers LSD.001. and Sp6) achieving statis.8.73.

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

30. This needling acupuncture points and that of nonneedle study for the first time demonstrates a link between placebos (2. these same effects may needling or minimal needle insertion without manipu. ful downstream effects at acupuncture points via Our results indicate that the effect of needle manip. Some differences nevertheless necessarily ex- needle manipulation appears to have pronounced ef. 36). gene ex. although many of these trials were puncture would be valuable in future studies. Attempts to identify unique anatomical and/or We thank Jason A. manual acu- vs. However.000 years (27a). and acupuncturists The difference between these two levels of effects fits modify these techniques according to the patient’s age. In the shorter term. (between muscles or between muscle and bone or stream effects ranging from cell contraction. 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.Weld for recruitment of vol- meridians so far have been mostly unconvincing. Reviews of these studies concluded that. secretion of paracrine or autocrine factors. 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. stimulation of these structures by the mechanical ulation on pullout force dominates over the effect of matrix deformation caused by tissue winding. A remove an important therapeutic component. Doran for assistance Various histological structures such as neurovascu. needle placement (acupuncture vs. endings (7. 29). The technique of practice. a wide variety of nee- effect. In the clinical situation. other hand. events in the tissue. 25. 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). 35) have been reported at This study was funded by the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine Grant no. tendon) (6. R. since neurovascular bun- plexing claim that acupuncture treatments can have dles are located along connective tissue planes. the impact of the insertion and manipulation of needles. 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. nonacupuncture points. 14. Hamill is also lar bundles (4. Needle grasp may therefore be pression. Riesner and Richard A. Needle trials showed the effectiveness of acupuncture vs. 26.jap. unteers. poorly controlled. 42. 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. Yandow for assistance in conducting the study physiological properties of acupuncture points and and preparing the manuscript. sistent with available evidence from clinical trials. These biomechanical events are specific physiological effect of needling. 39. Winding underlying condition. allowing controlled a technique (needle manipulation) vs. Apparent therapeutic effects acupuncture needle manipulation and biomechanical observed at control points were attributed to the “non. dling techniques are used (22). 44). 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. 33). W. those points. Developing an understanding inhibitory controls or DNIC”) (42. appears to be more subtle. 32) and various types of nerve gratefully acknowledged. first step toward determining the biological and clin- ture points and nonacupuncture points. Recent well. This study constitutes a differences in therapeutic response between acupunc. potentially associated with long-lasting cellular and eralized effect of noxious stimulation (“diffuse noxious extracellular effects. a grasp has been described in acupuncture textbooks credible sham procedure but did not aim to test for for over 2. slightly greater at acupuncture points because more and neuromodulation of afferent sensory input (21). on the other hand. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. ical significance of this phenomenon. acupuncture points. with illustrations. nonacupuncture The use of a computer-controlled instrument to per- point). Substrate ture. also provide important biological markers that can lation at nonacupuncture points (24. The ongoing support of Dr. In addition. 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.” or to the gen. resulting in deformation of some studies (8. palpation of tissues. 43). This matrix de. On the extracellular connective tissue matrix. connective tissue can wind around the needle at These effects may be prolonged and explain the per.org . Gale A. 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. and Adam D. This is con- potheses objectively but might. 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. NIH Center for Research Resources Grant M01RR-00109. ist between our study protocol and clinical acupunc- fects no matter where the needle is placed. and sensa- of connective tissue in response to needle rotation tions obtained during the needling itself (6. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2477 become mechanically coupled to the tissue. 11. These clinical be used in clinical trials of acupuncture. the therapeutic effects lasting days to weeks and even same amount of needle grasp may have more power- permanently. 47). with a mechanism involving tissue winding. 31) but not in others (28. in a clinical setting.

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