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Acupuncture for MMA

23/09/2011

Acupuncture Case Study. by Kieron Sheehan (Injury Therapist)

Patient ‘A’ is a 22 year old male professional Mixed Martial Arts Fighter. His current regime consists of 6 weekly sessions which need to increase due to an upcoming bout. He describes an “aching pain” in both shoulders which turns into a “sharp pain” when exercising, specifically when applying resistance. Examination revealed diffuse pain around the acromion with point tenderness over the supraspinatus and biceps tendons, with palpation of subacromial space increasing the pain as well as overhead activities. He describes an “achy feeling” once completing a training session. The external rotators are generally weaker than the internal rotators and there is tightness in the posterior and inferior joint capsule. There is a positive impingement sign, and both the empty can test and the drop arm test increase pain; however damage to the tendon is believed to not be severe. Abduction was painful at 90 ͦ and increased pain levels are present during latter stages of training, with the pain sometimes radiating down the right arm from the Radial Nerve, through the elbow, to the wrist and the hand. There was a painful arc of abduction between 60 and 120 ͦ increased with resistance at 90 ͦ. External Rotation 40. Neer’s Test (positive), Hawkins-Kennedy Test (positive).
 

 The Meridians essential for the rehabilitation of this type of injury from the Oriental point of view in particular are the Large Intestine as the patient is having trouble opening up the shoulder with the palm facing forward. Also the Small Intestine is suggested as the problem as the patient was displaying an inability to reach behind the body. Deltoid region pain leads many practitioners to a diagnosis of Large Intestine. There is a close link between the Stomach and Large Intestine channels, Large Intestine and Small Intestine 37 and 39, respectively.

 

Treatments

 

Stomach 38 was used as a distal point for acute shoulder pain, while the most effective use of St 38 is for a frozen shoulder; it also has the potential to help with decreased range of motion sometimes associated with supraspinatus tendonitis. As the patient experienced acute pain in the shoulder, accompanied by muscle spasms, pain on abduction and external rotation, with a reduced range of motion, this was the ideal distal point to remediate this condition ipsilateral to the affected side. Stomach 38 was needled perpendicularly, to a depth of around 1½ cun, in the direction of Urinary Bladder 57. Another needle was inserted into Urinary Bladder 57. Strong stimulation was applied to the needles while the patient actively moved the arm at the shoulder joint. The goal of this technique was to create an immediate improvement in the range of motion at the shoulder, while also decreasing pain.

 


Chosen points (over the course of treatments) - SI 1, LI 1, SI 11, LI 14 SI13, SJ 14
 

SI 3 affected side + Bl 65 opposite side, SI 12, while LI 1 treats the area of the tendon and its attachment to the humerus (LI 16 to LI 15). Traditional Point Categories SI 6 is one of the most effective points for acute cases of scapular shoulder pain. Other small intestine meridian points were not overlooked. Large Intestine points can be considered for pathology of the supraspinatus tendon (the region between LI 16 and LI 15). On palpation there was a degree of sensitivity at LI 11 and points distal to the elbow.

 

The belly of the muscle at SI 12 and the tendon between LI 16 and LI 15 are the usual sites of local needling, treatment to the adjacent muscle, the infraspinatus, at SI 11 were also added. Pain and taut muscle bands in the belly of the supraspinatus at SI 12; supraspinatus weakness and/or pain with resisted abduction; and a positive arc of pain.
 
The second treatment included SI 9, 10 and 11; a different combination was selected after treatments if the original one proved to be ineffective.
 

The reasoning for these points was to keep treatments precise, acupuncture point SI 12 is in the region of the supraspinatus origin and muscle belly in the suprascapular fossa as well as the motor and trigger points. SI 12 being at the belly of the muscle, and the tendon being between LI 16 and LI 15 are the usual sites of local needling. SI 11 was thought to benefit treatment as it is the site of the adjacent muscle, the infraspinatus. The first session Stomach 38 was used for the distal point, and then the next session Bladder 57 was used to complete the protocol.
 

The supraspinatus tendon attaches at the greater tubercle of the humerus, in the region of LI 15 and sometimes posterior towards SJ 14. Both inflammation and possible tears can occur to the tendon at this site. Supraspinatus has a precarious location beneath the bony acromion, between the points LI 16 and LI 15. The pain from the impingement is deep to the bone between LI 16 and LI 15. The muscle-tendon junction is at the lateral aspect of the suprascapular fossa, in the region of the point LI 16. The supraspinatus tendon must pass under the acromion, and this narrow fossa can become constricted. This contributed to the predictable referred pain pattern in the deltoid region. Palpation of the suprascapular fossa reproduced pain and revealed taut fascial bands of the muscle. This zone can extend medially to SI 13, as well as 1 to 3 cm lateral to the text location of SI 12.


During the first session, which mainly focused on the shoulder region, the patient felt faint and became pale. In the second session we added the wrist points, P6, TH5, LI4, as well as local points, HE7, LU9, and LU8. This really helped with the blood flow to the wrist and hand, the aching sensation that was previously there had gone and felt lighter with an easier range of motion. After the second session symptoms improved, this lasted for approximately 7 days. After which pain would appear during only the latter stages in the training session. After the subsequent sessions pain level had decreased with an increased ROM.

 

Due to the nature of the client being a professional athlete with an upcoming event exercise could not be avoided during the period of treatment sessions. All other forms of rehab such as joint mobilisations and sports massage were avoided during this period. Acupuncture in addition to exercise was better than just exercise for improving pain, range of motion, and function.
 
Side effects of headaches and dizziness were present during the session, as well as some swelling and bruising effect of the hand, but pain had relieved. Edema was present during needling.


In total 5 treatment sessions were conducted with positive results. Internal and external rotation had increased to near normal ranges (approximately 85 ͦ), Abduction (150 ͦ), quite normal ranges for a muscular built athlete. Some muscular pain remained on resisted abduction, this could be due though to the constant training protocol. Improvement may be linked to the acupuncture working either by releasing chemical compounds in the body that relieve pain, by overriding pain signals in the nerves or by allowing energy (Qi) or blood to flow freely through the body. This case study demonstrates that acupuncture can work for musculo-skeletal and soft tissue injuries.


 
 



 
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