acupuncture in prevention, treatment of injuries and

Revista Científica Multidisciplinar Núcleo do Conhecimento - RC: 41650 - ISSN: 2448-0959https://www.nucleodoconhecimento.com.br/health/acupuncture-in-prevention

Acupuncture in prevention, treatment of injuries andimprovement of performance in athletes: Literature review

REVIEW ARTICLE

JUNIOR, Julio Cesar Dias [1]

Junior, Julio Cesar Dias. Acupuncture in prevention, treatment of injuries and improvement ofperformance in athletes: Literature review. Revista Científica Multidisciplinar Núcleo doConhecimento. 04 year, Ed. 10, Vol. 10, pp. 59-98. October 2019. ISSN: 2448-0959, Access linkin: https://www.nucleodoconhecimento.com.br/health/acupuncture-in-prevention

SUMMARY

Studies have shown that acupuncture improves physical performance in professional athletes, but the bigproblem is sports injuries, which can leave them away from activities for long periods. The studyconducted a literature review, seeking the efficacy of the technique in the prevention, improvement ofperformance and in the treatment of lesions. Some authors exemplify and clarify the process of painneurophysiology and the way in which acupuncture can intervene in this problem, others, develop andapply protocols to achieve an improvement in performance, treatment of diseases and prevention ofInjury. Among the results were found eighty-nine articles on the subject, where: twenty two reported thetreatment of lesions and thirty-seven the prevention and improvement of athletic performance, directingthe application once in the week, of 20 - 30 minutes, presenting satisfactory results for the analyzed data.Based on this literature and evidence-based practice it can be concluded that acupuncture is a greatintervention to achieve these goals within the area of sport.

Keywords: Acupuncture, injuries, pain, performance.

INTRODUCTION

For several millennia acupuncture has been used as a form of prevention and treatment of variousdiseases of the body. This technique of Chinese medicine manipulated needles of stones and fish pimplesthroughout the stone age (3000 years BC). 1, 2 The Classic Yellow Emperor: Huang Di Nei Jing,constituted one of the oldest records of Traditional Chinese Medicine (MTC), integrating to the present

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day the philosophical bases, which conceptualizes the balance of the universe and nature, which in its(Chinese) vision, energy is called Chi or Qi. This factor has two antagonistic principles that are completedand tend to be in balance, even though it is under the influence of the universe, called Yin and Yang. 3

Acupuncture is defined as the harmonization of the individual with the environment in which he is, notonly, of inserting needles and remedying the problem of the disease, but achieving the ideal of preventionof various pathologies. 4, 5 It is a procedure performed with therapeutic objective, is not toxic, without theuse of chemical elements, with minimal side effects, although it is able to release endogenous substancessuch as neurotransmitters. 4, 6, 7, 8, 9

The intervention is to stimulate the acupoints to achieve the desired therapeutic effect and achieve thehomeostasis of the organism. Many studies exemplify the effects of non-opioid neural theory (inhibitsnerve impulses acting on the peripheral and central nervous system); humoral theory (stimulates releaseof endogenous opioids, other hormones and neurotransmitters).10, 11 Purpose in pain control, theassociation of needles with electrical current, called electroacupuncture, potentiates and presents benefitsin the clinical practice, in addition to being used also as: auricular acupuncture; skullpuncture;moxabustão; suction cups; laser acupuncture. 3, 10

In sports, the use of technology in search of better results continues to grow, exceeding the limits of thehuman body. Several natural or integrative therapies are studied as a source of complementary therapy toimprove athletic conditions. Although the number of studies is scarce, the acceptance of acupuncture isstill very curious, since many individuals still doubt the scientific evidence. 9 However, its use in thesports environment has been increasing, acting in the treatment of pain and athletic injuries, acceleratingthe process of recovery of the individual. Another issue presented is the effective intervention inimproving physical performance and preventing injury from amateur and professional athletes. 12, 13, 14

GOAL

The objective of this work was to conduct a bibliographic survey of the use of acupuncture in prevention,improvement of athletic performance and in the treatment of injuries in various sports modalities.

METHODOLOGY

A bibliographic survey was conducted in the Databases Scielo, Google Acadêmico, and Scoopus, toobtain information about: acupuncture in the prevention, improvement of performance and in thetreatment of sports injuries. The following keywords were used: acupuncture; acupuncture and pain;acupuncture in prevention; sports injury and acupuncture; acupuncture and improvement of athleticperformance; treatment of injuries and acupuncture.

To delimit the cutout of this study, an initial screening was performed among the numerous articlesfound, totaling 89 manuscripts, selecting 22 that addressed the acupuncture subject in the treatment ofinjuries and 37 addressing the prevention of sports injuries and improving athletic performance. Based onthis analysis, it is worth mentioning that of all studies found primarily, the universe of research comprised59 articles published in scientific journals, congress estates, books, websites, which in the title, abstract orkeywords terminologies used during the research.

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RESULTS AND DISCUSSION

In this search resulted in several articles (Graph 1; Table 1), having been performed in isolation throughthe key words.

Graph 1: Total number of articles found and used in the search.

Table 1: Articles related to prevention, improvement of athletic performance and treatment of sportsinjuries.

Authors Article Title Journals/Anais/Congresses/Site

s

Ehrlich D, Haber P, 1992 Influence of acupuncture on

pysical performance capacity and

Haemodynamic Parameters

J. Sports Med

Santos VC, Kawano MM, Banja

RA, 2008

Acupuntura na melhora da

performance em atletas juvenis de

handebol

Rev Saúde e Pesq

Rubio K, Godoy Moreira F, 2008 A dor em corredores com fascite

plantar: o uso da acupuntura

Rev Dor

Pires TF, Pellegrinotti IL, 2010 Acupuntura na Performance

Atlética: Estudo Exploratório

8ª Mostra Acadêmica da

UNIMEP

Yang HY, Liu TY, Gao M, 2006 Electrical acupoint stimulation Zhongguo Zhen Jiu

3 / 38


increases athletes rapid strength

Luna MP, Fernandes Filho J,

2005

Efeitos da Acupuntura na

performance de Atletas velocista

de alto rendimento do Rio de

Janeiro

Fit e Perform J

Dias Junior JC, Marino DM, 2019 Acupuntura na prevenção de

lesões musculares em atletas de

futebol profissional

Rev Fisiot S Fun

Maciocia G, 2007 Os fundamentos da medicina

chinesa: um texto abrangente para

acupunturistas e fitoterapeutas

Book

Akimoto T, Nakahori C, Aizawa

K, Kimura F, Fukubayashi T,

Kono I, 2003

Acupuncture and responses of

imunoligic and endocrine markers

during competition

Med Sci in Sports Exerc

Karvelas BR, Hoffman MD, Zeni

AI, 1996

Acute Effects of Acupuncture on

Physiological and Psychological

Responses to Cycle Ergometry

Arch Phys Med Rehabil

Fry AC, Kraemer KJ, 1997 Resistance exercise overtraing

and overreaching: neuroendocrine

responses

Sports Med

Knardahl S, 1998 Sympathetic nerve activity after

acupuncture in humans

Department of Clinical

Neurophysiology

Barlas PJ,

Robinson JA, Baxter GD, 2000

Lack ofeffect of acupuncture

upon signs

and symptoms of delayed

onset muscle soreness

Clinical Physio

Rossetto SC, 2009 Acupuntura nos Esportes Book

França D, Fernandes-Senna V,

Cortez CM, 2004

Acupuntura cinética como efeito

potencializador dos elementos

moduladores do movimento no

tratamento de lesões desportivas

Fisioter Bras

Wadsworth L T, 2006 Acupuncture in sports medicine Curr Sports Med Rep

Barela J A, 2000 Estratégias de Controle em

Movimentos Complexos: Ciclo

Rev Paul de Educ Fís

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Percepção – Ação no Controle

Postural

Papler PG et al., 1999 Reabilitação do joelho. In: Greve

J.M. A. e Amattuzzi, M.M.

Medicina de reabilitação aplicada

à ortopedia e traumatologia

Book

Gemeo LH. Ignatti C, 2004 Acupuntura como Ferramenta

Auxiliar do Aumento da

Performance Desportiva. In:

Anais do Simpósio Internacional

de Ciências Integradas da

UNAERP

Anais Simpósio

Frasca L, 2011 Desempenho na Ponta da Agulha Rev Farmac

Costa V, 2013 Acupuntura Previne Lesões e

ajuda a melhorar o Desempenho

nas Pistas [periódico na internet]

http://blogs.oglobo.globo.com/pul

so/post/acupuntura-previne-lesoes

-ajuda-melhorar-desempenho-nas-

pistas-500798.html.

Luna M, 2016 Os Benefícios da Acupuntura no

Esporte

http://www.ibramrp.com.br/notici

a/49/os-beneficios-da-acupuntura-

no-esporte

Bopp-Limoge C, 1998 L`acupuncture Permet-elle

D`ameliorer les Performances

Sportives Stude Personnelle a

Propos de 35 Sportifs de haut

niveau.

These Medicine

Lin ZP et al., 2009 Effects of acupuncture

stimulation on recovery ability

for male elite basketball athletes

Amer Jour of Chin Med

Lin, ZP et al., 2009 Effect of auricular acupuncture

on oxygen consumption of

boxing athletes

Chin Med Jour

Dhillon S et al., 2008 The acute effect of acupuncture

on 20-km cycling performance.

Clin Jour of Spo Med

Hubscher M et al., 2010 Immediate effects of acupuncture Euro Jour of Appli Physi

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on strength performance: a

ramdomized, controlled crossover

trial

Geng L J et al., 1995 Investigation on the effects of ear

acupressure on exercise-induced

lactic acid levels and the

implications for athletic training

Amer Jour of Acupu

Franco RS, 2012 Avaliação do Efeito da

Acupuntura sobre o Desempenho

Físico pelo Teste do Banco de

Harvard

Dissertação

Fonseca LP, Lessa JFM, 2011 Efeito da Aplicação da

Acupuntura na Resistência

Muscular Localizada de Membros

Superiores em Praticantes de

Exercício Resistido.

Monography

Belmiro H, Vicentini D,

Camilotti CM, 2013

Efeitos da Acupuntura no

Desempenho Motor de Atletas.

Rev Fac Educ Fis

Rubio K; Godoy Moreira F, 2007 A representação da dor em atletas

olímpicos brasileiros

Rev Dor

Parisotto D, 2014 Efeito Imediato da Aplicação da

Acupuntura na Dor Muscular

Tardia e na Capacidade de

Contração Muscular

Dissertation

Staud R, 2007 Mechanisms of acupunture

analgesia: effective therapy for

musculoskeletal pain?

Curr rheumatol Rep

Bucinskaite V, Lundeberg T,

Stenfors C, Ekblom A, Dahlin L,

Theodorsson E, 1994

Effects of electro-acupuncture

and pysical exercice on regional

concentrations of neuropeptides

in rat brain

Brain research

Shang C, 2009 Prospective tests on biological

models of acupuncture

Evid Based Complement Alternat

Med.

Bowsher D,1988 Mechanisms of acupuncture. In: Book

6 / 38


Filshie J, White A. editors.

Medial Acupuncture: a western

scientific approach.

Ma SX, 2004 Neurobiology of acupuncture:

Toward CAM


Med

Li J, Wang Q, Liang H, Dong H,

Li Y, Ng EH, et al., 2012

Biophysical characteristics of

meridians and acupoints: a

systematic review.


Med.

Lee, SH, Chung, SH, Lee, JS,

Kim, SS, Shin, HD, Lim, BV, et

al., 2002

Effects Acupunturaq on the

5-hydroxytryptamine synthesis

and tryptophan hydroxylase

expression in dorsal in the dorsal

raphe of exercice rats.

Neurocienses Letters

Zyloney CE, Jensen K, Polich G,

Loiotile RE, Cheetham A,

LaViolette PS, et al., 2010

Imaging the functional

connectivity of the Periaqueductal

Gray during genuine and sham

electroacupuncture treatment.

Mol pain

Minori AET, Mejia DPM, 2007 Atuação da Acupuntura para o

Tratamento de LER/DORT no

Ombro.

Monography

Brum KN, Alonso, AC, Brech

GC, 2009

Tratamento de massagem e

acupuntura em

corredoresrecreacionais com

síndrome do piriforme

Arq Cienc Sau

Hongwen S, 2003 Clinical Observation on

Acupuncture Treatment of

Piriformis Syndrome.

J Tradit Chin Med.

Rocha TBX, Vilela Junior GB,

Martins GC, Manzatto L, Grande

AJ, 2012

Análise Comparativa

Eletromiográfica do Reto

Femoral em Isometria na Posição

Inferior do Agachamento Wall

Slide, antes e após a Aplicação da

Acupuntura no Ponto ST45

Rev Bras Cien e Mov

Pinheiro RG, Mejia DPM, 2012 Efeito da Acupuntura na Melhora Monography

7 / 38


do Paciente com Quadro Álgico

de Lesão de Menisco Medial.

Nunes EA, Mejia DPM, 2012 Tratamento de Acupuntura para

Combater Dores nos Ombros.

Monography

Tolentino F, 2016 Efeito de um Tratamento com

Auriculoterapia na Dor,

Funcionalidade e Mobilidade de

Adultos com Dor Lombar

Crônica.

Dissertation

ACUPUNCTURE IN THE PREVENTION OF INJURIES

The prevention of injuries in sport is a great battle to be won by professionals who work with athletes. Infootball, muscle injury corresponds to 20-40% of all sports injuries, predominantly 80-90% in the lowerlimbs. 15

Muscle injury is the great villain of all athletes, from various sports, and can leave them away from theiractivities for a long period. Thus, it is interesting to present a proposal for prophylactic intervention,bringing the idea of a technique to prevent or reduce the risks of this type of injury in athletes. In this caseacupuncture proves to be a beneficial technique.

In his study, Dias Junior 16, was attended by 54 male athletes, belonging to a professional football team.They were distributed into 6 groups: group 1 - acupuncture to rebalance the system, found throughevaluation; group 2 - which received protocol with specific points: spleen pancreas 3, spleen pancreas 6(Figure 1A) and stomach 36 (Figure 1B); group 3 - stomach 36 (Figure 1B); group 4 - spleen pancreas 6(Figure 1A); group 5 - ear acupuncture; control group - received no intervention. After eight sessions, oneper week, the results showed: groups 1 and 2 did not present any type of injury; group 4: two lesions;groups 3 and 5: presented 1 lesion; control: presented 6 cases of muscle problems.

Figure 1 A: spleen pancreas 3 - on the medial side of the foot, posttero-inferior of the metatarsal-phalinejoint, in the line of the junction of dark and light skin; pancreas spleen 6: 3 tsun above the medialmaleolus, on the posteromedial edge of the tibia; B: stomach 36 - 3 tsun below the patella between theanterior tibia muscle and the long extensor muscle of the fingers; stomach 37 - 3 tsun below Zusanli(E36), on the lateral anterior side of the tibia muscle; stomach 38 - 8 tsun below the knee, 2 tsun belowthe Point Shangjuxu (E37), on the side of the anterior tibia muscle; stomach 41 - at the dorsal midpoint ofthe ankle above the cruciate ligament, between the tendons of the long hallux extensor muscle and thelong extensor of the fingers.

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Source:Wen 17

The pancreas spleen has the function of extracting energy from food, distributing to the body andcontrolling blood within blood vessels. The strong presenting Qi will be transported to all muscles in thebody, specifically to the limbs, but if the Qi is in deficiency, the energy will not be transmitted to muscletissue and the athlete will present fatigue and weakened muscles.18

According to Ross 19, the spleen points pancreas 3 and 6 are associated with stomach 36 by toniningblood Qi. The earth element is responsible for energy balance and the availability of Qi and blood asenergy sources for mental, emotional and physical activity. THE MTC, reports that by toning thiselement, it maintains the muscles nourished by Qi and Xue (blood in THE MTC), aiming at improvingathletic performance. This maintains the obligation to tone the organ that produces Xue (Liver) andmaintains the energetic fluid (Spleen Pancreas and Kidney), since the functionality of the blood is tonourish the body, in addition to completing the nutrient action of Qi.

Muscle training, relaxation and contractile strength is related to liver xue nutrition. If nutrition isdeficient, cramps and paresthesia of the limbs will cause injury. On the other hand spleen monitors thexue inside the vessels and removes qi from transmitting foods to the body: Strong Qi, will transmit goodenergy to the muscles; a weakened Qi will result in a tired and weak muscle. 19, 20

Based on this evidence this technique is practiced in sports presenting rapid results, improving the qualityof muscle strength, cardiorespiratory conditions, flexibility and mental and physical well-being ofsportsmen. 20, 21, 22 Yang and employees 22, achieved a significant increase in muscle strength, providingimprovement in the speed of athletes. In turn, Luna and collaborators 24, stated that stimulation ofacupuncture points improves sports performance, muscle plasticity preventing injuries.

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A study conducted in Japan highlights the effect of acupuncture on the physical well-being of femalesoccer players during the competition. They were divided into two groups, where one was submitted totreatment and the other control. Cortisol levels (endocrine system assesses) and physical well-beingassessment were evaluated using the POMS questionnaire (assesses physical and mental status): animprovement in the immune system was observed ( decreased SIgA secretion), improved mental stress(decreased cortisol) and improves physical well-being, flexibility and muscle tension. 25

However Ehrlich and employees 25, achieved an improvement in athletic performance, increasing thelevel of physical well-being, improving competitive response, during training and games, assisting in therecovery of muscle capacity.

Other lesions that can be prevented with acupuncture are ankle sprains, which affect the ligaments,triggering many pains and limitation of joint function. France 26, used the ashi points (painful points topalpation), associated with bladder 60 (Figure 2A) to eliminate pain; the gallbladder 39 that reinforces thebones, tendons and fights the algia in the extremities; and gallbladder 40 stimulates Qi and xue; stomach41 (Figure 2B) that treats lateral changes of the ankle and stomach 36 (Figure 1B) eliminating obstructionand stimulating the circulation of Qi and local xue.

Figure 2 A: bladder 60 - between the Achilles tendon and the edge of the lateral soleolus of the ankle, atthe level of the highest point of the maleolus; B: gallbladder 39 - 3 tsun above the highest point of theexternal maleolus, in depression between fibula and long and short fibular tendons and gallbladder 40 -on the antero-inferior side of the outer maleolus, in lateral depression of the tendon of the long digitalextensor muscle ; stomach 41 - at the dorsal midpoint of the ankle above the cruciate ligament, betweenthe tendons of the long halux extensor muscle and the long extensor of the fingers.

Source:Wen 17

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Some athletes may be surprised with spraincolor, which is defined as a cervical tendon injury that causesmuscle pain and stiffness. There is a protocol to remedy this problem and return the athlete to his duties.Wadsworth 27, used in addition to the ashi points that stimulate the circulation of Qi and xue, thegallbladder 39 (Figure 2B), gallbladder 20 acts in the circulation of Qi and xue, relaxing tendons andsoften pain; governor ousse 14 expelling the pathogenic factor and regulating meridian Qi; bladder 10;small intestine 14; gallbladder 21 (Figure 3A) stimulate the circulation of Qi and xue. If joint block limitsflexion and extension, use bladder point 60 (Figure 2A). Small intestine points 3, lung 7 promote thecirculation of Qi and xue of the neck, if it has rotation limitation, use the small intestine point 7 thatdrains the Taiyang meridian of the hand (Figure 3B).

Figure 3 A: gallbladder 20 - below the occipital edge in depression between trapezoid and sternum-clidomastoid muscles, on the margin of hair and gallbladder 21 - at the equidistant point between theDazhui (VC14) and the shoulder acromion, 1 tsun above the Tianilian point; governor's vase 14 - at themidpoint between the thorny processes; seventh cervical vertebra and first dorsal vertebra; bladder 10 - atthe level between the spines of the second and third vertebrae, 1.3 lateral tsun of the dorsal midline, onthe edge side of the trapezoid muscle and small intestine 14 - 3 lateral tsun of the axis of the vertebra; atthe horizontal level of the lower edge of the thorny process of the first dorsal vertebra; B: lung 7 - on themedial side of the forearm, 1.5 tsun above the wrist line between tendons of the long thumb adductormuscle and the long extensor muscle carporadial; small intestine 3 - ulnar side of the hand, behind themetacarpal-phalangian joint of the fifth finger, between the light and dark skins; Small intestine 7 - 5 tsunabove the wrist, on the ulnar side of the carpal-ulnar extensor muscle.

Source: Wen 17

Overloading the elbow joint, affects, especially tennis players, and can lead to a blockade of Qi and xue,triggering a chronic inflammation called epicondilite. Ashi points are used in the region promoting Qistimulation. 28

For treatment of wrist lesions, such as: tendinitis or tenosynovitis of the thumb, extensors and flexors ofthe fingers, France 26, used the ashi point associated with the large intestine 5 to disperse the heat of themeridian; small intestine 5 eliminating heat and unlocking the wrist (Figure 4A); Triple heater 4 that in

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addition to eliminating heat ceases inflammation and the large intestine 11 (Figure 4B) unlocking qi andxue calming the pain.

Figure 4 A: small intestine 5 - on the ulnar side of the wrist, in the depression between the pisiform andthe ulnar styloid process; Large intestine 5 - on the back-radial side of the wrist, a little distal of the radiobone, where there is depression between the tendons of the extensor muscle short and long of the thumb,when stretching and opening the thumb. B: triple heater 4 - on the dorsal side of the wrist, in thedepression in the middle of the dorsal fold of the wrist, between the tendons of the common digitalextensor muscles and digital extensor of the fifth finger;large intestine 11 - on the radial side of theelbow, in the brachioradial muscle; when bending the elbow, in radial depression at the end of the cubitalline.

Source:Wen 17

For low back pain, Barela 17, associated ashi points with bladder 23 and bladder 25 to stimulate local Qiand Xue, bladder 40 (Figure 5) that eliminates pain and heat.

Figure 5: bladder 23 - 1.5 tsun, lateral of the lower edge of the spinal process of the vertebra (L2); bladder25 - 1.5 tsun, lateral of the lower edge of the spinal process of the vertebra (L4); bladder 40 - 3 tsun,lateral of the axis (Du-Mai), at the lower edge level in the second spine of the vertebra (T2).

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Source: Wen 17

Now another injury that worries football athletes, are ligaments, meniscals and tendons of the knee. Thisare treated with ashi points, associated with gallbladder 33 (Figure 6) that relaxes tendons and treats pain;bladder 40 (Figure 5) eliminates joint pain, edema and heat, stimulating Qi and xue; stomach 36 (Figure1B) regulating the flow of Qi and xue of the meridian eliminating obstruction. 29

Figure 6: gallbladder 33 - at the lateral edge of the knee, 3 tsun above the yanglingquan point (VB34), inthe upper depression of the lateral epithenodilof of the femur.

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Source: Wen 17

Gemeo 30, stated that acupuncture can promote an improvement in the physical capacity of athletes,prevent and treat injuries that may occur before, during or after sports competitions, in addition toassisting and influencing emotional factors such as anxiety, irritability, insomnia and depression, whichcan directly hinder the athletic capacity of these individuals. He developed a specific protocol usingmaster acupuncture points, selecting according to the modality (Chart 1):

Table 2: Gemeo 30

Master of moral energy governor vase 19 (Figure 7)

Master of general energy influences general energy, acting on ancestral and

postnatal energy - governor's vase 4, 6, 10, 13

(Figure 7)

Masters of the upper limbs acts on forearm movements, wrists, hands and

shoulders: triple heater 15 (Figure 7)

Master of lungs interferes in the anterior thorax: lung 1 (Figure 7)

Back master diaphragm, breathing and nn. phrenic: bladder17

(Figure 7)

Belly master influence on abdominal waist: stomach 27 (Figure

7)

Master of the kidneys lumbar waist acts: bladder 47 and bladder 52

(Figure 8)

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Hip master acts the mm. glutes and coxofemoral joint (Figure

8)

Thigh master acts in the musculature of the thighs: gallbladder 30

(Figure 8)

Lower limb master influences the action of feet and muscles in general:

bladder 58 (Figure 8) and stomach 36 (Figure 1B)

Points for improving balance and reflection vaso conception 4, vaso conception 6 (Figure 9),

large intestine 11 (Figure 4B), bladder 46 (Figure

8), governor vessel 4 (Figure 7).

Figure 7: governor's vase 4 - in the center line of spine of the spine; in the space between the spines of thesecond and third lumbar vertebrae; governor vase 6 - in the center line of the column; between theeleventh and twelfth thorny process of the dorsal vertebrae; governor vase 10 - in the center line of thecolumn; between the sixth and seventh thorny process of the dorsal vertebrae; governor's vase 13 - in thecenter line of the column; between the first and second thorny process of the dorsal vertebrae; governor'svase 19 - 1.5 tsun behind Baihui (VG 20); stomach 27 - 2 tsun below the navel and 2 tsun next to themedial line on the lateral edge of the rectus-abdominal muscle; bladder 17 - 1.5 tsun of the axis, at thelower edge level of the spinal process of the vertebra (T7); lung 1 - on the anterolateral side of the chest,below the Yunmen point (P2) (pit between the clavicle and shoulder), in the space between the first andsecond rib, 6 tsun on the middle line side of the body; triple heater 15 - in the suprascapular pit, betweenQuyuan (ID13) and Jianjing (VB21).

Source: Wen 17

Figure 8: bladder 46 - 3 tsun, lateral of the axis, at the lower edge level of the vertebra spine (T9); bladder47 - 3 tsun, lateral of the axis, at the lower edge level of the vertebra spine (T10); bladder 52 - 3 tsun,

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lateral of the axis, at the level of the second spine of the sacrum, at the lateral edge of the iliossacral joint;bladder 58 - l tsun below the side side of chengshan point (B57); 7 tsun above the heel, on the lateral sideof the gastrocnemius muscle tendon; gallbladder 30 - in the buttock, in the line between the sacred hiatusand the prominent of the larger trochanter; one third of the lateral distance at the lower edge of thepiriform muscle; extra hip point - in the middle of the line ranging from the upper end of the interglutealgroove to the part of the outer crest of the ischio.

Source: Wen 17; Rosseto 31

Figure 9: vase conception 4 - 3 tsun below the navel, in the central line of the abdomen; vase conception6 - 1.5 tsun below the navel, in the center line of the abdomen.

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Source: Wen 17

ACUPUNCTURE IN THE IMPROVEMENT OF ATHLETIC PERFORMANCE

When dealing with acupuncture in the prevention of injuries in athletes, we must not forget that achievingthis preventive objective, consequently we improve quality and physical integrity and can intervene inimproving performance.

In Asian countries the use of acupuncture develops a physical well-being for athletes, regulated bynervous, endocrine, immune systems and as a result, an improvement in physical condition in severalmodalities. 32, 31, 34 In addition there are points applied before, during and after training and games, whichassist in the maintenance of muscles, such as in reducing lactic acid, reducing pain, fatigue, acceleratingrecovery and improving performance. 35

Acupuncture stimulates the release of biochemical substances that relieves muscle fatigue from intenseexercises, besides promoting increased antioxidant activity, decreasing oxidative stress rates. During astudy, the athletes received treatment with electroacupuncture for 30 minutes, over a period of 30 daysand the result was the significant increase of superoxide dismutase (SOD) and decreased blood malondial(MDA). Superoxide dismutase is an enzyme with antioxidant effects that protects cells against toxicsubstances by exerting potent anti-inflammatory response in the body. The MDA is related toinflammatory and degenerative diseases, allowing researchers to conclude that electroacupuncturedecreases MDA rates and increases SOD, contributing to fatigue relief and improving physicalperformance. 36

Although it is a millenary technique, its use improves the physical and mental performance of the athleteis recent. Luna, published a research demonstrating that acupuncture statistically improved the maximumstrength and potency of sprinter athletes (100, 200 and 400 meters shallow without barriers) and sincethen the research in this regard has been deepened. 37

In a research, Santos 20 used male Handbol athletes between 15 and 17 years old, where he performed two

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100-meter shots in each athlete (pre acupuncture). After 45 minutes of application of the protocol chosenfor treatment, he reevaluated in the same way. The points chosen were: bladder 58 (Figure 8) master ofthe legs and foot; stomach 36 (Figure 1B) tones the striated musculature and is used to potentiatetreatment; extra master point of the hips (Figure 8) tones the glutes and increases the flexibility of thecoxofemoral joint; gallbladder 30 (Figure 8) master of the thighs and promotes flexibility for themovement of the lower limbs; lung 1 (Figure 7) master of the lungs promotes efficient respiratory work;bladder 17 (Figure 7) master of the back, dorsal diaphragm shu and Xue's point of influence that regulatesrespiratory rhythm; triple warmer 15 (Figure 7) master of arms that commands the joint muscle group ofshoulders, nape, cervical spine, first six thoracic vertebrae, arms, forearms, wrists and hand.

The results identified a significant improvement, with a decrease in the time in the second battery of the100-meter tests. The average improvement in the times was 5.72% and the athlete with the bestperformance achieved reached reached a percentage of 10.84%.

This average of 5.72% achieved in the improvement of performance seems small, but if compared withresults of important competitions, we can see the validity of the practice: at the Pan American Games inRio de Janeiro 2007, in the final of the 100 meters shallow male to difference between 1st place and 8thwas 0.23 seconds, representing a time of 2.26% higher, that is, if this athlete achieved an improvement of5.72% in his performance, he would probably get other results.

There is little scientific attention, when we treat, of acupuncture effects on improvements in thephysiological response induced by exercise and few directed to high performance athletes. 24, 38 ButRossetto 31 presents a protocol for improving athletic performance in football and rugby using thefollowing points: bladder 52 and bladder 58 (Figure 8); bladder 17 and lung 1 (figure 7).

The bladder point 58, tones the striated musculature of the entire body, joint of the knees, ankles and feet.It is an important point to avoid fatigue, especially if used with stomach 36. Bladder 17 tones the dorsalmuscles, joint ligaments and even increases the flexibility of the vertebral joints themselves, promotingregulatory action on the diaphragm, respiratory rhythm and phrenic nerves. Bladder 52 tones the entireregion of the lumbar muscles and promotes willpower. Lung 1 is used to make respiratory work efficientand is related to supraclavicular and intercostal nerves (with deeper insertion) assisting in the brachialplexus. Using with bladder point 17 regularizes respiratory rhythm.

Like Bopp Limoge 39, applied a three-point fixed protocol: liver 5 (Figure 10), triple heater 15 (Figure 7)and bladder 58 (Figure 8), added to two other random points, placebo, in 35 athletes, achieving significantimprovement in athletic performance of the individuals tested.

Figure 10: liver 5 - 5 tsun above medial maleolus; at the posteromedial edge of the tibia.

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Source: Wen 17

The study by Akimoto 38 corroborates the results of several studies related to the improvement ofphysical and mental capacity, where he tested twenty-one soccer athletes during the competition phase,biochemically evaluating salivary IgA and cortisol, by rate muscle tension and fatigue, resulting inincreased cortisol and lower salivary IgA, confirming the effective improvement in athletic and mentalperformance.

In another research conducted in the treatment of sports injuries with kinetic acupuncture (association ofacupuncture with kinesiotherapy), in athletes of tennis, soccer, volleyball, Olympic gymnastics, capoeira,bale and jiu-jitsu; patients with locomotor disorders such as: Achilles tendonitis, low back pain, backpain, prarcicolo, tenosynovitis, carpal tunnel syndrome, pronador syndrome, muscle contusion, tenniselbow and gonalgia due to meniscus injury. All 31 athletes tested returned to training, at most, until thethird session: 53% returned after the first session; 37% after the second; 11% after the third, concludingthat this technique acted efficiently accelerating the recovery time of athletes. The explanation for this isthat acupuncture acts in the inhibition of the spasm cycle - pain, leading to a segmental afferent block,supraspinal descending block, through pyramidal pathways and activation of the process endogenousanalgesics. 26

In another study, the variables of maximum strength, explosive strength, anaerobic resistance and speedin high-yield sprinter corridors were evaluated during a transition period. The liver meridian was focused:liver 1; liver 3; liver 8 (Figure 11A), because the energy functions of this organ are to store blood, controldispersion, drainage and determine tendon and ligament conditions, in addition to controlling theemotional part, because an energy deficit can trigger: depression; irritability; insomnia; disturbingdreams. The first punctured acupoint was bladder 62, gallbladder 34, kidney 3 (Figure 11B), followed bythe pancreas spleen 3 (Figure 1A), liver 1, liver 3, liver 8 (Figure 11A), stomach 36 (Figure 1B) andclosing with the small intestine 3 (Figure 3B). Liver stitches were introduced in the eighth session. Theresults were positively impactful, developing an improvement in the functions studied. 24

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Figure 11 A: liver 1 - 0.1 tsun above the lateral angle of the nail bed of the toe and liver 3 - between thefirst and second metatarsals, behind the metatarsal-phalangeal joints; liver 8 - at the end of the medial sideof popliteal fold, on the antero-medial edge of the semimembraous and semitendinous muscles. B: kidney3 - between the posterior edge of the medial maléolus and the Achilles tendon; gallbladder 34 - l tsunbelow the knee, in anterior and lower depression of the head of the fibula, in the fascia of the longperorean muscle; bexia 62 - 0.5 tsun below the external maleolus, in the lower depression of the maleolus.

Source: Wen 17

Ehrlich 25, on the other hand, divided 36 male individuals into three groups: one treated with systemicacupuncture; another control group; another with placebo acupuncture. A significant improvement inphysical performance and hemodynamic parameters was obtained. One session was held per week at thegubernatorial vaso 20, vaso conception 15 and liver 13, bladder 43 (Figure 12), stomach 36 (Figure 1B)and spleen pancreas 6 (Figure 1A) for 5 weeks. They analyzed that the anaerobic threshold improved by6.62% and the maximum performance in 7.15% in the group that received systemic acupuncture, alreadyin the control group and placebo, there were no alterations.

Figure 12: governor vase 20 - on the center-vertical head line; 7 tsun above the posterior edge of the hair;5 tsun behind the anterior margin of hair; vaso conception 15 - 3 tsun above Zhongwan (RM12), in thecentral line of the abdomen and liver 13 - at the lower edge of the end point of the eleventh rib, on theside of the abdomen; bladder 43 - 3 tsun, lateral of the axis (Du-Mai), at the lower edge level of thevertebra spine (T5).

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Source:Wen 17

Lin 40, evaluated the effects of ear acupuncture on heart rate (Cmf), oxygen consumption (VO²max) andblood lactic acid in elite basketball athletes. They were divided into 2 groups of 12 athletes each, where:Group 1 - auricular acupuncture; Group 2 - control. Each of the athletes cycled on an exercise bike untilexhaustion, and the Cmax, VO2max and blood lactic acid were measured during the rest period, afterheating and during exercise: after 5, 30 and 60 minutes. The results showed that HR and blood lactic acidwere significantly lower than in the control group, after 30 and 60 minutes of activity.

The same author, Lin 41, in a new research, evaluated the same variables as FCmáx, VO²max and bloodlactic acid in 30 basketball athletes, divided into 3 groups: 1- systemic acupuncture; 2- sham group;3-control. In group 1, the circulation and sexuality point 6 (Figure 13), stomach 36 (Figure 1B) were usedand during the study each athlete performed the tests on an exercise treadmill for 15 minutes. Thevariables were measured in rest and in 5, 30 and 60 minutes after exercise, obtaining a significantreduction of the three variables after 30 and 60 minutes.

Figure 13: circulation and sexuality 6 - 1 tsun below jianshi point (PC5); 2 tsun above the wrist, betweentendons of long palmar muscles and carpal-radial flexor

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Source: Wen 17

Dhillon 42, evaluated the performance of 20 male cyclists, subdivided into three groups: treated withsystemic acupuncture: stomach 36 (Figure 1B), gallbladder 34 (Figure 11B), liver 11 (Figure 14), kidney3 (Figure 11B), governor vessel 20 (Figure 12 ); sham acupuncture; control, without intervention. Theathletes cycled by stationary bike for 20 km at their maximum supported speed. The analog scale of pain,visual, for the lower limbs, induced by exercise; Borg's scale of perceived effort; post-exercise bloodlactate concentrations. The acupuncture-induced group presented a higher score in the Borg Scale,meaning that the treatment promoted a greater effort during the activity and decreased the time ofcompletion of the test.

Figure 14: liver 11 - 1 tsun below ingüinal; at the antero-medial edge of the threshold of the long adductormuscle

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Source: Wen 17

According to Hubscher 43, he evaluated the maximum jump with bipodal landing and voluntary maximumisometric strength of the quadriceps, with surface electromyography to measure femoral rectus muscleactivity for 30 seconds of support. Thirty-three athletes were divided (13 female and 20 male) in threegroups: systemic acupuncture using stomach points 36 (Figure 1B), spleen pancreas 6 (Figure 1A), vasoconception 6 (Figure 9); acupuncture group with non-existent points; Control group used laser disabled.As a result found, it was a non-significant increase in the maximum jump, but an important increase in theisometric strength of the quadriceps.

In another Geng 44 survey, he recruited 12 healthy men with physical education students between 19 and25 years of age, evaluating the effects of ear acupuncture on blood lactic acid levels, induced by exerciseon treadmill (VO2max). He chose the points: Liver, Lung, Subcortex, Endocrine Glands and Triple Heater(Figure 15). The results were an increase in oxygen capacity building and decreased blood lactic acidlevels after exercises.

Figure 15: Ear Points

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Source: Author's Personal Archive

Another study of 28 male individuals divided into a control and experimental group. A data collectionwas performed before acupuncture sessions: Measurement of basal heart rate, through the oximeter; heartrate measurement after physical testing at Harvard Bank, with a height of 50 cm, performing ascents anddescents for 5 minutes; heart rate measured in 1 and a half minutes of the test, 2 and a half minutes and 3and a half minutes; calculation of the Physical Fitness Index (IAF); average heart rate and number ofascents and descents during harvard bank testing. The points were used: lung 10 and vaso conception 17(Figure 16), small intestine 3 (Figure 3B), in order to tone and lead to muscle relaxation, strengtheningtendons, lumbar spine and lower limbs. In the gallbladder points 34 (Figure 11B), spleen pancreas 4 andkidney 7 (Figure 16) were related to sedation to potentiate the movement of blood circulation (Xue) andlymph (Jing Yie). Eight sessions were performed, one each week and the results did not show asignificant improvement in relation to heart rate and physical fitness. In increasing physical performance,climbs and descents from the Harvard Bank, the values were significant to the experimental group inrelation to control. 36

Figure 16: lung 10 - on the palmar side, above the joint of the first digital metacarpal, between dark andlight skins; vase conception 17 - in the median line of the sternum at the level of the nipple; kidney 7 - 2tsun above Taixi (R3); on the antero-medial edge of the sole muscle; spleen pancreas 4 - on the medialside of the foot; 1 tsun behind the metatarsophal joint, at the junction of dark and light skin.

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Source: Wen 17

Fonseca 45, on the other hand, used a sample with 40 male individuals practicing muscle strain twogroups: control and intervention to evaluate the effects of acupuncture on localized muscle endurance(RML) of the upper limbs. The control group was submitted to the RML test for 1 minute, going througha rest period of 30 minutes and after, the test was repeated.

In the intervention group, the test was applied: the test; rested for 5 minutes; application of acupuncture,toning the points: spleen pancreas 3 (Figure 1A); kidney 7 (Figure 16); stomach 36 (Figure 1B);governor's vase 4; triple heater 15 (Figure 7); for 25 minutes. After applicability, the RML test repeated,resulting in a significant improvement in the muscle performance of the intervention group.

In 2015, Moniz, used 12 Rugby athletes where they were distributed in control group and test group,performing acupuncture for 20 minutes in the points: heart 5, bladder 15, bladder 44 (Figure 17) andcirculation and sexuality 6 (Figure 13). In the second weekly session, punctures were performed at thestress points and trigger points. The results clearly suggested that the application of acupuncture bringsadvantages to athletes over muscle problems, with total recovery at pain level and limitation ofmovements before the subsequent play the injury.

Figure 17: heart 5 - on the ventral and ulnar side of the forearm, on the ulnar side of the tendon of thecarpal ulnar flexor muscle; 1 tsun above handle; bladder 15 - at the lower edge level of the spinal processof the vertebra (T5), on the same vertical line as the Feishu point (B13); bladder 44 - 3 tsun, lateral of theaxis, at the lower edge level of the vertebra spine (T6).

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Source: Wen 17

Most studies present significant results regarding the improvement of physical performance, consequentlyleading to an improvement in the time of end of the tests. This causes individuals submitted toacupuncture treatment, receiving an activation of pain control neurophysiology, triggering animprovement in muscle performance, greatly influencing the final result. 46

ACUPUNCTURE USED IN THE TREATMENT OF LESIONS

Acupuncture acts in this process of curing the disease, eliminating its cause, and thus is beingadministered both for the treatment of various acute and chronic pains. It can be used in surgicalprocedures, in the improvement of physical conditions and in the prevention of injuries in various sports.24

Currently athletes and their coaches seek the improvement of physical performance and preventionthrough exhaustive training, nutritional monitoring, physiotherapeupic prevention, training plans,psychological monitoring and use of new sports equipment achieving objectives. Even with theseenhanced systems, many athletes prefer and move on the fastest path, using illicit treatment, such as theuse of anabolicsteroids and drugs. 32 According to Frasca 35, he states that acupuncture works in thehuman being as a whole, treating pain, improving performance and acting directly in the psychologicalsystem of athletes generating an increase in the psychic confidence of the sportsman.

According to Santos and collaborators 20, most athletes have had the experience of feeling late-onsetmuscle pain, which appear in training periods, where the intensity and volume of work are higher.Another type of pain is caused by an injury, moving athletes away from training and competitions forlong periods. 21

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Based on neurophysiology, histoanatomical and neurochemical, CTM explains that by punturating thepoint that is located in the channels of the specific meridians, it will facilitate the energy flow in thesestructures overloaded by sports modalities, achieving analgesic goals. 25, 47

Other authors report that the application of the technique has the action of endogenous opioids, therelease of â-endorphin that is identified in pain modulation and inhibition of nociceptive transmission atall levels of the nervous system occurs.) through the use of electroacupuncture, positive regulation of theexpression of the ratio of neural nitric oxide synthesis (nNOS) / NADPH diaphorase (NADPHd) occurs.measured through thalamic pathways and the dorsal medulla. There are also some data suggesting that inaddition to opioids, other mechanisms are involved in the treatment of pain. 6, 48, 49, 50, 51

The presence of NO favors the improvement of local vascularization, indicating a homeostotic action ofacupuncture, but the increase of NO in the icy fascicle may clarify this regulatory action of somaticreflexes caused by the technique. 6, 52 Other studies observe the release of serotonin after needlestimulation. 51, 52, 53

Acupuncture is applied to tone, relax athletes' muscles and maintain the energy balance of the body. Inaddition to the analgesic effect, it is possible to stimulate other biological factors, activating thehypothalamus and pituitary gland reaching systemic effects, such as: increased neuro-hormones andneurotransmitters.² improving the athlete's performance in their respective modalities, thus controlled bysystems, nervous, endocrine and immune. 36, 54, 55, 56, 57, 58, 59, 60 Many studies have shown that acupunctureoperates in these three systems, providing: relief of tensions and muscle pain; increased local blood flow;release of endogenous opioids, decreasing pain perception; improvement of the modulation ofsympathetic and parasympathetic nervous system balance; modulation of the immune system; activationof connective tissue and muscles releasing myosins that have anti-inflammatory effects, releasingantioxidant substances, decreasing oxidative stress; substances that have probable ergogenic effects. 5, 13,

61, 62, 63, 64

In a laboratory study with rats, Lee and collaborators, 65 reported that the animal when submitted toacupuncture and exercise presented a suppression of the effects on 5 HT (5 hydroxytryptamines) and theexpression of THP (hydroxylase tryptophan) in the dorsal rafe of guinea pigs, reaching ergogenic effect,since the 5 HT prevents the performance of exercise in humans and rats.

In one study, Zyloney and 66 collaborators reported that it is possible to find a different activity in thebrain, through magnetic resonance assessment, during the needle procedure. These changes appear inregions such as: epiaquedural gray matter, hypothalamus, primary somatosensory cortex, upper temporalgyrus, rostral anterior cingulate cortex and medial region of the occipital cortex. 48

In his research, Minori 67 treated repetitive shoulder stress injuries, with the combination of wonderfulvessel stitches: triple heater 5 - gallbladder 41 (Figure 18) that are used for chronic pain and smallintestine 3 (Figure 3B) - bladder 62 ( Figure 11B) for acute pain.

Figure 18: triple heater 5 - 2 tsun above the dorsal fold of the wrist, between the tendons of the commondigital extensor muscle and the fifth digit muscle itself; gallbladder 41 - in depression between the fourthand fifth metatarsals.

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Source: Wen 17

The local points for treatment are: large intestine 5 for wrist pain; large intestine 4 relieves pain andedemas (Figure 4 A); small intestine 9 arm pain; triple heater 14 indicated for pain and inflammation ofthe shoulder; large intestine 14 (Figure 19) used for stiffness, paresis, reduced shoulder mobility. Distantpoints, upper and anterior shoulder pain: stomach 36 to dissipate external pathogenic factors; stomach 37indicated for pain, sensitivity and circulation disorders; stomach 41 eliminates moisture, stagnation, windand soothes the shen (mind); stomach 38 eliminates acute pain and shoulder joint disorders (Figure 1B).For posterior and superior shoulder pain: gallbladder 34 indicated for reduced mobility, spasms,circulation disorders and functional disorders of muscles and tendons; gallbladder 38 disperses the windand releases heat, activates the meridian and its vessels (Figure 11B). Pain scapula, on the other hand:bladder 65 pacifis and strengthens the spirit, releases heat and relieves pain; bladder 64 suppresses spasmsand relaxes tendons; bladder 60 relieves pain and activates the meridian and emotional points (Figure2A); bladder 18 promotes general calm and eliminates spasms (Figure 19) and liver 8 relaxes tendons(Figure 11A).

Figure 19: small intestine 9 - in the posttero-lower region of the shoulder joint, on the postteroinferiorside of the larger round muscle; triple heater 14 - in depression between the achromic and the largerhumerus tuberculo, at the edge of the infraspinal tendon; large intestine 14 - covers the side side and someradial of the arm, at the distal point of the deltoid muscle, 3 tsun below jianyu point; bladder 18 - on thesame vertical line as geshu (B17), at the lower edge level of the spinal process of the vertebra (T9).

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Source: Wen 17

Brum 68, on the other hand, associated in his study to treat pyriform syndrome, massage and acupuncturetechniques in corridors, in order to improve muscle functions, flexibility and relief of symptoms. Theresearch included athletes of both sexes aged 30 to 60 years. The session focused on massage (Shiatsu) atthe beginning to release the stress points of the gluteal and thigh region on the affected side, followed byneedleing, as follows: clockwise; anti-time; deepening; superficializing the needle in the followingregions: origin and insertion of the piriform muscle (pelvic face of the sacrum and larger trocanter of thefemur); origin of the middle gluteus (lateral face of iliac bone); upper limit of the minimum gluteus;upper limit of the gluteus maximum; origin of hamstring muscles (sciaticatic tuberosity); femoral bicepsmuscle and semitendinous muscle diaphysis, finished with massage.

The results showed significant improvement, when related to the improvement of pain, flexibility, painpalpation in the piriform muscle and test for pyriform syndrome. This shows the agreement with the studyby Hongwen 69, where the effectiveness of acupuncture was 97.33% and with the research of France 26that associated the needles with kinesiotherapy reaching a relief of symptoms, the potentialization of theneuromuscular system, providing a faster return to sports activities.

In his work, Rocha 70, verified the improvement of the activation of the femoral rectus muscle, throughelectromyography, after stimulation of the stomach acupuncture point 45 (Figure 20). A total of 10participants (5 males and 5 females) were selected, where they performed an exercise of 2 squatrepetitions, where they selected the highest muscle activation index among the two movements by theelectromyographic signal. Then acupuncture was applied, toning the stomach point 45 for 10 minutes andthen the isometric squat was repeated in the lower phase. According to the results found acupuncturealtered the electrical activity of the femoral rectus muscle during the isometric phase in the lower phase ofthe squat, proving effective.

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Figure 20: stomach 45 - 0.1 tsun on the side of the side corner of the nail bed of the second toe

Source: Wen 17

In another study Pinheiro 71, characterized and filed some points for the treatment of meniscal lesion:liver 8 (Figure 11A) used to tone the liver canal with function of harmonizing and toning liver and bloodQi, promoting the fullness of the kidneys and leading to the relaxation of tendons and muscles,strengthening the Iq of the knee. The bladder point 40 (Figure 5) is found in the popliteal fossa enabling:dispersion of heat and perverse wind of the limbs; relaxation of muscles and tendons; destroying bloodvessels; reduces heat and eliminates blood stasis; decreased regidez and strengthens the knee and lumbar.On the other hand, the kidney point 10 (Figure 21) mobilizes water; tones yin Qi; expels moisture andperverse heat, treating knee pain, leg edema and numbing knee and popliteal cessum.

Figure 21: kidney 10 - on the medial side of popliteal fold, between semitendinous and semimembraousmuscles

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Source: Wen 17

In a study on shoulder dysfunctions, Nunes 72, reviewed the bibliography and filed the points ofwonderful vessels: small intestine 3 (Figure 3B) - bladder 62 (Figure 11B) to balance functions, relaxingmuscles and tendons; the points of the triple heater 5 - gallbladder 41 (Figure 18) relieve pain and relaxtendons; Ashi points; liver 8 (Figure 11A) and kidney 7 (Figure 16) to strengthen tendons; stomach 36(Figure 1B) eliminating cold and moisture from the joints; intestine 4 (Figure 4A) and large intestine 15(Figure 22) acting in the movement and pain of shoulder flexion; triple heater 14 (Figure 19) and largeintestine 16 (Figure 22) improving extension mobility and pain.

Figure 22: large intestine 15 - on top of the shoulder, on the lateral edge of the acromion, there are twodepressions, this point is in the anterior depression; large intestine 16 - in depression between the upperand posterior edge of the acromioclavicular joint and the spine of the scapula.

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Source: Wen 1

In order to verify the immediate effects of acupuncture on late-onset muscle pain (DMIT) and contractilefunctional capacity of muscles, Parisoto 73, selected 30 subjects (12 men and 18 women), aged between20 and 30 years, practitioners of activity 2 to 3 times a week. They were divided into three groups: treatedwith acupuncture; placebo sham; Control. The following were evaluated: pain threshold with thealgelometer; peak maximum isometric muscle strength; electromyographic activity; subjective perceptionof pain through the visual analog scale.

After the evaluations, the volunteers were submitted to induction of DMIT, performing flexion andextension of the elbow with load (biceps thread), up to the maximum limit of movement execution: 3series were performed until muscle exhaustion with an interval of 4 to 5 minutes. After this procedure, thestate in which the muscle was before acupuncture was reevaluated.

The points chosen for treatment of the acupuncture group were: large intestine 4 (Figure 4A), largeintestine 11 (Figure 4B), stomach 36 (Figure 1B), gallbladder 34 (Figure 11B), which are analgesic andtoning points of muscles and tendons. In the sham group, placebo points were used and the needles wereintroduced superficially; control group the individuals just lay down. Both groups remained at rest for 20minutes.

The results indicated: perception of pain with the analog scale was reduced in the acupuncture group; thethreshold of pain by the algelometer increased after intervention in this group. After acupunctureintervention, biceps muscle activation was reduced by 30% when related to the sham and control group.Muscle strength, after DMIT, decreased by 48% in the tested group, being lower than in the sham andcontrol groups (58% and 56% respectively). All groups presented maximum isometric muscle strengthdeficit after the dmit induction protocol: acupuncture decreased by 26%; sham 29%; control 33.5%.

However, it was concluded that acupuncture was effective in immediate improvement of pain perceptionand increased threshold by algelomer, providing neuromuscular alterations, but not improving contractileperformance of the musculature.

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In another Tolentin study 74, it evaluated the effect of auriculotherapy on pain, functionality and mobilityof individuals with chronic low back pain. Divided 31 participants into three groups: experimental withdisposable stainless blood needles of 1.5 mm; experimental with mustard seeds; control withoutintervention. The visual analog scale was used to assess pain; for the functionality test, the Quebeclumbar disability questionnaire and the sitting to standing test were used; lumbar mobility was performed.

The interventions were performed for 4 weeks, being a weekly session, applied in the points: Shenmen,Rim, Sympathetic, Analgesia, Muscle Relaxation, Lumbar and Adrenal Spine (Figure 10). After aninterval of 1 week after the last application, the individuals were reevaluated with the same protocol.

The results showed improvement in the condition of low back pain, as well as the improvement offunctional capacity in both experimental groups, unlike the control that there was no significantdifference in relation to initial pain. No difference was found between the techniques performed (needleand seed), indicating that both are beneficial for relief from chronic low back pain and increasedfunctional capacity.

Figure 23: Ear points

Source: Tolentino 74

FINAL CONSIDERATIONS

Based on the literature, analyzing all the results and their scientific evidence, it is considered thatacupuncture treatment is effective in the treatment, improvement of performance and prevention of injuryin professional and amateur athletes. Individuals receiving the intervention, even if they have some typeof injured complication, the problem is less severe and rapidly restoring organic function, that is, theathlete who suffers some type of injury and is performing acupuncture, this adversity will tend to beminimal and early return activities.

Even athletes who do not use acupuncture in order to prevent prevention and present the lesion, theintervention of this presents clinical evidence, based on neurophysiology, opioid release, with emphasis

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on the treatment of pain and improvement of the patient's well-being .

Acupuncture intervention, although it is a millennial technique, is still growing in the West, has beenperforming great results in clinical practice, issues of prevention of musculoskeletal injuries, and also inthe prevention and treatment of diseases psychosocial, acute and chronic pain.

Due to the balance of the energy system, acupuncture not only treats physical well-being, but also mentalwell-being, because the theoretical foundation of the technique does not separate the body from the mindbenefiting emotional stress, reducing anxiety and balancing the human mind.

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[1] Degree in Physiotherapy from the University Center of Araraquara - UNIARA - 2005 (Araraquara-SP);Lato sensu postgraduate studies in Orthopedic and Traumatological Physiotherapy from the CohenInstitute - Orthopedics, Rehabilitation and Sports Medicine - 2006 (São Paulo-SP)Training in OsteopathicManual Therapy by the Cefisa Institute - 2008 (Araraquara-SP); Professional Improvement in GlobalPostural Reeducation and Sensory Motor Reprogramming - RPG/RSM by the Paulista Institute ofSystemic Studies - IPES - 2010 (Ribeirão Preto-SP); Lato sensu graduate studies in SystemicAcupuncture from the Paulista Institute of Systemic Studies - IPES - 2013 (Ribeirão Preto-SP); Strictosensu Postgraduate Master's degree in Territorial development and environment from the UniversityCenter of Araraquara - UNIARA - 2016 (Araraquara - SP); Professional Improvement in Clinical andFunctional Pilates by the Paulista Institute of Systemic Studies - IPES - 2016 (Ribeirão Preto-SP).

Submitted: April, 2019.

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Approved: October, 2019.

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