Yoga and Acupuncture Research

In November 2014, we conducted a study to explore the effect of using a specific acupuncture technique - tangible ah-shi acupuncture - to treat old injuries and restriction of movement in yoga practitioners.

The research is part of an ongoing project - the ACUYOGA Programme - to work with yoga practitioners with injuries and restriction of movement and to develop effective treatment approaches for their needs based on tangible acupuncture.

The research paper is currently under review for journal publication later this year.

If you are interested you can read about the results of the study below or click to download the .PDF version by clicking below:

The Therapeutic Effects of Tangible Acupuncture in the Treatment of Yoga Practitioners

Abstract

The use of ‘ah-shi’ points to treat musculo-skeletal pain and dysfunction is one of the most practical applications in clinical acupuncture. This pilot study examines the importance of creating tangible sensations through acupuncture at ‘ah-shi points’ to effect improvements in flexibility, restriction of movement or pain in yoga practitioners.

Introduction

In an article entitled ‘Ah-Shi Points in Clinical Practice’ in the Journal of Chinese Medicine in February 2013, Andrew Nugent-Head, an advocate of ‘tangible acupuncture’ stressed the clinical importance of eliciting tangible sensations in patients to ensure success in treating tangible injuries.

The aim of this study was to see whether tangible sensations brought about through acupuncture treatment would treat musculo-skeletal pain or dysfunction in yoga practitioners, leading to changes in their ability to perform certain yoga postures (asana).

What is Ah-Shi Acupuncture?

Ah-shi acupuncture involves treating areas of the body which cause pain and dysfunction that are usually unknown to a patient but which often constitute the root cause of their pain or dysfunction.

When looking for ah-shi acupuncture points on the body these points are identified as being unexpectedly tender and causing an instant reaction.

When touched often with minimal pressure on these areas, this immediately causes an unexpectedly and disproportionately large response resulting in temporary weakness or flaccidity of the muscles or the entire body.

These points on the body are called ‘ah-shi points’ and acupuncture has been used for thousands of years to treat these points.

What is tangible acupuncture?

Whereas some forms and techniques of acupuncture aim to elicit minimal or no sensation at the acupuncture points, this study was designed around the use of what is referred to in the article as ‘tangible acupuncture’.

Tangible acupuncture is defined here as acupuncture that causes an expected, predictable and repeatable sensation that is obvious to the patient through needle stimulation of the ah-shi points.

In his article, Nugent-Head (2003) is clear that ‘tangible work that treats tangible injuries must be felt tangibly, in one of the eight ways outlined below’:

  1. Awareness or awakening in an area at a location other than the one being needled
  2. Spiderweb sensation radiating from the epicentre of the point in all directions
  3. Electricity up or down a specific pathway
  4. Throbbing at the point as blood flow increases or returns to the area
  5. Fullness or filling sensation where before there was weakness or flaccidity
  6. Heaviness
  7. Achiness
  8. Fasicullation (muscle twitching or spasms)*

*Tangible acupuncture should not be confused with trigger point acupuncture which tends to stress focus on fasicullation at the exclusion of the other seven sensations.

Other sensations often experienced during acupuncture include the feeling of sharpness (awareness of the needle), burning (needle is pressing on capillary or small blood vessel). These two sensations have little or no therapeutic benefit and are signs for the practitioner to relocate the needle.

Participant Selection

26 yoga practitioners completed a questionnaire to ascertain their level of health and 12 with persistent injuries or restriction of movement were selected. All 12 reported good all round health at the time of the study.

Of the 12 selected, 7 completed the full study which involved attending the clinic for a series of 3 treatment sessions over a 2 week period. No control group was used.

Study Methodology

Session 1: Medical History / Asana Demonstration / Ah-Shi Mapping

The first session included a basic medical history followed by each participant demonstrating 3 self-selected asana (yoga postures) which for them caused persistent pain, poor flexibility or restriction of movement. These 3 asana and related pain/restrictions were noted. Finally the participant had a full body palpation to locate, identify and record all ah-shi points present in the body.

Sessions 2 & 3 : Asana Demonstration / Ah-Shi Treatment / Asana Demonstration

The second and third sessions set 7 days apart involved an initial demonstration of the 3 key asana to record the nature and location of pain or restriction of movement.

Ah-shi acupuncture treatment was then carried out and the presence or absence of the eight tangible sensations was noted.

The participant then repeated the 3 asana and reported whether performing the posture was ‘Better’ ‘The Same’ or ‘Worse’. If there was a change they were then asked to briefly describe what had changed and their responses were recorded.

Homework Sessions

Each participant was also asked to repeat the 3 asanas at home within 24 hours of the ah-shi treatment and to note whether they felt that their ability to perform the posture was ‘Better’ ‘The Same’ or ‘Worse’ than before, along with a description of any changes noted.

Results

Experience of Tangible Acupuncture Sensations

Throughout each treatment session the presence or absence of the eight tangible acupuncture sensations was noted.

Of the 7 participants, 6 reported one or more of the eight tangible acupuncture sensations whilst the ah-shi points were being needled.

Participant 1 reported no tangible sensations other than needle sharpness and/or discomfort.

Overall Improvement Score

Each participant was asked to report any changes in their ability to perform each of the three asana on four separate occasions i.e. twice in the clinic session and twice at home.

This meant a total of 12 occasions to observe changes - 3 asana x 4 sessions = 12. For each response the following score was given:

(‘Ability to perform the asana is’)  Better = +1; The Same = 0; Worse = -1.

This gave a total score ranging from: +12 (Ability better on every occasion) to -12 (Ability worse on every occasion).

The results showed improvement for all participants ranging from an overall score of +2 to +12.

Participants 6 and 7 both experienced improvement in their ability to perform the 3 chosen asana on all 12 occasions. Participant 1 experienced only marginal improvement on 2 occasions, in all other occasions Participant 1 experienced no change.

Summary of improvement scores for each participant over the 12 sessions

Positive v Negative Language Frequency

Words used to describe changes following treatment were recorded and content analysis was carried out to select words that were used most frequently. These were grouped into five common themes:

  1. Flexibility during the asana (e.g. ‘more rotation’ ‘stretch further’ ‘binding easier’)
  2. Sensation during the asana (e.g. ‘looser’ ‘opening’ ‘softer’)
  3. Pain during the asana (e.g. ‘no pain’ ‘less pain’ ‘comfortable’)
  4. Strength during the asana (e.g. ‘stronger’ ‘weaker’)
  5. Overall flexibility (e.g. ‘more flexible overall’ ‘more open’ ‘generally looser’)

The number of words used to describe positive improvements in the ability to perform the chosen asana (136) were much higher than negative or neutral words (20). Overall the ratio of usage of positive to negative neutral words was over 6:1 (6.8:1).

The frequency of all words from all participant feedback describing a positive change, negative change or neutral outcome (no change) are summarised in the graph below:

Frequency of words used to describe changes - Positive, Neutral and Negative

Positive v Negative Language Infographic

The infographic below is comprised of all words from all participants used to describe changes following treatment. Words used with higher frequency appear larger relative to words with lower frequency:

Study Conclusions:

This study suggests overall that tangible acupuncture used to create tangible sensations using ah-shi points produces improvements to musculo-skeletal injuries and/or restriction of movement.

It is noteworthy that in terms of the eight defined tangible acupuncture sensations, all participants with the exception of Participant 1 experienced clear and tangible sensations during their treatment sessions.

Participant 1 experienced only a non-therapeutic sharp needle sensation and none of the eight tangible acupuncture sensations.  This seems to support the theory that when there is an absence of a clear tangible sensation the likelihood of any tangible change is reduced.

Further Work

I intend to undertake further studies to investigate the importance of tangible acupuncture sensations in clinical practice. This pilot study methodology was limited by a small participant group, a lack of control group and by no long-term follow-up - all of which would be necessary to determine the long-term efficacy of treatment using these techniques.

Further research in 2015 will be carried out through the ‘Acu-Yoga Programme’ in the form of clinical audit, patient case studies and the continued development of the use of tangible acupuncture techniques in clinic.

I would like to thank the partners of the Oxford Natural Health Centre for supporting this research with clinic time and resources.

References:

Nugent-Head, Andrew (2003) Ahsi Points in Clinical Practice. Journal of Chinese Medicine (101)