- Posted by Rim Boulos
- On April 29, 2021
- 0 Comments
- Acupuncture, Electroacupuncture, Neurofunctional Acupuncture, paediatric, Paediatric Physiotherapy
Acupuncture originated as a treatment tool in Traditional Chinese Medicine and dates back to as far as 100 BCE. It is the insertion of very thin needles through the skin to affect the nervous system. Acupuncture has been used for ages to relieve a variety of ailments. In the physiotherapy and rehab world, we use it to address neuromuscular pain and dysfunction. For this purpose, acupuncture has been modified, and these modifications have been given names, like dry needling, IMS, etc.
At All About Kids, we use Neurofunctional Acupuncture, also known as McMaster Medical Contemporary Acupuncture, to achieve even better results for our patients.
Neurofunctional Acupuncture – What’s the Difference?
Neurofunctional Acupuncture, as taught by Dr. Alejandro Elorriga Claraco in the McMaster Contemporary Medical Acupuncture program, uses TCM acupuncture points that specifically coincide with nerve pathways. Acupuncture needles are inserted to affect the nerves, and the tissues they innervate, at varying depths. The neurofunctional approach to assessment and treatment is just as important as the technique and is distinct from that taught in other traditional acupuncture methods. To treat neuromuscular dysfunction specifically, it is the most comfortable and comprehensive approach.
Want to know more about Neurofunctional Acupuncture as taught by Dr. Alejandro Elorriga Claraco? Check this out!
What is electroacupuncture?
Electroacupuncture is the electrical stimulation applied to acupuncture needles to trigger a motor contraction. It can be done 1 needle at a time with a “pointer” tool to target one specific area, or through multiple needles at once with clip-on wires and a stim box. Before this technology, a similar effect was achieved in TCM acupuncture through manually twirling the needles to increase input into the nervous system. Using electrical stimulation with the needles is a more recent option for increasing stimulus into the nervous system, and it is used in Neurofunctional Acupuncture, TCM acupuncture, and IMS. The ability to stimulate a motor twitch response with electricity is useful to trigger connective tissue re-modeling and improve tissue plasticity.
Take a look for an idea of what multi-needle electroacupuncture looks like in practice!
So what are the results clinically?
- Improved ability to accurately contract the intended muscle
- Improved active & passive range of motion (the muscle can take you further & can relax further)
- Increased strength (the muscle can better resist gravity or your resistance)
- Improved endurance (the muscle can contract for longer)
- The patient reports a better awareness of the muscle contracting
- The patient reports the exercise is now easier to do
That all sounds great, but HOW does acupuncture work?
To understand how acupuncture works, it helps to see all physiotherapy interventions as different ways to affect the nervous system. We call this modulating the nervous system. Some interventions are just more specific, effective, and longer-lasting than others.
For example, exercise as a physiotherapy intervention greatly modulates the nervous system. This is why doing the correct exercises in the correct form is imperative because it will reinforce that movement pattern. As we always tell our patients – Perfect practice makes perfect.
Let’s talk about Neuromotor Control
Neuromotor control is a fancy word for mind-muscle connection! It’s how well the nervous system connects to the muscle to tell it WHEN to contract, how MUCH to contract, for HOW LONG to contract, and to modify how MUCH to contract based on the changing environment.
The mind-muscle connection is generally pretty well understood. We know there’s a signal sent from a certain part of the brain, down a certain part of the spinal cord, out the spinal cord through a nerve, which branches off, and then that branch talks to a muscle and says TURN ON.
Using electroacupuncture always results in an improvement in neuromotor control. This could be through:
- Providing proprioceptive input (awareness of the muscle)
- Reducing chemicals and pain signals that inhibit the nerve from activating or releasing the muscle (better activation & relaxation, further active & passive range of motion)
- Improving blood flow to tight areas so they can relax and activate better
- Increasing the muscle’s ability to react to changing demands (needed for balance & smooth contractions)
- Improving motor unit recruitment (recruits part of the muscle faster and smoother)
- Toning down the activity of a hypertonic muscle (a muscle that is too turned on), and toning up the activity of a hypotonic muscle (a muscle that is not turned on enough)
This is an amazing adjunct to physiotherapy exercises to then take advantage of the new activation, new strength, new endurance, new range, and new sensation!
Neuromotor Inhibition occurs as a protective mechanism
We know which nerves innervate which muscles and we even know where they travel and often branch off. For example, think of nerve-muscle signals as having a volume. That connection could be coming through at 100% volume, and that muscle will turn on at 100% of its capability. Sometimes, that connection could be 50%, and that muscle will then struggle to do the same function. This is known as neuromotor inhibition.
It encourages rest and healing when there is inflammation, swelling, physical injury, or pain. However, the problem is that neuromotor inhibition can persist, unless otherwise treated. Neuromotor inhibition also occurs when a weak muscle works too hard for too long. Just like us when we are overworked, it gets cranky (tight or tense) and tired (inhibited). This creates a cycle of a weak muscle becoming inhibited, which then makes it present weaker.
In typical adults and even in typical children these days (because of cellphones, Ipads, and laptops), you will find an abundance of muscles in this state – inhibited, tight or taut, weak, painful – and this cycle continues. In an adult or child with cerebral palsy, this is the state of most muscles.
So, what does acupuncture do about this?
Well, acupuncture needles can physically reach these nerves that tell the muscles what to do. When you insert a needle close to a nerve, it modulates that pathway and resolves the neuromotor inhibition. That effect then travels up from the branch of that nerve to the spinal cord, up the spinal cord, and to the brain.
Any effect of acupuncture you can think of happens via the nervous system – the acupuncture needle acts as a gateway into the nervous system. The more areas of overworked and inhibited muscles, the more valuable gateways into the nervous system.
However, not all acupuncture is the same. The effectiveness is based on how close you get to the nerve, the more specific the nerve targeted, how long and how often enough, and whether with or without electrical stimulation.
But how permanent are the effects of Acupuncture? How many treatments will I need?
The answer to these questions are as unique as the patients we treat, but in general – it depends on your body! A few treatments can be enough to produce more lasting effects IF:
- Every other nerve-muscle connection is optimal – so there are no other injuries or dysfunctions to address
- There is enough existing strength already and a consistent strengthening program is in place
- That muscle does not continue to be overloaded whether through intensity (how difficult is it to move) or volume (how much difficult moving is your child doing)
- The neuromotor inhibition or lack of awareness of that muscle was short-lived, maybe due to a recent injury, pain, inflammation, etc, (as opposed to long-term and ongoing)
So, in summary, a few treatments may be sufficient for really simple orthopaedic issues. Otherwise, repeat treatments will be necessary. For patients who often overwork, overload, overexert themselves, or lack the proper recovery practices, consistent neurofunctional acupuncture is ideal for performance maintenance. While most typical adults don’t over-exert themselves, athletes of any age do, and our kiddos with cerebral palsy do, too.
How can Neurofunctional Acupuncture help you reach your goals?
Here are the main ways acupuncture can help you:
- Reduce pain
- Improve neuromotor control
- Increase local blood flow
- Improve local metabolism
Let’s talk about Performance Maintenance
For patients without neurological conditions, maintaining anything (range of motion, strength, optimal neuromotor control, awareness) is easier than for patients with neurological conditions like cerebral palsy.
If walking or crawling is already efficient, as long as you keep doing them, you’ll be good enough at it. If walking or crawling is difficult, takes more effort, and is less efficient, then JUST continuing to walk or crawl will NOT be enough to keep you good enough at it.
With the added challenge of growing longer and heavier, it becomes harder to even maintain those skills. Muscles become overworked, tight, and inhibited. Prolonged inhibition causes loss of range, strength, endurance, and awareness. This can then lead to injury and regression of function.
This happens to athletes who don’t do sufficient training outside of their sport, and it happens to our kiddos with cerebral palsy who don’t do sufficient training outside of their goal (whether it be sitting, crawling, standing, or walking).
This is why we see swimmers train outside of the pool, and sprinters train with weights. Why older adults do strength training, yoga, and a walking program to maintain their function as they age. This is why the Therasuit Method (a type of paediatric physiotherapy intervention) focuses on first breaking down the component needs to achieve a goal, then effectively isolating those components in the cage. This is the active side of performance maintenance.
Therasuit Method? What’s the Therasuit Method? Take a look at the link below to learn all about The Therasuit Method and what it can do for you and your child!
The passive side of performance maintenance addresses the ongoing inhibitions and tension that occurs with overtraining. This looks different in different populations and can include massage therapy, osteopathy, chiropractic care, physiotherapy, naturopathy, TCM acupuncture, and neurofunctional acupuncture.
Neurofunctional Acupuncture and Cerebral Palsy
Do you want to learn more about Cerebral Palsy? Maybe you want to see what treatment methods we’ve been using to get these amazing results for our kiddos? Check this out – Cerebral Palsy in Children
For our kiddos with cerebral palsy specifically, a lack of performance maintenance via physiotherapy leads to loss of strength, function, and overworked, tight, and weakened muscles. Consistent physiotherapy using Therasuit Method prevents this regression when done at a minimal frequency. The volume of performance maintenance is relative to the maintenance/progression of function. At a high enough frequency, you can see progress. However, even then depending on how difficult or inefficient it is to move daily, the muscles can still become overworked, inhibited, and tight. They benefit from the other side of performance maintenance – neurofunctional acupuncture to restore optimal neuromotor activation, awareness, and flexibility.
I’ve always thought of our kiddos with cerebral palsy as athletes. Their goals to sit, crawl, walk, or run are as BIG and need as MUCH dedication and time as the goals of professional athletes. The volume and diversity of training are just as important for kids with cerebral palsy. This is where Therasuit Method succeeds over any other “types” of paediatric physiotherapy for individuals with neurological conditions.
The quality of passive performance maintenance through neurofunctional acupuncture and soft tissue work is just as important for kids with cerebral palsy as it is for athletes. You can bet that the athletes with the excellent rehab team perform better both short-term and long-term, AND avoid injury. Athletes with rehab teams that have the hype but lack skill sustain silly injuries and are prescribed needless surgeries. Unfortunately, we see the same thing with our kiddos! Right down to the needless, harmful surgeries.
Who can have neurofunctional acupuncture?
Acupuncture is reasonably limited to those kiddos who are able to tolerate the idea and stay relatively still. For kiddos who can’t tolerate the idea, we use the pointer tool without needles, to electrically stimulate superficial nerves through the skin to get a muscle contraction. This is a more direct and local form of NMES (Neuromuscular Electrical Stimulation). Then we follow that up with TASES – Task-Specific Electrical Stimulation (This is more commonly known as FES – Functional Electrical Stimulation).
What does Neurofunctional Acupuncture look like at All About Kids?
Let’s look at an example of how neurofunctional acupuncture works:
Stimming the inferior gluteal nerve with Gluteus Maximus contraction
Results – lifts to 70% height briefly
Stimming the inferior gluteal nerve with Gluteus Maximus contraction
Results – lifts to 100% height and holds
The needle didn’t grow muscle size or strengthen the muscle in minutes. So his muscle HAD the size and potential strength to lift that high and hold that long. He just wasn’t able to access that potential. Electroacupuncture made it possible to access his existing strength and endurance. It got him from working at a fraction of his potential to 100%! But is that 100% of his potential yet? Not quite! Because a repeat treatment saw even MORE gains.
2 days post-treatment, he still has a strong carry-over
Result – holds for 12 seconds at max height
Another treatment allows him to access even MORE!
Result – holds for over 45 seconds at max height
What is going ON?
Not magic, just our nervous system. The challenge is to understand and explain the many intricacies of how it works!
And this is just test-retest on the bed. What about in standing, or walking? This kiddo made equal improvements in functional goals like maintaining hip extension in standing! That’s where it gets even more interesting and harder to quantify the effect of acupuncture. Combine that with Therasuit Method Intensive Therapy and you see massive improvements in performance.
With greater access to potential, comes greater gains! Now with exercise, you can strengthen in a new range, and you can actually hold longer in order to better stimulate physiological changes in muscle size and number.
Check out our instagram to see even more awesome results from our kiddos!
I am so happy to bring the amazing results that my mentors and I see with the general population, to the kids who deserve the BEST they can get. One treatment of neurofunctional acupuncture will not be a one-time fix, just like one treatment of physiotherapy using the Therasuit Method will not be a one-time fix.
The RIGHT neurofunctional acupuncture, along with the RIGHT physiotherapy program via Therasuit Method, at the RIGHT volume, will bring consistent progress and performance maintenance. And I am so EXCITED about it!
— Nastassia P., MScPT
Do you want to explore Neurofunctional Acupuncture as a treatment option for you or your child? Follow the link below to book a consultation with our exceptional staff!
Neurofunctional Acupuncture is a technique that precisely stimulates peripheral nerves, in which fine solid needles are inserted into specific locations, and stimulated manually or with electricity for the therapeutic purpose of modulating abnormal activity of the nervous system. It is a physiological intervention similar to exercise that elicits existing available regulatory mechanisms through the up-regulation and down-regulation of specific cellular processes.
Traditional Chinese acupuncture is based on the belief that it can restore the flow of Qi, an energy that flows through your body. Western medical acupuncture, which includes neurofunctional acupuncture, is evidence-based and only administered after a full assessment and diagnosis.
Medical Acupuncture is a therapeutic technique that involves inserting fine needles into certain points across the body, with the goal of relieving pain and encouraging healing.