Physiopuncture, which is the use of different therapeutic modalities on body points without needles, recently became one of the most useful techniques to help patients. It is derived from traditional acupuncture, which has been used in China for more than 3,000 years. Today, therapists use modern modalities, such as laser, ultrasound, and electrical stimulation, to perform physiopuncture treatments. Physiopuncture is a noninvasive, safe technique that provides therapists with the ability to regulate patient stimulation.

Acupuncture
Acupuncture is an integral part of an ancient Chinese system of medicine that has been used for centuries to treat diseases and relieve pain. The process of acupuncture involves the use of small needles placed at specific points along the energy meridians in the body to regulate the flow of qi (vital energy) and blood.

The way acupuncture works is still unclear. Some studies suggest that acupuncture may increase central endorphin secretion and modulate the negative effects of hormones and/or neuropeptides.^1,2

Unfortunately, we still do not have enough data from randomized studies to prove the effects of acupuncture. Specific problems unique to acupuncture randomized controlled trials are treatment effects, matching sham control, and heterogeneity of acupoints. To achieve the level of placebo-control studies, researchers have to use “sham acupuncture,” that is, acupuncture at random points on the body surface that are thought to be inactive and are not located on the meridian.

Another method is to use Streitberger needles, as follows. As the needle is pushed against the skin, it causes a pricking sensation. But as increased pressure is applied, the shaft of the needle disappears into the handle, giving the impression that the needle is actually entering the skin. Recent evidence suggests that the Streitberger needle is promising as a valid and convincing placebo needle for use in acupuncture trials.^2,3,4 

As with every method, acupuncture has its own disadvantages, such as invasiveness, pain, possible trauma of blood vessels, possible use of nonsterile needles, and patient fear of needles.

Some people are reluctant to try acupuncture due to their concerns regarding hygiene and safety. Moreover, it has been demonstrated that the serious side effects reported are five times more frequent when treatments are provided by nonmedically trained therapists compared with professionally registered health care providers.¹

Physiopuncture
Physiopuncture is a noninvasive method of stimulating acupuncture points with different therapeutic modalities. Techniques of physiopuncture include manual acupressure, acupressure wristbands, transcutaneous electrical stimulation, laser stimulation, ultrasound, magnetic and thermal stimulation, etc.^5,6,7

Compared with acupuncture, physiopuncture has the following advantages: it is less painful, and hence, more acceptable to patients, especially small children; it requires less specialized training; and it provides improved pain relief.

How Physiopuncture Works
Methods of physiopuncture include manual acupuncture (acupressure), electropuncture (electroacupuncture or transcutaneous electrical acustimulation), electromagnetic acupuncture, thermopuncture, auriculotherapy, hydropuncture, laserpuncture, and a combination of procedures listed above. The most widely used forms are manual acupuncture, laserpuncture, and electropuncture.

Physiopuncture is based on the ability of tissues to absorb energy. There are many theories regarding physiopuncture. It is thought that physiopuncture affects neurotransmitters and opioid production, elevates endorphins, and/or activates the endocrine system. It is also thought that physiopuncture activates serotonin production, thereby resulting in an analgesic effect, cardio-protection, and immune-system stimulation. For instance, results of recent studies suggest that urinary neurokinin A and calcitonin gene–related peptide (two neuropeptides involved in inflammation and/or vasodilatation) decreased significantly after 4 weeks of electropuncture.⁴

Electropuncture has a long history and a favorable safety profile. The analgesic effect of electropuncture was reported to be different according to the frequency of stimulation used, suggesting that different neurotransmitters are involved. High frequency (100 Hz) reportedly provided better postoperative pain control in patients undergoing abdominal surgery compared with low frequency (2 Hz).^8,9 

Electropuncture is also believed to be effective for alleviating osteoarthritic pain. A single-blind randomized controlled trial was conducted to investigate the treatment effectiveness of electroacupuncture on people with knee osteoarthritis.⁸ Electroacupuncture was applied at four acupuncture points: ST 35, ST 36, SP 10, and EX-LE4. All subjects demonstrated improvement in the pain parameter and some domains in SF 36 (p<0.05). When compared to the sham group, the acupuncture group demonstrated greater improvements in their visual analog scale scores, domains of physical functioning, and body pain. No adverse reaction was reported throughout the study.

Electropuncture is an effective adjunct treatment to exercise training for people with knee osteoarthritis because it helps relieve knee pain, restore physical function, and improve the quality of life among patients with osteoarthritis of the knee. Some scientists believe that electropuncture has a successful future because it is a simple, noninvasive method of stimulation.⁸

In recent decades, pulsed electromagnetic field (PEMF) has been recognized as an effective treatment modality for promoting fracture healing. Many physiotherapists who added PEMF—using 50 Hz with a field intensity of 99 gauss—to combined treatment found that it enhanced the effects of patient treatment.

Laserpuncture is a technique of laser application to the acupuncture points. Laser is a device that emits a focused directive beam of coherent monochromatic polarized electromagnetic irradiation (the light in a very narrow spectral region).

Contraindications for laserpuncture are cancer, pregnancy, endocrine pathology (goiter/IDDM, etc), seizures, fever of an unclear etiology, psychosis, and liver or renal insufficiency, congestive heart failure, and last-stage lung disease.

Any points on the body—corporal, auricular, meridian, or cranial—can be used for laserpuncture. It is recommended to begin treatment of chronic diseases by using general points and then segmental points, local/signal points, and auricular points. Points have to be changed from treatment to treatment. The basis of the laser effect is in enzyme activation, which is followed by the stimulation of biological and biochemical processes in a cell. Laserpuncture can be applied by different modern modalities, which might have only a laser source or a laser with magnetic stimulation. The most effective laser is a two-color (blue and red) and three-color (blue, red, infrared) laser.⁵ 

Laserpuncture treatment does not cause the patient any unusual physical sensations. Lasers can be applied to meridian points or directly to local painful spots on the body. According to recently published studies, laserpuncture was found to be an effective method of treatment in elderly patients with lumbosacral radiculitis, trigeminal neuralgia,⁹ and some pain syndromes. Laserpuncture can help restore the body’s self-regulation of pain. However, a very important rule must be followed: When the patient experiences sharp pain, the practitioner must use points located far from the damaged organ or on the opposite side before using local points. There is no doubt that randomized trials will prove the usefulness of other applications of laserpuncture.^5,10 

Auriculotherapy is a method of stimulating the acupuncture points on the external ear for therapeutic purposes. Paul Nogier, MD, a French western physician, is considered to be the “father of auriculotherapy.” He discovered that some auricular points become hypersensitive with some diseases and then return to normal sensitivity with recovery. The principle of auriculotherapy is based primarily on the somatotopic representation on the auricle of several somatic and visceral structures. In auriculotherapy, ear points can be stimulated by different methods, such as inserting acupuncture needles, ear stapling, laser, electropuncture, and ultrasound. These techniques are applied to a variety of conditions, particularly acute or chronic pain syndromes. For a stimulus to be effective, it should be of adequate intensity.^10,11

Another widely recognized method of physiopuncture is ultrasound puncture. If ultrasound is contraindicated on a particular area, it might be applied on the general points or the points that are far from the damaged area along the meridian. For ultrasound puncture there is a special extension of the ultrasound device. However, not all ultrasound machines are enabled for ultrasound puncture. Therefore, check before buying.

Different ultrasound frequencies can be applied for points:
• Low frequency US: 22 to 44 kHz;
• Moderate frequency: 88 kHz; or
• High frequency 2,640 kHz.

Low frequency is preferable for sedative effects, and high frequency is preferable for stimulation/activation. The distal points should be treated by high and moderate frequency. The therapist should be directed by the patient’s feelings. The energy of ultrasound must be no more than 1 W/cm². Each procedure should usually run no more than 15 to 25 minutes. The patient should rest for 30 minutes after treatment.^2,7

Original acupuncture requires specialized training and many years of experience. Patient selection, acupoint selection, needling techniques, and mode of acupuncture are important factors to consider when applying acupuncture. A lot of people avoid this type of treatment because of hygiene and safety reasons. Moreover, it has been demonstrated that the serious side effects reported are five times more frequent when treatments are provided by nonmedically trained therapists compared with professionally registered health care providers.

The results from recent studies of noninvasive techniques and systematic reviews of acupoint stimulation techniques suggest that they are effective.

Currently, PTs in United States are beginning to use physiopuncture as a new treatment modality. During the last 2 to 3 decades, PTs have often lost treatment of hand problems to occupational therapists, treatment of sport injuries to athletic trainers, and treatment of soft-tissue diseases to massage therapists.

Physiopuncture is an important new treatment for physical therapy practices. A large amount of ongoing research is being conducted on this topic, and every practitioner should follow the new data to find the most suitable modality and settings for every particular case.

Shmuel Tatz, PT, PhD, has experience with sports injuries and has worked with the Soviet Olympic teams. Tatz has written 52 scientific articles and is the author of two books: Hands of the Pianist and Body Tuning. He can be reached at tatzstudio@yahoo.com.

References
1. Carpenter JS, Neal JG. Other complementary and alternative medicine modalities: acupuncture, magnets, reflexology, and homeopathy. Am J Med. 2005;118(12 Suppl 2):109–117.

2. Chernyak GV, Sessler DL. Perioperative acupuncture and related techniques. Anesthesiology. 2005;102:1031–1049.

3. Lee A, Chan S. Acupuncture and anaesthesia. Best Pract Res Clin Anaesthesiol. 2006;20: 303–314.

4. Lin JG, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ. The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery. Pain. 2002;99:509–514.

5. Anan’in NN, Razumov AN, Klemenkov SV, Levitskii EF, Kolesnikova IV. Color-physiopuncture corrections of autonomic disorders. Vopr Kurortol Fizioter Lech Fiz Kult. 2002;1:27–96.

6. Ceccherelli F, et al. Reflextherapeutische Behandlung von myofaszialem Schmerz bei Patienten mit Zervikalarthrose. Deutsche Zeitschrift fur Akupunktur. 1989;32:74–82.

7. Travell J, Simons D. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, Md: Williams & Wilkins; 1982.

8. van Tulder MW, Furlan AD, Gagnier JJ. Complementary and alternative therapies for low back pain. Best Pract Res Clin Rheumatol. 2005;19: 639–654.

9. Samosiuk IZ, Kozhanova AK, Samosiuk NI. Physiopuncture therapy of trigeminal neuralgia. Vopr Kurortol Fizioter Lech Fiz Kult. 2000;6:29–32.

10. Schlager A, Offer T, Baldissera I. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anaesth. 1998;81:529–532.

11. Sator-Katzenschlager SM, Szeles JC, Scharbert G, et al. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesth Analg. 2003;97:1469–1473.