Acupuncture for Ankle Pain and Sprains in Denver

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Design

Individual patient data meta-analysis of randomized trials of acupuncture versus imitation acupuncture or no acupuncture for nonspecific musculoskeletal pain, osteoarthritis, chronic headache or shoulder pain. Only trials with adequate allocation concealment were included; raw data came from 39 trials, searched to December 2015.

Result

Acupuncture was superior to imitation acupuncture and to no acupuncture for each pain condition (all P < .001), with differences close to 0.5 standard deviations versus no acupuncture and close to 0.2 versus imitation acupuncture. Effects persisted, with only about a 15% decrease at 1 year. The authors say referral for a course of acupuncture is a reasonable option for chronic pain.

Limit

Ankle pain was not one of the four conditions studied, and the search ended in 2015. Effects were smaller when the imitation treatment used a penetrating needle.

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Design

Systematic review and meta-analysis of randomized trials of acupuncture or similar needling in people with chronic ankle instability. Eight trials were pooled.

Result

Compared with control groups, needling improved pain, joint position sense, balance and self-reported function, including the Cumberland Ankle Instability Tool score.

Limit

The trials used different needle types and techniques, and results for pain and some function scores varied widely between trials.

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Design

Systematic review and meta-analysis of randomized trials of acupuncture for acute ankle sprain, alone or combined with usual treatments.

Result

Acupuncture relieved pain more than rest, ice, compression and elevation (p = 0.02) and raised the recovery rate as the trials defined it (p = 0.004). Acupuncture added to that routine relieved pain more than the routine alone (p < 0.00001). Acupuncture combined with massage relieved pain more than massage alone (p = 0.04).

Limit

The ankle function score did not differ from the routine (p = 0.75). The authors say larger, better designed trials are needed.

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Design

Meta-analysis of randomized trials comparing real with imitation acupuncture for musculoskeletal pain, measured within a week after treatment. 63 studies with 6,382 people and eight condition types were included.

Result

Pain relief was moderate (59 trials, 4,980 people, SMD -0.61, 95% CI -0.76 to -0.47) and disability improvement was large (31 trials, 4,876 people, SMD -0.77, 95% CI -1.05 to -0.49). The authors describe this as about a 12-point reduction on a 100 mm pain scale.

Limit

The authors rate the evidence low quality, outcomes were measured only up to one week after treatment, and the conditions named do not include ankle pain.

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Design

Systematic review and meta-analysis of randomized trials of acupuncture in people with ankle sprains, searched up to February 2012.

Result

More people reported global symptom improvement with acupuncture than with no acupuncture (risk ratio of symptoms persisting 0.56, 95% CI 0.42 to 0.77). Acupuncture added to other treatment also improved global symptoms compared with other treatments alone (RR 0.61, 95% CI 0.51 to 0.73). The benefit stayed significant when only two studies with a low risk of bias were analyzed.

Limit

Trial quality was generally poor: only three trials reported adequate randomization and only one reported allocation concealment. The authors say the first result is probably an overestimate, and that the evidence is insufficient to recommend acupuncture as an evidence-based option.

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Design

Overview of systematic reviews of treatment for acute ankle sprain and for recurrent sprain (chronic ankle instability). 46 papers were included, with a mean quality score of 6.5 out of 11.

Result

After an acute sprain there was strong evidence for anti-inflammatory drugs and early mobilization, and moderate evidence for exercise and manual therapy. Evidence on surgery and acupuncture was conflicting. Bracing and exercise therapy were supported for preventing repeat sprains.

Limit

It summarizes other reviews, and for acupuncture it reports conflicting evidence, which is neither a recommendation nor a rejection.

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Design

Review of randomized and quasi-randomized trials of acupuncture for acute ankle sprains in adults. Seventeen of the 20 studies were done in China.

Result

One study found a higher recovery rate (as the trial defined it) at five days with acupuncture than with no treatment (31 of 31 versus 1 of 30). Pooled recovery rates versus no acupuncture and versus other treatments tended to favor acupuncture but were not statistically significant.

Limit

Every study had a high risk of bias, certainty was rated very low, and the authors concluded the evidence does not provide reliable support for or against acupuncture.

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Design

Evidence map of 111 systematic reviews of acupuncture covering 35 musculoskeletal pain conditions, searched up to 23 August 2024 and rated for quality with the AMSTAR 2 checklist.

Result

The short-term effects of acupuncture were positive across most comparators in major musculoskeletal pain, and the authors conclude acupuncture has favorable effects on major musculoskeletal disorders.

Limit

All of the reviews were rated low or critically low for quality, so the map shows where evidence exists, not how certain it is. It does not single out ankle pain.

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Design

Randomized trial in chronic ankle instability: strength training plus acupuncture (24 people) versus strength training alone (22 people), for 8 weeks.

Result

After 8 weeks the acupuncture group had greater ankle dorsiflexion and plantar flexion strength and better front-to-back balance and plantar flexion movement sense than the strength training group.

Limit

It was a small trial of young adults. The Cumberland Ankle Instability Tool score rose by a similar amount in both groups (13.7% and 13.8%).

The evidence is limited but leans positive. After a sprain, acupuncture relieved pain more than rest, ice, compression and elevation in a 2020 review. In a 2013 review, sprain symptoms were about 44% less likely to linger, though the authors warned that is probably an overestimate. A 2023 review found better pain, balance and function in chronic ankle instability. The Cochrane review rated its evidence very low certainty and found no reliable proof either way.

The review abstracts do not state a standard number of treatments, so I will not invent one. The three small trials that stated a schedule used three sessions a week for 8 weeks. For a recent sprain, we review progress after the first few visits. For lingering ankle pain, we review after the first five visits. If the ankle has not changed, I will tell you.

Yes. In the 2020 review, acupuncture added to rest, ice, compression and elevation relieved pain more than that routine alone and raised the recovery rate as the trials defined it. Acupuncture combined with massage also relieved pain more than massage alone. I treat acupuncture as one part of your recovery, alongside your doctor's advice, and not as a replacement for it.

Yes. A 2017 overview of 46 reviews found strong evidence for early mobilization after a sprain, moderate evidence for exercise, and support for bracing and exercise in preventing repeat sprains. In the 2024 trial, acupuncture was added to strength training, not used in place of it. I work alongside your doctor or physical therapist.

See your doctor first for an ankle or foot you cannot put weight on or take four steps on, pain when you press on the bone at the ankle or foot, an obvious deformity, numbness, fever, redness or hot skin, severe swelling, a sprain that is not improving after several days, or a pop at the time of injury that has not been imaged. If you have any of these symptoms and have not already told your doctor, please let them know.

At The Subtle Point a 90-minute first visit is $150 and follow-ups are $60 for 30 minutes of acupuncture, $95 for 60 minutes of acupuncture with Tuina massage, or $130 for 90 minutes of acupuncture with Tuina massage and cupping. HSA and FSA cards work, and you receive a superbill for your insurer.

Rarely, and never the way an injection does. Acupuncture needles are about the width of a human hair. Most people feel a brief tap, then a dull, heavy or warm sensation that fades in a few seconds. If any point feels sharp, tell me and I will adjust or remove it.