Pacific Wellness Institute Clinic: Bloor-Yorkville Toronto

Sports Injury and Conditioning Clinic Toronto


Knee Injury - sports running knee injuries on woman. Female runner with pain from sprain knee. Close up of legs, muscle and knee outdoors in forest.

Sports Conditioning Using Acupuncture and Related Therapies at The Pacific Wellness Institute

For many years, acupuncture has been used to treat various types of muscular pain.

While acupuncture can be a useful tool in recovering from acute injuries, more and more athletes are using acupuncture to treat chronic injuries as well as in their regular conditioning.

Based on my 20 years of clinical experience and research in acupuncture and applied physiology, I have developed an acupuncture therapy protocol to treat a variety of health conditions.  The therapy targets three key areas: enhancing blood flow, improving muscle coordination, and optimizing physiological balance.  The combined approach that aims to achieve these three effects via acupuncture and related therapies not only can provide effective relief for various pain conditions and injuries but is also useful for preventing injuries and improving overall physical and mental performance.

The effect of acupuncture on muscle blood flow

How poor blood flow affects muscle pain

Though muscular pain occurs for many reasons, poor blood flow inside the muscle is a common cause (Tanaka, Mori et al. 2009).  In order for the muscle to function, it must receive adequate blood flow.  Compromised blood flow allows waste metabolic substances such as lactic acid to accumulate, resulting in muscle fatigue and pain and negatively affecting overall muscle endurance.  Good blood flow enhances the removal of metabolic waste and allows the muscles to obtain more oxygen to perform their job.

Sufficient blood flow is also important to prevent injury.  This is why it’s important to spend some time warming up before starting any serious physical activity. 

Sports Injury and Conditioning Clinic Toronto

How acupuncture improves muscle blood flow and helps attenuate pain and fatigue

A series of experimental studies demonstrated that acupuncture can improve blood flow in ischemic tissue (tissue with poor blood flow), thereby enhancing the removal of substances that cause pain and fatigue (Sandberg, Lundeberg et al. 2003; Sandberg, Lindberg et al. 2004; Sandberg, Larsson et al. 2005).

The increase in blood flow caused by acupuncture is mediated by two mechanisms: localized vasodilatations via the axon reflex and a generalized systemic response via the autonomic nervous system (Tanaka, Mori et al. 2009).  In clinical practice, it is important to consider and utilize these two mechanisms simultaneously to generate desirable short- and long-term clinical outcomes.

Different types of massage therapy have also been shown to positively influence blood circulation (Tanaka and Mori 2006).

Sports Injury and Conditioning Clinic Toronto

The effect of acupuncture on muscle coordination

Moving our body involves a wide variety of muscles. Some muscles work together (synergistic) while other muscles work against each other (antagonistic).  Proper coordination of different muscles is important not only for preventing pain and injuries but also for optimal physical performance.

For example, when we bend our arm, the biceps muscle contracts as the prime mover (agonist), while the triceps muscle relaxes (antagonist).  If antagonist muscles contract together with the agonist, the movement will not be smooth and will cause unnecessary strain to muscles, tendons, and ligaments—somewhat like pressing the gas and the brake at the same time while driving.  When we observe a muscle activation pattern during movement using a dynamic electromyography (EMG) method, we can see, in some individuals, co-activations in both agonist and antagonist muscles.  Such an abnormal EMG pattern, referred to as co-contraction, is typically observed in patients having a central nerve disorder such as Parkinson’s disease or multiple sclerosis.  But mild and transitory co-contraction can also be observed among individuals without such a pathological illness, particularly when the person is suffering from acute pain or chronic conditions such as muscle spasm or an irritated nerve (Tanaka 2004).

On the other hand, the asymmetrical dynamic EMG activity of synergist muscles during symmetrical movement (i.e., lumbar flexion) is often observed among individuals suffering from one-sided pain, muscle spasms, or an irritated nerve.  It can be also caused by acute or chronic muscle distortion due to lifestyle, or by participating in a sport or occupation involving the uneven usage of left- and right-side muscles.  A dynamic EMG study I conducted demonstrated improvements in the coordination of synergist muscles following acupuncture (Tanaka and Nishijo 1998; Tanaka, Leisman et al. 1998).

The movements that athletes are required to perform are far more complex and involve a larger number of muscles than the simple movements described above as examples.  Nevertheless, in preventing injury and enhancing sports performance it is important to emphasize not only muscle strengthening but also the crucial role of proper muscle coordination.  This includes the coordination of synergistic muscles and the corresponding relaxation of the appropriate antagonist muscles (reciprocal inhibition).

More information on this subject is available below:

Sports Injury and Conditioning Clinic Toronto

Sports Injury and Conditioning Clinic Toronto

Sports Injury and Conditioning Clinic Toronto

Sports Injury and Conditioning Clinic Toronto

Optimizing Physiological Balance through Breathing and Acupuncture

The importance of proper physiological state during performance:

In clinical practice at The Pacific Wellness Institute Acupuncture Clinic, I teach patients to breathe in a specific rhythm.  When breathing in a specific fashion, we can observe a large increase in heart rate variability (HRV) in most individuals.  (Please note that “heart rate variability” and “heart rate” are two different things.)

The parasympathetic nervous system is primarily associated with relaxation and the activation of internal organs.  During intense activity, however, more blood and oxygen must be delivered to the skeletal muscles; thus, our body shifts gears, activating the sympathetic nervous system to meet the increased demand while temporarily shutting down other functions such as digestion and elimination.

But over-activation of the sympathetic nerves does not lead to a desirable outcome in most cases: it can negatively affect muscle coordination and efficient movements, as well as cause negative emotions such as anxiety and panic.  Returning to the driving metaphor, in order to drive a car safely and effectively, the driver must use both the gas and brake pedals.  In this scenario, the gas pedal is the sympathetic nervous system and the brake is the parasympathetic nervous system. Accordingly, what is important during sports is the proper regulation of the autonomic nervous system.

Sports Injury and Conditioning Clinic Toronto

The figure above displays a healthy person’s heart rate and respiration recorded over a one-minute period.  The individual was breathing naturally during the first 30 seconds; then, for the next 30 seconds, he breathed according to specific visual cues displayed on the computer screen.  A highly coherent and larger variability in heart rate appears in the second 30 seconds of the recording.  In applied psychophysiology, this state is referred to as a “coherent state” or “resonant state.”  During the coherent or resonant state, the parasympathetic and sympathetic systems work in coordination and the autonomic nervous system functions in optimal modulation.  An athlete’s mental and physical performance is greatly heightened during this type of physiological state.  The bottom part of the graph displays the frequency pattern of HRV.  In most cases, when a person is breathing in a specific rhythm (with approximately a 10-second cycle), the low-frequency range of the HRV spectrum is distinctly augmented.  The LF band of the HRV spectrum is closely related to blood pressure and hormonal regulation (Marek 1996).

In recent years, HRV-based breathing exercises and HRV biofeedback have been increasingly utilized not only to treat a variety of internal diseases and emotional disorders but also in the field of sports psychophysiology, in an attempt to enhance mental concentration and physical performance for athletes in various types of sports, such as baseball and dancing (Strack 2003; Raymond, Sajid et al. 2005).

Acupuncture’s Influence on Heart Rate and the Autonomic Nervous System

A patient’s typical response to a skillful and gentle acupuncture technique is a spontaneous decrease in heart rate, indicating the activation of the parasympathetic nervous system (a branch of the autonomic nervous system related to relaxation and the activation of most internal organs) (Nishijo, Mori et al. 1997).  This parasympathetic activation response is particularly important during the recovery state following intensive physical activities.

At The Pacific Wellness Institute Acupuncture Clinic, I utilize both a passively created response (via acupuncture) and a proactive response (enacted by the patient) in order to produce optimal short- and long-term clinical results.  In order to achieve such results, we use breathing training audio CDs that I designed for the purpose (Calming Massage, 2003; Breathing for Relaxation, 2009).  These CDs’ techniques are based on HRV Biofeedback  (Tanaka 2003).  With the aid of these custom-made CDs, most patients are able to augment HRV and maintain a peak oscillation of around 0.1Hz without visual feedback.  This combined approach is termed the Acupuncture- and Sound-Assisted Autonomic Modulation Technique.  The combined HRV Biofeedback and acupuncture approach provides a powerful stimulus that modulates the autonomic nervous system.

Sports Injury and Conditioning Clinic Toronto

The link pages shown below summarize the scientific background behind this acupuncture- and HRV-based combined breathing approach.



Tim H. Tanaka, Ph.D. is the Director of The Pacific Wellness Institute, Toronto, Ontario, and Visiting Research Fellow at the School of Health Science, Tsukuba University of Technology, Japan.  He holds licenses in Acupuncture and Massage Therapy and is board certified in Biofeedback.


Marek, M. (1996). “Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use.” Circulation 93(5): 1043-1065.

Nishijo, K., H. Mori, et al. (1997). “Decreased heart rate by acupuncture stimulation in humans via facilitation of cardiac vagal activity and suppression of cardiac sympathetic nerve.” Neurosci Lett 227(3): 165-8.

Raymond, J., I. Sajid, et al. (2005). “Biofeedback and dance performance: a preliminary investigation.” Appl Psychophysiol Biofeedback 30(1): 64-73.

Sandberg, M., B. Larsson, et al. (2005). “Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia.” Eur J Pain 9(5): 497-510.

Sandberg, M., L. G. Lindberg, et al. (2004). “Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia.” Eur J Pain 8(2): 163-71.

Sandberg, M., T. Lundeberg, et al. (2003). “Effects of acupuncture on skin and muscle blood flow in healthy subjects.” Eur J Appl Physiol 90(1-2): 114-9.

Strack, B. (2003). “Effect of heart rate variability biofeedback on batting performance in baseball.” Dissertation Abstracts International 64: 1540.

Tanaka, H. (2004). Influence of acupuncture on muscle coordination revealed by dynamic electromyographic evaluation. 53rd Annual Meeting of the Japan Society of Acupuncture and Moxibustion. Chiba, Japan.

Tanaka, H. and H. Mori (2006). Efficacy of Anma, Massage, Shiatsu – Comprehensive Review of Touch Therapy Research. An Illustrated Basic Protocol of Anma, Massage, and Shiatsu. H. Mori. Tokyo, Ishiyaku Publishers: 155-171.

Tanaka, H., H. Mori, et al. (2009). Effect of Acupuncture on Circulatory System. Textbook of Clinical Acupuncture and Moxibustion (in Japanese). H. Mori and K. Sasaki. Tokyo, Ishiyaku Publishers: 48-61.

Tanaka, T. (2003). The Creation and Efficacy of a HRV-Autonomic Trainer CD in Assisting Heart Rate Variability Biofeedback Training: Preliminary Report. . 34th Annual Meeting of Association for Applied Psychophysiology and Biofeedback,. Jacksonville, Florida.

Tanaka, T. and K. Nishijo (1998). “Influence of Acupuncture Stimulation on Dynamic Electromyographic Activity.” Journal of The Japan Society of Acupuncture and Moxibustion 48(2): 105-119.

Tanaka, T. H., G. Leisman, et al. (1998). “Dynamic electromyographic response following acupuncture: possible influence on synergistic coordination.” Int J Neurosci 95(1-2): 51-61.