In a randomized controlled trial conducted at Nellis and Eglin Air Force Bases, researchers found that electroacupuncture (EA), when used adjunctively with eccentric exercise, significantly improved short-term pain outcomes in patients with insertional Achilles tendinopathy. The study concluded that while both groups experienced functional improvement, the EA group demonstrated superior pain reduction immediately following exercise sessions, indicating a beneficial role for EA in managing acute pain in this condition [1]. Nellis Air Force Base is located in southern Nevada, just northeast of Las Vegas. Eglin Air Force Base is situated in the Florida Panhandle, near the city of Fort Walton Beach along the Gulf Coast.
The trial enrolled 59 participants, of whom 52 completed the study, resulting in 69 affected Achilles tendons due to some subjects presenting with bilateral inflammation. All participants were Department of Defense beneficiaries over 18 years of age, clinically diagnosed with insertional Achilles tendinopathy—defined as pain within 2 cm of the calcaneus insertion and persistent symptoms for more than 8 weeks. Eligibility required a VISA-A (Victorian Institute of Sports Assessment–Achilles) score of less than 60. Participants were randomized into two groups: one receiving eccentric exercise therapy alone, and the other receiving the same exercise program with adjunctive EA over the initial four clinical visits [1].
Acupuncture Procedures
Electroacupuncture was administered at the first four clinical visits of the treatment group. The acupuncture points used included BL60 and BL61, and KD3 and KD4. Stainless steel filiform needles (SEIRIN, 0.25 mm × 40 mm) were inserted until a firm catch of the tendon was palpated by the provider, indicating penetration of the paratenon or surrounding connective tissue. The paratenon is a vascular connective tissue layer surrounding a tendon that facilitates movement and provides essential blood supply for tendon healing and function. The needling technique was tendon-directed.
The EA protocol applied a continuous current using an ES-130 electroacupuncture unit. Two electrode circuits were employed: one connected from KD3 (negative lead) to KD4 (positive lead), and the other from BL61 (negative) to BL60 (positive). Stimulation was delivered at a frequency of 30 Hz for 15 minutes per session, at the maximum amplitude tolerated by the patient [1].
Exercise Protocol
All participants, regardless of group, followed a home-based eccentric-exercise regimen based on protocols outlined by Arnold and Moody, and further supported by prior literature from Childress and Beutler. Eccentric exercise involves lengthening a muscle under load and is commonly used in rehabilitation protocols to strengthen tendons and reduce pain in tendinopathies. Each patient performed two specific exercises, 15 repetitions each, three times daily over a 12-week period. At each visit (weeks 0, 2, 4, 6, and 12), patients completed one supervised set of exercises and reported pain levels pre- and post-exercise using a Numeric Pain Rating Scale (NPRS), ranging from 0 (no pain) to 10 (worst pain) [1].
Clinical Outcomes
While both groups achieved functional gains over 12 weeks, the improvements in VISA-A scores did not differ significantly between them. The treatment group demonstrated a mean improvement of 21 points (P < 0.01), and the control group improved by 22 points (P = 0.02). However, the number of patients reaching full recovery—defined as a VISA-A score ≥90—was higher in the EA group (6 participants) than in the control group (2 participants) [1].
Where EA proved clearly beneficial was in short-term pain relief. The treatment group experienced a statistically significant reduction in pain immediately after exercise, with a mean decrease of 1.0 points on the NPRS (95% CI: 0.7 to 1.3; P < 0.01). Conversely, the control group exhibited a slight increase in pain post-exercise (mean change = -0.3; 95% CI: -0.5 to 0.02; P = 0.065). The between-group difference in pre- to post-exercise pain scores was also statistically significant (P < 0.01), indicating that EA provided effective acute analgesia during rehabilitative activities [1].
Acupuncture Needle Safety and Adverse Effects
No major adverse events occurred in either group, affirming the safety of EA in a clinical setting when performed by trained acupuncture providers [1].
Interpretation and Implications for Practice
While functional recovery over 12 weeks was similar between groups, EA significantly mitigated short-term exercise-induced pain. The findings suggest a potential role for EA in enhancing patient adherence and tolerance to rehabilitation by reducing discomfort during therapy.
Acupuncturists seeking to reproduce the protocol should note the specific parameters: bilateral needling at BL60–BL61 and KD3–KD4, 0.25 mm × 40 mm filiform needles, tendon-directed insertion, and continuous electrical stimulation at 30 Hz for 15 minutes at maximum tolerated amperage. Treatments were delivered over four sessions during the early stages of a 12-week eccentric rehabilitation course [1].
Acupuncture used as an adjunct to standard eccentric exercise therapy, improves short-term pain outcomes in patients with insertional Achilles tendinopathy. The integration of EA can facilitate better patient tolerance during exercise sessions—especially in the acute phase of rehabilitation. Future trials may explore extended EA protocols and their effect on long-term outcomes and recurrence prevention.
Achilles Tendon Acupuncture
HealthCMi staff acupuncturists note that the above research found limited functional recovery benefits although excellent pain relief using electroacupuncture. This may be, in part, due to the parameters of the acupuncture point selection. Improved outcomes may be attainable using more specifically targeted points with a direct therapeutic focus on the Achilles tendon. The following three acupuncture points are beneficial for the Achilles tendon:
- N-LE-3 (Genping, Level with the Heel)
- M-LE-10 (Quanshengzu, Spring at the Foot)]
- M-LE-9 (Nuxi, Woman’s Knee)
Genping is located on a line connecting the medial and lateral malleoli, at the posterior aspect of the body on the achilles tendon. A local point for the treatment of the achilles tendon, this acupoint is often needled to a depth of 0.5–0.8 cun. This point is traditionally indicated for foot disorders due to infantile paralysis.
Quanshengzu is located at the back of the heel, at the middle of the superior margin of the calcaneus bone, at the achilles tendon. Needle insertion is typically 0.2–0.3 cun. Indications include esophageal spasms, diseases of the brain, and lower back pain.
Nuxi is located at the back of the heel, at the center of the calcaneus bone. Needle insertion is typically 0.2 cun. Indications include gingivitis and mental illness. Additional acupuncture points include KD3 (Taixi), SP6 (Sanyinjiao), GB39 (Xuanzhong), and other local points.
Ankle Disorders
Chronic ankle instability, recurrent sprains and strains, and post-surgical recovery are commonly addressed in acupuncture clinics. For persistent or recurring conditions, local acupuncture points are selected to enhance joint stability and improve functional strength. Frequently used acupoints include:
- KD3 (Taixi)
- BL60 (Kunlun)
- GB40 (Qiuxu)
- ST42 (Chongyang)
Over time, some patients begin to internalize their condition, believing their ankle dysfunction is permanent. However, many of these individuals can achieve full recovery or substantial functional improvement with appropriate care. Both manual acupuncture and electroacupuncture are employed to stimulate local microcirculation, reduce inflammation, and promote tissue repair, often accelerating recovery and supporting long-term joint health.
Source
1. Matthew Hawks, Erik Clauson, Pamela Hughes, Rebecca Lauters, and Paul Crawford, “Treatment of Insertional Achilles Tendinopathy Using Adjunct Electroacupuncture Therapy: A Randomized Controlled Trial,” Medical Acupuncture 35, no. 2 (2023): 76–81. Testing at Florida and Nevada facilities.
