Effects of Acupuncture, Moxibustion, Cupping, and Massage on Sports Injuries: A Narrative Review

This comprehensive narrative review examines the application of four therapeutic modalities of Traditional Chinese Medicine (TCM) in the treatment of sports injuries: acupuncture, moxibustion, cupping, and massage. The study arises from the growing interest of athletes and patients in seeking therapeutic alternatives when conventional medicine cannot adequately alleviate musculoskeletal symptoms. The research demonstrates that these millennia-old therapies offer significant advantages, being effective, economical, and convenient, with some able to be administered by trained patients at home. Acupuncture, based on the theory of meridians and acupoints, proved effective in several athletic conditions.

Results indicate 100% efficacy in the treatment of ankle sprains when combined with tendon manipulation, and 80% success in chronic plantar fasciitis compared with only 13.3% in the control group. Electroacupuncture promotes tendon repair by upregulating growth factors such as TGF-β1 and b-FGF, and demonstrates analgesic effects through modulation of neurotransmitters such as serotonin and 5-HT2A/2C receptors. Moxibustion, a technique that uses heat generated by burning mugwort (Artemisia) to stimulate acupoints, presented efficacy rates of 83.4% in the treatment of ligament injuries and 94.59% in tennis elbow. From the TCM perspective, it regulates qi (氣) and blood, while modern medicine explains its effects through infrared radiation that penetrates up to 10 mm into the skin, providing energy for cellular regeneration and accelerating healing.

Cupping, popularized by swimmer Michael Phelps at the 2016 Olympics, uses negative pressure to increase blood flow and reduce inflammation. Studies show 95.8% efficacy when combined with McKenzie therapy for low back pain, and 97.62% when combined with moxibustion and medium-frequency pulse. The technique promotes hemolysis through negative pressure, increasing histamine production and improving the physiological function of organs. Chinese massage (Tuina) involves broad technical manipulations performed by fingers, hands, elbows, or feet applied to muscles and soft tissues.

It demonstrated significant efficacy when combined with other therapies in the treatment of knee osteoarthritis, intervertebral instability, and plantar fasciitis. Massage regulates the nervous, endocrine, and immune systems through sensory stimuli, releasing endorphins, acetylcholine, serotonin, and catecholamines related to analgesia. The four therapeutic modalities demonstrated complementary mechanisms of action: acupuncture through neurohumoral modulation and production of analgesic substances; moxibustion via infrared radiation and cellular activation; cupping through increased perfusion and reduced inflammation; and massage through systemic regulation and release of analgesic mediators. All therapies showed favorable safety profiles with minimal adverse effects when performed properly.

The study highlights the importance of preventing sports injuries, citing examples of elite athletes such as Usain Bolt, who used massage regularly before training and competitions to optimize physical condition and prevent injuries. The research suggests that these therapies should be included as non-pharmacological tools within multimodal treatment strategies, potentially reducing medication use and offering self-management options for trained patients.