Effects of a single session of acupuncture on suboccipital muscles: hamstring flexibility and proprioception

Article information

J Korean Med. 2025;46(1):1-14

Publication date (electronic) : 2025 March 01

doi : https://doi.org/10.13048/jkm.25001

Eun-song KIM ¹^,

, Jae-keun Oh ²

, Jin-Ho Yoon ³

¹Graduate School, Korean National University of Physical Education

²Department of Healthcare, Korean National University of Physical Education

³Department of Physical Education, Korean National University of Physical Education

Correspondence to: Eun-Song KIM, Graduate school, Korean National University of Physical Education 1239, Yangjae-daero, Songpa-gu, Seoul, Republic of Korea, Tel: +82-2-410-6954, E-mail: art2k@naver.com

Received 2024 August 22; Revised 2024 November 6; Accepted 2025 February 13.

Abstract

Objectives

This study was conducted to investigate the immediate effect of a single session of acupunture to suboccipital muscle on the hamstring flexibility and proprioception.

Methods

Forty-two adult men who exercise at least twice a week were randomized to the acupuncture group (n=14), the sham acupuncture group (n=14), and the self-myofascial release group (n=14). Hamstring flexibility test, cervical joint position error test, and lower extremity proprioception test (Tandem romberg test) were measured immediately before and after the intervention. Two-way ANOVA with Repeated measures was performed to verify the effect. Differences between groups were analyzed using the independent sample t-test, and differences between time periods within each group were analyzed using the paired t-test. All statistical significance levels were set to p<.05.

Results

Hamstring flexibility showed significant differences in the acupuncture group (left, p=.001; right, p<.001) and in the self-myofascial release group (left, p=.038; right, p=.004). There was no significant difference of lower extremities proprioception according to the intervention method.

Conclusions

Acupuncture treatment was shown to be effective in increasing hamstring flexibility immediately, and it is thought to have a similar level of effect with self-myofascial release.

Keywords: Acupuncture; Hamstring flexibility; suboccipital muscle; proprioception

Fig. 1

Flowchart for the Study

Fig. 2

Assessment of hamstring flexibility

Fig. 3

Assessment of lower limb proprioception

Fig. 4

Location of GB 20

Fig. 5

Location of BL 20

Fig. 6

Method of sham Acupuncture group

Fig. 7

Method of self myofacialrelease group

Fig. 8

Changes in left hamstring flexibility between groups and time

Fig. 9

Changes in right hamstring flexibility between groups and time

Fig. 10

Changes in average tandem rombergtest between groups and time

Table 1

Characteristics of Subjects

Table 2

Changes in Left Hamstring Flexibility between Groups and Time (°)

Table 3

Changes in Right Hamstring Flexibility between Groups and Time (°)

Table 4

Changes in Average Tandem Romberg Test between Groups and Time (second)

References

1. Peck D., Buxton DF., Nitz A.. 1984;A comparison of spindle concentrations in large and small muscles acting in parallel combinations. Journal of morphology 180(3):243–252. https://doi.org/10.1002/jmor.1051800307.

2. McPartland JM., Brodeur RR., Hallgren RC.. 1997;Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study. Journal of manipulative and physiological therapeutics 20(1):24–29.

3. Cho SH., Bae CH., Gak HB.. 2013;Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction. Journal of physical therapy science 25(10):1239–1241. https://doi.org/10.1589/jpts.25.1239.

4. Toosizadeh N., Ehsani H., Miramonte M., Mohler J.. 2018;Proprioceptive impairments in high fall risk older adults: the effect of mechanical calf vibration on postural balance. Biomedical engineering online 17(1):51. https://doi.org/10.1186/s12938-018-0482-8.

5. Verhagen E., van der Beek A., Twisk J., Bouter L., Bahr R., van Mechelen W.. 2004;The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. The American journal of sports medicine 32(6):1385–1393. https://doi.org/10.1177/0363546503262177.

6. Chang JS., Kayani B., Plastow R., Singh S., Magan A., Haddad FS.. 2020;Management of hamstring injuries: current concepts review. The bone & joint journal 102-B(10):1281–1288. https://doi.org/10.1302/0301-620X.102B10.BJJ-2020-1210.R1.

7. Guex K., Degache F., Morisod C., Sailly M., Millet GP.. 2016;Hamstring Architectural and Functional Adaptations Following Long vs. Short Muscle Length Eccentric Training. Frontiers in physiology 7:340. https://doi.org/10.3389/fphys.2016.00340.

8. Wan X., Qu F., Garrett WE., Liu H., Yu B.. 2017;The effect of hamstring flexibility on peak hamstring muscle strain in sprinting. Journal of sport and health science 6(3):283–289. https://doi.org/10.1016/j.jshs.2017.03.012.

9. Jandre Reis FJ., Macedo AR.. 2015;Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk Range of Motion in Low Back Pain and Asymptomatic Volunteers during Forward Bending. Asian spine journal 9(4):535–540. https://doi.org/10.4184/asj.2015.9.4.535.

10. Bazzaz-Yamchi M., Naghdi S., Nakhostin-Ansari A., Hadizadeh M., Ansari NN., Moghimi E., Hasson S.. 2021;Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study. The Scientific World Journal :7259956. https://doi.org/10.1155/2021/7259956.

11. Dadebo B., White J., George KP.. 2004;A survey of flexibility training protocols and hamstring strains in professional football clubs in England. British journal of sports medicine 38(4):388–394. https://doi.org/10.1136/bjsm.2002.000044.

12. Myers TW.. 2005. Anatomy trains: Myofascial meridians for manual and movement therapists 2nd edth ed. New York: Churchill Livingstone.

13. Williams W., Selkow NM.. 2019;Self-Myofascial Release of the Superficial Back Line Improves Sit-and-Reach Distance. Journal of sport rehabilitation 29(4):400–404. https://doi.org/10.1123/jsr.2018-0306.

14. Aparicio EQ., Quirante LB., Blanco CR., Sendín FA.. 2009;Immediate effects of the suboccipital muscle inhibition technique in subjects with short hamstring syndrome. Journal of manipulative and physiological therapeutics 32(4):262–269. https://doi.org/10.1016/j.jmpt.2009.03.006.

15. Cho SH., Kim SH., Park DJ.. 2015;The comparison of the immediate effects of application of the suboccipital muscle inhibition and self-myofascial release techniques in the suboccipital region on short hamstring. Journal of physical therapy science 27(1):195–197. https://doi.org/10.1589/jpts.27.195.

16. Kang HS., Kwon HW., Kim DG., Park KR., Hahm SC., Park JH.. 2021;Effects of the Suboccipital Muscle Inhibition Technique on the Range of Motion of the Ankle Joint and Balance According to Its Application Duration: A Randomized Controlled Trial. Healthcare (Basel, Switzerland) 9(6):646. https://doi.org/10.3390/healthcare9060646.

17. Alaei P., Nakhostin Ansari N., Naghdi S., Fakhari Z., Komesh S., Dommerholt J.. 2020;Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial. Journal of sport rehabilitation 30(3):452–457. https://doi.org/10.1123/jsr.2020-0111.

18. de Carvalho AO., Cabral L., Rubini E.. 2011;Acupuncture Improves Flexibility: Acute Effect of Acupuncture Before a Static Stretch of Hip Adductors. Medical Acupuncture 23(1):27–33. https://doi.org/10.1089/acu.2010.0773.

19. Kim D., Jang S., Park J.. 2020;Electroacupuncture and Manual Acupuncture Increase Joint Flexibility but Reduce Muscle Strength. Healthcare (Basel, Switzerland) 8(4):414. https://doi.org/10.3390/healthcare8040414.

20. Faul F., Erdfelder E., Buchner A., Lang A.. 2009;Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods 41:1149–1160.

21. Saghaei M.. 2004;Random allocation software for parallel group randomized trials. BMC medical research methodology 4:26. https://doi.org/10.1186/1471-2288-4-26.

22. Kang MH., Jung DH., An DH., Yoo WG., Oh JS.. 2013;Acute effects of hamstring-stretching exercises on the kinematics of the lumbar spine and hip during stoop lifting. Journal of back and musculoskeletal rehabilitation 26(3):329–336. https://doi.org/10.3233/BMR-130388.

23. Diamantopoulos II., Clifford E., Birchall JP.. 2003;Short-term learning effects of practice during the performance of the tandem Romberg test. Clinical otolaryngology and allied sciences 28(4):308–313. https://doi.org/10.1046/j.1365-2273.2003.00710.x.

24. Fernández-de-Las-Peñas C., Mesa-Jiménez JA., Lopez-Davis A., Koppenhaver SL., Arias-Buría JL.. 2020;Cadaveric and ultrasonographic validation of needling placement in the obliquus capitis inferior muscle. Musculoskeletal science & practice 45:102075. https://doi.org/10.1016/j.msksp.2019.102075.

25. Chan YT., Zhang HW., Guo YQ., Chan T., Kwan YK., Lee CK., et al. 2018;Effectiveness and safety of acupuncture for elderly overactive bladder population in Hong Kong: study protocol for a randomized controlled trial. Trials 19(1):376. https://doi.org/10.1186/s13063-018-2706-4.

26. Amato A., Messina G., Giustino V., Brusa J., Brighina F., Proia P.. 2021;A pilot study on non-invasive treatment of migraine: The self-myofascial release. European journal of translational myology 31(1):9646. https://doi.org/10.4081/ejtm.2021.9646.

27. Borges M., Medeiros D., Minotto B., Lima C.. 2017;Comparison between static stretching and proprioceptive neuromuscular facilitation on hamstring flexibility: systematic review and meta-analysis. European Journal of Physiotherapy 20(1):1–8. https://doi.org/10.1080/21679169.2017.1347708.

28. Schleip R., Müller DG.. 2013;Training principles for fascial connective tissues: scientific foundation and suggested practical applications. Journal of bodywork and movement therapies 17(1):103–115. https://doi.org/10.1016/j.jbmt.2012.06.007.

29. Suchomel TJ., Nimphius S., Bellon CR., Stone MH.. 2018;The Importance of Muscular Strength: Training Considerations. Sports medicine (Auckland, N.Z.) 48(4):765–785. https://doi.org/10.1007/s40279-018-0862-z.

30. Ajimsha MS., Al-Mudahka NR., Al-Madzhar JA.. 2015;Effectiveness of myofascial release: systematic review of randomized controlled trials. Journal of bodywork and movement therapies 19(1):102–112. https://doi.org/10.1016/j.jbmt.2014.06.001.

31. Stecco C., Porzionato A., Lancerotto L., Stecco A., Macchi V., Day JA., et al. 2008;Histological study of the deep fasciae of the limbs. Journal of bodywork and movement therapies 12(3):225–230. https://doi.org/10.1016/j.jbmt.2008.04.041.

32. Day J., Kasuske K.. 2021;The effectiveness of dry needling on hamstring flexibility:A systematic review. International Journal of Physiotherapy and Research 9(5):4035–39. https://doi.org/10.16965/ijpr.2021.186.

33. Yoon KB., Cho MRN., Jung H.. 2001;The Clinical Study on the Efficiency of the A-Shi Point. J Acupunct Res 18(1):226–236.

34. Sandberg M., Lundeberg T., Lindberg LG., Gerdle B.. 2003;Effects of acupuncture on skin and muscle blood flow in healthy subjects. European journal of applied physiology 90(1–2):114–119. https://doi.org/10.1007/s00421-003-0825-3.

35. Cagnie B., Barbe T., De Ridder E., Van Oosterwijck J., Cools A., Danneels L.. 2012;The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of manipulative and physiological therapeutics 35(9):685–691. https://doi.org/10.1016/j.jmpt.2012.10.005.

36. Treleaven J.. 2008;Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy 13(1):2–11. https://doi.org/10.1016/j.math.2007.06.003.

37. Wah SW., Puntumetakul R., Boucaut R.. 2021;Effects of Proprioceptive and Craniocervical Flexor Training on Static Balance in University Student Smartphone Users with Balance Impairment: A Randomized Controlled Trial. Journal of pain research 14:1935–1947. https://doi.org/10.2147/JPR.S312202.

Article information Continued

Fig. 2

Assessment of hamstring flexibility

Fig. 3

Assessment of lower limb proprioception

Fig. 6

Method of sham Acupuncture group

Fig. 7

Method of self myofacialrelease group

Fig. 8

Changes in left hamstring flexibility between groups and time

Fig. 9

Changes in right hamstring flexibility between groups and time

Fig. 10

Changes in average tandem rombergtest between groups and time

Table 1

Characteristics of Subjects

	N	Age	Height	Weight	BMI
Acupuncture	14	27.0±3.2	173.2±5.0	72.5±15.8	24.0±4.4
Sham acupuncture	14	26.2±3.4	172.7±5.8	69.3±7.8	23.2±2.7
self-myofacial release	14	28.0±2.9	171.9±4.0	69.1±6.8	23.3±2.0
Total	42	27.0±3.2	172.6±4.9	70.3±10.7	23.5±3.2

Table 2

Changes in Left Hamstring Flexibility between Groups and Time (°)

Group	Pre-intervention(A)	Post-intervention(B)	MD† (B-A)	Sig‡
Acupuncture	142.29 ± 12.54	149.14 ± 11.60	6.85**	Time	<0.001
Sham acupuncture	145.21 ± 7.27	145.86 ± 8.69	0.65	Time× Group	0.038
self-myofacial release	144.79 ± 8.79	149.21± 9.41	4.42*	Group	0.904

Statistics analysis using Two-way ANOVA with repeated measures Between-time post hoc comparison(Paired t-test);

p<.05,

^**

p<.001;

^†

MD, mean difference;

^‡

Sig, significant;

Table 3

Changes in Right Hamstring Flexibility between Groups and Time (°)

Group	Pre-intervention(A)	Post-intervention(B)	MD† (B-A)	Sig‡
Acupuncture	143.14 ± 10.84	150.07 ± 11.03	6.92**	Time	<0.001
Sham acupuncture	143.71 ± 10.97	145.43 ± 10.08	1.71	Time× Group	0.008
self-myofacial release	145.90 ± 9.28	148.93 ± 7.84	3.02*	Group	0.735

Statistics analysis using Two-way ANOVA with repeated measures Between-time post hoc comparison(Paired t-test);

p<.05,

^**

p<.001;

^†

MD, mean difference;

^‡

Sig, significant;

Table 4

Changes in Average Tandem Romberg Test between Groups and Time (second)

Group	Pre-intervention(A)	Post-intervention(B)	MD† (B-A)	Sig‡
Acupuncture	48.41 ± 37.05	58.25 ± 36.03	9.84	Time	0.309
Sham acupuncture	61.43 ± 36.89	66.03 ± 40.24	4.60	Time× Group	0.600
self-myofacial release	59.79 ± 32.35	58.79 ± 35.08	1.00	Group	0.714

Statistics analysis using Two-way ANOVA with repeated measures

^†

MD, mean difference;

^‡

Sig, significant;