How acupuncture affects recovery and performance for running, OCR, and endurance sports
Thomas Solomon, PhD.
Updated onReading time approx 5 minutes (1250 words).
What you’ll learn:
Acupuncture is a traditional Chinese medicine technique where a practitioner inserts very thin needles into specific points on the body.
For exercise recovery and performance, acupuncture is unlikely to give you a meaningful boost (and the research base is pretty thin).
There might be a small effect on muscle soreness in some situations, but the evidence is low quality and side effects are not zero.
Curious about the how and why? Scroll down for the details, the nuances, and the nerdy bits.
The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.
What is acupuncture?
Acupuncture is about 2500 years old and sits at the heart of traditional Chinese medicine. The basic idea is simple: a practitioner inserts thin needles into specific sites on the body (often called “acupoints”). Traditionally, it’s described as helping to “restore the balance of energy flow”. In modern life, it’s also marketed as a do-it-all solution for a long list of long-term health problems (because of course it is).
A stack of Cochrane systematic reviewsA systematic review answers a specific research question by systematically collating all known experimental evidence, which is collected according to pre-specified eligibility criteria. A systematic review helps inform decisions, guidelines, and policy. has dug into acupuncture across different conditions. And while the evidence does not support many of the headline claims, there is reasonable evidence that acupuncture may help relieve migraines (Linde et al. 2016), headaches (Linde et al. 2016), and chronic (long-term) lower-back pain (Mu et al. 2020). So yes: there are areas where it may help. But you can also find at least one study for basically any condition suggesting acupuncture is the answer. That’s where we should put on our nerd glasses.
One reason for scepticism is how often the literature reports “positive” effects. For example, a review of pain treatment reported that 100% of trials (all 36 trials) conducted in China found a statistically significant benefit of acupuncture, while 68% of trials (171 of 252) conducted worldwide favoured acupuncture over control. The high prevalence of “wins” like this makes you wonder whether publication biasPublication bias in meta-analysis occurs when studies with significant results are more likely to be published than those with non-significant findings, leading to distorted conclusions. This bias can inflate effect sizes and misrepresent the true effectiveness of interventions, making it crucial to identify and correct for it in research. (and related reporting issues) might be lurking in the background. To be fair, there are other possible explanations: acupuncture might work better where it is traditionally practised, or practitioners might be more skilled in that setting. Still, a 2008 review argued that many acupuncture studies in pain research used designs that increase the likelihood of false positive findings (Ernst 2008). In other words: the study quality often deserves a raised eyebrow. NOTE: For a great read on why study design, statistics, and “P-hacking” matter (a lot), I can thoroughly recommend “The Art of Statistics”, by David Spiegelhalter.
Now, to exercise recovery. Some studies report that acupuncture reduces exercise-induced delayed-onset muscle soreness (DOMS) (example here), while others find no clear effect (see here and here). That “some yes, some no” pattern shows up a lot in recovery research. Which is why the big question is not “can I cherry-pick a cool study?”, but “what does the whole body of evidence say?” (Yes, I know. I’m fun at parties.)
What is the scientific evidence on the effect of acupuncture on recovery and athletic performance?
Quick note: this section summarises evidence on acupuncture for recovery from exercise and exercise performance. It is not about acupuncture for injury rehab, illness, or pain management in clinical populations.
A 2013 systematic reviewA systematic review answers a specific research question by systematically collating all known experimental evidence, which is collected according to pre-specified eligibility criteria. A systematic review helps inform decisions, guidelines, and policy. by Urroz et al. found 1 study reporting that acupuncture performed after exercise reduced heart rate, blood lactate, and oxygen consumption during the 30 to 60 minute post-exercise recovery period. However, the review found only 4 trials in total and concluded that there were too few robust randomised controlled trialsThe “gold standard” approach for determining whether a treatment has a causal effect on an outcome of interest. In such a study, a sample of people representing the population of interest is randomised to receive the treatment or a no-treatment placebo (control), and the outcome of interest is measured before and after exposure to the treatment and control. to justify pooling results in a meta-analysisA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment.. Translation: there was not enough high-quality evidence to calculate one clean “overall effect”.
A 2020 systematic reviewA systematic review answers a specific research question by systematically collating all known experimental evidence, which is collected according to pre-specified eligibility criteria. A systematic review helps inform decisions, guidelines, and policy. by Chang et al. included 15 studies and reported a trivial to small (and practically unconvincing) effect of acupuncture on exercise-induced delayed-onset muscle soreness (DOMS). The key detail: the 95% confidence interval (CI)A measure of uncertainty used in Frequentist statistics. The 95% confidence interval is a plausible range of values within which the true value (e.g., the true treatment effect) would be found 95% of the time if the data were repeatedly collected in different samples of people. If this range of values (the confidence interval) crosses zero, there is little confidence that the average value is the true effect. If the confidence interval does not cross zero, we can be confident that the average value is the true effect. for the summary effect sizeA standardised measure of the magnitude of an effect of an intervention. Unlike p-values, effect sizes show the size of the effect and how meaningful it might be. Common effect size measures include standardised mean difference (SMD), Cohen’s d, Hedges’ g, eta-squared, and correlation coefficients. crossed zero, which means the overall “average effect” could plausibly be no effect at all.
Another 2020 systematic reviewA systematic review answers a specific research question by systematically collating all known experimental evidence, which is collected according to pre-specified eligibility criteria. A systematic review helps inform decisions, guidelines, and policy. by Huang et al. reported small to moderate benefits for soreness, creatine kinase (CK; a marker linked to muscle damage), and restoration of muscle strength at 72 hours after exercise. But there was no clear effect at 24 hours or 48 hours after exercise. The authors also judged the quality of evidence in their meta-analysisA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment. to be low.
Putting those reviews together: acupuncture after exercise might reduce muscle soreness and help strength bounce back, but mainly in scenarios where your next hard session (or race) is around 72 hours later. Even then, both reviews highlight a messy evidence base: too few studies, underpowered trials, inconsistent reporting, weak or missing placebo controls, limited blindingBlinding is when people in a study don’t know which treatment they’re getting. It stops expectations or beliefs (from patients or researchers) from skewing the results. “Single-blind” means participants don’t know; “double-blind” means participants and researchers don’t know; “triple-blind” means that the participants, researchers, and data analysts are kept in the dark. The goal is simple: fair tests and trustworthy findings., and sometimes vague descriptions of where the needles even went.
There’s also the risk-benefit question. Acupuncture is not risk-free. Rare adverse outcomes include hospitalisation and death, and more common side effects include pain, bleeding, and bruising. And those “common” side effects are, ironically, things that can slow recovery rather than speed it up. So the practical question becomes: even if there is a small potential upside for soreness in some cases, is it worth the hassle and risk for you?
If you tolerate acupuncture well (no pain, bleeding, or bruising) and you accept the added risk, acupuncture does not appear to harm recovery of performance and it might slightly reduce soreness for some people. But here’s the core nerd-truth: recovery is supposed to restore your normal balance, not add another stressor — your training session was already the stressor that messed things up.
Can acupuncture enhance recovery and athletic performance?
Acupuncture after exercise is unlikely to meaningfully improve muscle soreness or speed up the recovery of performance.
Because there is not enough research, it is unclear whether effects differ between trained athletes and untrained people, or between males and females.
Keep in mind: there are very few studies, high heterogeneity (variability)Heterogeneity shows how much the results in different studies in a meta-analysis vary from each other. It is measured as the percentage of variation (the I2 value). A rule of thumb: if I2 is roughly 25%, that indicates low heterogeneity (good), 50% is moderate, and 75% indicates high heterogeneity (bad). High heterogeneity means there’s more variability in effects between studies and, therefore, a less precise overall effect estimate. in study designs and effects between studies, a high risk of biasRisk of bias in a meta-analysis refers to the potential for systematic errors in the studies included in the analysis. Such errors can lead to misleading/invalid results and unreliable conclusions. This can arise because of issues with the way participants are selected (randomisation), how data is collected and analysed, and how the results are reported., and possible publication biasPublication bias in meta-analysis occurs when studies with significant results are more likely to be published than those with non-significant findings, leading to distorted conclusions. This bias can inflate effect sizes and misrepresent the true effectiveness of interventions, making it crucial to identify and correct for it in research.. So, the overall certainty of evidenceCertainty of evidence tells us how confident we are that the published results accurately reflect the true effect. It’s based on factors like study design, risk of bias, consistency, directness, precision, and publication bias. High certainty means that the current evidence is so strong and consistent that future studies are unlikely to change conclusions. Whereas, low certainty means more doubt and less confidence, and that future studies could easily change current conclusions. is low. Therefore, additional high-quality randomised controlled trialsThe “gold standard” approach for determining whether a treatment has a causal effect on an outcome of interest. In such a study, a sample of people representing the population of interest is randomised to receive the treatment or a no-treatment placebo (control), and the outcome of interest is measured before and after the exposure to treatment/control. are needed to increase confidence in the overall effects reported in meta-analysesA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment..
The nice part: acupuncture does not appear to hurt recovery or performance on average. So if you like it, and you feel it helps you, you’re not doing anything obviously “wrong” by using it. That said, if a session causes pain, bleeding, or bruising, that is more likely to delay recovery than promote it. Also, time and money spent doing recovery with something that has no clear benefit might be better spent sleeping, eating something decent, hydrating, and doing something calm (yes, I’m basically prescribing a nap).
How to use this: If you want to try acupuncture, treat it as an optional extra, not a cornerstone. Use it only if you tolerate it well (no lingering pain, bleeding, or bruising), and don’t let it replace the boring-but-powerful stuff like sleep, food, and smart training. If you have a medical condition, take blood thinners, or you’re unsure about risk, talk to a qualified doctor first.
Information you can trust. All content on Veohtu is meticulously researched and written by Thomas Solomon, PhD. He does not sell supplements, recovery products, or ad space, and he has no sponsorships, brand affiliations, or ambassador roles. Everything you read reflects his independent views, shaped solely by peer-reviewed scientific evidence — and that will never change.
Full list of meta-analyses examining acupuncture for recovery
Here are the meta-analyses I've summarised above:
Effects of Acupuncture on Delayed-Onset Muscle Soreness: A Systematic Review and Meta-Analysis. Chang et al. (2023) Evid Based Complement Alternat Med.
Does Acupuncture Benefit Delayed-Onset Muscle Soreness After Strenuous Exercise? A Systematic Review and Meta-Analysis. Huang C, Wang Z, Xu X, Hu S, Zhu R, Chen X. Front Physiol. 2020
Effect of acute acupuncture treatment on exercise performance and postexercise recovery: a systematic review. Urroz P, Colagiuri B, Smith CA, Cheema BS. J Altern Complement Med. 2013
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Who is Thomas Solomon?
My knowledge has been honed following 20+ years of running, cycling, hiking, cross-country skiing, lifting, and climbing, 15+ years of academic research at world-leading universities and hospitals, and 10+ years advising and coaching in athletic performance and lifestyle change.
I have a BSc in Biochemistry, a PhD in Exercise Science, and over 90 peer-reviewed publications in medical journals.
I'm also an ACSM-certified Exercise Physiologist (ACSM-EP), an ACSM-certified Personal Trainer (ACSM-CPT), a VDOT-certified Distance Running Coach, and a UKVRN Registered Nutritionist (RNutr).
Since 2002, I’ve conducted biomedical research in exercise and nutrition and have taught and led university courses in exercise physiology, active recovery, biochemistry, and molecular medicine.
And, with my personal experience of competing on the track (800m to 10,000m), the road (5 k to marathon), on the trails, and in the mountains, by foot, bicycle, cross-country ski, and during obstacle course races (OCR), I deeply understand what it's like to train and compete — I've been there, done it, and gotten sweat, mud, and tears on my t-shirt.
Disclaimer: I occasionally mention brands and products, but it is important to know that I don't sell recovery products, supplements, or ad space, and I'm not affiliated with / sponsored by / an ambassador for / receiving advertisement royalties from any brands. I have conducted biomedical research for which I’ve received research money from publicly-funded national research councils and medical charities, and also from private companies, including Novo Nordisk Foundation, AstraZeneca, Amylin, the A.P. Møller Foundation, and the Augustinus Foundation. I’ve also consulted for Boost Treadmills and Gu Energy on R&D grant applications, and I provide research and scientific writing services for Examine.com. Some of my articles contain links to information provided by Examine.com but I do not receive any royalties or bonuses from those links. Importantly, none of the companies described above have had any control over the research design, data analysis, or publication outcomes of my work. I research and write my content using state-of-the-art, consensus, peer reviewed, and published scientific evidence combined with my empirical evidence observed in practice and feedback from athletes. My advice is, and always will be, based on my own views and opinions shaped by the scientific evidence available. The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.