How Does Acupuncture Work?
Acupuncture has been used for thousands of years, but it often raises the same question from new clients: “How does acupuncture actually work?”
As a physiotherapist, I regularly explain this to patients in both NHS and private practice. The truth is, acupuncture is a fascinating blend of ancient practice and modern science. While traditional Chinese medicine (TCM) describes acupuncture in terms of energy flow or “Qi,” modern research provides us with clear physiological explanations for how and why it helps with pain, stress, and recovery.
In this post, we’ll break down how acupuncture works — from both the traditional view and the latest scientific evidence.
1. Traditional View: Balancing Energy Flow
In traditional Chinese medicine, health is thought to depend on the smooth flow of energy, or Qi (pronounced “chee”), through channels in the body called meridians. Illness or pain is said to arise when this flow becomes blocked or imbalanced.
Acupuncture involves inserting very fine needles at specific points along these meridians to restore balance and harmony.
While this explanation doesn’t fit modern medical models, it remains a meaningful way for many people to understand acupuncture. The key point is that acupuncture works by stimulating the body to restore balance and healing — a principle that has stood the test of time for over 2,000 years.
2. Modern Scientific Explanation
From a Western medical perspective, acupuncture works through several overlapping mechanisms in the body. The evidence shows it has local, spinal, and central (brain) effects.
🔹 Local Effects
When a needle is inserted into muscle or soft tissue, it causes:
Micro-trauma that stimulates blood flow and healing at the site
Release of local adenosine, a chemical that reduces pain sensitivity
Relaxation of tight muscle fibres (especially useful for trigger points)
This is why acupuncture can quickly reduce muscle stiffness or knots.
🔹 Spinal Effects
Nerve fibres at the site of needling send signals to the spinal cord. This activates a mechanism known as the “gate control theory of pain” — essentially closing the “gates” that allow pain signals to travel to the brain.
As a result, the brain perceives less pain from that area.
🔹 Central (Brain) Effects
Perhaps the most powerful effect of acupuncture happens in the brain. Research using functional MRI has shown that acupuncture:
Stimulates the release of endorphins and enkephalins (the body’s natural painkillers)
Activates areas of the brain involved in relaxation and emotion regulation
Deactivates brain regions associated with the perception of pain
This explains why acupuncture can help with both physical pain and emotional wellbeing.
👉 A review in Neuroscience Letters (Zhao, 2008) summarised the neurobiological mechanisms of acupuncture and confirmed its influence on both peripheral (local) and central (brain) pathways.
3. Evidence for Acupuncture’s Mechanisms
Several high-quality studies support these mechanisms:
Endorphin release: Research has shown that acupuncture increases levels of endorphins in cerebrospinal fluid, correlating with pain relief (Han, 2004).
Neuroimaging studies: fMRI scans demonstrate changes in brain activity after acupuncture, especially in the limbic system and pain-modulating areas (Hui et al., 2010).
Inflammation reduction: Acupuncture has been shown to down-regulate pro-inflammatory markers such as TNF-α and IL-6, which contribute to chronic pain (Zijlstra et al., 2003).
These findings help bridge the gap between traditional explanations and modern biomedical science.
4. Acupuncture and the Nervous System
A key part of understanding acupuncture is its effect on the autonomic nervous system (ANS).
The sympathetic nervous system is responsible for “fight or flight” — stress, muscle tension, and pain sensitivity.
The parasympathetic nervous system is the “rest and digest” mode — relaxation, healing, and recovery.
Acupuncture appears to rebalance the ANS, reducing sympathetic overactivity and promoting parasympathetic activation. This explains why many patients feel not just less pain, but also calmer, more relaxed, and sometimes even sleepy during or after a session.
5. Placebo or Real Effect?
Skeptics sometimes ask whether acupuncture is just a placebo. While all treatments carry some placebo effect, research shows that acupuncture’s benefits go far beyond this.
👉 In a large individual patient meta-analysis of nearly 18,000 participants, acupuncture was significantly more effective than both sham acupuncture and usual care for chronic pain (Vickers et al., 2012, BMJ).
This demonstrates that while expectation plays a role (as it does in all healthcare), acupuncture has genuine, measurable physiological effects.
6. What to Expect in a Session
For those curious about trying acupuncture, here’s what typically happens:
A full assessment of your symptoms and health history
Selection of acupuncture points tailored to your condition
Insertion of sterile, single-use fine needles — often surprisingly comfortable
Sensations may include tingling, warmth, or a dull ache (known as “De Qi”)
Needles usually stay in place for 15–30 minutes
You may feel relaxed, drowsy, or energised afterwards
🌟 Key Takeaway
Acupuncture is more than just “needles in the skin.” It works through a combination of local tissue effects, spinal mechanisms, and changes in brain chemistry and activity. These processes help reduce pain, relax tight muscles, lower stress, and promote overall wellbeing.
While traditional explanations use the language of energy and balance, modern science provides clear evidence that acupuncture is a safe, effective, and biologically active therapy.
📞 Curious about how acupuncture could help you? Book your session with JN Physiotherapy today.
📚 References
Han, J.S. (2004). Acupuncture and endorphins. Neuroscience Letters, 361(1-3), 258–261.
Hui, K.K.-S., et al. (2010). Acupuncture mobilizes the brain’s default mode and its anti-correlated network in healthy subjects. Brain Research, 1313, 111–120.
Vickers, A.J., et al. (2012). Acupuncture for chronic pain: individual patient data meta-analysis. BMJ, 344, e431.
Zijlstra, F.J., et al. (2003). Anti-inflammatory actions of acupuncture. Mediators of Inflammation, 12(2), 59–69.
Zhao, Z.-Q. (2008). Neural mechanism underlying acupuncture analgesia. Neuroscience Letters, 437(2), 81–84.