Acupuncture & Endurance Sports: A Complete Guide for Distance Athletes and Ultramarathoners
If you're logging 50-mile training weeks, toeing the line at mountain ultras, or chasing a marathon PR, your body is absorbing a kind of accumulated stress that most people never experience. Tendons under constant eccentric load. Nervous systems running chronically hot. Tissue damage accumulating faster than it can be repaired.
Standard sports medicine handles acute injuries well. But the slower, subtler problems that define endurance sport, like persistent tightness, unresolved tendinopathies, deteriorating sleep quality deep in a training block, and the creeping fatigue that precedes a stress fracture, often fall through the cracks of conventional care.
That's where acupuncture, dry needling, and electroacupuncture have a meaningful role to play.
Not as an alternative to evidence-based sports medicine, but as a complement to it, targeting the physiological systems that determine whether you recover fast enough to train again, whether your nervous system can modulate pain signals efficiently, and whether your soft tissue can adapt to the load you're asking it to absorb.
This is a deep-dive into exactly how these tools work, what the research says, and how we use them at West End Acupuncture with runners, triathletes, and ultramarathoners in Portland, Maine.
What Makes Endurance Sport Physiologically Unique
Before getting into mechanisms, it's worth establishing why endurance athletes are a specific clinical population, not just "recreational exercisers doing more of it."
Ultramarathoners and serious distance athletes experience a physiological profile that's distinct from other sports:
Cumulative musculoskeletal load. Runners absorb 2–3 times their body weight per footstrike. At 180 steps per minute, that's roughly 10,000–15,000 impact cycles per hour of running. Over a 100-mile race, that number becomes almost incomprehensible. Tendons, plantar fascia, IT bands, and hip flexors absorb this load continuously, often with incomplete recovery between sessions.
Autonomic nervous system dysregulation. Heavy endurance training chronically stimulates the sympathetic nervous system (fight-or-flight). When recovery is insufficient, athletes get stuck in a state of sympathetic dominance: poor sleep, elevated resting heart rate, impaired digestion, mental irritability, and blunted immune function. Elite coaches call this overreaching; left unaddressed, it becomes overtraining syndrome.
Systemic inflammation. Exercise-induced inflammation is necessary for adaptation, but chronic low-grade inflammation impairs tissue repair, increases injury risk, and contributes to immune suppression. Research on ultramarathon runners shows dramatically elevated inflammatory cytokines post-race, with some markers remaining elevated for days to weeks.
Gut compromise. Endurance athletes frequently experience GI distress: nausea, bloating, and gastrointestinal cramping during and after long efforts. Reduced splanchnic blood flow during high-intensity exercise, combined with altered gut microbiome composition in high-mileage athletes, creates a significant performance liability.
Tissue repair under stress. The body's ability to repair tendons, fascial tissue, and muscle depends on local blood flow, fibroblast activity, and adequate sleep. When training volume exceeds recovery capacity, this process falls behind.
Each of these issues, musculoskeletal load, autonomic dysregulation, inflammation, gut function, tissue repair, maps onto mechanisms that acupuncture and dry needling directly target and why these tools have become increasingly integrated into elite endurance sport contexts.
How Acupuncture Works: The Relevant Mechanisms for Endurance Athletes
Acupuncture stimulates nerve pathways that trigger cascading physiological responses which are directly relevant to endurance performance and recovery. Here's what the science shows is actually happening:
1. Endorphin and Enkephalin Release
Needling activates Aδ and C nerve fibers, triggering the release of endorphins, enkephalins, and other endogenous opioids from the hypothalamus, pituitary, and spinal cord. These are the same compounds involved in the "runner's high" and they're the body's primary internal pain modulation system.
For endurance athletes, this means acupuncture can reduce perceived pain from tendinopathies, shin splints, and musculoskeletal overuse injuries without the systemic side effects of NSAIDs, which, if taken chronically, impair tendon healing and gut integrity.
2. Local Blood Flow and Tissue Healing
Needling increases local microcirculation at and around the insertion site, delivering oxygen and nutrients to tissue that may be chronically underperfused. In tendons, which have notoriously poor blood supply, this is clinically significant. Increased circulation also supports fibroblast activity, which is central to collagen remodeling and tendon repair.
For runners with Achilles tendinopathy, patellar tendinopathy, or plantar fasciitis, this mechanism explains why acupuncture or dry needling combined with load management often produces better outcomes than passive treatment alone.
3. Autonomic Nervous System Regulation
This is arguably the most underappreciated mechanism for endurance athletes. Acupuncture has measurable effects on autonomic tone, specifically, it downregulates sympathetic activity and upregulates parasympathetic function (the "rest and digest" state).
Research shows acupuncture increases heart rate variability (HRV), a key marker of recovery readiness that many endurance athletes already track. For athletes whose HRV has been suppressed by training load, stress, or poor sleep, regular acupuncture can help tip the nervous system back toward the parasympathetic dominance needed for tissue repair, immune function, and quality sleep.
Think of it this way: your body can't adequately recover in a state of sympathetic overdrive. Acupuncture creates a window of parasympathetic activation that allows the repair processes to actually run.
4. Anti-Inflammatory Effects
Acupuncture modulates the release of pro-inflammatory cytokines (including IL-1β, IL-6, TNF-α) and promotes anti-inflammatory mediators. For endurance athletes dealing with chronic low-grade systemic inflammation from high training volume, this is a meaningful lever.
Importantly, this isn't immune suppression, acupuncture helps normalize inflammatory signaling rather than simply damping it down. Post-race recovery, in particular, may benefit from sessions timed to help regulate the acute inflammatory response.
5. Descending Pain Inhibition
Acupuncture activates descending pain inhibitory pathways via the periaqueductal gray (PAG) and rostral ventromedial medulla (RVM). This mechanism helps explain why acupuncture often reduces pain not just at the site of needling but systemically and why it can help athletes who are running with chronic pain maintain more normal movement patterns.
Ready to make acupuncture part of your training?
Zach has worked with runners, triathletes, and endurance athletes at every level. If you're dealing with an injury, deep in a training block, or just ready to recover faster, we're taking new patients now. Book online or call us at (207)-376-0264
Dry Needling for Endurance Athletes: Targeting Trigger Points and Myofascial Restriction
Dry needling, the targeted needling of trigger points in myofascial tissue is a core part of how we work with endurance athletes at West End Acupuncture. For endurance athletes, dry needling addresses specific problems that accumulate from high-mileage training:
Trigger point deactivation. Active trigger points, the hyperirritable spots in taut muscle bands are ubiquitous in endurance athletes. They develop from repetitive eccentric loading, inadequate recovery, and biomechanical asymmetries. They restrict range of motion, reduce force production, and create referred pain patterns that can masquerade as other injuries. Direct needling of trigger points causes a local twitch response, which temporarily increases local circulation and helps resolve the metabolic stagnation sustaining the trigger point.
IT band syndrome. The iliotibial band itself doesn't contain trigger points (it's a dense fascial structure), but the TFL, gluteus medius, and lateral quad muscles that feed tension into it absolutely do. Dry needling these muscles, combined with glute strengthening and run mechanics work, is one of the most effective approaches to stubborn IT band syndrome.
Plantar fasciitis. Dry needling the plantar fascia, intrinsic foot muscles, and gastrocnemius/soleus complex addresses the myofascial component of plantar fascia pain. Combined with load management and eccentric calf exercises, this approach significantly accelerates recovery.
Achilles and patellar tendinopathy. Dry needling around the tendon, not into the tendon itself, plus needling the relevant musculature, stimulates local blood flow and reduces pain sensitivity. It's most effective when combined with progressive tendon loading protocols.
Hip flexor and psoas restriction. Distance runners notoriously develop chronic hip flexor tightness that alters pelvis position, increases lumbar stress, and reduces stride length. Direct needling of the psoas and iliacus releases this restriction more efficiently than most manual therapies.
Glute inhibition. Gluteal muscle inhibition, where the glutes fail to fire appropriately during the running gait, is one of the most common contributors to knee pain, IT band syndrome, and hip injuries in runners. Needling combined with targeted activation work helps restore normal muscle recruitment.
Electroacupuncture: The Tool for Deep Tissue Work and Nervous System Reset
Electroacupuncture (EA) involves attaching a mild electrical current to acupuncture needles, amplifying and sustaining the physiological response that manual needling initiates. For endurance athletes, it has several specific advantages:
Stronger endorphin release. EA stimulates stronger and more sustained release of endogenous opioids than manual needling alone, making it particularly effective for managing significant pain like post-race soreness, tendinopathy flare-ups, or acute muscle damage.
Nerve conduction improvement. Research in diabetic peripheral neuropathy has shown electroacupuncture is the most effective acupuncture modality for improving nerve conduction velocity. While this research involves a pathological population, the underlying mechanism, enhanced peripheral nerve function through improved microcirculation and neurotrophic factor modulation, is relevant to athletes managing overuse-related nerve entrapments (meralgia paresthetica, piriformis syndrome with sciatic irritation, etc.).
Autonomic recalibration. EA at specific frequencies has measurable effects on heart rate variability and autonomic tone. Low-frequency EA (2–4 Hz) tends to promote parasympathetic activation and is well-suited to recovery sessions. This makes it a useful tool in the week before a race or immediately post-event.
Condition-by-Condition: Acupuncture for the Most Common Endurance Injuries
IT Band Syndrome (Iliotibial Band Syndrome)
IT band syndrome is the leading cause of lateral knee pain in distance runners. Needling addresses the upstream musculature (TFL, glute med, vastus lateralis) that creates fascial tension along the lateral chain. Combined with hip strengthening and load management, we typically see meaningful improvement within 3–6 sessions.
Plantar Fasciitis
One of the most common and frustrating injuries in endurance sport. Dry needling the plantar fascia insertion, intrinsic foot muscles, and the calf complex addresses both local tissue sensitivity and the upstream contributors that overload the fascia. Electroacupuncture can be particularly effective for chronic cases where passive treatment has stalled.
Achilles Tendinopathy
Insertional and mid-substance Achilles tendinopathy respond well to a combined approach: dry needling around the tendon and through the gastrocnemius/soleus, electroacupuncture to stimulate local tissue response, and concurrent progressive tendon loading (heavy slow resistance).
Shin Splints (Medial Tibial Stress Syndrome)
Dry needling the tibialis posterior, flexor digitorum longus, and soleus, the muscles whose fascial attachments contribute to periosteal stress along the tibia, reduces pain and allows earlier return to running. Acupuncture also addresses the systemic inflammatory component that makes bone stress injuries more likely in overtrained athletes.
Hip Flexor Tightness and Hip Pain
Chronic hip flexor tightness in distance runners contributes to anterior pelvic tilt, increased lumbar extension stress, reduced hip extension at toe-off, and compensatory overuse injuries throughout the chain. Direct needling of the psoas, iliacus, and rectus femoris releases this restriction. Combined with gait analysis and hip extension strengthening, the results are often dramatic.
Hamstring Tendinopathy (Proximal)
Proximal hamstring tendinopathy, pain at the sit bone, aggravated by hills and seated compression, is notoriously slow to heal. Dry needling the proximal hamstring complex combined with progressive loading is one of the more effective approaches for this stubborn condition.
Stress Fracture Prevention and Recovery
Acupuncture doesn't heal bone. But the systemic effects, improved sleep quality, reduced inflammatory signaling, better nervous system regulation, support the hormonal and metabolic environment in which bone remodels. Athletes with a history of stress fractures often benefit from acupuncture as part of a return-to-running program that includes load monitoring, nutritional assessment, and hormonal evaluation.
Overtraining Syndrome and Non-Functional Overreaching
This is where acupuncture's autonomic and systemic effects are most clinically relevant. Athletes in a state of overreaching or early overtraining syndrome present with elevated resting heart rate, suppressed HRV, mood disturbance, persistent fatigue, and impaired performance despite rest. This reflects a nervous system stuck in sympathetic overdrive.
Regular acupuncture, particularly with electroacupuncture protocols targeting autonomic regulation, is one of the tools that can help shift this state. It won't replace adequate rest and periodization, but it can accelerate the recovery of autonomic tone and help athletes return to quality training sooner.
Ready to make acupuncture part of your training?
Zach has worked with runners, triathletes, and endurance athletes at every level. If you're dealing with an injury, deep in a training block, or just ready to recover faster, we're taking new patients now. Book online or call us at (207)-376-0264
When to Use Acupuncture in Your Training Calendar
Timing matters. Here's how endurance athletes can think about integrating acupuncture into a training year:
During base training. Regular sessions (every 2–4 weeks) for maintenance to manage accumulated tightness, supporting recovery quality, and keeping the nervous system regulated. This is the preventive phase.
During peak training load. Weekly or twice-monthly sessions to keep pace with tissue stress accumulation. Pay attention to any early warning signs of emerging injuries, they're far easier to address sooner than later.
Pre-race taper. A session 7–10 days out can help resolve any residual muscle tension without creating excessive soreness. Avoid aggressive dry needling in the 48–72 hours immediately before a race.
Post-race recovery. A session 3–5 days after a major race or ultra supports the inflammatory resolution process and helps reset autonomic tone. Many athletes find they sleep better and feel systemically recovered faster after post-race acupuncture.
During injury rehabilitation. Integrated into the broader rehabilitation plan alongside physical therapy, load management, and strength training. Acupuncture works best as part of a team approach, not in isolation.
How Many Sessions Do Endurance Athletes Need?
There's no universal answer, but here's a general framework:
Acute injury (recent onset, less than 4 weeks): 2-6 sessions often produces noticeable improvement. The tissue is still responsive and inflammatory, and acupuncture can meaningfully influence the early healing environment.
Subacute/moderate injury (4–12 weeks): 4–10 sessions, with reassessment at the midpoint. If there's no meaningful change after 4 sessions, the approach should be reconsidered.
Chronic/longstanding injury (12+ weeks, or recurring): 8–16 sessions, with concurrent strength and load management work. Chronic tendinopathies and overuse injuries require structural adaptation alongside symptom management.
Maintenance and performance: Ongoing periodic sessions (every 2–6 weeks depending on training load) to maintain the gains and prevent re-accumulation.
What to Expect at West End Acupuncture
We work with endurance athletes, runners, and active people throughout Portland, South Portland, Cape Elizabeth, Scarborough, and the greater Portland, Maine area. Zach has recieved training in Sports Medicine Acupuncture Certification, a year-long advanced training program through the Sports Medicine Acupuncture International that represents the most comprehensive sports-focused credential in the field.
A sports acupuncture session at West End Acupuncture typically includes:
A detailed intake about your training load, injury history, biomechanics, and recovery quality
Orthopedic assessment to identify the specific tissues and movement patterns involved
Targeted needling, a combination of traditional acupuncture points and dry needling trigger point work, depending on what you need
Electroacupuncture for cases where deeper stimulation or autonomic regulation is the priority
Cupping or gua sha if fascial restriction is part of the picture
Practical recommendations for training load, rehab exercises, and recovery protocols
We also communicate with physical therapists, sports medicine physicians, and orthopedic surgeons when you're navigating care across multiple providers. If you've been seen by a PT or sports medicine doc, bring your notes, coordination makes the whole process more effective.
Frequently Asked Questions: Acupuncture for Endurance Athletes
Does acupuncture actually help athletic performance, or just injuries?
Both. The most well-documented applications are injury treatment and pain management, but the autonomic and recovery-related effects are performance-relevant. Improved sleep quality, better HRV, and faster tissue repair between sessions all translate to more consistent training, which is the actual driver of endurance performance over time.
Is dry needling different from acupuncture?
Dry needling uses the same needle as acupuncture and shares significant mechanistic overlap. The distinction is primarily in training tradition and clinical framing, dry needling is taught within a musculoskeletal/trigger point framework, traditional acupuncture within a broader physiological framework. In practice, a well-trained acupuncturist integrates both approaches. At West End Acupuncture, Zach uses both depending on what you need.
Will acupuncture make me sore? Can I train the same day?
Mild soreness at needling sites is common, particularly with dry needling of active trigger points. Most athletes can train the same day or the next day, though we typically recommend lighter effort in the 24 hours following a session with significant dry needling. For sessions timed close to races, we use gentler protocols.
How is this different from a physical therapist doing dry needling?
Licensed acupuncturists complete a Master's degree program that includes thousands of hours of clinical training specifically focused on needling. Physical therapists typically add dry needling through a weekend certification course. The difference in clinical hours and training depth is substantial, which matters for safety, accuracy, and outcomes.
Can acupuncture help with race-day nerves and pre-competition anxiety?
Yes. The autonomic regulation effects of acupuncture, particularly its ability to downregulate sympathetic tone, can be helpful for athletes who struggle with pre-competition anxiety or whose race performance suffers relative to training due to stress. A session in the week before a major race can help establish the calm, focused baseline you want on race morning.
Is acupuncture covered by insurance?
Coverage varies significantly by plan. Some insurance plans cover acupuncture for pain conditions with a referral; others don't cover it at all. We're happy to provide a superbill for out-of-network reimbursement, and HSA/FSA funds can typically be used for acupuncture. Contact us for details about your specific situation.
Do you work with ultramarathon runners specifically?
Yes. The physiological demands of ultras, extended duration, technical terrain, altitude in some cases, sleep deprivation in 100-milers, create a specific pattern of accumulated tissue stress, autonomic load, and recovery challenge. We've worked with athletes training for events ranging from 50Ks to 100-milers and can tailor both the treatment approach and the timing of sessions to your training cycle.
Ready to Work With Us?
If you're an endurance athlete in the Portland, Maine area and you're dealing with a nagging injury, working through a heavy training block, or just looking to train more consistently with fewer interruptions — we'd love to talk.
Book online at westendacupuncture.janeapp.com or call us at (207)-376-0264. We see patients Monday through Thursday 8am–6pm and Friday 8am–4pm at 231 York Street, Portland, Maine 04102.
This article is written by Zach Haigney, M.S., L.Ac., a licensed acupuncturist with over a decade of clinical experience treating endurance athletes, active adults, and chronic pain patients.
This content is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare provider for diagnosis and treatment of specific conditions.