In 1979, the World Health Organization published an initial list of indications where acupuncture demonstrated benefits in clinical reports – a turning point that elevated traditional practices into the discourse of modern medicine. Throughout the long history of acupuncture, female practitioners in China and later in Western universities have shaped the integration of this knowledge into pain therapy. Today, high performers are asking: Can finely placed needle stimulation restore energy, sharpen focus, and dampen pain to make performance possible again – without long-term medication?

Acupuncture is a stimulus therapy: Fine, sterile needles are inserted into defined skin points to modulate the nervous system. Central to this is the understanding of nociceptiontransmission of pain signals in the nervous system, gate control theorymodel suggesting that non-painful stimuli can dampen the transmission of pain signals in the spinal cord, and endogenous opioidsbody’s own pain-relieving substances such as endorphins. In practice, this means that needle stimulation can switch pain perception, improve local circulation, and normalize muscle tone via reflex arcs. For performance-oriented individuals, it is particularly relevant that successful pain regulation stabilizes sleep quality, training consistency, and cognitive resilience – three pillars of sustainable performance.

Clinically, many patients report less pain and more mobility after treatment series. At the same time, it must be noted that acupuncture is not a zero-risk procedure. Rare but sometimes serious infections have been documented, especially when inadequately qualified individuals treat or hygiene standards are ignored. Case reports show perivertebral infections following acupuncture with plausible direct introduction of pathogens along the needle insertion channel – a hint that technique, hand hygiene, and single-use needles are non-negotiable ^[1]. An infectious endocarditis of the tricuspid valve has also been described following long needle technique, requiring weeks of antibiotic therapy – an extreme but educational example that even immunocompetent individuals can develop serious complications with poor sterilization ^[2]. Regarding skin disinfection: Literature shows that thorough hand hygiene and clean, visibly uncontaminated skin are usually sufficient for injections; in contaminated areas, alcohol disinfection is advisable. This analogy is also applied to acupuncture, with the additional note that needling near infected regions should be avoided ^[3].

The clinical evidence for acupuncture is heterogeneous, which relates less to the idea than to methodology and standardization. An imaging-supported case series documented pyogenic spinal infections after acupuncture. The context: observational and case reports, not a randomized study – but the anatomical and temporal plausibility makes the causal pathway (direct inoculation of pathogens) convincing and clinically highly relevant. Key finding: acupuncture remains safe when trained professionals use single-use needles and Clean Technique; otherwise, the risk of rare but severe infections increases ^[1]. Another case report describes a right-sided infectious endocarditis following long-needle acupuncture without classical risk factors. Although an individual case, it underscores the importance of early diagnosis, appropriate antibiotic selection, and – preventively – strict hygiene practices. In practice, this means careful medical history taking before needling (heart valves, immunosuppression, skin lesions) and clear complication management ^[2]. Additionally, a review work on skin disinfection prior to injections – used as a methodological analogy – indicates that microorganisms in deeper skin structures are hardly reached through disinfection; crucial are hand hygiene, single-use materials, and avoidance of contaminated areas. Visibly contaminated skin should be cleaned, and areas close to infections disinfected with alcohol. Applied to acupuncture, this provides a pragmatic, risk-based standard ^[3].

- Choose qualified practitioners: Pay attention to formal training, certificates, and transparent hygiene standards. Actively inquire about single-use needles and Clean Technique ^[1].
- Check before the first appointment: Report open skin lesions, chronic infections, heart valve diseases, or immunosuppression. Special caution is required in these cases ^[2].
- Enforce hygiene rules: Hands should be disinfected before patient contact; visible skin contamination should be cleaned, areas near infected spots disinfected with alcohol; use single-use gloves depending on region/procedure ^[3].
- Start structured: 6–8 sessions over 3–4 weeks is a common clinical testing period. Keep a pain diary (intensity, sleep, function in daily life) to objectively assess efficacy.
- Combine instead of polarizing: Acupuncture often shows the greatest benefit as an add-on to active therapy – mobility, progressive strength exercises, sleep hygiene, and stress regulation stabilize the effects on pain and performance.
- Take warning signs seriously: Fever, increasing pain, redness, swelling, or persistent fatigue after a session should be medically evaluated immediately – early detection of infections prevents severe courses ^{[1] [2]}.

The next years of research should address two questions: standardized treatment protocols for each pain syndrome and clear, evidence-based hygiene guidelines specifically for acupuncture rather than a mere injection analogy. Meanwhile, registry data could systematically capture complications, thereby further enhancing quality assurance and patient safety.