Maximize Healing After Spinal Cord Injury
Maximizing Healing After a Spinal Cord Injury: How Neuro-Acupuncture Can Help
Every spinal cord injury and recovery process is unique. There is no way to predict how much recovery will occur or which symptoms may arise along the way. Anybody who has a spinal cord injury understands how challenging it can be to adapt to a new body and be left wondering; how much will I heal?
Although much of the current research on spinal cord injury recovery focuses on modern technologies, such as spinal implants and stem cell therapy, numerous studies and reviews are shedding light on how acupuncture, a traditional medical technique, can provide a protective and healing effect following a spinal cord injury.
Below, we’ll go over the classification of spinal cord injuries, then delve into the physiological changes that acupuncture can stimulate to support healing. Using a contemporary scientific framework, we’ll examine how current research shows that acupuncture can harness the body's natural healing potential and help individuals with spinal cord injuries optimize their healing outcomes.
How Are Spinal Cord Injuries Classified?
When someone sustains a spinal cord injury, healthcare professionals will conduct a thorough neurological assessment using the American Spinal Injury Association (ASIA) Impairment Scale. This scale, ranging from A to E, helps determine the extent of motor and sensory function below the injury level and guides the path forward.
Understanding the ASIA Scale
The ASIA Impairment Scale is a standardized tool used to assess the degree of neurological function after a spinal cord injury:
ASIA A (Complete Injury): No motor or sensory function is preserved below the level of injury. As emergency medical care improves, outcomes for people with ASIA A scores have increased over recent decades; studies show a 13% chance of regaining some motor function and a 30% chance of recovering some sensory function (9,14). These rates can vary significantly depending on the spinal level and mechanism of injury.
ASIA B–D (Incomplete Injury): Some motor and/or sensory function remains below the level of injury. Individuals in this category have a 40% chance of regaining additional function (11).
As healing progresses, reassessment is important and can lead to an improved ASIA score.
When a person sustains a spinal cord injury and receives their initial ASIA score, it is important to remember that this is the starting point on their healing journey. Many factors influence recovery, including the nature of the injury, age, access to timely medical care and rehabilitation programs, and support from family or community. The most significant improvements often occur within the first 18 months; however, many individuals continue to improve at a slower rate for years after the injury (15).
The Role of Acupuncture in Spinal Cord Injury Recovery
The spinal cord is a vital component of the central nervous system, serving as a superhighway for communication between the brain and the rest of the body. Unlike other tissues that regenerate quickly, the spinal cord is a delicate environment that is extremely sensitive to the bleeding, inflammation and scar tissue that accompany an injury.
By helping attenuate the local environment within the spinal cord following an injury, acupuncture is a unique therapy that can help improve the spinal cord's healing process.
Here Are the Top Three Ways That Acupuncture Can Help with Spinal Cord Healing:
1) Enhancing Microcirculation: Fueling the Healing Process
One of the major challenging factors after a spinal cord injury is poor blood flow to the damaged area. The injury can damage blood vessels or cause them to rupture, leading to reduced oxygen and nutrient delivery, which are essential for tissue repair and regeneration. This lack of circulation also slows the removal of waste products and inflammatory molecules, which can worsen the injury over time.
As recommended by the American Association of Neurological Surgeons, doctors will use medication to artificially raise blood pressure for 7 days after a spinal cord injury. This is done to improve circulation to the injured spinal cord, and has been shown to improve healing outcomes (2). Acupuncture can also be used to help improve blood flow and studies have demonstrated it's ability to increase microcirculation by decreasing capillary refill time in healthy adults (18). This enhanced blood flow to injured tissues plays a key role in acupuncture's healing effects.
Acupuncture has also been shown to stimulate the release of vascular endothelial growth factor (VEGF), a protein that promotes the formation of new blood vessels and regulates endothelin receptors, which control blood vessel constriction (7). Together, these effects help restore healthy blood flow, reduce tissue stress, and support the body's natural healing mechanisms.
2) Reducing Glial Scarring: Clearing the Path for Nerve Regrowth
The spinal cord is composed of neurons that transmit nerve impulses and other helper cells, called glial cells. The glial cells don’t transmit nerve signals but perform various functions, such as supporting and nourishing neurons, forming the myelin sheath around nerves, stimulating inflammation after injury, and helping clear waste and debris.
There is a special type of glial cell called an astrocyte. Astrocytes are star-shaped cells that play a crucial role in spinal cord health and protection. They form the blood-spinal cord barrier and, by regulating blood flow, maintain the proper environment for neurons to thrive.
Astrocytes also play an important role after a spinal cord injury. The astrocytes form a protective barrier around the injured portion of the spinal cord, called a glial scar. This is a unique type of scar found only in the brain and spinal cord. While this scar initially helps stabilize the injury site, it also creates a physical blockade that prevents new nerve fibers from growing through the damaged area. These scars are a unique fibrous web of tissue composed of astrocytes and proteins that inhibit axonal regeneration.
Acupuncture has been shown in animal models to initially increase glial cell expression, which stops the spread of damage to neighbouring areas. Later, the effect of acupuncture shifts to reduce the expression of scar-forming astrocytes, thus limiting the secondary growth of fibrous scar tissue and making it more permissive for nerve regeneration (3,4). This is a remarkable finding that demonstrates acupuncture's unique ability to enhance the body’s natural response and healing processes as they shift in subsequent stages of healing. By modulating the cellular environment, acupuncture helps create a more favourable landscape for neural repair and functional recovery.
3) Activating Neural Stem Cells: Rebuilding from Within
Neural stem cells are the body’s internal repair system, capable of transforming into neurons and other types of cells, including the helper glial cells. However, after a spinal cord injury, inflammation and oxidative stress can suppress their activity. Studies have shown that acupuncture with electrical stimulation promotes the release of mesenchymal stem cells, which can turn into functional neurons (12). This process is supported by acupuncture’s ability to regulate neurotrophic factors, proteins that support neuronal survival and growth. By activating these stem cells and supporting proteins, acupuncture encourages neuroplasticity and the rebuilding of damaged neural pathways (7).
A Holistic Path to Healing
To date, numerous preclinical studies demonstrate that acupuncture stimulates and enhances the nervous system's healing potential in animal models. Smaller clinical studies in humans have shown that acupuncture treatment improves motor function, sensation, and bladder function following spinal cord injury (5,1,10,18). Although there is still a need for larger clinical studies to help authenticate these findings, acupuncture has proven to be a safe and effective treatment that improves healing outcomes following a spinal cord injury.
While conventional rehabilitation focuses on physical therapy, medication, and surgical interventions, research shows that acupuncture offers a synergistic healing effect rooted in both traditional medicine and modern neuroscience.
For individuals navigating the challenges of recovery following a spinal cord injury, acupuncture may help improve neurological function and ease some of the new daily challenges of life. By supporting the body’s innate healing mechanisms, acupuncture helps bridge the gap between injury and recovery.
Jennifer Midlane is a neuro-acupuncturist practicing in Victoria, British Columbia. She focuses on providing care for those with neurological conditions by integrating the wisdom of Traditional Chinese Medicine with modern scientific research.
References
1) Cheng, P. T., Wong, M. K., & Chang, P. L. (1998). A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients: A preliminary report. Spinal Cord, 36(7), 476–480. https://doi.org/10.1038/sj.sc.3100689
2) Hadley, M. N., Walters, B. C., Grabb, P. A., Oyesiku, N. M., Przybylski, G. J., Resnick, D. K., & Ryken, T. C. (2002). Blood pressure management after acute spinal cord injury. Neurosurgery, 50(3 Suppl), S58–S62. https://doi.org/10.1097/00006123-200203001-00012
3) Hai, Z., Luxi, C., Zhao, P., Sisi, Z., Shiqi, W., Zhuowen, L., Minan, C., Shujun, L., & Yimin, Z. (2023). Efficacy of acupuncture on repair of glial scars in rats with traumatic brain injury. Journal of Traditional Chinese Medicine, 43(2), 329–336. https://doi.org/10.19852/j.cnki.jtcm.20221226.003
4) Hong, E. S., Yao, H. H., Min, Y. J., Sun, J., Zhou, X., Zeng, X. B., & Yu, W. (2021). The mechanism of electroacupuncture for treating spinal cord injury rats by mediating Rho/Rho-associated kinase signaling pathway. Journal of Spinal Cord Medicine, 44(3), 364–374. https://doi.org/10.1080/10790268.2019.1665612
5) Honjo, H., Naya, Y., Ukimura, O., Kojima, M., & Miki, T. (2000). Acupuncture on clinical symptoms and urodynamic measurements in spinal-cord-injured patients with detrusor hyperreflexia. Urologia Internationalis, 65(4), 190–195. https://doi.org/10.1159/000064874
6) Hou, J., Xiang, Z., Yan, R., Zhao, M., Wu, Y., Zhong, J., Guo, L., Li, H., Wang, J., Wu, J., Sun, T., & Liu, H. (2016). Motor recovery at 6 months after admission is related to structural and functional reorganization of the spine and brain in patients with spinal cord injury. Human Brain Mapping, 37(6), 2195–2209. https://doi.org/10.1002/hbm.23163
7) Jiang, K., Sun, Y., & Chen, X. (2022). Mechanism underlying acupuncture therapy in spinal cord injury: A narrative overview of preclinical studies. Frontiers in Pharmacology, 13, 875103. https://doi.org/10.3389/fphar.2022.875103
8) Kirshblum, S., Snider, B., Eren, F., & Guest, J. (2021). Characterizing natural recovery after traumatic spinal cord injury. Journal of Neurotrauma, 38(9), 1267–1284. https://doi.org/10.1089/neu.2020.7473
9) Marino, R. J., Leff, M., Cardenas, D. D., Donovan, J., Chen, D., Kirshblum, S., & Leiby, B. E. (2020). Trends in rates of ASIA Impairment Scale conversion in traumatic complete spinal cord injury. Neurotrauma Reports, 1(1), 192–200. https://doi.org/10.1089/neur.2020.0038
10) Norrbrink, C., & Lundeberg, T. (2011). Acupuncture and massage therapy for neuropathic pain following spinal cord injury: An exploratory study. Acupuncture in Medicine, 29(2), 108–115. https://doi.org/10.1136/aim.2010.003269
11) North American Spinal Cord Injury Consortium. (2025, March 16). The ASIA impairment scale. NASCIC SCI Knowledge Base. https://nascic.org/the-asia-impairment-scale/
12) Salazar TE, Richardson MR, Beli E, Ripsch MS, George J, Kim Y, Duan Y, Moldovan L, Yan Y, Bhatwadekar A, Jadhav V, Smith JA, McGorray S, Bertone AL, Traktuev DO, March KL, Colon-Perez LM, Avin KG, Sims E, Mund JA, Case J, Deng X, Kim MS, McDavitt B, Boulton ME, Thinschmidt J, Li Calzi S, Fitz SD, Fuchs RK, Warden SJ, McKinley T, Shekhar A, Febo M, Johnson PL, Chang LJ, Gao Z, Kolonin MG, Lai S, Ma J, Dong X, White FA, Xie H, Yoder MC, Grant MB. Electroacupuncture Promotes Central Nervous System-Dependent Release of Mesenchymal Stem Cells. Stem Cells. 2017 May;35(5):1303-1315. doi: 10.1002/stem.2613. PMID: 28299842; PMCID: PMC5530374.
13) Silver, J., & Miller, J. (2004). Regeneration beyond the glial scar. Nature Reviews Neuroscience, 5, 146–156. https://doi.org/10.1038/nrn1326
14) Spiess, M. R., Müller, R. M., Rupp, R., Schuld, C., EM-SCI Study Group, & van Hedel, H. J. (2009). Conversion in ASIA Impairment Scale during the first year after traumatic spinal cord injury. Journal of Neurotrauma, 26(11), 2027–2036. https://doi.org/10.1089/neu.2008.0760
15) Stenimahitis, V., Gharios, M., Fletcher-Sandersjöö, A., El-Hajj, V. G., Singh, A., Buwaider, A., Andersson, M., Gerdhem, P., Hultling, C., Elmi-Terander, A., & Edström, E. (2024). Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: A population-based cohort study. Scientific Reports, 14(1), 20945. https://doi.org/10.1038/s41598-024-71983-2
16) Tran, A. P., Warren, P. M., & Silver, J. (2022). New insights into glial scar formation after spinal cord injury. Cell and Tissue Research, 387(3), 319–336. https://doi.org/10.1007/s00441-021-03477-w
17) Wang, H., Song, G., Chuang, H., Chiu, C., Abdelmaksoud, A., Ye, Y., & Zhao, L. (2018). Portrait of glial scar in neurological diseases. International Journal of Immunopathology and Pharmacology, 31, 2058738418801406. https://doi.org/10.1177/2058738418801406
18) Wong, A. M., Leong, C. P., Su, T. Y., Yu, S. W., Tsai, W. C., & Chen, C. P. (2003). Clinical trial of acupuncture for patients with spinal cord injuries. American Journal of Physical Medicine & Rehabilitation, 82(1), 21–27. https://doi.org/10.1097/00002060-200301000-00004
19) Yeh, B. Y., Chao, Y. L., Chen, Y. S., & Yu, H. P. (2021). Effect of acupuncture on capillary refill time in healthy adults: A clinical study. Microvascular Research, 135, 104135. https://doi.org/10.1016/j.mvr.2021.104135
