One sunny morning seven years ago, Norm Yip woke up in immense pain. His back hurt so much that it took him more than two hours just to struggle out of bed, and after all that effort he found himself lying on the floor in front of the bathroom. A few more attempts and a couple of painkillers later, he was finally able to get up. To this day, after five acupuncturists, two physiotherapists, two naprapathy practitioners, one acupressure practitioner and a new age curer, Mr Yip still does not know what caused the dramatic episode. At the time of the incident he was going to the gym six times a week - three for weight training and another three for cardiovascular exercises to keep in shape. He could only deduce that something had gone wrong with his exercise routine. He talked of his experiences with the various healing hands: 'I would try something for three to four times and when it didn't work, I would try the next [practitioner],' the 44-year-old photographer said. He has spent almost HK$20,000 on treatments. One practitioner told him that he did not need an operation, but he should do some exercises to stretch his main nerves and side muscles. So he started body balance classes, which included yoga, tai chi and Pilates that trained his 'inner body muscles'. 'Yoga is for stretching muscles, tai chi is like a slow dance and Pilates can strengthen my core muscles,' he said. He does body balance four times a week, and also goes for massages to stretch his muscles and ligaments. Mr Yip said that some of the practitioners he visited only relieved his pain for a short time after a visit while others just made him feel worse. He found his last acupuncturist the most effective. 'He has good techniques. He pokes several needles into the skin of my back and leg for two to three seconds and I don't feel pain anymore,' he said. It was common for people to get sports injuries when they overstretched the strength and frequency of their workout, said Polly Lau Mo-yee, physiotherapist and president of the Hong Kong Physiotherapy Association. She said acupuncture was effective in pain control and relief, so more physiotherapists incorporated it into treatments for painful musculoskeletal conditions. The principles of acupuncture analgesia are sensory stimulations. Needling stimulates the small pain fibres in the muscle which cause sensory signals to the spinal cord, then the brain. The spinal cord and the brain are activated to release endorphins, which are chemicals for pain control and are also anti-inflammatory. An acupuncturist is able to locate acupuncture points on various parts of the human body. These 'landmarks' were in similar positions on everybody, Dr Lau said. Once located, the acupuncturist punctures the skin vertically or obliquely. Slight bleeding or swelling may occur in some cases. But acupuncture was just one of the steps in physiotherapy, she said. It must be combined with other treatments such as exercise therapy for muscle and cardio training or electrotherapy or hydrotherapy. The key is to undertake a comprehensive diagnosis to cure the pain. 'Acupuncture is effective in the same way Panadol is. You cannot just rely on it in a medical treatment,' Dr Lau said. She said prevention was better than cure. With the 2008 Beijing Olympics next year, many Hongkongers have started to take up sports and to go to the gym, but they might lack proper guidance and sports injuries can easily occur. Sports physiotherapist Ng Chun-ting said contest sports such as football, rugby and basketball caused common acute injuries of body parts like the upper and lower limbs, back and neck, more easily. He said there was a general misconception that stretching exercises were sufficient for a warm-up. But specific muscle training was essential on those muscles that were liable to be strained in playing certain sports. 'If one treatment can cure every sports injury then no patients would come to see me,' Mr Ng said. 'Only properly guided sports training and precaution could ensure that one enjoys sports safely.' Tips to prevent sports injuries Gather enough knowledge about a sport or get proper instruction about the equipment you are going to use before you begin your training. Ensure that you use the right posture and that you use your muscles correctly when training. Do not overdo things when it comes to strength, intensity and frequency when you train at the gym. Seek guidance from doctors and coaches to avoid injury. Source: Gilbert Ho Ming-chiu, senior physiotherapist, Queen Elizabeth Hospital physiotherapy department