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Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say?

<p>Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian <a href="https://australian.physio/research/prf/translation/five-facts-about-acupuncture-and-dry-needling-musculoskeletal-pain" target="_blank" rel="noopener">physiotherapists</a> in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.</p> <p>Is it just a fad or does science support it?</p> <h2>Needling, three ways</h2> <p>Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/23801002/" target="_blank" rel="noopener">Dry needling</a> involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/28739020/" target="_blank" rel="noopener">Western acupuncture</a> uses traditional needling <a href="https://www.sciencedirect.com/science/article/pii/S2005290110600143" target="_blank" rel="noopener">meridians</a> (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goals is to trigger pain-relieving chemicals, muscle activation or relaxation.</p> <p>Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine.</p> <p><a href="https://healthtimes.com.au/hub/pain-management/44/research/kk1/acupuncture-for-pain-management/1581/" target="_blank" rel="noopener">Traditional acupuncture</a> uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches.</p> <p>All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the <a href="https://www.ahpra.gov.au/" target="_blank" rel="noopener">Australian Health Practitioners Regulatory Agency</a> and the <a href="https://www.physiotherapyboard.gov.au/" target="_blank" rel="noopener">Physiotherapy Registration Board</a>. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public.</p> <p>Minor reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015026/#:%7E:text=Examples%20of%20minor%20adverse%20reactions,pain%20during%20or%20after%20treatment." target="_blank" rel="noopener">side effects</a> related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare.</p> <h2>What’s needling good for?</h2> <p>Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated.</p> <p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedling" target="_blank" rel="noopener">review</a> that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found they may be useful add-on therapies but could not make firm conclusions due to a lack of quality trials.</p> <p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600071/#CIT0034" target="_blank" rel="noopener">review</a> reported the growing popularity of dry needling world wide and across disciplines and points out that many questions still remain regarding the use of needling.</p> <p>For <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001218.pub3/full?highlightAbstract=acupuncture%7Cmigraine%7Cmigrain%7Cacupunctur" target="_blank" rel="noopener">migraine</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=acupuncture%7Cheadach%7Ctension%7Cacupunctur%7Cheadache%7Ctype" target="_blank" rel="noopener">tension</a> headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.</p> <p>Acupuncture and dry needling may reduce pain and improve function for people with <a href="https://pubmed.ncbi.nlm.nih.gov/17224820/" target="_blank" rel="noopener">neck pain</a>. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat <a href="https://pubmed.ncbi.nlm.nih.gov/22965186/" target="_blank" rel="noopener">certain types of chronic pain</a>. However, some research only shows <a href="https://pubmed.ncbi.nlm.nih.gov/33066556/" target="_blank" rel="noopener">small and temporary</a> relief for neck pain with dry needling.</p> <p>Results from randomised control trials support the use of needling for <a href="https://pubmed.ncbi.nlm.nih.gov/27062955" target="_blank" rel="noopener">shoulder pain</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32301166/" target="_blank" rel="noopener">tennis elbow</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32186030/" target="_blank" rel="noopener">osteo arthritic knee pain</a>. But a recent systemic review of research reported only weak evidence to support needling to treat <a href="https://pubmed.ncbi.nlm.nih.gov/33760098/" target="_blank" rel="noopener">plantarfasciitis and chronic ankle instability</a>.</p> <h2>Not just for sporting injuries</h2> <p>Similarly, small randomised control trials have shown acupuncture and dry needling might reduce <a href="https://pubmed.ncbi.nlm.nih.gov/17095133/" target="_blank" rel="noopener">problematic jaw pain</a> (<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd#:%7E:text=Temporomandibular%20disorders%20(TMD)%20are%20disorders,may%20result%20in%20temporomandibular%20disorder." target="_blank" rel="noopener">temporo mandibular disorder</a>) and improve mouth opening.</p> <p>Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of <a href="https://www.healthline.com/health/tendinopathy" target="_blank" rel="noopener">tendinopathy</a> (the breakdown of collagen in tendons) and <a href="https://pubmed.ncbi.nlm.nih.gov/30787631/#:%7E:text=At%20follow%2Dup%20in%20the,for%20the%20management%20of%20FM." target="_blank" rel="noopener">fibromyalgia</a> (chronic pain in the muscles and bones).</p> <p>For women’s health, acupuncture has been shown to be effective for reducing pain with <a href="https://pubmed.ncbi.nlm.nih.gov/29879061/" target="_blank" rel="noopener">periods</a>, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.</p> <p>Though <a href="https://www.cochrane.org/CD002962/PREG_acupuncture-or-acupressure-induction-labour#:%7E:text=Acupuncture%20involves%20the%20insertion%20of,with%20onset%20of%20labour%20contractions." target="_blank" rel="noopener">widely used</a> in pregnancy, research into the use of acupuncture to <a href="https://pubmed.ncbi.nlm.nih.gov/32032444/" target="_blank" rel="noopener">induce labour</a> reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.</p> <p>In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed.</p> <h2>Just one part of a treatment program</h2> <p>Needling <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedlin" target="_blank" rel="noopener">may be useful</a> as part of multimodal care – that is, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780149/" target="_blank" rel="noopener">more than one treatment</a> is used in conjunction to treat a problem.</p> <p>Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.</p> <p>Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.</p> <p><em><strong>This article originally appeared on <a href="https://theconversation.com/physio-dry-needling-and-acupuncture-whats-the-difference-and-what-does-the-evidence-say-181939" target="_blank" rel="noopener">The Conversation</a>.</strong></em></p> <p><em>Image: Shutterstock</em></p>

Body

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Will microdermabrasion or skin needling give you better skin?

<p>Microdermabrasion and skin needling are relatively new fads in skin beauty treatments. While claims of their effectiveness for more serious skin conditions are probably overblown, they may be beneficial for minor, superficial complaints.</p> <p><strong>What is microdermabrasion?</strong></p> <p>Microdermabrasion has gained popularity over the last decade because it’s a simple and cost-effective treatment for the skin with minimal recovery time. It’s important to differentiate microdermabrasion from dermabrasion, which is an invasive procedure that has been used to treat UV damage and skin scarring for decades.</p> <p>Dermabrasion is a traditional skin resurfacing treatment, usually performed under a general anaesthetic. It uses a specialised “sanding” device to strip off deep layers of the skin, leaving an open wound that may take several weeks to heal. This repair results in the formation of new skin and improvement in skin quality. But it <a href="https://www.ncbi.nlm.nih.gov/pubmed/21824537">carries significant risk</a> of complications such as hypopigmentation (whitening of the skin) and scarring. Dermabrasion isn’t done much anymore, because lasers can do the same job but more carefully and precisely.</p> <p>Microdermabrasion, in contrast, is non-invasive and low risk. It uses a high-pressured stream of fine crystals to “polish” the skin. This is effective in removing superficial layers of dead skin cells, but it doesn’t wear away the deeper layers of the skin. It’s essentially painless and side effects such as mild redness are minimal. It’s safe for most skin types, requires no time off work, and aims to improve skin texture and radiance.</p> <p><strong>Does it work?</strong></p> <p>Despite being one of the most popular cosmetic procedures performed, most physicians believe microdermabrasion has <a href="https://www.ncbi.nlm.nih.gov/pubmed/20048628">minimal clinical effect</a>. This perception is partly due to the widespread marketing of microdermabrasion for a variety of inappropriate indications such as deep wrinkles and scars. These contour changes require stimulation of deeper skin layers or damage to initiate enough rejuvenation and repair to see any clinical improvement. They will not improve noticeably with a mild and superficial mechanical treatment such as microdermabrasion.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/20048628">However, there is some evidence</a> that microdermabrasion can stimulate the production of collagen, the protein that gives our skin strength and elasticity. This may help “fill in” superficial contour changes such as fine wrinkles and mild scarring. It can also improve the absorption of active skin care ingredients such as vitamin A or antioxidant creams by removing the outer barrier layer of the skin. It’s most useful in achieving a minor improvement in the textural irregularities and pigment changes that occur from sun damage.</p> <p><strong>What is microneedling?</strong></p> <p>Microneedling is a relatively new but popular cosmetic procedure used for skin regeneration and treatment of various skin conditions such as scarring, wrinkles and stretch marks. It’s considerably cheaper than other rejuvenating procedures such as resurfacing lasers, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28796657">has been found</a> to be reasonably effective at promoting collagen.</p> <p>The procedure involves the use of an automated pen or roller device studded with microneedles as small as 0.1mm in diameter. It creates numerous micro-punctures through the skin with minimal damage to the upper epidermal layer, but microscopic injury to the deeper dermal layer. The injury and minor bleeding trigger a “wound-healing” cascade in the skin. This results in increased collagen and elastin (elastic fibers) production and some degree of repair.</p> <p>Microneedling is usually performed using a topical anaesthetic cream to ease discomfort, and may take 10-20 minutes depending on the size of area being treated. The skin should ideally be pre-treated with appropriate skin care products that can boost skin regeneration, such as retinoid (vitamin A) creams, and antioxidants including vitamin C. Following the procedure, patients can expect some pinpoint bleeding that settles quickly, as well as redness and some minor discomfort. They may experience some mild swelling and persistent redness for a few days.</p> <p>Fortunately, complications are uncommon. Skin infections, reactivation of herpes simplex (cold sores), inflamed pigmentation and aggravation of skin diseases <a href="https://www.ncbi.nlm.nih.gov/pubmed/28796657">have been reported</a>. Raised scarring <a href="https://www.ncbi.nlm.nih.gov/pubmed/28491962">has also been reported</a>, but is rare. The superficial needle holes close rapidly (in around 15 minutes), which means getting a skin infection is highly unlikely.</p> <p><strong>Does it work?</strong></p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/28796657">Studies have shown</a> significant improvement in the appearance of wrinkles and scars following microneedling, due to collagen and elastic fibre production that help the skin become more “filled out”. The tiny injuries to the dermal (deeper) layer of the skin cause an inflammatory cascade, triggering proliferation of cells in the dermis (upper layer) and subsequent new skin formation.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/21617430">Researchers have demonstrated</a> increased collagen and elastin thickness in skin biopsies after microneedling, and this improvement is usually evident within three to four weeks. Further changes can be seen for some months.</p> <p>Although definite improvement is usually seen, it may be subtle and slow. The efficacy and results <a href="https://www.ncbi.nlm.nih.gov/pubmed/29072375">may be enhanced using combination treatments</a> such as microneedling with chemical peels or platelet-rich plasma (<a href="https://theconversation.com/explainer-whats-actually-in-our-blood-75066">components found in blood</a> that enhance healing). In most studied cases, people required multiple treatments over a long period of time to achieve good results.</p> <p>Generally speaking, the more aggressive a procedure is, the fewer the number of treatments required to achieve the desired result. But this also means more healing time. Choosing the right option can be a complicated process, and depends on the nature and severity of the patient’s problem, coexisting complaints, skin type and desired outcome, as well as budget and lifestyle factors.</p> <p>Some clinicians may promote a procedure due to availability and experience, but the cumulative cost and ability to achieve the desired result should be carefully considered in all cases before embarking on treatment.</p> <p><em>Written by Cara McDonald. Republished with permission of </em><a href="https://theconversation.com/will-microdermabrasion-or-skin-needling-give-me-better-skin-86619"><em>The Conversation</em></a><em>.</em></p>

Beauty & Style

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Girl arrested: Confesses to needles in strawberries "prank"

<p>A 12-year-old has reportedly admitted to inserting needles into strawberries in what police believe to be a copycat prank.</p> <p>New South Wales Acting Assistant Police Commissioner Stuart Smith said the child was caught in recent days but refused to release any further details.</p> <p>While the youngster was reported as a male due to Mr Smith addressing the child as a “he” at a press conference, it is now discovered that the police commissioner misspoke.</p> <p>After inserting the needles into the strawberries, the girl then showed her friends at school in the NSW Blue Mountains, reported <em><a href="https://www.dailytelegraph.com.au/">The Daily Telegraph</a></em>. One student informed staff and the police were immediately called to the scene. They reportedly interviewed the girl at her home and she eventually confessed.</p> <p>“Obviously, in the last few days we found a young person has admitted to a prank, including putting needles in strawberries,” Mr Smith told reporters in Sydney.</p> <p>Mr Smith said the child would be dealt with under the youth cautioning system.</p> <p>He further went on to say that while some may believe the behaviour could be “called a prank”, he warned that any copycat cases would be dealt with the full extent of the law.</p> <p>“What we’ve seen in the state (of NSW) we believe is the work of copycats and pranksters, we’ve got to deal with it though, the way we deal with any crime,” he said.</p> <p>The event comes as the Attorney-General said there have now been over 100 reported cases of sabotaged fruit across the country, with the scare initially starting in Queensland then spreading to Tasmania and Western Australia.</p> <p>The most recent incident occurred at a primary school in Newcastle today, where a student discovered a needle inside the banana that they packed for lunch.</p> <p>The child, a pupil at St Paul’s Primary School, alerted teachers after biting into the banana and finding the sharp object lodged inside.</p> <p>Detectives were sent to the school to investigate the incident and have removed the banana for further tests.</p> <p>A spokesman for NSW Police said authorities will not comment on individual cases as they had a “duty of care.”</p>

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