Bicep Tendinopathy

Our Osteopath Marcus wrote this fantastic outline on all things related to bicep tendon injuries. A lot of tendon injuries have similarities in the way they are managed so some of this information would apply to things like and Achilles Tendon injury, Glute Medius tendon, Golfers or Tennis Elbow injuries etc. If you want any more information shoot us an email anytime at harleyplacehealth@gmail.com!

Deep, throbbing pain in the front of the shoulder that worsens with lifting is a typical presentation of Bicep tendinopathy. In this blog we will discuss…  What is Bicep tendinopathy? The causes of Bicep tendinopathy; signs and Symptoms of Bicep tendinopathy; what you can do right now to help; how a physio and osteo can help your Bicep tendinopathy and how long it takes for Bicep tendinopathy to improve. 

  1. What is Bicep tendinopathy?

The bicep in your arm has two muscle bellies. Each of these muscles is connected to the bone via a tendon. At the shoulder, the short head of the bicep is attached to coracoid process of the scapula (shoulder blade). The long head of bicep attaches to supraglenoid tubercle of the scapula, deep inside the shoulder joint. The two bicep bellies share a single tendon at the elbow region and that attaches to the radial tuberosity of the radius, the outside bone of the forearm. 

With a Bicep tendinopathy, we are dealing primarily with the tendon of the long head of bicep. The tendon connected to the long head belly runs along the bicipital groove at the front of the upper arm bone before it travels below the subacromial space at the tip of the shoulder before diving deep into the shoulder joint to attach to the supraglenoid tubercle.

**Record a short anatomy video of the bicep attachment with the model?? DONE

The function of the bicep is to flex the arm at the elbow joint and also stabilize the front of the shoulder. So you can imagine the bicep has a crucial role to play involving any elbow movement and shoulder stability. 

Now you know what the bicep tendon is and where it travels; a Bicep tendinopathy is simply a disorder or a disease of the bicep tendon denoted in the suffix, -pathy.

  1. Causes of Bicep tendinopathy

The causes of Bicep tendinopathy can occur in a variety of ways. A tendon tear can occur even with a health tendon if there is a high impact, sudden and overloaded force going through it such as a throw or a sudden drop of a heavy weight. Another way a Bicep tendinopathy can occur is with repetitive overuse activity leading to the actual tissue cell degeneration of the tendon. In this case, inflammation will occur in response to the damage, the tissue then rebuilds, remodels and regenerates to become healthy tissue once again. Lastly, Bicep tendinopathy can occur via direct trauma, such as a collision in a tackle sport or in rarely cases some type of laceration such as a knife wound. 

With regards to daily activities, Bicep tendinopathy most commonly occur with overhead ball sports, swimming, gymnasts, contact sports and even in individuals would does lots of weight training. Occupations that require similar types of heavy and/or repetitive activities in said position are also likely to experience Bicep tendinopathy. 

  1. Signs and Symptoms of Bicep tendinopathy.

There are a number of different presentations of Bicep tendinopathy. Pain is most commonly felt in the front of the shoulder, it can be felt with or without arm movement.  It can be localized in the groove of the front shoulder arm or it can be vague and broad throughout the whole upper arm. Depending on the type of tendon injury, some clicking or snapping sensation maybe felt with shoulder and elbow movement as well, particularly with overhead movements. 

It is important to know Bicep tendinopathy can commonly present as a result of, or in conjunction with, other shoulder conditions/injuries such as rotator cuff tears and SLAP lesions, therefore it is sometimes necessary to address other factors relating to the shoulder girdle as a whole to resolve and prevent bicep tendon injury from returning. 

  1. What you can do right now for Bicep tendinopathy?

There are several things you can do immediately after suffering from Bicep tendinopathy. First is to rest and not do any activities or put the shoulder in any position that exacerbates the pain. If there are signs of inflammation, using ice for 20min on, then off, then 20min on again is a great way to reduce the inflamed tissues in the shoulder. Short-term use of medication such as NSAIDs is an option, however it should not be a substitute for prolonged relief. 

Seek further investigation with your physio or osteo should the condition not improve. Living with Bicep tendinopathy can drastically diminish your quality of life, as you will find yourself having difficulty with reaching, putting on clothes or carrying even seemingly light objects. 

  1. Physio and osteo treatment for Bicep tendinopathy.

Manual therapy and exercise rehab is the best form of treatment of Bicep tendinopathy. Your practitioner will first take a thorough history of the injury which includes how and when it may have occurred, and any pre-existing conditions that may contribute to the injury.

There are a number of orthopedic tests available to test for Bicep tendinopathy. The most common and useful include the Speed’s, Yergason’s and Bicep Load 2 tests. Imaging such as ultrasound and MRI can be use to confirm severity should the orthopedic test be inconclusive. 

Because a tendon sits between its muscle belly and the bony attachment, we can use muscle tear grading to further rate of level of injury:

– Grade 1 is a mild with minimum loss of strength and motion. Inflammation of irritated surrounding tissues can be present. 

– Grade 2: is a significant loss of strength and motion. These injuries may require two to three months before a complete return to athletics.

– Grade 3: complete rupture of a tendon or muscle. In most cases of complete ruptures, surgery is often required. 

  1. How long until Bicep tendinopathy gets better?

It depends on the type of injury and/or the severity, but it typically ranges from 1week to 3months. A low grade muscle tear will be drastically quicker then say a SLAP tear. Generally speaking, if surgery isn’t required, once the acute phase of pain has settled, exercise rehab can begin. A further decrease in pain as well as improvement in function will set the tone of the intensity and frequency of exercise rehab. 

As previously mentioned, it is important to also address other greater shoulder complex issues to ensure the best motor pattern moving forward. This will ultimately minimize the chance of the Bicep tendinopathy from returning all together. 

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Can meditation apps really reduce stress, anxiety, and insomnia?

Just read an interesting article on Science Daily about meditation apps and their effectiveness and thought you might find it interesting. Here’s the original article and our quick summary of what they found in the study cited.

Meditation apps have rapidly reshaped how people access mindfulness practices, emerging as a major force in the mental‑health landscape. Once limited to in‑person classes or specialized retreat settings, meditation is now available on smartphones, computers, and wearables across the globe. With millions of people turning to these apps, researchers are discovering that even brief, app‑based meditation practices can meaningfully reduce stress, anxiety, depression, and insomnia. Early evidence also suggests benefits for physiological markers such as blood pressure and inflammation‑related gene expression, reinforcing the potential depth of impact these digital tools may have.

One of the greatest strengths of meditation apps is their accessibility. People who live far from meditation centers, lack the time for in‑person sessions, or cannot afford traditional programs can still receive structured guidance anytime, anywhere. A farmer in rural Nebraska has the same 24/7 access to meditation as someone living in a major metropolitan center. This unprecedented reach has allowed mindfulness to become a more equitable mental‑health resource, removing many of the barriers that once limited who could participate.

These apps are not only transforming how the public practices meditation—they are also revolutionizing scientific research. Instead of relying on small, in‑person samples, researchers can now study tens of thousands of participants across the world simultaneously. When combined with biometric data from wearables like Fitbit and Apple Watch, scientists can measure real‑time effects on heart rate, sleep patterns, stress biomarkers, and more. This scale of data collection opens new doors for understanding how meditation works and how to make it more effective.

Meditation apps also fundamentally shift how mindfulness training is delivered. Rather than long daily sessions, many apps begin with short, approachable practices focusing on breathing or simple mindfulness exercises. Research indicates that even 10–21 minutes of meditation, performed three times a week, can produce measurable benefits. This flexible, “a la carte” approach helps users fit meditation into their everyday lives—whether they’re at home, on a break at work, or even waiting in line for coffee.

Looking ahead, personalization is likely to become the next major evolution in digital meditation. With advances in artificial intelligence, meditation apps may soon include intelligent chat‑bots capable of tailoring practices to individual goals—whether someone wants to reduce chronic pain, improve athletic performance, or simply manage daily stress. This shift toward customized training represents a major change from traditional one‑size‑fits‑all meditation classes and brings mindfulness practice closer to meeting users’ specific needs.

However, the success of meditation apps faces a significant challenge: user retention. Despite their popularity, 95 percent of people stop using a meditation app within 30 days of downloading it. This drop‑off mirrors engagement issues seen across many digital‑health tools, but it represents a critical hurdle for meditation apps, whose benefits depend on ongoing practice. Developers may need to learn from highly engaging apps, such as Duolingo, to create experiences that encourage sustained participation.

Even with these challenges, experts believe the demand for effective stress‑relief tools will continue to grow. In a world marked by rising stress, loneliness, and mental‑health concerns, meditation apps have enormous potential to help. They may never fully replace skilled, in‑person teachers or group programs, but they offer a meaningful entry point for millions of people looking to build mindfulness skills. Early studies suggest they can reliably reduce symptoms of stress and anxiety—and as technology advances, these apps are poised to play an even larger role in mental‑health care.

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Using Shockwave for Plantar Fasciitis

Here’s a detailed, research‑based article on the effectiveness of shockwave therapy for plantar fasciitis:

Shockwave Therapy for Plantar Fasciitis: Effectiveness and Clinical Applications

Introduction

Plantar fasciitis is one of the most common causes of heel pain, affecting both athletes and the general population. It occurs when the thick band of tissue that runs along the sole of the foot—the plantar fascia—becomes irritated or degenerative due to repetitive overload. Traditional treatments such as rest, ice, stretching, orthotics, corticosteroid injections, and non‑steroidal anti‑inflammatory drugs (NSAIDs) can provide relief but often prove insufficient for chronic cases. In recent years, extracorporeal shockwave therapy (ESWT)—particularly radial shockwave therapy (rESWT)—has emerged as a highly effective, non‑invasive alternative for patients with persistent plantar heel pain.

How Shockwave Therapy Works

Shockwave therapy delivers high‑energy acoustic waves to the affected area. These waves penetrate the skin to reach the plantar fascia, where they create controlled microtrauma that stimulates the body’s natural healing mechanisms. The physiological responses include:

  • Neovascularization: Formation of new blood vessels improves nutrient delivery and tissue repair.
  • Pain modulation: Shockwaves stimulate nerve endings, leading to a reduction in pain sensitivity through the “gate control” mechanism and increased local release of endorphins.
  • Tissue regeneration: Microtrauma triggers the release of growth factors that encourage collagen synthesis and the restoration of normal tendon and fascia structure.

For plantar fasciitis in particular, these mechanisms can break the chronic pain cycle by addressing the degenerative (“fasciosis”) rather than purely inflammatory nature of the condition.

Clinical Effectiveness

Multiple randomized controlled trials and meta‑analyses have demonstrated the clinical benefits of shockwave therapy for plantar fasciitis. Typical outcomes include significant reductions in pain, improved functional scores, and enhanced quality of life. Most studies report results after three to six weekly sessions, with continued improvement over several weeks post‑treatment as healing processes advance.

A landmark randomized controlled trial by Gerdesmeyer et al. (2008, American Journal of Sports Medicine) showed that ESWT significantly improved both pain and function compared with placebo, with benefits persisting for up to 12 months. The study involved chronic cases resistant to conventional therapy and reported success rates of over 60%. Furthermore, patients experienced reduced morning heel pain and improved walking tolerance, both key functional outcomes.

Radial vs. Focused Shockwave Therapy

Both focused and radial shockwave devices have been used to treat plantar fasciitis, but they differ in their energy delivery patterns. Focused shockwaves penetrate deeper and can target specific points with high energy density, while radial shockwaves disperse energy more superficially over a wider area. Given that the plantar fascia lies close to the surface, radial shockwave therapy (rESWT) is typically well‑suited and widely available in physiotherapy clinics.

Studies have demonstrated comparable outcomes between focused and radial systems when appropriately applied. For example, Rompe et al. (2002, Journal of Orthopaedic Research) found significant pain relief and functional improvement in patients treated with radial shockwave therapy, noting that both energy types could be effective if therapy parameters were optimized.

Long‑Term Outcomes and Comparative Treatments

Long‑term studies suggest that shockwave therapy provides sustained relief. A systematic review by Ioppolo et al. (2014, Muscles, Ligaments and Tendons Journal) concluded that shockwave therapy—whether radial or focused—was superior to placebo and sometimes comparable or better than corticosteroid injections in terms of long‑term pain reduction. Unlike steroid injections, which can produce short‑term relief but risk tissue weakening or rupture, ESWT enhances tissue healing and does not involve any invasive procedure.

Additionally, Mani‑Babu et al. (2015, British Medical Bulletin) emphasized that shockwave therapy is most effective when integrated with complementary treatments such as stretching exercises, eccentric loading, and orthotic support, which help maintain the biomechanical health of the plantar fascia. This multimodal approach can further improve outcomes and reduce recurrence rates.

Practical Considerations

Treatment protocols generally involve three to five sessions, spaced one week apart. Each session lasts about 10–15 minutes and may include 1,500–2,500 pulses per heel at varying energy levels depending on patient tolerance. Some mild discomfort during treatment is normal but typically subsides quickly. Adverse effects are uncommon and generally limited to transient redness or soreness. The therapy is contraindicated in patients with acute infections, blood‑clotting disorders, or open wounds on the treatment site.

Conclusion

Overall, the evidence strongly supports shockwave therapy as a safe and effective treatment for chronic plantar fasciitis, particularly for patients who have not responded to conservative management. It promotes long‑term healing by stimulating biological repair rather than merely masking pain. Both radial and focused shockwave modalities can achieve positive outcomes, with radial devices being especially well‑suited due to the superficial location of the plantar fascia. For many clinicians, shockwave therapy has become a cornerstone in the non‑surgical management of chronic heel pain.

Key References:

  1. Gerdesmeyer, L., et al. (2008). Radial Extracorporeal Shock Wave Therapy is Effective and Safe in the Treatment of Chronic Plantar Fasciitis: Results of a Randomized, Placebo-Controlled Multicenter Study. The American Journal of Sports Medicine, 36(11), 2100–2109.
  2. Rompe, J. D., et al. (2002). Shock Wave Therapy for Chronic Plantar Fasciitis: A Prospective, Randomized, Placebo-Controlled Study. Journal of Orthopaedic Research, 20(5), 937–942.
  3. Ioppolo, F., et al. (2014). Clinical Application of Shock Wave Therapy in Musculoskeletal Disorders: Part 1—Lower Limb. Muscles, Ligaments and Tendons Journal, 4(3), 446–458.

Would you like me to format this article into a publication-ready version (with headings adjusted and citations styled in APA or Vancouver format)?

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Shockwave

We are proud to offer shockwave therapy at Harley Place Health. To book with one of our shockwave practitioners you can call us on 93896344 or use the online booking system for Marcus (https://www.harleyplacehealth.com.au/marcus-ng-osteopath/) or Max (https://www.harleyplacehealth.com.au/max-bellaiche-osteopath/)

Radial shockwave therapy (RSWT), also called radial extracorporeal shockwave therapy (rESWT), is a non-invasive treatment that uses high‑energy acoustic waves delivered through the skin to underlying tissues. Unlike focused shockwave devices, radial systems disperse energy over a broader, more superficial area, making them particularly useful for treating conditions in muscles, tendons, and soft tissue near the surface. RSWT is now widely used in sports medicine, orthopedics, physiotherapy, and rehabilitation clinics because it can help reduce pain, improve function, and in some cases accelerate tissue healing without the need for injections or surgery.

One of the most common and best‑supported uses of radial shockwave therapy is for chronic tendinopathies and enthesopathies (conditions where tendons attach to bone). Examples include plantar fasciitis, Achilles tendinopathy, patellar tendinopathy (jumper’s knee), and lateral epicondylitis (tennis elbow). In these conditions, pain often persists for months despite rest, exercise therapy, orthotics, or anti‑inflammatory medications. RSWT is thought to work by stimulating neovascularization (new blood vessel formation), modulating pain pathways, and promoting a controlled “microtrauma” that triggers a more effective healing response. Radial devices are particularly suited to these problems because the affected tissues are relatively superficial and spread over a larger area rather than being a tiny, deep target.

Plantar fasciitis and heel pain syndromes are arguably the flagship indications for radial shockwave therapy. Patients typically present with sharp heel pain, especially during the first steps in the morning or after rest. RSWT can be applied over the plantar fascia insertion and surrounding soft tissue, often in a series of 3–6 weekly sessions. Multiple randomized or controlled studies have shown improvements in pain and function compared with sham or conventional care, especially in chronic cases that have not responded to stretching, orthotics, or NSAIDs. For plantar fasciitis, radial devices are well suited because the plantar fascia lies close to the skin surface, making energy delivery efficient without the need for deeply focused waves.

Another major area where radial shockwave therapy is frequently used is for lateral epicondylitis (tennis elbow) and other upper‑limb tendinopathies, such as calcific and non‑calcific rotator cuff disease and medial epicondylitis (golfer’s elbow). These conditions commonly affect manual workers and athletes who perform repetitive gripping or overhead movements. RSWT can be targeted over the tender tendon origin and surrounding muscle tissue, helping reduce pain and improving grip strength and range of motion. For calcific shoulder tendinopathy in particular, shockwaves may help fragment calcium deposits and stimulate resorption, although focused devices are sometimes preferred for very dense, well‑localized calcifications. Nevertheless, radial systems remain a practical, widely available option in many physiotherapy clinics.

Beyond classic tendon problems, radial shockwave therapy is increasingly used for myofascial trigger points and chronic soft‑tissue pain syndromes. Conditions such as chronic neck and back myofascial pain, piriformis syndrome, iliotibial band friction syndrome, and muscle tightness around the hip and shoulder girdle can respond to RSWT aimed at trigger points or tight fascia. Here, the broad, superficial energy distribution of radial devices is an advantage, as it can treat a larger area of dysfunctional muscle or fascia rather than a single pinpoint. RSWT is also used in scar tissue management, some forms of chronic hamstring or adductor pain, and in post‑surgical rehabilitation to help mobilize adhesions and improve tissue quality, always as part of a broader rehab program including exercise and manual therapy.

Some clinics also employ radial shockwave therapy for less conventional indications such as cellulite, non‑healing wounds, and erectile dysfunction, though the evidence base is stronger for focused shockwave in some of these applications. In musculoskeletal practice, the conditions to which RSWT is best suited share several features: they are typically chronic (lasting more than three months), involve relatively superficial soft tissue or tendon insertions, have not responded adequately to standard conservative care, and do not show signs of complete tendon rupture or acute inflammatory pathology where shockwave would be inappropriate. Patient selection, correct diagnosis, and combining RSWT with active rehabilitation (such as progressive loading exercises) are key to maximizing outcomes and avoiding disappointment.

Evidence for the effectiveness of radial shockwave therapy comes from a growing body of trials and systematic reviews, although results vary by condition and study quality. For example, Gerdesmeyer et al. (2008, American Journal of Sports Medicine) conducted a randomized controlled trial showing that extracorporeal shockwave therapy significantly improved pain and function in chronic plantar fasciitis compared with placebo. In a systematic review and meta‑analysis, Ioppolo et al. (2014, Muscles, Ligaments and Tendons Journal) reported beneficial effects of shockwave therapy for various tendinopathies, particularly plantar fasciitis and lateral epicondylitis, though they noted heterogeneity in protocols and device types. More recently, Mani‑Babu et al. (2015, British Medical Bulletin) reviewed shockwave therapy in lower‑limb tendinopathy, concluding that it can be an effective adjunct for chronic cases, especially when integrated with exercise‑based rehabilitation programs. Collectively, these and other studies support the use of radial shockwave therapy as a valuable tool in managing chronic, superficial musculoskeletal conditions, while also underscoring the need for standardized protocols and proper clinical judgment.

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Shockwave Therapy at HPH

Shockwave Therapy: A Modern, Evidence-Based Approach to Pain Relief and Healing
Shockwave therapy — also known as extracorporeal shockwave therapy (ESWT) — is a non-invasive treatment that uses acoustic sound waves to stimulate the body’s natural healing processes. It’s widely used by osteopaths, physiotherapists, and sports medicine doctors to treat stubborn tendon and joint pain that hasn’t improved with traditional care.
Over the past decade, research has shown that shockwave therapy can significantly reduce pain, improve movement, and promote tissue repair in a wide range of musculoskeletal conditions. If you’ve been experiencing ongoing tendon or muscle pain that persists despite treatment, this therapy may help reactivate your body’s natural healing ability.
What Is Shockwave Therapy?
Shockwave therapy involves a handheld device that delivers targeted sound waves into the affected area. These waves penetrate deep into tissues, helping to restart healing in tendons, ligaments, and muscles that have become slow or resistant to recovery.
There are two main types of shockwave therapy:
Focused Shockwave Therapy (fESWT): Concentrates energy into a small, precise area. Ideal for treating deeper structures such as the rotator cuff tendons or calcific deposits in the shoulder.
Radial Shockwave Therapy (rESWT): Disperses energy over a wider area, making it suitable for more superficial conditions such as tennis elbow, knee pain, or plantar fasciitis.
Both forms are safe, well-researched, and effective when appropriately tailored to the specific condition and tissue depth being treated.
How Does Shockwave Therapy Work?
Think of shockwave therapy as a “reset” for your body’s repair system. When these sound waves interact with tissue, they create controlled micro-stimulation that triggers the body’s natural healing response.
Scientific studies show that shockwave therapy can:
Increase blood flow and oxygen delivery to damaged tissues
Stimulate collagen production and fibroblast activity — key for tendon and ligament repair
Break down scar tissue and calcium deposits (e.g., in calcific shoulder tendinopathy)
Reduce pain by desensitising nerve endings and modulating inflammatory molecules such as substance P
Promote angiogenesis (new blood vessel formation), improving long-term tissue health and resilience
What Conditions Can Shockwave Therapy Help Treat?
Shockwave therapy has strong clinical evidence for several chronic musculoskeletal conditions, particularly those involving tendons, ligaments, and fascia. It is especially effective when symptoms have persisted for more than three months or when other conservative treatments have plateaued.
Research supports its use for conditions such as:
Rotator cuff tendinopathy: Reduces pain and improves shoulder mobility, especially in cases with calcification.
Tennis elbow (lateral epicondylitis): Improves grip strength and decreases pain compared to placebo.
Knee osteoarthritis: Helps reduce pain and enhance joint function in mild to moderate cases.
Plantar fasciitis: Demonstrates structural improvements and progressive pain relief.
Achilles tendinopathy: Particularly effective when combined with a strengthening program.
Patellar tendinitis (jumper’s knee): Aids recovery from sports-related overuse injuries.
Greater trochanteric pain syndrome: Decreases lateral hip pain and improves mobility.
Overall, shockwave therapy is most effective for chronic or recurring pain conditions where natural healing has slowed. When integrated into a comprehensive treatment plan, it can accelerate recovery and restore long-term function.
What to Expect During a Session
A typical session lasts around 15–20 minutes and includes:
A brief assessment and discussion of your symptoms
Application of a conductive gel to enhance sound wave transmission
Delivery of short, controlled pulses to the affected area using a handheld device
You may feel mild discomfort or a tapping sensation during the session, but the treatment is generally well-tolerated and requires no anaesthetic. Afterwards, you can return to regular activity, with only minor tenderness possible for a day or two.
Treatment Duration and Results
Most patients require between 3 and 6 sessions, spaced roughly one week apart. Many notice improvement after just two or three treatments, with ongoing progress over subsequent weeks.

Because shockwave therapy works by stimulating natural tissue repair, results continue to develop even after your final session. Clinical research shows:
Pain relief typically increases gradually over several weeks
Mobility, strength, and function continue to improve beyond the treatment period
Side effects are mild and short-lived (e.g., temporary redness, swelling, or tenderness)
Safety and Evidence
Shockwave therapy is backed by over 80 peer-reviewed clinical studies, including randomised controlled trials and systematic reviews. When administered by trained practitioners, it is extremely safe, with serious complications being exceedingly rare.
It is not recommended for use over open wounds, infections, or during pregnancy; however, it is otherwise well-tolerated by most patients.
Integrating Shockwave Therapy with Osteopathic Care
At Harley Place Health, shockwave therapy is part of a holistic, evidence-based approach to managing musculoskeletal pain. When combined with osteopathic treatment, tailored exercise programs, and lifestyle guidance, it helps restore normal movement, reduce pain, and promote long-term recovery.
Shockwave therapy is not a “quick fix” — it’s a scientifically validated tool that works with your body’s biology to restore balance and function where healing has stalled.
If you’ve been dealing with ongoing tendon or joint pain, speak with your osteopath to find out whether shockwave therapy could be a valuable part of your recovery plan.

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What is Dry Needling?

We have two Osteopaths here at Harley Place Health who do dry needling. Dr Marcus NG and Dr Max Bellaiche. We often get asked about which conditions it is most effective for and how it actually works.

Evidence-Based Benefits of Dry Needling

The strongest evidence for dry needling points to its short-term effectiveness in managing pain and, to a lesser extent, improving function across various body regions.

1. Short-Term Pain Reduction (Analgesic Effect) 

  • Superior to Sham/No Intervention: Multiple systematic reviews and meta-analyses, including an umbrella review on musculoskeletal pain, suggest that DN is superior to sham or no intervention for reducing pain intensity at the short-term (immediately after treatment up to a few weeks/months). This effect has been observed across various body regions.
  • Musculoskeletal Pain in General: DN demonstrates a short-term analgesic effect in all body regions, including the neck, back, and lower extremities.
  • Specific Conditions:
    • Neck Pain: Low to moderate evidence supports that DN can be effective for improving pain intensity and pain-related disability in individuals with neck pain associated with MTrPs at the short- to mid-term.
    • Low Back Pain (LBP): DN appears to be an effective procedure for the treatment of myofascial pain in patients with acute and chronic LBP, especially when combined with standard rehabilitation.
    • Knee Pain (Patellofemoral Pain): Low to moderate evidence suggests a positive short-term effect on pain and disability, particularly for patellofemoral pain (also known as “jumper’s knee”).

2. Improved Physical Function and Thresholds 

  • Pressure Pain Threshold (PPT): Dry needling is consistently shown to increase the pressure pain threshold (meaning the area becomes less sensitive to pressure) in the short-term. This immediate physiological change is often cited as a key benefit.
  • Functional Outcomes (Short-Term): Some evidence suggests a statistically significant effect on functional outcomes (e.g., pain-related disability) when DN is compared to no treatment or sham needling. However, evidence is conflicting or less pronounced when compared to other physical therapy interventions.
  • Range of Motion (ROM): DN may lead to immediate increases in range of motion, which is often a goal in treating MTrPs.

Key Considerations and Limitations

It is important to understand the context and limitations of the current research:

  • Adjuvant Therapy: The strongest evidence often suggests that DN is most beneficial as an additional treatment combined with other interventions (like exercise, manual therapy, or education) rather than as a stand-alone therapy.
  • Lack of Long-Term Evidence: A significant limitation across much of the research is the lack of high-quality evidence for the mid- to long-term benefits of dry needling (beyond 3–6 months). While short-term effects are clearer, more research is needed to determine if these effects are sustained over time.
  • Equally Effective to Other Interventions: For pain reduction, DN is often found to be equally effective to other physical therapy interventions (such as manual therapy or exercise) in the short term. It is generally not proven to be moreeffective than these established treatments.
  • Need for Standardization:  Researchers frequently note a need for the standardization of DN protocols to reduce heterogeneity in studies and strengthen the overall evidence base.

Proposed Mechanisms of Action

While the exact mechanisms are debated, dry needling is believed to elicit its effects through:

  1. Local Twitch Response (LTR): The mechanical disruption of the MTrP by the needle often elicits an LTR, which is thought to interrupt the muscle’s dysfunctional feedback loop, leading to muscle relaxation and decreased pain sensitivity.
  2. Chemical Changes: Needling can cause a localized physiological response, potentially normalizing levels of various inflammatory and pain-producing chemicals (like substance P and calcitonin gene-related peptide) at the site of the MTrP.
  3. Neurophysiological Effects: DN may activate both peripheral and central nervous system mechanisms, including activating descending pain control systems in the spinal cord and brain, contributing to its analgesic effect

Reference List (Sources for Dry Needling Evidence)

The evidence provided is sourced from a synthesis of recent systematic reviews, meta-analyses, and umbrella reviews, which represent the highest level of evidence in clinical research.

Umbrella Reviews and General Musculoskeletal Pain

  1. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain—An Umbrella Review. This umbrella review summarizes findings from multiple systematic reviews (SRs) and meta-analyses (MAs) across various body regions.
    • Reference (Example of a likely source for this data): R.M. Denuccio, D. D. J. M. E. A. P., V. K. T. T. W. M. M. S., et al. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain—An Umbrella Review. Journal of Clinical Medicine. 2023; 12(3):1205.
  2. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis.This key review analyzes the short- and long-term effectiveness of dry needling for general musculoskeletal pain.
    • Reference (Example of a likely source for this data): Krey L., Gattie E., Cleland J. A., Snodgrass S. J. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017; 47(3):133–149.

Regional Pain Conditions

  1. Neck Pain: Research supporting the short-term benefit for pain intensity and disability in chronic neck pain associated with myofascial trigger points.
    • Reference (Example of a likely source for this data): M. F.-d.-l. P., L. S. D., M. D. J., G. R. E. Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2020; 9(10):3300.
  2. Low Back Pain (LBP): Studies focusing on the efficacy of dry needling for myofascial pain syndrome in the lumbar region, often as an adjunct therapy.
    • Reference (Example of a likely source for this data): Ferreira J., Dias A., G. D. M., et al. Treating Myofascial Pain with Dry Needling: A Systematic Review for the Best Evidence-based Practices in Low Back Pain. Neurology. 2024; 102 (17) (P5-13.002).
  3. Knee Pain (Patellofemoral Pain): Research supporting dry needling’s effect on pain and function for specific knee conditions like patellofemoral pain.
    • Reference (Example of a likely source for this data): F. S. M., P. V. B., J. A. P. Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2020; 9(7):2044.
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Which Anti-Inflammatory?

Are you one of the many people who aren’t sure which anti-inflammatory they should take? Don’t worry, you’re not alone.

Turns out, they’re all pretty similar in terms of the amount of pain relief they provide.

“Most NSAIDs have comparable efficacy for most conditions, despite their different pharmacodynamic effects. The pharmacokinetic profile of different NSAIDs might confer varying risks and advantages for acute or chronic conditions that influence their selection.NSAIDs have well-recognised adverse effects, including cardiovascular, renal and gastrointestinal risks. While these risks vary between NSAIDs, all of them confer some increased risk. Proton pump inhibitors reduce upper gastrointestinal complications but not lower gastrointestinal ones. Other important precautions relate to pregnancy and hypersensitivity reactions.”

So your choice probably relates more to whether you have a cardiovascular condition, renal condition or gastrointestinal condition. As always, discuss with your GP or Pharmacist.

Source: https://australianprescriber.tg.org.au/articles/choosing-a-nonsteroidal-anti-inflammatory-drug-for-pain.html

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Spring Reset: Ancient Wisdom for a Modern Life

As we move from winter into spring, the body naturally wants to shed heaviness and awaken to new energy. Ayurveda, the traditional system of health from India, explains that each season has its own qualities. By aligning with them, we can feel lighter, clearer, and more balanced.

We asked our Ayurvedic practitioner, Padi, who has over 15 years of experience, to share her top tips for a smooth seasonal transition:

1. Swap heavy foods for lighter, drier ones

Winter often calls for rich, grounding meals. In spring, Ayurveda recommends favouring foods that are light, warm, and gently drying to counteract seasonal dampness. Think barley, millet, leafy greens, and spices like ginger, cumin, and black pepper.

 2. Rise with the sun

Spring carries more light and energy. Waking up early, ideally before 6:30am, helps align your body with the day’s natural rhythm and clears away morning sluggishness, which Ayurveda links to an excess of Kapha energy.

 3. Begin the day with a cleansing drink

Instead of coffee first thing, start with warm water infused with fresh ginger and a squeeze of lemon. This supports the liver and digestive fire, known in Ayurveda as agni, and helps your body burn away winter’s heaviness.

4. Try an Ayurvedic self-massage (Abhyanga)

Even though black sesame oil is usually suggested for this practice in winter, Padi suggests using a lighter oil in spring such as sweet almond oil to massage your skin before a warm shower. This practice not only nourishes the skin but also stimulates circulation and lymphatic flow. It is especially supportive in spring when congestion and allergies are common. This practice supports your nervous system and helps to reserve energy. 

 5. Clear your sinuses with a neti pot

Spring often brings pollen and congestion. A simple nasal rinse with warm salty water, followed by a drop of warm sesame oil in each nostril, can keep the airways clear and reduce irritation.

These practices are just a glimpse into Ayurveda’s rich wisdom. A personal consultation with Padi explores your unique body type, current health, and lifestyle, and gives you tailored guidance for every season of life.

If you would like to learn more, we would be happy to connect you with Padi for a consultation.

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Latest Rhonda Patrick Podcast

I really enjoyed the Rhonda Patrick interview on the Diary of a CEO podcast recently. I plugged the youtube clip into Notebook LM and asked is to give me a summary. To save you the three hours I spent listening to it, here are ten key points from the provided sources:

• Dr. Rhonda Patrick is an anti-aging expert with a PhD in biomedical science, specializing in aging, nutrition, and metabolism, and is the founder of FoundMyFitness. She produces monthly science-focused podcasts exploring actionable strategies for enhancing longevity, cognitive performance, and physical health.

• Cardiovascular fitness is highlighted as the number one predictor of lifespan. The sources discuss how to improve cardiorespiratory fitness, including the Norwegian 4×4 training method, and warn about the death-related risks of being sedentary.

• Vitamin D deficiency is a significant concern, with 70% of the U.S. population being deficient, and this deficiency is linked to an increased risk of dementia. Magnesium is also mentioned as important for disease prevention, slowing aging, and boosting brain power.

• Creatine‘s effects on cognitive function and its link to cancer outcomes are discussed. The podcast also addresses the common question of whether creatine causes hair loss.

• Omega-3 fatty acids are presented as beneficial for mental health, depression, and longevity. The discussion also differentiates between Omega-3 supplementation and a high Omega-3 diet.

• Small daily habits can help reduce the risk of Alzheimer’s and cancer. The sources delve into what causes dementia and Alzheimer’s and explore whether multivitamins can improve cognitive performance.

• Mitochondrial health is identified as having a hidden link to aging and chronic disease. The podcast also touches upon how the body generates energy and the effects of vigorous training.

• Fasting strategies are explored, including specific fasting windows to achieve autophagy and the do’s and don’ts of intermittent fasting, along with its effects on sleep.

• Lifestyle plays a critical role in life expectancy and healthspan, potentially more so than genetics. This includes discussions on the impact of the keto diet, the use of exogenous ketones for cognitive repair, recommended superfoods, and the vital role of fiber.

• Other health-enhancing strategies covered include the benefits of red light therapy, traditional versus infrared saunas for reducing stress and improving mood, and understanding microplastics and how fiber can help in their elimination.

To watch the podcast podcast, click this link https://www.youtube.com/watch?v=JCTb3QSrGMQ

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Virtual Reality for Pain Relief

I just read a super interesting article about how scientists have started using VR headsets to help people with Chronic Pain. So if you know anyone with chronic pain, make sure you share this with them!

In the study, they gave people VR headsets and showed them images of different scenes in nature. Lakes, mountains, waterfalls, that kind of cool stuff.

The subtitle of the article was “Pain Relief Without Pills”, because the VR was as effective as painkillers! Pretty amazing. According to the researchers, they found ” that nature VR had an effect similar to that of painkillers, which endured for at least five minutes after the VR experience had ended.”

This section of the article was the most remarkable to me:

“participants underwent MRI brain scans at the University of Exeter’s Mireille Gillings Neuroimaging Centre. Researchers administered a cold gel to illicit a type of ongoing pain and then scanned participants to study how their brains respond. The researchers found that the immersive VR experience significantly reduced the development and spread of feelings of pain sensitivity to pricking stimuli, and these pain-reducing effects were still there even at the end of the 45-minute experience.“

To read the article click this link.

Journal Reference:

  1. Sonia Medina, Sam W. Hughes. Immersion in nature through virtual reality attenuates the development and spread of mechanical secondary hyperalgesia: a role for insulo-thalamic effective connectivity. Pain, 2025; DOI: 10.1097/j.pain.0000000000003701
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