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Dry Needling VS Acupuncture: What's The Difference? 

Clinical director and physical therapist, Doug Soell, explains the difference between dry needling and acupuncture. How are they they same? How are they different?

TennisElbowClassroom's insight:
They appear to be the same: The needles are the same and, from a distance, the application seems identical - but the techniques of Dry Needling and Acupuncture are based on different systems.

Acupuncture being based on Traditional Chinese Medicine and Dry Needling having more of a Western Medical basis and perspective.

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Tennis Elbow Treatment
What's the best treatment for Tennis Elbow? How do you avoid the myths and mistakes and choose the right therapies and remedies?
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Do Tennis Elbow Braces Help Your Tendons Heal?

Do Tennis Elbow Braces Help Your Tendons Heal? | Tennis Elbow Treatment | Scoop.it

Pain relief vs. healing – A key distinction – But one that’s easy to miss when one is in urgent pursuit of relief and needs to get on with the necessities of life.


Braces and other supports DO seem to relieve pain, and it’s only natural to assume that if it’s feeling better it must be getting better. It must be healing – But is it? Will the brace help the injury HEAL?

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What Is Pickleball Elbow And How Do You Treat It?

What Is Pickleball Elbow And How Do You Treat It? | Tennis Elbow Treatment | Scoop.it
Is there such a thing as Pickleball Elbow or is your Pickleball injury pain likely either Tennis Elbow or Golfer's Elbow? – Learn the right way to treat and heal it yourself, either way – And discover why the standard treatments of pills, shots, ice, braces and creams are NOT the answer! https://tenniselbowclassroom.com/tennis-elbow-treatments/pickleball-elbow/
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'Dry Needling Controversy: Strictly Acupuncture – Or Also A Physical Therapy Modality?

'Dry Needling Controversy: Strictly Acupuncture – Or Also A Physical Therapy Modality? | Tennis Elbow Treatment | Scoop.it
Some physical therapists have taken up an unproven practice that looks like acupuncture.
TennisElbowClassroom's insight:
There is definitely a lot of debate - if not an outright turf war - over this question!

Some Acupuncturists, and their State boards, claim Dry Needling is a technique that falls entirely within their scope of practice and no others.

But, according to USA Today, the US Physical Therapy Association apparently advises members in at least seven states…

Including California, Florida, Hawaii, Idaho, New York, South Dakota and Washington to avoid using Dry Needling, because of recent regulatory decisions or language in existing Physical Therapy licensing laws.

The USA article also claims that most of the United States' 200,000 Physical Therapists have not been trained in Dry Needling, and only approx. 6,000 have taken courses in it.

I tend to think that if you're a P.T. with training in the technique, you should be allowed to practice it... What do you think?
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Treating Lateral Epicondylitis With Trigger Point Dry Needling

Treating Lateral Epicondylitis With Trigger Point Dry Needling | Tennis Elbow Treatment | Scoop.it
Dry needling is gaining more popularity and becoming another great option when dealing with trigger points as well as pathologies such as lateral epicondylitis.
TennisElbowClassroom's insight:
Trigger Point Dry Needling is being used by Acupuncturists and Physical Therapists to treat Tennis Elbow by "inactivating" 'Trigger Points' in the muscles involved.

(Personally, I view Trigger Points as symptoms that cause other symptoms and not the root of the dysfunction.)

See also these related posts:


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The Top Treatments For Tennis Elbow In Physical Therapy

How is Lateral Epicondylitis or 'Tennis Elbow' treated in a Physical Therapy or Physiotherapy clinic? Physical Therapy is a system for rehabilitation that has …
TennisElbowClassroom's insight:
When we think of Physical Therapy we tend to think of exercises; rehab exercises, strengthening exercises, stretches and so forth.

And, although exercise is certainly an essential part of a treatment program for Tennis Elbow, Physical Therapy is a system for rehabilitation that has many components.

Here are the top five of these treatment components, known in medical speak as Modalities.

And for an in-depth look at PT and Tennis Elbow, including an attempt to answer the question of "how effective are these modalities?" visit:


#TennisElbow
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Study Suggests Ice In Physical Therapy Treatment Not Helpful For Tennis Elbow

Study Suggests Ice In Physical Therapy Treatment Not Helpful For Tennis Elbow | Tennis Elbow Treatment | Scoop.it
The use of ice as a supplement to an exercise programme has been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined its effectiveness.To investigate whether an exercise programme supplemented with ice is mor
TennisElbowClassroom's insight:
In this clinical pilot trial the authors, P Manias and D Stasinopoulos, conclude that:

"Ice as a supplement to an exercise programme offers no benefit to patients with LET." [Lateral Elbow Tendinopathy / Tennis Elbow]

(In Physical Therapy, the exercise program is key, and although ice / Cryotherapy may provide some temporary pain relief, there's little to no evidence that it encourages healing.)
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Surgery For Lateral Epicondylitis - How Do You Know When It's Time To Consider It? [VIDEO]

When you have an extremely stubborn, chronic case of Lateral Epicondylitis or Medial Epicondylitis (Tennis Elbow or Golfer's Elbow) And you've been struggling with for it months – Or maybe even for years – When should you realistically begin to consider surgery as a treatment option? And how do you know if you're a good candidate for a surgical procedure or not?
TennisElbowClassroom's insight:
Sure, surgery for Tennis Elbow may very well be a quick and "easy" procedure, but it's still surgery. The question is: How do you know when to throw in the towel on more conservative measures and decide it's time for surgery?
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World-Wide Tennis Elbow Treatment Market Expected To Hit 10 Billion USD By 2022

According to the latest report published by Credence Research, Inc. “Lateral Epicondylitis (Tennis Elbow) Market - Growth, Future Prospects and Competitive Analysis, 2016-2022,” the  Lateral Epicondylitis (Tennis Elbow) market was valued at USD 8,104.
TennisElbowClassroom's insight:
Apparently, the vast majority of the current 8+ billion dollars spent globally each year on Tennis Elbow treatment goes to Cortisone shots and NSAID pills (anti-inflammatories)...

Neither of which treat the underlying cause or the injury itself: Tendinosis / tendon degeneration - Cortisone shots have been shown to weaken collagen and further the degeneration, if anything.

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Surgeon Reveals Why Your Operation, Including Tennis Elbow Surgery, May Not Work

Surgeon Reveals Why Your Operation, Including Tennis Elbow Surgery, May Not Work | Tennis Elbow Treatment | Scoop.it

"Commonly performed operations can be found to be useless, according to a practicing Sydney surgeon."

TennisElbowClassroom's insight:
Ian Harris, an Australian Orthopedic surgeon and Professor makes some startling claims in his new book, 'Surgery, The Ultimate Placebo.'

Including that the evidence for the success of many surgical procedures has become accepted without proper scrutiny, and that the only benefit of some surgeries may be a 'placebo effect.' 

One of the dozen plus surgeries he criticizes is for Tennis Elbow - In his opinion, it's: 

"Another procedure that is in decline. The condition largely gets better over time and surgery doesn't add anything to that process."
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Placebo 'Sham' Procedure No Better Than Actual Surgery For Treatment Of Tennis Elbow, Study Finds

Placebo 'Sham' Procedure No Better Than Actual Surgery For Treatment Of Tennis Elbow, Study Finds | Tennis Elbow Treatment | Scoop.it
Surgical treatment of lateral epicondylitis: a prospective, randomised, blinded, placebo controlled pilot study Kroslak, Martin, Clinical School - St George Hospital, Faculty of Medicine, UNSW 2012
TennisElbowClassroom's insight:
"The only difference observed between the groups was that patients who underwent the Nirschl procedure for Tennis Elbow [genuine surgery] had significantly more pain with activity at 2 weeks, when compared with sham surgery alone (p<0.05)"...

"Conclusion: This pilot study indicates that, in the short term, surgical excision of the degenerative portion of ECRB [the tendon most often associated with classic Tennis Elbow] confers no additional benefits to patients with chronic Tennis Elbow over and above a skin incision alone."

[So, basically, one group of people had an actual surgical procedure for Tennis Elbow, and one group had a fake / sham procedure, where the skin was cut open but nothing else was done - Obviously, the 2nd group didn't know they weren't getting a real surgery.]

[Both groups improved equally over time, so, since the people who got the "real" surgery didn't do any better that the people who got the fake surgery there isn't any proof that this type of surgery actually "works" - and the "benefits" could all be due to the placebo effect, which is one of the most powerful "drugs" known to man and medicine.]
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Is Platelet-Rich Plasma An Effective Treatment For Tennis Elbow? [Video]

Is Platelet-Rich Plasma (PRP) a breakthrough in Tennis Elbow treatment or an overpriced, hyped-up fad?

 

In this “podcast video” Allen Willette from Tennis Elbow Classroom, discusses the upsides and downsides of PRP, (an injection procedure that uses your own blood)...

 

Including whether it's a safe and effective treatment for Tennis and Golfer's Elbow; whether it's worth the price – and the pain afterward (also sometimes during) – and whether there are any alternatives to achieve the same goals.

TennisElbowClassroom's insight:

For a full article with news sources and medical cites visti:


http://tenniselbowclassroom.com/tennis-elbow-treatments/platelet-rich-plasma-for-treating-tennis-elbow-does-it-work/

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PRP And Inflammation... Airplanes, Cabin Pressure And Swollen Joints

PRP And Inflammation... Airplanes, Cabin Pressure And Swollen Joints | Tennis Elbow Treatment | Scoop.it

An inflammatory response to Forte knee treatment athletic trainer and physical therapist - By John Doherty

TennisElbowClassroom's insight:

Interesting article about running back Matt Forte, his knee ligament injury and skipping a flight.

 

The decreased pressure inside an airplane (lower than I realized!) and joint swelling (and any kind of circulatory issue) are not a good combination.

 

(Something to always keep that in mind if you've recently had joint surgery and are considering flying.)

 

And this columnist, John Doherty, an athletic trainer and physical therapist, totally gets that Tennis Elbow is not an inflammatory condition! Which is what really got my attention:

 

"PRP is supposed to work by triggering an inflammatory response — inflammation is the first step in healing."

 

"That it works on tennis elbow makes perfect sense. Tennis elbow is a degenerative condition marked by an absence of inflammation."

 

Like I've been saying, inflammation is part of the healing process of injured tissues - NOT something to suppress - Especially when it's missing in the first place with Tennis and Golfer's Elbow!

 

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Hope and Hype Outpace Proven Treatments As Sports Medicine's Growth Explodes

Hope and Hype Outpace Proven Treatments As Sports Medicine's Growth Explodes | Tennis Elbow Treatment | Scoop.it
The popularity of sports medicine stems from the fact that celebrity athletes, desperate to return after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.
TennisElbowClassroom's insight:

After contributing to the publicity-driven explosion in popularity of Platelet-Rich Plasma Therapy (PRP) with this article in 2009:

 

http://www.nytimes.com/2009/02/17/sports/17blood.html

 

The New York Times takes a more reasoned, cautious view of PRP in this post in 2011, questioning whether it really works:

 

http://well.blogs.nytimes.com/2011/01/26/phys-ed-does-platelet-rich-plasma-therapy-really-work/

 

...And in this more comprehensive article linked above, (mostly on the subject of PRP) 'As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments'

 

The NYT speculates on the perfect storm that gives rise to popular - but untested treatments:

 

"If ever anyone wanted to know how untested sports medicine treatments come into use, they would need only look at platelet-rich plasma, medical experts say."

 

"...It is what Dr. John Bergfeld, an orthopedic sports medicine specialist at the Cleveland Clinic, calls the Orthopedic Triad: famous athlete, famous doctor, untested treatment."

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How Guitar Playing Causes Tennis Elbow And The Keys To Treating It

How Guitar Playing Causes Tennis Elbow And The Keys To Treating It | Tennis Elbow Treatment | Scoop.it
If you have Guitar Elbow, don't fret it! Here's how to treat the real, underlying muscular causes of your injury – and keep playing your guitar, whether you have Tennis Elbow, Golfer's Elbow or a wrist or finger tendon injury. https://tenniselbowclassroom.com/tennis-elbow-treatments/guitar-elbow/
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Topical Tennis Elbow Treatments: Are Creams Of Any Use When It Comes To Healing?

Topical Tennis Elbow Treatments: Are Creams Of Any Use When It Comes To Healing? | Tennis Elbow Treatment | Scoop.it
Can topical anti-inflammatory creams (medical or herbal) help you heal the injured tendons of your Tennis Elbow or will they just rub you the wrong way?
TennisElbowClassroom's insight:
Lotions, creams, sprays and medicated anti-inflammatory gels (sometimes even steroid creams) are often used to treat Tennis Elbow and Golfer's Elbow symptoms...

But, the question is, can these topical remedies actually help you heal your injured tendons or are they just “covering over” the symptoms?
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Video On Dry Needling For Tennis Elbow - 'Acupuncture' Version

Demonstration of dry needling of a motor point for treatment of Tennis Elbow
TennisElbowClassroom's insight:
Here's a demonstration of Dry Needling for Tennis Elbow, utilizing the Acupuncture Needle version.

(There is also a Dry Needling technique that utilizes a Hypodermic Needle, which is a very different procedure.)

See also these related posts:



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Dry Needling VS Acupuncture: What's The Difference? 

Clinical director and physical therapist, Doug Soell, explains the difference between dry needling and acupuncture. How are they they same? How are they different?

TennisElbowClassroom's insight:
They appear to be the same: The needles are the same and, from a distance, the application seems identical - but the techniques of Dry Needling and Acupuncture are based on different systems.

Acupuncture being based on Traditional Chinese Medicine and Dry Needling having more of a Western Medical basis and perspective.

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Electrical Stimulation And Other Treatments For Lateral Epicondylitis (Some More And Some Less 'Sketchy')

Electrical Stimulation And Other Treatments For Lateral Epicondylitis (Some More And Some Less 'Sketchy') | Tennis Elbow Treatment | Scoop.it

"Equipment is used to deliver electrical current into the painful area over multiple sessions. Often a corticosteroid cream or patch or other medication is added and it is then pushed through the tissue with the electricity (this combination is known as Iontophoresis)."

TennisElbowClassroom's insight:
According to the Tennis Elbow Foundation, when it comes to the use of Electrical Muscle Stimulation - or 'Estim' for treatment:

"There is little to no medical evidence that this approach works for chronic Tennis Elbow."

"Further investigation and study is needed. Health insurance companies are now becoming hesitant to pay for this..."

Did anyone ever really think that zapping muscles with electricity and making them involuntarily twitch is going to help HEAL Tennis Elbow? ...

Or has it always been just another modality to take on to the Physical Therapy clinic's bill to the insurance company?
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Surgeon Answers: Should I have Surgery for my Tennis Elbow?

Philipp Streubel, M.D., UNMC College of Medicine
TennisElbowClassroom's insight:
In this video Philipp Streubel, M.D., of the UNMC College of Medicine, explains when to consider Tennis Elbow surgery, revealing that 90% of Lateral Epicondylitis cases resolve without the need for surgical intervention - And, for a more detailed look, see also: https://tenniselbowclassroom.com/tennis-elbow-treatments/tennis-elbow-surgery-when-is-it-time/
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Lateral Epicondylitis / Tennis Elbow Treatment Costs Projected To Hit 10 BILLION By 2022

Lateral Epicondylitis / Tennis Elbow Treatment Costs Projected To Hit 10 BILLION By 2022 | Tennis Elbow Treatment | Scoop.it
Lateral Epicondylitis (Tennis Elbow) Market Valued At USD 8,104.0 Mn In 2015, And Expected To Reach USD 10,582.1 Mn By 2022, Growing At A CAGR of 3.2% From 2016-2022
TennisElbowClassroom's insight:
Tennis Elbow is on the rise Globally - And people are spending a fortune on it! 8 Billion in 2015 and forecast to hit 10 BILLION by 2022! (Most of which apparently goes to Cortisone shots and anti-inflammatory pills, sadly = "Symptom Chasing")
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Questioning The Tennis Elbow Cortisone Shot "Quick Fix"

Questioning The Tennis Elbow Cortisone Shot "Quick Fix" | Tennis Elbow Treatment | Scoop.it
Steroid injections for tennis elbow may turn out to do more harm than good.
TennisElbowClassroom's insight:

Once again, another study suggests that Cortisone injections, while effective in the short term for Tennis Elbow (in relieving pain) frequently worsen the condition in the months to come.

Gretchen Reynolds, in the New York Times Well Blog, cites a study from Norway published in BioMed Central's Musculoskeletal Disorders Journal:
    

This is not the first study showing good short-term benefits but poor long-term outcomes, calling into question this ubiquitous, "preferred first line of treatment among many orthopedic specialists...." according to "Recent surveys in the United States and Britain."

For a detailed look at Cortisone shots and Tennis Elbow, including references from and links to several other studies, see:

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Leading Surgeon Reveals Why Doctors Perform 'Unnecessary' Surgeries

Leading Surgeon Reveals Why Doctors Perform 'Unnecessary' Surgeries | Tennis Elbow Treatment | Scoop.it
A leading Sydney surgeon has admitted to performing surgeries that don't work to appease patients. Professor Ian Harris notes that sometimes the only benefit from surgeries is the 'placebo effect'.
TennisElbowClassroom's insight:
"I have operated on people that didn't have anything wrong with them in the first place," writes Professor Harris, a Sydney Australia Orthopedic Surgeon, in his new book 'Surgery, The Ultimate Placebo.'

"This happens because if a patient complains enough to a surgeon, one of the easiest ways of satisfying them is to operate."

When it comes to surgery for Tennis Elbow, he writes, "Tennis Elbow is a condition that improves over time and surgery is not believed to be effective."
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Surgery, The Ultimate Placebo

Surgery, The Ultimate Placebo | Tennis Elbow Treatment | Scoop.it
In a new book, Australian orthopedic surgeon Ian Harris argues that the evidence for the success for many common operations, including Tennis Elbow surgeries, knee arthroscopies, spinal fusions, epidural steroid injections and cardiac stenting procedures is no better than placebo and may actually cause more harm than good.
TennisElbowClassroom's insight:
Ian Harris, an Australian Orthopedic surgeon and Professor has confessed to performing surgery "that doesn't work" in response to pressure from patients and other factors.

In his new book, 'Surgery, The Ultimate Placebo' he writes:

"For many complaints and conditions, the real benefit from surgery is lower and the risks are higher than you or your surgeon think."

I admire this Doctor's honesty and willingness to utter what may be tantamount to medical heresy!

Here's a mini post where I go into a little more detail:
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What It Means To Treat Injuries With Platelet-Rich Plasma? (Likely Painful For 2 Weeks Afterward, FYI)

What It Means To Treat Injuries With Platelet-Rich Plasma? (Likely Painful For 2 Weeks Afterward, FYI) | Tennis Elbow Treatment | Scoop.it
Recently, platelet-rich plasma is being used to treat tendon and cartilage injuries. A Dubai orthopaedic specialist talks about the experimental treatment that has risen in popularity after being used by elite athletes such as Rafael Nadal and Tiger Woods.
TennisElbowClassroom's insight:

Dr Harold Vanderschmidt, an Orthopedic Surgeon in Dubai, who has treated approx. 800 patients using PRP since 2012, reminds us that:

 

"The treatment is not a pain medicine... and, in fact, can result in more pain for up to two weeks after the injection."

 

(That's because PRP triggers a healing response, which is initiated by inflammation.)

 

Inflammation is the first stage of the healing process of injured tissue and there's no way around that.

 

But it sounds like this Surgeon has a high success rate with it, and most of his patients don't end up needing surgery.

 

Looks like he still believes in trying other methods before resorting to PRP though, and uses it:

 

"...only when the patient has tried different treatment models and they are not working."

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Is Platelet-Rich Plasma (PRP) An Effective Treatment For Tennis Elbow?

Platelet-Rich Plasma (PRP) and the similar Autologous Blood Injection (ABI) appear to be a promising, new treatment approach to stubborn, chronic tendon injuries, like Golfer's Elbow and Tennis Elbow – But is that just the "hype" talking?
TennisElbowClassroom's insight:

A Storify compilation of the recent stories and studies on PRP and ABI in the last few years attempting to answer the challenging question of whether this promising, new treatment approach works.

 

Is it an effective treatment for stubborn, chronic tendon injuries like Tennis Elbow and Golfer's Elbow - Or is it all about the hype?...

 

And for a more detailed look, including my own take on it, see my latest post on PRP here:

 

http://tenniselbowclassroom.com/tennis-elbow-treatments/platelet-rich-plasma-for-treating-tennis-elbow-does-it-work/

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Platelet-Rich Plasma Therapy Remains Unproven?

Platelet-Rich Plasma Therapy Remains Unproven? | Tennis Elbow Treatment | Scoop.it
Pro athletes and duffers alike are trying injections of platelet-rich plasma to treat chronic injuries like tennis elbow. But despite thousands of studies, it's not clear that the treatment works.
TennisElbowClassroom's insight:

This article at NPR.com refers to a study French researchers presented at a conference in Paris:

 

http://www.sciencedaily.com/releases/2014/06/140611093720.htm

 

They gave two groups of people with Tennis Elbow (a total of 44) two injections four weeks apart.

 

Half the people got injections of Platelet-Rich Plasma, half got saline injections (salt water.) Most people were pain-free after a year, but the people who got PRP did no better than people who got saline.

 

"...injections of growth factors-containing platelet-rich plasma are no more effective in treating recently developed epicondylitis than injections of saline."

 

"while PRP injections were shown to have no inherent benefit... what is exciting is that pain scores in both treatment groups decreased significantly over the course of the trial."

 

(The pain scores in the both groups had improved by about 50-60% at the 6-month mark.)

 

"The healing process is stimulated by the echo-guided injection of a substance and/or by the own effect of the needle (needling); the injections stimulate the process of tendon repair through an irritation effect, a technique known as Prolotherapy."

 

So this is not a negative or necessarily a confusing result, as the NPR story suggests . The study suggests that BOTH PRP and Prolotherapies (and/or dry needling/Fenestration) may be effective treatments.

 

(Although it's hard to separate the "Needle Effect" from the placebo effect, because any time they put a needle into a patients tendon - even if it's just as a control group and nothing is injected - you still have a potential benefit from the needle (again, the dry needling/Fenestration therapeutic effect.)

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