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Comment by tastysandwich | Hacker News Reader

Mark Rippetoe swears by a remedy he developed for elbow tendonitis, based on pin firing. Pin firing is an old treatment for certain injuries to a horse's leg, whereby inflammation is intentionally exacerbated using a hot poker. The idea being that this increased inflammatory response causes the original injury to heal.

His remedy for elbow tendonitis basically involves a few sessions of doing chin ups until your elbow pain is unbearable. And then keep going. Many low-rep sets over and over. The idea is that this will increase inflammation, causing your body to heal the original injury along with the inflammation.

He claims this healed his own elbow tendonitis and has worked for countless others.

I follow Rip's strength training program. However I can't say I'd ever give this a try and I'm not sure there's any scientific evidence that it works.

Just thought it was pretty interesting, even if it's just bogus. I have no idea!

https://startingstrength.com/training/elbow-tendonitis-how-i... https://en.wikipedia.org/wiki/Pin_firing (an article on his website)

https://www.youtube.com/watch?v=c1frSvu8KyE (he talks about it in this podcast)

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I've always believed that this was the science behind acupuncture. You're deliberately reminding the body of old scar tissue and blocked lymphs that the body has forgotten about. This causes localized inflammation and the bodies own response to go back in and clear out tissue or built up crap.

I haven't heard anyone else describe it that way but it makes sense to me. Wonder if this would be better than applying repetitive stress injuries to an existing problem.

There's loads of studies of acupuncture though showing no benefit.

Here's one meta-analysis of RCTs showing benefit for pain in fibromyalgia patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365227/

That's in comparison to a sham acupuncture placebo. And the placebo effect is already pretty powerful. Even in the "no benefit" studies, that's usually in comparison to a sham acupuncture placebo that has a real effect compared to waiting. In terms of pain treatment, I'd say even a safe non-addictive placebo treatment is pretty good, better than getting hooked on opioids at least.

I wouldn't get acupuncture hoping for a cure to cancer. But it's not exactly a stretch to think that manipulating nerves with needles will help with pain.

According to that meta-analysis, none of the studies included were properly blinded.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365227/figure/...

Almost all of the studies blinded the participants in the outcome assessment. That avoids bias when asking patients about their pain.

It's difficult to imagine how you would blind the acupuncturists performing the treatment. I suppose you could have one acupuncturist mark the needle location and another blinded one stick the needle in. But a skilled acupuncturist would probably be unblinded by their own knowledge of where it makes sense for the needle to go. So there is definitely risk of performance bias, but they're sticking needles into patients at predefined points - I don't think it's a very large risk.

It's very unfortunate that this "nerve treatment with needles" for which "some evidence" exists is mashed together with the "pseudo scientific magic spot acupuncture".

>fibromyalgia

Transcutaneous electrical nerve stimulation (TENS or TNS) : https://en.m.wikipedia.org/wiki/Transcutaneous_electrical_ne...

Fibromyalgia (FM) : https://en.m.wikipedia.org/wiki/Fibromyalgia

You are way simplifying the studies. From what I understand:

+ We are pretty sure acupuncture, done correctly, won't cause any harm

+ It is on par or sometimes slightly exceeds placebo

+ Sometimes "things that seem like acupuncture but are not acupuncture" also give the same kind of results.. even though they shouldn't?

I'd still be pretty skeptical about it, but the risk of trying it seems quite low

So its effectiveness is about on par with faith healing, got it.

The placebo effect is a helluva drug

No, it really isn't. Its help rate can be as low as 15%. Using anything that is only 15% effective as a drug is not only not effective, but can easily be mistreatment. Most of the time, you have to lie to the patient so they can get an effect (IF they get it at all) and then you often have a drug that is consistently more effective than the placebo.

It isn't a helluva drug. It is a bad drug that often simply won't work for you.

It can be. And it's not all positive. The nocebo effect can be so strong, that people actually die because they think they are cursed (other examples: Covid vaccines, statins, ...).

Any generalised statement about the effect of placebo/nocebo is difficult, because some portion of the effect is regression to the mean, and relatively little is known about the mechanism of action (e.g. there is some indication about a genetic factor).

Not disagreeing with you that it may not work for you, but it may work quite well for some people. Acupuncture being a prime example.

We need to throw out Allopatic medicine that does not work, along with Acupuncture, Chiropractic, Naturopathic, Osteopathic bad healing techniques that work slightly better than Placebo in an Indian village in studies with less than 100 poor souls, and a questionable Control group, and rumors of payola floating around.

Meaning enough with the bullshit remedies that don't work.

Most Psychiatry drugs are on my hit list.

I can't believe these $450 a visit fancy boys are allowed to prescribe 90% of their bread and butter drugs. I'm not just picking on shrinks either, but they are an easy target.

I am beyond disillusioned that our FDA has approved drugs that are harmfully and actually don't work.

(Former Chiropractic student who walked out after hearing, "We have over 15 upper cervical techniques--and they all work Equally well.")

Enough is enough.

Then it is a good thing you have no say in our access to psychiatric pharmaceuticals.

The only way known to distinguish one variety of depression from at least a half-dozen others is to see which medication relieves it. So, any RCT of a depression treatment necessarily throws together people with a half-dozen or more independent conditions, some of which might be relieved by the treatment, others worsened.

Repeat after me: RCT results depend absolutely on precise and correct diagnosis. If you cannot diagnose, you cannot design a valid RCT. Invalid RCTs are easy, though; people run those all the time. The RCTs that seem to prove psychiatric drugs are ineffectual are exactly those.

We are in the condition of people getting arm and leg fractures, but we can't tell where. Splinting is seen to help; doctors who put splints on various places usually hit on a place where it manifestly helps. But our RCTs of splints placed on left shinbones seem to help only a precious few of our patients. Some people swear up and down, loudly and repeatedly, that they are dead certain this means splints are useless and a big scam.

to start off, i do not "understand" the "homeopathy" to either dismiss it as mumbo jumbo and dangerous but my granddad was a medical practitioner and he is said to have used homeopathy but not in the sense people use it now.

i'm told he strictly used it literally as a placebo ONLY when he knew the cause of the "problem" was not physical or something wrong because of infection or something. I'm told he would treat patients with depression by counseling without telling them (usually family members) and prescribing this "white medicine" to keep up appearances.

i'm told he never treated anyone outside of this usecase because well, there are medicines for that purpose.

remind you this is from 50 years ago when my town had 3 hospitals in total and there was no "medical equipment" like we have currently or that were available in major cities. Call it the neck of the woods so its not like there was modern medical care available but patients didn't seek it. He was the physician of his time and pretty successful at that.

No. These junk "remedies" like acupuncture absolutely have risks. You can get infections from acupuncture. Your acupuncture "provider" could easily infect you with bloodborne diseases.

People have even been documented to have died from acupuncture https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951167/

The benefits are zero. Potentially living with a chronic disease like Hepatitis C because of a lazy provider that reuses a needle or contaminates it in some way, is a serious risk.

There's also the fact that by engaging in these activities you perpetuate junk science, just like Q anon people, just like climate change deniers, it's all the same insanity.

Let me try again, maybe with more caps.

> We are pretty sure acupuncture, DONE CORRECTLY, won't cause any harm

Yes, if you get stabbed with a dirty needle, you might get a disease. That's true for acupuncture, a tattoo shop, and even a vaccine. Don't get stabbed with dirty needles! I fully suggest not getting stabbed with dirty needles. Bad. Avoid. 0/10.

> The benefits are zero

https://pubmed.ncbi.nlm.nih.gov/3982837/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984198/

It's probably about as effective as placebo? (Maybe?) That isn't zero, that's placebo - and that is an important difference

> you perpetuate junk science,

You're just wrong. This isn't even just a "you might have a different opinion". The absolute best science we have, the entirety of realms of research, is "well, it's probably placebo and maybe it's kind of an expensive placebo". The most scientific answer you can give is "we should do more studies and ask more questions", and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

One of the ways I avoid getting stabbed with a dirty needle is based on background rates. I think I'm safe in sticking with my priors that acupuncture clinics are held to less of a standard than vaccines are. Hypodermic needles necessarily come in sanitized packages, after all.

There's more to science than just asking questions and collecting data though, there's also developing models. Without good models, you can't gain much insight from data, and in fact you'll sometimes gain incorrect understandings. If there's no supported mechanism for how acupuncture works, it's really not a good sign, and it seems dishonest to think it's at all in the same realm of safety as something like vaccines which do have known mechanisms of action.

I think back to how much "data" we had in the 50s that tobacco was harmless. Is it ever a good idea to go for something so invasive to the body as needles without a strong reason, just because the dangers aren't readily apparent? Medicine passes the necessity bar, placebo does not.

Dunno, I had some acupuncture sessions as recommended by my doctor.

The accupuncturist's needles were each individually packed, he washes his hands thoroughly, then puts on gloves as well. Every needle gets thrown away immediately after use.

Not sure how any of that is potentially unhygienic other than the room itself possibly being slightly dirty? (it was clearly well cleaned, but obviously not to surgical standards... why should it?)

> If there's no supported mechanism for how acupuncture works, it's really not a good sign

Acupuncture works as well as sham acupuncture (inserting needles at non-acupuncture locations). Which suggests to me that acupuncture works on the same basic principle that your doctor giving you sugar pills with a fancy name and strict instructions to take one every four hours with a glass of water works.

> I think back to how much "data" we had in the 50s that tobacco was harmless.

We had pretty good evidence it was bad for you, especially during pregnancy. This is maybe a better example for talking about peer review and conflicts of interest - which is still a real problem.

We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.

Acupuncture, in a sterile environment, is pretty safe. We also know that skin deep needle penetration is pretty safe given that lots of people get tattoos. It still requires hygiene, but it is a safe activity.

I'm totally sympathetic to "we should be doing health inspections of acupuncture, like we do tattoo shops". I think some areas already do this. It's probably a good idea.

> Which suggests to me that acupuncture works on the same basic principle that your doctor giving you sugar pills with a fancy name and strict instructions to take one every four hours with a glass of water works.

Except that sugar pills don't give anyone HIV or Hep C.

> We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.

No. Harm is relative to reward. Cancer drugs are extremely harmful. But dying from cancer is worse.

The reward for acupuncture is 0. Just sit and eat a Twix instead. It has the same medicinal benefits. The harm of acupuncture is absolutely real, as I linked above, people have died, people have gotten chronic diseases.

> You're just wrong. This isn't even just a "you might have a different opinion". The absolute best science we have, the entirety of realms of research, is "well, it's probably placebo and maybe it's kind of an expensive placebo". The most scientific answer you can give is "we should do more studies and ask more questions", and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

No. That's junk science. There's no different opinion here. It's very clear from many many studies of acupuncture it does nothing. This kind of attitude sells people on something that does not work.

> The most scientific answer you can give is "we should do more studies and ask more questions"

Absolutely not! I am a scientist. That's a total dumpsterfire of an answer. This is how people end up with people taking crazy COVID "treatments", because we "need more study". As a community we have studied this trash extensively now. It is junk. That's it.

If acupuncture was a drug, it would be so widely discredited you couldn't get $1 to do a study. Actually, you couldn't even run a study on it because your local ethics board would think the potential harm for benefit ratio would not be good. The only reason people keep studying this is because dishonest people sell other people on acupuncture as a treatment, so it's a neverending cycle. As long as people keep wanting to engage with this junk, the scientific community needs to keep studying it, we keep finding it's total trash, but then people like you say "Oh look, people are studying it, therefore there is merit". There is no merit.

> and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

The medical industry cannot police snake oil salesmen. This is a well known problem. People get all sorts of insane treatments. From having your back violently adjusted by chiropractors (another junk science where people die) to having the crap beaten out of them with stainless steel rods (something called the "Graston technique"; I have seen the outcome of this, it can be horrific).

A central concept in medicine is that the patient gets to lead the charge. And attitudes like yours are exactly why so many people get caught up in this pseudoscience junk. To immense detriment to their health.

In my book, a medical treatment that does not beat placebo is ineffective. That's also what we are asking pharmaceutical companies to prove through those double blind studies.

If acupuncture does not beat placebo, lets direct people to homeopathy instead - which basically means drinking water - to get the exact same placebo results. There are less risks associated with drinking water than being stabbed with needles, dirty or not. We could even have those cost fully covered by the state, few millilitres of water won't bankrupt anyone.

You are conflating effectiveness (change in outcomes) with efficacy (change in outcomes relative to placebo or other intervention). Both are worth knowing, because usually there are no free lunches to be had - interventions (also those that are known placebos!) can have negative side effects.

Not sure if that's what you meant: In Germany, e.g. acupuncture (and other specific types of homeopathic treatments) are reimbursed by public health insurance, for specific conditions. Exactly because they can induce a significant beneficial placebo effect on average while having less risks, and being cost effective.

BTW, depending a bit on jurisdiction, placebos are routinely given even in hospital care. If you have family/friends who are doctors, do ask them.

My main points is that I do not believe that it's OK for the state to be paying for things that have not proven their efficacy. My whole relatives are MD Doctors (father, 5 sisters, wife and best friend) and they all agree that we are lacking funding for the health sector as a whole, so paying for people beliefs isn't a priority.

On top of that, it puts the state in a weird situation because it has to decide which beliefs are OK (acupuncture fixes fibromyalgy is an OK belief -> reimbursed) and which one aren't (getting a PS5 fixes depression is not and OK belief -> not reimbursed).

People are absolutely entitled to have their own beliefs, but if a treatment hasn't shown any efficacy, we should aim for a close to 0 spending of the public health sector on it.

I feel that creating a state controlled millilitre water bottling company would make some placebo available at virtually no cost, so could be a nice way of offering some effectiveness for free, but acupuncture isn't.

Agreed.

On top of that, opportunity cost is a thing. If you pursue completely ineffective therapy - and spend time figuring out if your local acupuncture parlor uses dirty needles - you waste time and energy that would be spend pursuing worthwhile treatment.

My study isn’t peer reviewed or anything so it’s just like my life or whatever, but it helped me save my life. I don’t know why it was effective, I was skeptical throughout. I still am. But it was one of the most effective treatments for severe acute anxiety I’ve ever had, it not the most effective.

I was just talking to someone about this.

Perturbations.

Life isn't a double blind randomised placebo controlled study, mostly on rats / students / in a clinical setting / lab, and therefore there's a strong case to be made that we shouldn't necessarily use that model to model our behaviour.

Back to perturbations, I mean in the astronomical sense: deviation of a celestial body from a regular orbit about its primary, caused by the presence of one or more other bodies that act upon the celestial body.

You go to a one or more acupuncture sessions and your life is, in a very literal sense, changed.

It's not just a placebo, you actually went and did something you otherwise wouldn't have, with the intention of seeking improvement, thereby setting your life on a divergent path to what it otherwise would have been.

Over time, the divergence can be drastic.

This a very under appreciate power of our ability.

My initial reaction to this was that it felt more woo than I like, but I get your meaning and I even think it was probably part of it. And it was one of several changes I made in that time, some more impactful than others.

But placebo or not, I’ll also say that the physical impact was genuinely calming. And while the setting and circumstances might account for most of that—soothing music, dark room, being still for about an hour with no interruption—I also found different needle placements had noticeably different effectiveness.

It’s not for everyone. I wouldn’t dream of suggesting anyone try it who wasn’t already open to it. But it did really help me, regardless of the science. And I’m grateful for it.

Appreciate your response, thanks.

That's a common myth. It has no benefit relative to placebo, i.e. needles placed at random.

And needles placed at random do seem to have significant placebo effect for some conditions and people.

But if added inflammation through needles is how acupuncture works, that's not a good placebo, since maybe the placement is not as important as the body's response.

Modern, Western physical therapists are using something similar to acupuncture called dry needling. They did it for my wife's torn rotator cuff. They said it causes the muscle to return to a normal state, after it's been trying to compensate for the injury. Or at least that's the understanding she got from their explanation. Since they are still trying to treat the injury, I'm not sure causing the muscle to reset would be helpful.

The main difference is that in the western use of needles they don't really follow paths on the body, you just work over an area to create the spasms that result in a knot loosening etc.

But like acupuncture, there isn't proof for dry needling working better than a placebo. Studies that are there are, well, bad and looks to be on-par with a placebo. Which means that you get risks without medical benefit. Might as well get a massage, which won't involve someone putting needles in your skin.

As far as I know dry needling causes the muscles to contract. This squeezes the acids out of the muscles causing a better blood flow afterwards. So as far as I know this is almost the same as a massage but more localized.

But as with a massage, if the cause of the knot in the muscle it not taken away the effect will only be temporarily (couple of days maybe).

I just used the TheraBand Flex bar. It's a lot more efficient and I like the explanation for how it works. Basically through eccentric motion, it targets and strengthens the ligaments/tendons by "stretching" them so they're not so tense.

I experienced elbow pain after doing a lot of deadlifts and I assume my tendons couldn't bear the weight, since they take longer to strengthen than muscle tissue.

Fixed it after ~2 weeks of use. Highly recommend.

amazon.com/TheraBand-Tendonitis-Resistance-Tendinitis-Intermediate/dp/B00066D6K4/ref=asc_df_B00066D6K4/?tag=hyprod-20&linkCode=df0&hvadid=198109692418&hvpos=&hvnetw=g&hvrand=6240534091611235770&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9031499&hvtargid=pla-404191336687&th=1

I have another anecdote about this product to share...

A couple of years ago, I got golfer's elbow from doing high volume chin-ups (supinated pull-ups). I'm at an age where this kind of thing is common (I've heard of it referred to as "middle age pull-up syndrome").

I tried to ignore it and work through it, but it got worse, and I eventually went to therapy where they recommended the Flex bar. It took more than a few weeks, but eventually it completely resolved the pain. For me at least, it did the job, and it's a lot cheaper than a single visit to the therapist (even if you end up buying multiple "levels" of it).

Nowadays I do my pull-ups on gymnast rings, so these creaky old elbow joints can move freely rather than being stressed by a fixed hand position.

Same story here. MAPS from frequent pull-ups. TheraBand has kept it at bay. Also switched to gymnastics rings. I also modified my programming to alternate between pullups and seal rows for 6 week training blocks, so I'm also doing half the volume of pullups as I was previously when the pain was very bad. But the elbow pain is practically gone now.

Had Golfer's Elbow and acupuncture did not work - physical therapy with these flexbars worked.

Conversely, my wife's debilitating ankle injury was going nowhere with physical therapy and after a single trip to a local acupuncturist she could walk pain free.

Second this. I believe the real benefit comes from being able to exercise the extensors instead of the flexors, which helps with remedying an imbalance in tendon strength that leads to tendonitis.

See "Prolotherapy": https://en.wikipedia.org/wiki/Prolotherapy

"The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times when hot needles were poked into the shoulders of injured gladiators"

Nowadays they (thankfully!) use a mix of Lidocaine/Dextrose but the key is to NOT take ANY anti-inflammatories to allow the body to react & repair itself.

I've not gotten confirmation, but my impression is the piece says that a temporary increase in inflammation due to white blood cells activity prevents chronic pain. So that sounds to me like some kind of actual healing activity.

Hot PokerStars potentially kill infection. Heat is a well known means to help kill infection.

Exercise increases the rate at which lymph is returned to the circulatory system from the tissues. That's how the body takes out the trash.

Inflammation is poorly understood and I don't like these hand wavy hypotheses.

In my experience, I’ve used low weight high rep reverse EZ bar curls to treat/improve elbow tendinitis. I’d never try to work high effort through the pain, but using the affected area and getting a pump made a big difference in how quickly I healed.

It could easily be true, but that's definitely something I'd only try as a last resort until there's some good experimental evidence (which will probably only happen if enough people self-experiment for there to be an obvious benefit).

This is what has been done historically (and I think still today) to "treat" Achilles tendinosis, which is a surgical technique called scarification. The surgeon makes small cuts in the tendon to promote inflammation and blood flow and thus increase the speed of tendon repair. Tendon injuries tend to become chronic because of poor blood flow to the tissue.

I had a similar surgery 14 years ago (part of the heel bone was sawed off and the tendon was "scarred"), followed by 2 weeks on crutches. I was coming from more than 2 years of terrible pain in my right Achilles. Three months after the surgery, performed arthroscopically, I ran a 10K. I never had any problems or pain after surgery.

Intriguingly, being an eternal explorer of alternative methods, I had tried using a number of remedies/procedures to heal my Achilles (acupuncture, "shock waves," electrostimulation). I was an athlete and it was all under medical supervision. Virtually nothing worked except cortisone injections, which only mask the pain for a few weeks. But what did work, albeit for a few hours, was Alpha-stim ("an electrotherapy device that relieves post-traumatic, acute and chronic pain through painless electrical stimulation"). I applied the microcurrents with the stick and pads provided (Alpha-stim is mostly used transcranially) and I remember the pain that was torturing me disappeared for a few hours. I went out for a run and felt nothing, it felt miraculous. I feel that electro-medicine has been understudied and under applied.

Sometimes I have aphthous ulcers that absolutely nothing will treat and the only thing that seems to reliably work is if I press on it so hard that it bleeds (with a Q tip - very painful). After that, the ulcer seems to get better within 1-2 days however the other ones remain.

Now that I think about it I wonder if it still works if the area is numbed first.

I don't think I'd ever try anything as extreme as that, but inducing mild inflammation is used in various less potentially crippling situations as well. One example is microneedling of the skin. Inducing damage to the skin through microneedling has been shown [0] to induce a healing response that can promote collagen production. This (sometimes in combination with platelet rich plasma during treatment) is often used for things like scar treatment, skin conditioning, sun spot reduction, and fine line treatment.

[0] https://pubmed.ncbi.nlm.nih.gov/28690124/

I've found the same to be true for running: if I continue running (or more accurately, limping) on a sprain, and massage the area when I get back home, the sprain usually heals within a few hours and I can run again the next day as if nothing happened. OTOH, if I stop running, and either ice the injury or take painkillers, it takes almost a week for the sprain to heal.

this sounds somewhat similar to the only treatment that works for me when i get poison ivy: very hot water right up to the edge of what i can stand. The overload dramatically reduces the itching for several hours.

I wonder if it's because at high temperatures, you're basically denaturing the proteins that cause the allergic reaction.

Wow!

We don't have poison ivy in Australia, but apparently this works for things like rashes, mosquito bites, etc. I'd never heard of it before.

I can't wait to get a rash or something so I can try this. Thanks!

They even make electric pens for bites. The tip of the pen heats up when you put it on a bite and the itch is gone.

I think that's basically hormesis? https://en.wikipedia.org/wiki/Hormesis

This kind of rhymes with John Sarno’s work on back pain. The prescription for many pain ailments is to square away your mental health and work through the pain.

But doesn't he explicitly rest his entire theory on Freudian psychology being specifically correct?

I workout through tendinitis after a short break, but the priority is about form and lower weight.

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