#86 - The Intersection of Dry Needling and Acupuncture in Clinical Practice with Dr. Gary Estadt, Part 2

Hi guys, welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome to one of our final episodes of the summer. Can you believe it's already time for kids to head back to school? It's been a rather hectic time with the Factor team as well. We've launched a ton of great new course offerings this year, including a functional nutrition certification, a foundational and advanced dry needling course, a chiropractic acupuncture certification, and have 2 other large online certification programs in the works. Currently, we're in the midst of planning for our 2025 in-person course dates. So do me a favor and send us a message on Instagram. Our handle is @factoreducation. That's F-A-K-T-R education. And let us know what cities and states should be on our list. So today on the podcast, we wrap up part 2 of our training with Dr. Gary Eastott on the intersection of dry needling and acupuncture in clinical practice. Dr. Eastott will walk us through real-world applications and success stories that showcase the quick and profound effects of needling. On complex conditions like frozen shoulder, peripheral neuropathy, and even phantom limb pain. We will also chat more about the importance of patient education and how to discuss the use of these treatments with patients who may have a fear of needles. So bookmark this one— you'll definitely want to revisit it more than once. Let's dive in.

I'm gonna leave you with a couple last slides, and then we're going to just show you in practice how the 3 work together. So when we stick a needle in somebody, we get analgesia by stimulating the small nerves, which sends impulses to the spinal cord, then up to the midbrain, primarily to the periaqueduct gray, the ventral tegmental area, and the rostrum ventromedial medulla. Here in the lower brain, as well as up into the somatosensory cortex and the thalamus. At all 3 levels, we're getting a release of endorphins and monoamines, which results in pain suppression and analgesia. So we get the descending pain modulation pathways inhibits the pain that's coming up, and it's blocking the ascending pain pathways in the spinal cord, which is central, as well as at the pain site, which is peripheral. And we can increase it by using electrotherapy with the needling. This is another slide on the neuromechanisms of acupuncture analgesia. It basically shows when you have a painful stimulus, it goes up the spinothalamic tract through the spinal cord to the thalamus and the cortex. And when you needle, it affects the spinal cord, blocking pain there, as well as going the anterolateral tract to the midbrain and the pituitary hypothalamus complex, blocking and suppressing the pain pathway as it's coming up. And you get chemical release at the spinal cord of enkephalin and dynorphin. You get various neurotransmitters released by the midbrain, as well as in the pituitary hypothalamus and adrenal complex. And those chemicals that are being released Not only stop pain and inhibit pain messages, but the pituitary and hypothalamus complex dumps beta endorphins and ACTH into the blood and CSF, promoting analgesia and homeostasis of the immune, cardiovascular, and respiratory systems. Also helps with tissue healing, and the ACTH release also activates the adrenal gland to further modify pain sensations and help with the immune reactions. So let's just look at the differences on how we would needle. So here's a tight muscle in the thumb. So in basic trigger point dry needling, we would needle myofascial trigger points here in the thumb for any forearm, wrist, hand, or thumb pain. Pretty straightforward. But that same point is also a neuromuscular reflex point. It's the superficial radial nerve right here. And it's also a testing site for the radial nerve. It's found in the— on the web between the thumb and index finger. And that nerve is innervated by C3 through T— C8, the posterior cord of the brachial plexus. And that point is used for any hand, forearm, elbow, shoulder, cervical spine, face, chest, stomach disorder. And it influences the hypothalamus and the periaqueductal gray. It also stimulates the sympathetic nervous system. So it's used to treat pain anywhere, especially the same side of the face, the neck, or the throat, and cervical pathologies that originate from C3 to C8. So it can be used as a trigger point, can also be used as an acupuncture point. But needling that point there affects every nerve of the upper thoracic limb. It affects the radial, the ulnar, the median, nerve, especially when we needle deeply, and it affects the sympathetic nerve fibers. So it's a very profound point to treat in the body. And when we couple it with other— another point, it modulates specific regions of the spinal cord. Here we have traditional Chinese acupuncture. We have Large Intestine 4, which they call Hei Gu. We can see that's the same point. We Well, in traditional Chinese medicine, they say it regulates defensive Qi and adjusts sweating. It regulates the face or expels wind and releases the exterior. It regulates the face, the eyes, the nose, the mouth, and the ears. It activates the channel and alleviates pain, restores the Yang, and induces labor. Well, what does all that mean? Well, if we look at it from a scientific Western medical approach to acupuncture. And here we have the same point. It's the muscle, or it's the nerve, or it's the acupoint. We said it does this in traditional acupuncture. Well, it has autonomic nerve influence. It's been found that if you stimulate that point, it'll produce short-term cooling in the arm followed by long-term warming, which is a sympathetic effect. It also increases palm temperature. By dilating the cutaneous blood vessels and activates, as I said, the sympathetic nervous system. It has an analgesia effect. It's been found to diminish dental pain perception. And what we found in analgesia is it's not an opioid response because when we inject naloxone into the patients, it doesn't reverse the reduction in pain, which if it were an opioid only, it would have reversed it. So needling increases pain pressure thresholds, and it's been found that unilateral electroneedling can have an effect on the opposite extremity. That's one of the reasons why we use it to treat phantom limb pain and CRPS. It has an effect on the nervous system, which we just talked about. It activates the limbic system and the subcortical gray areas of the brain. As well as the posterior cingulate and supratemporal gyrus. It activates your hypothalamus, your somatosensory cortex. It activates the pain pathways in the limbic systems. And this activates the entire spinal cord from C5 to T1 with peak activity at C7. And lastly, it induces labor. It's been found that when you put this point together with the tibial nerve point in the leg, It ripens the cervix and shortens the time interval between the estimated date of confinement and delivery. And it also reduces the amount of pain associated with delivery without changing the contractions. So that's pretty much the differences between dry needling, traditional Chinese acupuncture, and Western medical acupuncture. We do 2 programs. I do a program that we will be doing in Texas in January. It's called Dynamic Neuromuscular Dry Needling or DNX2. And I call it that because it involves more than just needling trigger points. It involves the neurophysiological responses that occur with needling that you can combine with trigger points to get much more profound therapeutic effects in the body and better patient outcomes. So we do a 2-weekend live seminar. Our first weekend is Level 1 Basic Techniques. We just demonstrate clean needle technique, what the OSHA requirements are. We teach you understanding and identifying myofascial trigger points. We talk about various dry needling techniques, and then we do a needling workshop through the weekend where we needle literally every muscle that's accessible in the body. We then talk about setting up the clinic as well as coding, documenting, and recordkeeping. And when you leave the basic class on Sunday, you're ready to start needling on Monday. About 4 to 5 weeks later, we come back with our Level 2 Advanced Techniques program. And during that time, we will have assumed that you've been needling patients and family and getting comfortable with needling. So then we talk about the role of pain in the central and peripheral nervous systems. Central sensitization and neuroplasticity, locating and treating neuromuscular reflex points, treatment protocols for those, electrode dry needling and acupuncture, treatment of tendinopathy and scars, and peripheral nerve root entrapments. And then we also finish the weekend with a clinical conditions workshop where we simulate various patient conditions. The practitioners will set the patient up along with whatever protocols they feel is appropriate and then discuss why they're picking the points they are. It gets them very comfortable with needling in a much more profound manner rather than just doing myofascial trigger points. And we also do a program on acupuncture. We have a basic 100-hour— it's actually a hybrid program of 80 hours live, 20 hours online, where we go into intro to acupuncture, TCM theory, the meridians, musculoskeletal acupuncture, internal disorders, microsystems like ear and scalp, accessory techniques like Gua Sha and moxa and that kind of stuff, and then TCM diagnosis, primarily pulse and tongue as well as pattern diagnosis. And then we go into research. On top of that, we have advanced online education that can be done both live and online for advanced 200 and 300-level hours where we're doing advanced history and pulse, advanced scalp acupuncture, peripheral neuropathies, differential diagnosis in internal medicine, men's and women's health, pediatrics, neurological conditions, NADA protocols, battlefield acupuncture, research and case studies. And we've developed more than 200 hours so that doctors who wish to expand their acupuncture knowledge can pick and choose the programs that seem to best fit their practice and develop their, their curriculum based upon what they think they would be doing in their particular programs.

At Southeast Professional Education Group, we are incredibly selective about the courses we host on our online learning platform. We only want to offer our students the best, most dynamic evidence-based courses, and because of this, we only launch new courses a few times each year. We are unapologetically selective, so I am beyond excited to announce that new courses have just launched and registration is now open for our Chiropractic Acupuncture 100-hour certification program. In this hybrid course format, you'll complete a mixture of self-paced virtual coursework and attend 4 live hands-on sessions in beautiful West Palm Beach, Florida. Not only does this course prepare you to add acupuncture to your treatment offerings, it also fulfills the requirements to qualify you to sit for the NBCE's acupuncture board exam. You can register for the full program or choose to only complete specific course modules that interest you. Learn more at the acupuncture link in our show notes.

So that concludes my presentation. Jessica, we want to go over into some questions that may have been asked.

Yes, absolutely. Thank you so much. This has been an incredible presentation, and I know I've learned a lot. We've had a lot of good questions that have come in both through the comment section and then also through our chat feature as well. One person had a question here about the recommendations on reading materials for needling effects.

I would tell you there's several books. There's been a couple books written on dry needling by Dr. Hoon Tam Ma. But the experts, the authors in dry needling over the years have been, of course, Janet Travell, Dr. Gunn, Dr. Baldry, Dr. Fisher and his technique I really like because it ties the spinal cord in a lot. But you can also, if you just type in neurophysiological effects or neural effects of acupuncture analgesia in PubMed, you'll get tons and tons of articles from both a dry needling and an acupuncture perspective. One of the other areas you can go into is if you go into the Council of Chiropractic Acupuncture website, Which is the ACA's Council on Acupuncture. In the doctor section, we have a lot of reference material on actual articles on both dry needling and acupuncture that are— you can pull them out, read them. They're all PDFs. You can read any information on that. There's a lot of good textbooks on both acupuncture theory and dry needling. But Ma has written several books. That are pretty good, pretty easy to understand. There's a book called Introduction to Medical Western Acupuncture that's very good. There's also a book called The Web That Has No Weaver. If you're looking at like traditional acupuncture and tying it in, The Web That Has No Weaver, I can't remember the author, it might be Kaput, K-A-P-U-T or something like that. It looks at diagnosis from a Western standpoint of a patient versus what an Eastern medical standpoint would be and how the treatment would vary or be similar. So it kind of gives you a Western look at how the Eastern philosophy of Chinese acupuncture looks at things that we look at in the West through a different lens.

It looks like The Web That Has No Weaver is authored by Ted Kapchuk?

Yeah, Kapchuk, that's it.

Yeah, so that's K-A-P-T-C-H-U-K. I'll put that in the chat for any of you guys that are here on the live event.

And I— and if you, if you go to— I'm going to give you my email address. It's estadthc@gmail.com. You send me any questions, I'll be happy to answer them for you and give you some references and Some places to look. So if after this presentation's over you have additional information, I'd be happy— feel free to reach out to me. I'd be happy to give you some additional information. Wonderful.

Thank you for that. And everyone, I did put that in the chat for you also so that you can follow up. And then for those of you that are watching the recorded replay, you will be able to chat in questions here in the comment section. And then, those questions will be emailed to Dr. Eustace so he can see those questions and follow back with you afterwards. I also just posted a link as well for the CE form for those of you that would like CE credit for today's presentation. Again, that's for those of you that are attending live, and there is up to 1 hour of CE available for chiropractors in specific states. Continuing on with our questions here, when you first started using dry needling and acupuncture in your practice, Yes. Were there any conditions or patient complaints that surprised you that resolved very easily with these needling protocols or something that you just didn't expect when you started implementing this into practice?

One was I had a guy who had had 3 shoulder surgeries and had frozen shoulder and workers' comp wanted to send him for a 4th surgery and he decided to come in and try getting needled. And after the first treatment, he got off the table and raised his arms straight over his head and just went, holy crap. And I went, holy crap, because it was pretty early in my career of needling. I've had similar cases with frozen shoulder where I was treating one guy for lower back pain. He was about in his early 30s. I didn't even know he had frozen shoulder. That's not why he came to see me. And I sent him into rehab and trainer came out and said, did he tell you about his shoulder? I'm like, what is— no, what's wrong with his shoulder? He injured it playing baseball when he was a kid. He was a pitcher and he couldn't elevate his arm past 90 degrees. Been that way for about 15 years. And on his next visit, when he came back in, I needled him and he immediately went straight overhead and put his arm up on the wall. That was a 15-year-old injury. That to me was— was shocking. I treat things like peripheral neuropathy that responds so well to acupuncture, phantom limb pains that I've treated that— because when I was at the VA, I would see that not infrequently. And you do 1 or 2 needling sessions and the pain's under control or gone. I had an employee— I tell this story at my seminars, And I usually get choked up. I'll try not to do it because I'm not looking at any of you. I had an employee that she got pregnant, one of my best employees, front desk. She ended up going to have her baby, always wanted to be a mom. They did an epidural on her and immediately paralyzed her. She spent 3 days laying on flat on her back in the hospital, unable to move her legs while they did nothing in the hospital. Finally, on the 3rd day, they did an MRI and she had a huge blood clot in her spinal cord. And they left her lay there for another day. So then in the middle of the night, they put her in an ambulance, put all her records on the gurney, and shipped her down to University Hospital in Cleveland. And the neurosurgeon there took one look at her, did another MRI, and Told her they had to do emergency surgery and she'd never walk again. So I went down to visit her when she recovered. I suggested we get her into Cleveland Clinic spinal trauma unit so they could do spinal trauma rehab on her. She asked me if I would do acupuncture on her, and I had no idea what to do, but I knew what points were important nerve points, so I was going to hit them all. And so I went to the Cleveland Clinic and I met with the doctor who said, I don't know what you're going to do. I don't want to know what you're going to do. And I don't want to be here when you're doing it, but do whatever you got to do. She walked out of that clinic in 4 weeks. And she was never supposed to walk again. It took me a year to get her bowel and bladder dysfunction back, but I have seen some really, really profound things with acupuncture. And the greatest thing about it is, you know, within 2 to 3 treatments whether it's gonna work on the patient. It's not something you gotta treat them for 6 weeks to see if it's gonna help. They get a response by the first or second visit and you know whether or not it's gonna be effective when you treat them.

Wow, that is amazing.

And I'm using acupuncture and dry needling Interchangeably, I should be saying needling, but I've used it on both styles.

So I guess that's the next question, and that kind of leads into our next question here. In regards to educating your patients and having those conversations with patients, the general public, I would imagine, is not crazy about needles. When people think of going to a chiropractor especially, they're not thinking about necessarily having needles be a part of their treatment.

Yes.

How do you have that approach, that conversation?

Well, first thing, first thing I do is I put some, I put some things out in some of my social media things to my patients. Second thing I do— did was I put, if I was doing acupuncture, I had acupuncture charts in the rooms. And, but I had those specifically in rooms I do acupuncture in, but in all the other rooms, I have myofascial trigger point charts. Because I can't tell you the number of times patients have come up to me and point to the chart and say, that's exactly what I'm feeling. And they're pointing to the referred pain from the trigger point, which is an easy segue of, you know what, let's see if it's a trigger point problem because I can release that through needling. And it's a very easy crossover to move the patient from just doing the things we've always done to adding needling as a new modality. And I have had Patients come in that have been patients for years that I try needling on them. And then they come in the next visit and they're going, can you do that needling thing on me again? Because that worked really well. And like I said, things for like neuropathy, they immediately get off the table. And when they plant their feet on the ground, they're like, oh my God, I can feel my feet. Or when you have somebody that's got a knee disorder and need treatment with Dry needling and acupuncture both is very simplistic. They literally— the first thing they do, they get off the table, they squat down to the floor, they bend their leg a few times, and they're like, oh my God, I can't believe the difference. It's, it's that profound and that quick. So having the tools out to where they see the charts, it gets them asking questions. And then sometimes I'll just say, You're really not responding the way you thought you should be responding with what we've been doing. Let's try something a little different on you. And sometimes I don't charge them the first visit. I said, let's just try it and see if it's helpful. If it is, we can always use this as a form of treatment. And a lot of times the first treatment, they notice a profound difference. And you don't have to sell anything. It's— they come in and ask for it. Probably the people that ask for it the most are the CrossFit people because they're always getting hurt. They know how well it works and it's able to get them back into competition. But I use it on older patients, younger patients, patients that are inactive, patients that are active. It's a very easy addition to the practice and it's very inexpensive to equip a clinic to do acupuncture. You're in for a couple hundred dollars maximum.

That's huge. And I know oftentimes, especially when providers are starting out, they're looking for those really impactful treatments that they can utilize that don't have that large upfront cost.

I'll say one other thing about that. And I've said this every time I teach. Needling, of all the things I've learned in 43 years of practice, needling is the thing that most closely mirrors Philosophically and physiologically what we do as chiropractors. If I could only do one thing with chiropractic treatment, it would be needling. And I've—

Mm-hmm.

I'm board certified in rehab. I've done orthopedics. I've done a lot of the specialties, but acupuncture, once you understand the principles of the neurology, mirrors so closely to what we do in Okay, you got another question?

Yes, someone was asking a follow-up to what you were saying earlier about usually within 2 to 3 visits, you know, if a patient's gonna respond well. How do you have that conversation if they're not having a great response in that second or third visit?

So typically what I'll do with the patient— so there's 3 types of patients with, with needling. You're gonna have a patient that feels better when you Treat them first or second time, they're gonna have no change, or they're gonna feel a little worse. The worst of those 3 outcomes is the patient that feels nothing, because even the patient that feels worse reacted to the needling. So your needling, you may have overstimulated them, you may have done too many points, and they were in a weakened state, because when a patient has a bad homeostatic state and they're in a weakened physiological condition, you use fewer needles on them. Otherwise, you kind of bombard them. But typically, I will treat a patient twice a week for 2 weeks. I'll tell, we're gonna treat you twice a week for 2 weeks and see how you respond. And that, that's my initial treatment plan. Within those 4 visits, if they haven't responded, I typically don't continue treating them with needling. If they're starting to respond, depending on the response, I will either start to diminish the treatment, or if they've responded totally, which a lot of times happens, then you're done treating them until they have a flare-up. Or if they're responding, but they're responding slowly, I may go another 2 weeks of twice a week before I start diminishing the treatment. And it, some of it depends on whether I'm doing electrotherapy, like electroacupuncture and dry needling, or whether I'm just doing stimulating of the needles by hand or where I'm treating the patient. So sometimes if I don't get a response, I change the treatment and see if I can get a physiological response by treating them elsewhere for the same condition. That's the beauty of acupuncture. It's not like I'm gonna, and dry needling, it's not like I'm gonna teach you and Here, here's the way you have to do it. I'm going to explain how you— how it works. I'm going to explain all the various principles of the experts and how they utilize it. And then I teach you— I teach all of them, and then I teach you— you choose what you're comfortable with. And if you're not comfortable not getting a response here with the patient, then you, you change the style and see if you can get a response that way. So, works very well for— and you can adapt on the fly with what you do.

Wonderful. And do you have kind of a guideline or rule of thumb that you use when it comes to choosing whether to go the dry needling route versus the acupuncture route since you have both of those in your clinical toolkit?

I do. So, if I'm treating somebody who's got, let's say, more organic dysfunctions and things like that, I do more acupuncture. If I'm doing musculoskeletal, I do more dry needling, but I do acupuncture. Let me say it this way. I do dry needling and I add acupuncture points in, but I don't teach them in dry needling as acupuncture points. I teach them as neuromuscular reflex points because that's what they are. From a Western perspective, and they have that profound effect like the point we talked about in the hand. Because that point affects the entire upper kinetic chain in the arm, if the patient had a shoulder problem, I would dry needle to the shoulder, but I would probably also stick that point in the hand because it's affecting all of the neurology up the entire brachial plexus through the shoulder. So there are ways with which you add what we call local distal treatment. I'm treating local trigger points, but I'm using some distal neuromuscular reflex points to get a more profound therapeutic effect. And I have a lot of people who have taken physical therapists that I, 'cause I treat, I train the physical therapists at our local hospital, university hospital also. And a lot of them have taken acupuncture or dry needling programs in PT. And they come to my program and they're like, wow, we never learned this. We never learned that. What do you mean you can do this point with that and this point with that? And I'm like, yeah, you can do those things and it's going to enhance your effect, which is what really makes it kind of cool.

Absolutely. Someone else here had submitted a question regarding the use of needling with patients that have EDS or Ehlers-Danlos syndrome. They have a lot of patients that have EDS ranging from mild to severe. Are there contraindications for using needling for them, or are there some great recommendations you can make about ways you can utilize needling for them?

Yeah, there— so there are relative contraindications, and we go over that in needling, what the different conditions are. And it's the same thing with when somebody's on like blood thinners and things like that, and we're introducing a needle into the Well, unless they're really on heavy, heavy, heavy doses of blood thinners, it's— you're okay to needle. And a lot of it has to do with where you're needling. So I'll give you a simplistic example, 2 of them. One is if somebody came to me and they had lymphedema, I certainly would never stick a needle in that extremity. I could use other points on the body that are healthy tissues that I could needle into. And simulate the same therapeutic effect. It's the same thing with somebody who comes in and let's say they have CRPS, complex regional pain syndrome, and it's affecting their entire right arm. The absolute worst thing you would do for a patient is stick a needle in that arm because it literally sets them on fire. But you can treat the right leg and do a mirroring technique. You can treat the left arm because we get a crossover technique, as I explained, when you treat that neuroreflex point at the hand. So you can get crossover effects. That's the same thing we do with phantom limb. So there are usually points on the body you can treat with most health disorders. I treat patients ranging from stroke to MS to epilepsy and Parkinson's disease, resting tremors, things like that. that you can treat them neurologically and have an outcome on those kinds of conditions.

I know that you have been involved with a lot of the state boards in terms of their push to have more state boards for chiropractic allow acupuncture and scope of practice and things like that. I know you've been involved from a legislative standpoint with, with some of those. I know that also a lot of US states, and Texas, for example, we do allow chiropractors to utilize acupuncture, but it has to be related to musculoskeletal and it's limited to that. So the scope of practice does not go beyond kind of the musculoskeletal realm. Are you seeing that in a lot of US states? Do you see any future?

It depends on— it depends on the state, like Arizona, theirs all deals with Free flow of chi. So it's a very traditional acupuncture and it's written into the state law that way, which is to me is bizarre. And if you look at things that the World Health Organization promotes, they're promoting a lot of the neuromusculoskeletal effects. The 5 major areas where you see things with needling are Musculoskeletal, neurological, internal disorders, primarily OB-GYN, and as well as some digestive issues, psychological issues, and addiction-type problems, things like that. That's where you're seeing all of the research kind of going around on that. And I typically try to talk to— when I'm talking to the states, try to, I tell them, keep it as broad as you can and practice within that framework. Like in Ohio, we just have the right to use acupuncture. And so acupuncture, based upon what the literature is showing, is based upon— some of it's skeletal, some of it is not skeletal. And if it's musculoskeletal, does that allow the treatment of neurological? Well, I would submit it's neuromusculoskeletal. That's why I teach neurological points also, because things that we thought were musculoskeletal that respond well to acupuncture, like fibromyalgia, is actually neurological. Migraine headaches, neurological, responds very well to acupuncture. So I kind of keep neuro— neuromusculoskeletal all within that same framework, especially when I'm training docs.

I have a few more for you here. Any updates you can share on insurance reimbursement for a code 20560 or 20561?

So that's— those are the dry needling codes. I was part of the group that brought those codes to the CPT coding committee at the AMA, and if you'll notice, those codes are under The surgical codes. That doesn't mean you have to be able to do surgery to do the codes. It was just the best descriptor because those codes mirror the trigger point injection codes. The only difference being trigger point needling doesn't inject a substance, but it's pretty much the same procedure. And if you go into the physical medicine codes and you look at either manual therapy 97140 or acupuncture, it will say for trigger point needling or ASHI acupuncture, utilize such-and-such code, and it directs you to those codes. It's being paid by some insurers, it's not being paid by some insurers. I think as it continues to grow, it's going to continue to be accepted by more insurance companies because more and more literature is documenting the medical necessity of it.

Wonderful. Another one here: is there a relationship between the reflex points and the myofascial lines?

Very interesting question. So I'm reading some books right now, probably between dry needling and acupuncture. I probably got about 60 books I'm in various stages of reading. Historically, it's been stated from Western scientific perspective that The acupuncture meridians follow either nerve pathways or vascular pathways, like the lung meridian mirrors the cephalic vein down the arm. More recently, I'm reading a lot about the myofascial pathways and how the supposed meridians may actually be myofascial pathways. So there's some new literature coming out on that. I'm also— there's really some fascinating stuff. I'm doing some research on scalp acupuncture in the treatment of mental health disorders. That's pretty groundbreaking stuff that just came out in 2021. And I'm all of a sudden starting to find more and more articles in PubMed related to it. So it's We're really on the edge of really just learning about what acupuncture and dry needling can do. And one of the problems we run into with research is the research that comes out of, especially out of Asia, isn't— it's more case studies. And the reason is it's hard to do RCTs because it's hard to have a sham acupuncture group. Because even though, and it's been shown on functional MRI that if I have an area lit up with pain and I needle it, it immediately reduces the pain area registered on the functional MRI. But it does the same thing to a lesser degree on sham MRI. And for years it confused researchers. But if you think about it, if you're inserting a needle into the body, even if it's not where you think in acupressure, point is you're putting a sensory input into the body and the spinal cord and the brain are going to react. So even with sham techniques, you see reactions. So they're starting to relook at all this research and all the literature on needling, and they're coming up with totally different conclusions now.

That is absolutely fascinating. One final question for you. We always like to ask in our presentations here about tips and advice for the next generation, the chiropractic students that are coming out of school right now. What recommendations would you have for students that are considering taking a dry needling course, getting certified in acupuncture? Is there one that's better to do before the other? What are your thoughts and recommendations for them for doing one, the other, or both?

To me, I think both is the best way to go because 'Cause you understand needling from different perspectives. And I'm learning things. I got certified in 2007 in acupuncture and I am still learning stuff and going, oh yeah, now I get it, 15, 17 years later. The needling, dry needling gives you a very easy segue into getting comfortable with needling. And the reason I teach it the way I teach it is because it's not dissimilar to trigger point needling of acupuncture. So conceivably, could we get these hours as part of an acupuncture program to get you some additional hours? We're looking at doing that. But if you're going down straight down the acupuncture realm, we get pretty early into— in our second class, we teach musculoskeletal, and then we get into some of the techniques that I also treat in dry needling, tendinopathy, treatment of scars, things like that. And people who have a background in acupuncture, I can do a dry needling program very quickly for them because what Once they're comfortable with needling, we just need to talk about what are some of the techniques that we do in dry needling and how they differ. So people who already have an acupuncture background, I can usually do a 1-day program and show them how to dry needle. But I think both are beneficial. Dry needling from a perspective of a clinician is a lot easier to understand early on.

Yeah.

Once you understand it then, and you go into things like acupuncture, it makes the understanding of the acupuncture much easier.

Wonderful. Thank you so much. We really appreciate your time today, and it's been a wonderful presentation. That's it for today's episode. Be sure to tune in next time where we kick off a new 2-part training titled Body Mechanics and Beyond: Crafting a Sustainable Manual Therapy Practice with my friend, Dr. Ty Pence. You won't want to miss it. Episode 87 drops in 2 weeks. As always, I highly suggest you check out our show notes today for more great insight and free resources. You'll find a link there to register for our upcoming free webinar training, On August 22nd at 1:00 PM Eastern with Dr. Lisa Goodman. This month's topic is The Roadmap for the Healthcare Entrepreneur: Building Your Brand, the Value of Associateships, and Community-Based Marketing for Practice Success. You'll also find a link to download the PDF from today's episode and the link to our podcast website where you can use our AI features to chat with each episode. And create your game plan to implement what you've learned. And if you're interested in getting certified in dry needling or chiropractic acupuncture, be sure to visit our website at online.sports-seminars to view our list of upcoming course dates and get started with the online content right away. And if you're interested in getting certified in dry needling or chiropractic acupuncture, be sure to visit online.sports-seminars.com To view our list of upcoming course dates and get started with the online content right away. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offers. offerings, as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.