Complexities of acupuncture for heel pain

RCCM member  Richard Clark talks about his interest in acupuncture and heel pain:

“When I first set out to look up the evidence base for using acupuncture for plantar heel pain (PHP) I thought it would be simple and quick.  Little did I know!

One SR[1] and one CIS[2] later, I realised the extent, complexity and contradictory nature of this topic.  Frustrated by wordcount limitations, I set out to explore the ideas further and have just published my reflections[3].  I considered all the evidence I could find, set against relevant theoretical contributions.  I analysed problems and synthesised a set of over 20 research recommendations, which are presented in chapter 8.  These are at three levels:   

  • General pointers – e.g. Context bias should be explicitly recognised as a limitation of formal studies, which should aim for ‘ecological validity’
  • Broad questions – e.g.  How do practitioners think?  How is this influenced by different contexts?  How can we use the Patchwork model to elucidate this?
  • Specific questions – e.g. How does use of the single ashi point compare with the ‘circle the dragon’ technique … in terms of analgesia and long-term healing?

As a lone wolf, prowling the shoreline between the mainland of orthodoxy and the ocean of alternatives, I tow no party line.  I questioned assumptions, revealing challenges to any clinicians or researchers who might be set in their ways.  For example, some see heel pain as a Kidney problem, because heel pain was thought due to bony heel spurs and ‘Kidney rules bone’ but now we know most patients don’t have spurs, so is it time to challenge the hegemony of KI3 as first choice for treatment?  There are so many alternatives!

Similarly, some dry-needlers look no further than the calf for trigger points; they may be surprised to find other myofascial therapists treating PHP from the neck.

But the issues are much larger than which point to use.  I have articulated an integrative, exploratory approach which I call ‘Refractive practice’ that offers a framework within which to construct radically different approaches to practice and research, not just for heel pain but for acupuncture in general.  And there is more – the Patchwork model (from our CIS) combined with a feminist analysis, led me to a radically new perspective on the field of research as a whole, seeing it as a membrane whose convolutions distort the very nature of the truths we co-create.  

I am hoping this model will contribute new approaches to the challenges we face.  This is where you come in – I have set up a discussion forum[4] and I look forward to seeing you there” 

Richard Clark

@AcuHeel

  1. Clark R and Tighe M. The effectiveness of acupuncture for plantar heel pain: a systematic review. Acupunct Med 2012; 30: 298-306. DOI: 10.1136/acupmed-2012-010183.
  2. Clark MT, Clark RJ, Toohey S, et al. Rationales and treatment approaches underpinning the use of acupuncture and related techniques for plantar heel pain: a critical interpretive synthesis. Acupunct Med 2017; 35: 9-16. DOI: 10.1136/acupmed-2015-011042.
  3. Clark RJ. Advances in acupuncture for heel pain: towards integrative practice and research. Birmingham, UK: Independent, 2020.
  4. https://PodAc.info
Complexities of acupuncture for heel pain