I am excited to get going on this. Having co-authored papers on this topic in academic journals, and now finally got the book published, I am looking forward to developing some discussion. Also I feel it is time to share what we have learned more widely. Few acupuncturists read the journals and even fewer people with heel pain; in any case there are problems with these publications which limit their value. I shall be going into this in later posts. My aims are sharing knowledge, challenging assumptions, suggesting ways forward, stimulating discussion.
One thing I have learned is that there are people working on this all around the world but they are not connected. They seem unaware of each other’s work and keep ‘reinventing the wheel’. I hope this blog will contribute to a pooling of knowledge and a developing conversation.
Heel pain looms large in the lives of those who suffer from it but, in the broader scheme of things, it is a tiny fraction of healthcare practice. Meanwhile acupuncture is used widely around the world for many ailments but in the management of heel pain it is used very little and does not appear in official treatment guidelines. So my focus here is but a grain of sand on the beach of healthcare practice – yet I believe that grain can be a window on the world (if you’ll forgive the jump between metaphors) and there is much to learn about the broader practice of integrative healthcare from this tiny field of study.
What I plan to do in these pages is to share my experience and findings, so that acupuncture practitioners and researchers can be fully informed. Not that I have all the answers; I don’t. But I do have a whole lot of questions and challenges for those who think they do have the answers. I hope to inspire debate and discussion. So, before I go on, let me say who I am and where I am coming from.
I am a denizen of the shoreline. I grew up on the mainland of orthodoxy (science A-levels, physiology degree, medicine) then I sailed the seas of the alternatives (acupuncture, meditation, healing and holism). Integrative healthcare is like a beach – the foundation is solid but the sands can shift with the tides. There is a rich but unpredictable harvest from the ocean and occasionally something really useful or beautiful is washed up. For four decades I have combed this littoral space – practising, researching and teaching. I taught medicine to the ‘sailors’ and acupuncture to the ‘land lubbers’. This is how I came to focus on heel pain.
As the 20th century drew to a close, I was chair of the education committee of the British Medical Acupuncture Society when we were asked to provide acupuncture training for National Health Service (NHS) podiatrists based at St Giles Hospital in Southwark. The committee decided not to take this on so, after much deliberation, I did so myself.
I designed a five-day course – the first specific podiatric acupuncture course in the world, as far as I know. It was validated in 2000 by the Society of Chiropodists and Podiatrists, in London, and delivered for ten years, until the unit was closed due to NHS reorganisation. All of the podiatrists in the Southwark group (and many from outside) successfully completed the training and acupuncture was used regularly in their NHS pain clinic.
As part of the ongoing development of this course I started to review the evidence for the use of acupuncture for podiatric problems, with heel pain as a primary focus. This developed into a collaborative research process that resulted in a systematic review (SR) and a critical interpretive synthesis (CIS)
As David Sackett said, Evidence-Based Practice is about “integrating individual clinical expertise with the best available external clinical evidence…” 1. Our reviews (SR and CIS) were, on publication, the ‘best available external clinical evidence’ so I next set to complementing them with my ‘individual clinical expertise’ in reflecting on the issues they raised. This gave rise to my book: Advances in acupuncture for heel pain: towards integrative practice and research, in which I summarised and explored everything we had found. Three new perspectives emerged as I did so:
- DO points
- Refractive practice
- The Quilt Continuum concept
I shall be exploring these and other topics in future posts. If anyone has particular aspects you would like us to explore, please say so in your Comments.
Disclaimer 1: this blog is intended as an educational resource for practitioners who have undertaken adequate training in acupuncture, or students who are doing so. It remains the responsibility of such practitioners, in partnership with their clients, to ensure safe and appropriate practice. This is not about self-help – anyone suffering with foot problems should seek appropriate professional advice.
Disclaimer 2: I am not a follower of tradition for its own sake, nor do I worship at the altar of scientism. If you are an adherent of either, I hope we can have a constructive dialogue.
- Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72. doi: 10.1136/bmj.312.7023.71