In a clinic a short stroll from Mong Kok MTR station, Jeremy Ritcey yelps in pain. "That was getting close to a 10," he says, laughing nervously to distract himself from the needles piercing his skin, tearing into his injured muscles. Ritcey, 38, is a competitive trail runner who suffers from the dreaded iliotibial band syndrome (ITBS), an injury that puts many runners out of action each year.
Today, he is receiving treatment from Alain Chu, affectionately known in the sports community as the "Needleman" because of the needles he uses with amazing, although painful, effect.
A trained physiotherapist, master of acupuncture and holder of a masters in exercise and sports science, Chu sees a full schedule of patients each week who suffer from sports injuries and chronic musculoskeletal pain. The method he developed over 25 years combines trigger point therapy and the latest research on muscles and fascia (the "myofascial system").
Using needles sourced from China, Chu makes rapid incisions deep into a patient's muscles at points determined after a detailed consultation. It's a labour-intensive process, requiring skill and an intimate knowledge of anatomy.
Sound excruciating? It is. But according to his patients, it's worth it. "He's magic. He healed me when it couldn't be done," says Ritcey, who discovered the treatment in 2009 after a knee injury put him out of action. Facing the Oxfam Trailwalker in two months, Ritcey had to do something drastic, or he would let his team down.
"I was clutching at straws; it [the injury] wasn't getting better," he says. "I was seeing a physio, but it wasn't enough. My first experience [with Chu] - much like every other since - was agonising. But it was immediately rewarding."
After three sessions over 10 days, he was as "good as gold", and went on to complete Trailwalker. Although he has ongoing injuries as a runner, and continues to get treatment for ITBS, he has not suffered any more major injuries that have put him out of action.
The treatment's success, Chu claims, is down to redefining the source of the musculoskeletal problems: the fascia.
Fascia is a fibrous tissue including the tendons, joint capsules and ligaments. It encases our muscles in complex ways, connecting our bony structure and supporting the nerves, blood vessels, and internal organs.
When we strain muscles, they are unable to fully heal on their own, sometimes causing contraction points (known as "trigger points") in the myofascial system. The trigger points compress blood vessels and nerves, causing joint dysfunction and pain.
Where muscles do heal, fine scars are often left in the myofascial system, known as "adhesions". These affect the ability of the muscle fibres, tendons and ligaments to slide over each other, tangling them with nerves and blood vessels.
Chu's treatment releases and breaks down these tension points while stimulating the body's natural healing process.
Born out of Chu's frustration with his physiotherapy practice 25 years ago, the method is a product of his determination to find a solution for the ongoing issues he saw his patients face.
During his quest, he came across the work of Dr Xuan Zhe-ren, an orthopaedic surgeon on the mainland. Through research and clinical observations, Xuan had discovered how the use of needles could help solve this problem. Xuan's needling technique informs Chu's own practice.
Chu also relies on an ancient Chinese medical text known as the Huang Di Nei Jing, which maps the connections between muscles. Discovering the text and Xuan's practices was a vindication of years of research for Chu. "I always had the idea that musculoskeletal pain is not coming from the bone but from soft tissue and that there are other ways to solve these problems," he says.
Others, like Andrew Lam, agree. Seven years ago, Lam suffered a prolapsed intervertebral disc (PID), leaving him in extreme pain and reducing his mobility.
Several doctors told Lam, 40, a teacher, that he needed surgery to have the disc removed. "But I didn't want surgery because I knew it wouldn't solve my problems. It might even have caused more problems," he says.
So he sought the advice of Chu, who was a guest lecturer at his university. Chu used his technique to release the tightness of the soft tissue around the muscle surrounding the disc, allowing the nerve to move. "Once the nerve is not impinged, even though the patient still has PID, it will not cause any of the pain symptoms," says Chu.
Lam says he can now play basketball and swim, thanks to the treatment.
Ten years ago, Tom Myers, a fascia expert, was one of the first in the medical profession to argue the importance of the fascia. In his latest book, Anatomy Trains, Myers maps the connecting units of the fascia. This, Chu says, is almost identical to the tendino-muscular channels mapped centuries earlier in the Huang Di Nei Jing. The intense skill and knowledge required for Chu's treatment is the reason he has no successors.
"I have not found the right person yet," he says. Instead, he spends his time recording his knowledge. He ultimately hopes to publish a book.
Physiotherapist David Garrick from Physio Central also believes the treatment has merit. "It can provide symptomatic relief for tight or overactive muscles, which can either result from or lead to abnormal tendon function," Garrick says.
"That said, I do not feel needling will cure a tendinosis problem alone and often a multifaceted approach is needed," Garrick adds. "As with any injury, the cause needs to be addressed and eliminated for a full return to function and less chance of recurrence." Garrick says there is no point seeking treatments which just provide temporary symptomatic relief: "Ultimately, you need a cure."
But for the many returning patients, the Needleman is the cure. Paralympian wheelchair fencer Sik Lau, who won bronze at the 1988 Paralympics, used to see Chu on a weekly basis during his intense training. These days, he does not hesitate to refer others to Chu.
"Alain is humble and full of innovation," says Lau. "He keeps on reading and learning to find out the effective way to solve his patients' problems."
But the treatment is not for all problems, and certainly not for everyone. One ex-patient, a 31-year-old engineer who prefers not to be named, says the treatment was painful and not suited to his injury, lateral ankle pain. "Stretching with a physiotherapist helped me much more," he says.
Patients must be determined to recover, says Chu, and endure the pain that comes with the process - perhaps the reason why his clinic is visited by many of Hong Kong's extreme and elite athletes. "They have to make an effort. They cannot simply pay money," he says. A screening procedure, listed on his door, requires patients to trust Chu and be prepared for the discomfort.
It's an approach which has made him friends and lost him some, too. "I walk my own way," he says. "I've no colleagues. I spent more than 20 years self-studying and following my mentors," he says.
Chu continues stubbornly towards his goal of finding a treatment. "Some people have sought out other treatments, and have been healed. But in my view, this technique is the most effective, and the fastest - even though it is painful," he says. "I wouldn't say that it's the only way, but sometimes I think it is the best way."