How is Acupuncture Different Than Dry Needling?

One of the most frequently asked questions I get is how is acupuncture different from dry needling. Usually I'm asked this while giving a treatment, so I provide the simplest answer-that dry needling is one of many acupuncture techniques. It's more complex than that though, so let's take a look.

History of Dry Needling

I haven't done a ton of research into the history of dry needling, but one figure stands out to me because she was a trail-blazing woman. Back in the 1930s, the American physician Janet Travell was determined to understand the root cause of her patients pain, illness and discomfort. Through her long career, she mapped out the trigger point referral patterns and symptomology, and in the 1980's, along with physician David Simons, published the famous book Myofascial Pain and Dysfunction. The Trigger Point Manual.

Travell used different techniques to release trigger points (myofascial constrictions/"muscle knots"), including injecting procaine into the muscle. She realized that puncturing a trigger point with a needle also worked without the injection, and eventually the practice evolved into the dry needling we know today, using acupuncture needles instead of a big syringe needle and without injecting anything.

Trigger Point Dysfunction and Acupuncture Theory

Trigger points are areas in the tissue that are hyperirriable and tender when pressed. If the trigger point becomes really sensitive, the pain can refer to other areas, or can even affect the nervous system and cause strange symptoms that don't seem muscular at all. For example, the SCM muscle in the front of the neck can causes issues like dizziness or the sensation of fluid in the ear.

What's really fascinating to me as an acupuncturist is how these referral pathways often mirror the pathways of the acupuncture channels. Here's an example I borrowed from class notes, showing the referral pattern of a couple shoulder trigger points on the left, and the Large Intestine acupuncture channel on the right.

Thousands of years ago, as acupuncture was being developed, I'm sure these pathways were noted by the ancient physicians and were an important part of the development of the acupuncture channel system.

Is Dry Needling Really Different?

Acupuncturists have been using needling techniques like dry needling on trigger points and other painful areas for thousands of years. Books as old as The Spiritual Pivot, dated between the 2nd-1st century BCE, describe needling tender points for pain relief, whether they were traditional acupuncture points or not. Sun Si Miao's text in 652 CE popularized the term"ah shi" points, which translates to something like"right there!" or "ah! yes" which is what his patients would exclaim when he palpated a painful spot.

According to a study titled "Comparative Techniques of Acupuncture and Dry Needling Intersecting with Trigger Point Physiology and Diagnostics: A Cross-Discipline Narrative Review" PubMed,

"The physiologic effects of acupuncture and DN (dry needling) are identical in musculoskeletal needling, despite the differences in language and the models used in acupuncture theory. The clinical mechanisms are identical, regardless of the cultural or linguistic paradigm used."

I do think many American acupuncturists have adopted a gentler approach than what you would see in China or most dry needling practices, but that has more to do with patient comfort and practitioner preference than what acupuncture is or is not. Not all acupuncturists do the dry needling style acupuncture, but it is a part of the medicine.

Do Acupuncturists Only Treat Energy?

In order to add dry needling to their scope of practice, physical therapists have made the argument that dry needling is not acupuncture. A lot of misinformation has been spread because of this, including that dry needling is a new, science based technique, and that acupuncture just works with "energy" and only treats the energy meridians/channels.

It might surprise you that there are acupuncturists who have a myofascial or nervous system approach and don't think in terms of Qi or energy at all! The channel theory and acupuncture we learn in school is a reliable and adaptable roadmap.

Safety

There are safety concerns around dry needling. At present, there is no nationally standardized, independently accredited educational pathway or competency examination specific to dry needling.

In Colorado, the requirements for a physical therapist to perform dry needling are "A minimum of 46 hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training."

Last year, after Pittsburgh Steelers linebacker T.J. Watt experienced a collapsed lung (pneumothorax) following a dry needling procedure, the California State Oriental Medicine Association released "A Public Statement from CSOMA on Patient Safety, Dry Needling, and Acupuncture Standards" that you can read here. California is one of the last states to not allow dry needling by physical therapists.

Using more aggressive needling techniques and pistoning the needles in and out will involve more risk for injury, especially around the lungs. Even with great training and experience, the risk is there.

The Bottom Line

Dry needling is identical to certain acupuncture techniques. Not all acupuncturists use those techniques. Both acupuncturists and physical therapists have an amazing ability to help people get out of pain without surgery or drugs. The more training and classes anyone takes in needling, the better they will be at it. Practitioners from either profession can become excellent at releasing muscles using needles. Most people need more than muscle releases in order to get long lasting pain relief, and physical therapists and acupuncturist diverge on what they have to offer beyond this one thing.

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