Benjamen Clancy DAOM, L.Ac, Dipl. Ac.

So, “what is the difference between dry needling and acupuncture,”? This is a common question I hear in my clinic almost on a daily basis. Here’s how I explain the differences and similarities to my patients. I like to begin by explaining acupuncture is only one tool which is used under the umbrella of Chinese medicine. Other tools include, Chinese herbal medicine, Tui na (massage), cupping, moxa, Chinese diet therapy, exercise (tai qi), to name a few. Acupuncture is a broad term used to describe many forms of needling techniques used to stimulate the body’s natural healing mechanisms. One of those needling techniques is dry needling.

Dry needling uses solid filiform needles also known as acupuncture needles, these needles are in inserted into muscular trigger points with the intention of relieving myofascial pain.[1] This method of acupuncture needling has commonly been used since the invention of acupuncture over 2,500 years ago in China, it is called ashi acupuncture. During ashi acupuncture, the acupuncturist will palpate the muscle tissue and find a tender/tight spot and insert a needle into that area with the intention of relieving pain, restoring health and function.

The main difference between an acupuncturist and physical therapist using acupuncture needles would be the areas and method of stimulation. As mentioned physical therapists primarily are working with trigger points found within muscular tissue. In contrast, acupuncturists may treat near nerves, tendons, and even the bones for treatment of sciatica, carpel tunnel, tendon issues and arthritic joint pain.

The method of stimulation of the needles may also differ in treatment. In traditional Chinese acupuncture there are several needle stimulation methods, including inserting and withdrawing, lifting and thrusting, twirling and rotating, to mention a few. A specific method is chosen depending on the diagnoses of the condition. Unfortunately, acupuncture has received some bad press in the past which has made the profession appear to be flaky. Acupuncture has been sadly defined as the movement of Qi throughout the body in order to restore balance. I think where people get hung up is the term qi (loosely described as energy). I understand, by saying we are moving qi around the body makes us sound like shamans. From the big perspective, everything is energy and by stimulating the body in various manners we are moving energy around in the body. That said, acupuncture can be viewed from a more approachable perspective, a scientific perspective.

In the US it is my observation acupuncture and Chinese medicine is being taught to be more inclusive to Western medicine. In China I observed in hospitals acupuncturists requesting x-rays, MRI’s and lab work in order to improve their ability to diagnosis and prescribe treatment. Here in the US we are taught to do the same. We examine our patients from both a Traditional Chinese medicine perspective and Western orthopedic and neurological perspective. Traditional Chinese medicine has many similarities when it comes to diagnosis, but it also has many dissimilarities and the terminology of those diagnosis can often come across as flaky. More on that in another blog.

Acupuncture is not some kind of hocus pocus, and science has shown through overwhelming evidence its effectiveness. There have been many studies that demonstrate the positive effect of acupuncture on the body and mind. Acupuncture is able to stimulate the body’s natural healing mechanisms including reducing pain and inflammation, increasing blood flow, balancing hormones and reducing insulin resistance, and reduce cortisol levels (the body’s stress hormone). [2, 3, 4, 5, 6]

So, back to the topic, there are some similarities and differences pertaining to the terms acupuncture and dry needling. As mentioned, dry needling is a type of acupuncture method or technique found under the umbrella of acupuncture. In modern Chinese medicine the intention of the acupuncturist or physical therapist is the same i.e., stimulating trigger points or ashi points to reduce pain and restore health to soft tissue dysfunction. The methods may differ in technique, acupuncture may use several techniques which are different to stimulate the needle, including leaving the needle in place for up to 20-30 minutes or applying electrical current to the needle. Unique to acupuncture, heat may also be applied to the needle in forms of moxa (an herb burned on or around the needle which does not harm the skin) in order to warm the needle area intended to improve blood flow and relax muscle tissue.

From my perspective I do not have a problem with physical therapists practicing dry needling. My only concern is public safety. Acupuncturists in the US typically have over 800 hours of supervised clinical needling experience. In contrast, physical therapists can become certified to puncture the body with needles up to 5 inches long in a couple of weekends. Acupuncture has been performed safely for thousands of years and rarely results in harm to the patients. Side effects may include bruising, and minor aches. That said, in the hands of an inexperienced practitioners serious injuries have been observed.

So, if both acupuncturist and physical therapist offer dry needling where should one go? Being an acupuncturist I’m slightly biased to that question, but from my perspective acupuncturists have more to offer when it comes to treating soft tissue issues. As mentioned, Chinese medicine has many tools for treating pain and inflammation which go far beyond dry needling. We also practice a medicine which has thousands of years under its belt. When it comes to treating pain related conditions I believe acupuncture and Chinese medicine have more to offer.

References

1. https://www.tandfonline.com/doi/abs/10.1179/108331913X13844245102034
2. https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-312
3.https://aim.bmj.com/content/33/1/65
4. https://www.ingentaconnect.com/contentone/cog/aetr/2017/00000042/00000003/art00005
5. https://aim.bmj.com/content/early/2016/06/02/acupmed-2016-011074.short
6. https://www.sciencedirect.com/science/article/pii/S016503271500052X