Acupuncture vs Dry Needling: What's the Difference?

What is Dry Needling (DN) and how does it differ from Acupuncture?

Acupuncture, as defined by The National Center for Complementary and Integrative Health "describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. Practiced in China and other Asian countries for thousands of years, acupuncture is on of the key components of traditional Chinese medicine."*  There are many forms of acupuncture (Chinese, Japanese, Korean, Orthopedic, 5 Element, to name a few) and each style is a bit different. Overall, acupuncture is used to create healing in the body for both acute and chronic problems due to injury or illness. It is a holistic form of medicine that has been used for thousands of years. Usually an acupuncture treatment is a comfortable, relaxing experience that leaves the patient with an overall sense of well being, and symptom relief either immediately or within 24-48 hours of treatment, depending on the issue.

Dry Needling (as opposed to the "wet" needling of injection therapy) is a form of acupuncture where an acupuncture needle is inserted into a trigger or motor point to elicit a twitch response. This twitch releases the muscle making it more relaxed to improve its function. This tends to be a more symptom based treatment dealing with musculo-skeletal problems, rather than internal problems, like insomnia, anxiety, IBS or hormonal regulation, which are better treated by acupuncture. The treatment can be a little uncomfortable, but the discomfort is short lived. After DN the patient should leave with an overall decrease in their pain levels.

There is an ongoing debate in the physical medicine world about Dry Needling. Physical Therapists and Chiropractors are treating their patients with DN for the purpose of healing symptoms and improving physical function, because needling the body is effective; this has been proven by Acupuncturists all over the world for millenia. So what's the problem?

The biggest problem is lack of proper training. A licensed acupuncturist has had 2-3 years of supervised needling training by the time they go into the student clinic to begin to treat patients and by graduation, 3-5 years. Most Dry Needling courses take place over the course of a weekend and typically have only about 10 hours of needle practice. The students are not being trained by Acupuncturists, who understand not only how to needle, but what and why to needle, they are being trained by other Chiropractors or PTs.

Would you go to see an acupuncturist to get your spine adjusted after (s)he took a weekend chiropractic course? I wouldn't. It's like calling a plumber to work on your electrical problem. Great skills, just the wrong set of skills for the job at hand.

My biggest concern is safety. PTs and Chiropractors have extensive training on how the physical body works: how to rehab a knee replacement, how to create strength and stability in the hips, how to realign the spine and pelvis, how dysfunction in one area can affect another, etc. What they don't have is extensive training in needling the body. Massaging a tight muscle and putting a needle into it are two different skill sets. With massage you don't need to worry as much about where blood vessels and nerves are, or how deep (or shallow) the Lungs or Intestines are relative to the surface. Acupuncturists have an entire semester course learning about acupuncture points, not only where they are located, but how deep and at what angle you should needle each point. Understanding these needling depths and angles (which are based on the anatomy beneath them), keeps a licensed Acupuncturist from creating a pneumothorax (puncturing a Lung) or hitting an artery. This course is separate from the course taken about the functions of each point. When DN is taught by someone not trained in depths and angles, this can be very dangerous for a patient. Even when a practitioner is not needling an acupuncture point per se, but perhaps a motor point or trigger point, there is still the underlying anatomy to consider. Acupuncturists needle acu-points (which are located along the 14 main meridians), "extra" points (not on the main meridians), "ashi" points (points when pressed there is a sore sensation, also not necessarily on main meridians), motor points (a point on a muscle that when stimulated causes the muscle to contract) and trigger points (a sore point that causes generalized muscle pain when over stimulated). There was a Dry Needling training video that circulated the Internet a few years ago where an instructor actually caused a pnuemothorax during the training because he used a needle that was too long and he went too deep into the upper back of a relatively thin person. He made this mistake due to not fully understanding how to properly needle that area, despite what he believed was taking proper precautions.

In my practice I have seen the sequelae of DN performed by well meaning, but insufficiently trained practitioners (like large swellings, increased inflammation, decreased range of motion, increased pain). Most of my patients know that if they need Dry Needling, they come to see me.

It is this lack of education that I believe is the biggest health risk when it comes to DN. Is it effective? Yes, but only when performed by a trained, Licensed Acupuncturist, or a health practitioner who has taken much more than just a weekend course.

* https://nccih.nih.gov/health/acupuncture

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Pelvic Floor Pain: How Acupuncture Can Help

When it comes to pain, not everyone thinks about acupuncture as the solution. With intense pelvic floor pain, the idea of needles anywhere near the pelvic floor can have you running in the other direction. You will be pleased to know that although it is possible to needle the muscles in the pelvic floor, it is not necessary to be able to address pelvic floor pain with acupuncture. One of the benefits of using acupuncture for pain is that there are many ways to treat the body, many ways to see the body and a seemingly indirect treatment can be the most powerful.

Case Study

59 year old female came to my office with her Chief Complaint as Pelvic Floor Pain that she had been experiencing 6 times per year for 15 years. The pain was intense, an 8-9 out of 10 and lasted at that intensity for 45-60 minutes. It usually appeared at night, waking her, but recently it had happened while at work or while driving. The pain was in the rectum as well as at the base of her spine and was a throbbing, pounding pain. The pain would start suddenly, then stop just as suddenly. The patient had seen multiple types of specialists, none of whom could do anything but give her pain killers for when she had the pain, and physical therapy hadn't helped; no one was able to help her with prevention, and could help only mildly with pain management. The pain was slightly better with NSAIDs and nitroglycerin but nothing prevented the pain from occuring; she just had to wait it out.

I first saw her in late February and the last episode of the pain had been late December.

Observing her posture, her rib cage was shifted to the left relative to her pelvis and her right Quadratus Lumborum (QL) was tight and contracted. Her left SI joint was jammed causing a medial shift when she lifted her knee. Her left psoas was tighter than her right and her right pubic bone was slightly deep relative to her left. There was no movement in her right ThoracoLumbar Fascia (TLF) or sacrum, which was jammed moving superiorly. The movement of her TLF and sacrum were detected by using a light touch to detect the body's various rhythms subtle movements.

I saw her weekly for 2 weeks, then every other week for 4 more treatments. After the first treatment her SI joints were moving properly and evenly, and her QL tightness had released. Her rib shift was also gone. As the acupuncture treatments progressed, I addressed imbalances in her piriformis and hamstrings and continued to address the sacrum which improved with every treatment. We were able to trace the problem back to her left foot which had had a seismoid bone resection many years before that affected her overall alignment, causing her to overuse her right side.

Typically the pain had occurred every 2 months for 15 years. During the 3 months that I saw this patient, she had no recurrence of the pain. Our last treatment was in May, so she had been pain free for 5 months.

I find that looking at the whole body, rather than just focusing on the one part in pain, it's the best way to get rid of pain more permanently. The body is a master at compensating and over time subtle, often unconscious shifts in posture and gait can lead to bigger problems down the road. By correcting the way a person moves through their life by correcting their imbalances, it can have a profound effect on how someone feels on a daily basis.

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Cupping for Athletes

Cupping is a hot topic among athletes these days, spurred on by the purple spots on competitors like Michael Phelps and Wang Qun at the Olympics and more and more celebrities and professional athletes across numerous sports. The Chinese (as well as Europeans) have been using cupping for thousands of years, for all sorts of muscle and joint pain, as well as for respiratory infections and digestive issues.

You can read about the basics of cupping in my previous post, "Cupping and Gua Sha: What are they and what are their benefits?" by clicking here. This post will focus on how cupping works to benefit athletic performance and recovery, as well as treating sports injuries.

Any athlete, whether a professional, an amateur or a weekend warrior, knows that soreness and injury is par for the course. Soreness is the build up of lactic acid and micro-tearing of tissue that when healed, creates a stronger muscle. With intense use, muscles can get tight or inflamed, and many people use ice to battle that inflammation. Unfortunately this practice is outdated and is actually interfering with the healing process. You can read more about that here. By restricting blood flow, you are actually impairing the body's ability to heal itself. It's like a fever: when you have a fever, the body has raised its temperature to kill off the virus or bacteria that is making you sick. When you reduce a fever, the body can't do its job as well (I am referring to fevers under 102.5 degrees; anything above is more serious and may require other interventions). Icing an acute injury delays the healing process by interrupting blood flow to the area. According to Traditional Chinese Medicine (TCM) you are infusing cold into the area which leads to a stagnation of energy, or Qi (pronounced Chee) and causes pain. Many times ice will numb the area, but won't actually get rid of the pain, since once the numbness wears off, the pain returns.

Practices like acupuncture and cupping are very helpful for recovery as they move the lactic acid out of the muscles, encouraging Qi and blood flow, helping the body recover. Cupping is great for muscle tightness, acting like a deep massage, to help release what is stuck and return the muscle to better functioning. Acupuncture encourages blood flow to the area so that the body can more efficiently heal the micro-tears and return the muscles to strength and stability. These two practices complement each other, but each can also stand alone when it comes to recovery.

In terms of healing injury, depending on the injury, acupuncture is my first go to, as it encourages blood flow to encourage healing. Moxa is another great modality for treating injury for the same reason. Our blood contains the nutrients that help us heal; encouraging blood flow encourages healing. Moving Qi and Blood can also reduce pain and swelling, often immediately after treatment.  Cupping can be helpful as long as there is no muscle tearing as part of the injury. It is great for muscle spasms or tightness, and can be helpful with scar healing, once the scar is stable and closed. Cupping (or Gua Sha, see the above link to the article "Cupping and Gua Sha: What are they and What are their Benefits"), can help the scar become more supple, prevent adhesions and help the body return to proper function.

Scars can be very problematic, post-surgery or otherwise, if they don't heal well. Puckered or tight scars can impair function not only of the affected area, but can also cause problems in other related areas, like nearby joints. I had a patient who had a lumpectomy and the scar was very deep and tight. She came to me because of a shoulder injury on that same side. Once I released the tension in the scar, her shoulder felt much better. Cupping, Gua Sha and acupuncture are all great ways to treat scars and encourage them to complete the healing process so you can return to the activities that you love.

https://www.usatoday.com/story/sports/olympics/rio-2016/2016/08/08/how-cupping-works-and-why-olympic-athletes-use/88410804/

https://www.independent.co.uk/news/world/americas/rio-2016-cupping-what-is-it-olympics-athletes-suction-cups-skin-marks-a7178731.html

For more information about who I am and what I do, go to www.integrativetherapeutics.com.
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Musings of an Acupuncturist Treating Veterans

Musings of an acupuncturist treating veterans:

I love the vision of people, mostly men but some women, coming into the Veterans Acupuncture Care clinic,
a little nervous, a little unsure. Before they’ve been treated they don’t know what’s going to happen. Does it hurt?
How will I feel after? Does it hurt? What should I expect? Does it hurt?
They walk in, sign in and take a seat in one of of almost a dozen wing chair and couch seats. They sit down,
swab their ears with alcohol and await the needles. Within 5 minutes or so of receiving the needles, I see the peace
and calm wash over their faces. Soon the subtle sounds of gentle snoring mix with the flute music playing in the
background. They sit until they feel complete, for some it is 30 minutes, for some 90 minutes, for many it is
something in between. I take my cues from them. After the treatment, they arise, refreshed and ready to take on
whatever their life may bring. Initially the contentment may last only a few hours or a few days, but over time the
effects last longer and longer. The treatments build up in the system helping them hold on the more good feelings
than bad. Bodies have an amazing ability to heal themselves; I only facilitate that action. That’s why I do what I do.
I am an acupuncturist.

* * * * *

Everyone experiences stress in their lives, but after experiencing war and combat, the stress is a little different.
At first it may be subtle, like feeling irritable and isolated, or yelling at your spouse and children. Then it might be
more invasive, interrupting your sleep, causing nightmares and flashbacks, driving your desire to drink or behave
recklessly. PTSD, or Post-Traumatic Stress Disorder is not always immediately apparent to the person experiencing it.
If you or someone your love has been affected by a traumatic event in war or combat, know that help is available.
Veterans Acupuncture Care (VAC) Metrowest offers free acupuncture treatments specifically geared toward easing
your experience of your trauma and giving you a deep sense of peace and well-being.
For more information, please visit www.vacmetrowest.com.