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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