Acupuncture vs. Dry-Needling

We have a lot of patients tell us that acupuncture has been a successful form of pain relief for them in the past and that they are very excited to have discovered our new Meridian clinic. However, many times patients tell us after the treatment that it was quite unlike their previous experiences with acupuncture: "This was much less painful." "I can really tell a difference already." "Your explanation of the problem really makes sense." "The physical therapist put the needles in different places."

Wait - you got acupuncture from a physical therapist? "Actually, he called it dry needling, and it was so painful, I was hesitant to come get acupuncture again." Well, that's never a good sign. Let's take a look at this.

What is Dry Needling?

Dry needling is a technique developed in the late 1970s by a physician who noticed that injections into painful muscles relieved pain irrespective of the analgesic used. With this in mind, he started using empty hypodermic needles from syringes to poke areas of knotted muscle tissue, or trigger points. Needling these trigger points causes a local "twitch" response: the muscle will involuntarily contract or "jump" due to reflexive signals sent from the spinal cord. This is believed to allow the muscle to relax and thus relieve pain, although the insertion of the needle and the local twitch response can themselves be quite painful. 

Dry needling is presently performed by physical therapists and chiropractors, depending on state laws. Many have gotten smarter over the years, realizing that patients generally don't like syringes inserted into their muscles, so they've started using the same solid, filiform needles that we acupuncturists use. 

What's the Difference between Dry Needling and Acupuncture?

Essentially, practitioners using dry needling are performing rudimentary acupuncture. The technique of needling directly into an area that is painful upon palpation is outlined in the earliest foundational text about Chinese medicine and acupuncture, the Huang Di Nei Jing (黄帝内经), written around the 4th century BCE. Acupuncture has been further refined over the centuries to high levels of sophistication; dry needling represents, at best, the crudest and most elementary form of acupuncture techniques and, at worst, non-acupuncturists attempting to rebrand an ancient medical technique for modern insurance billing purposes.

Here are some of the advantages of acupuncture over dry needling:

1) Dry needling aims for trigger points and knotted muscle fibers whereas acupuncture employs and is based on the meridian system. As discussed in previous blog entries (here and here), the meridian system maps out the flow of Qi throughout the body - to the various organ systems and body tissues. We are able to relieve pain by stimulating points along specific meridians, and often the site of the needling is far away from the painful area. Dry needling does not take into account this fundamental aspect of Chinese medicine.

2) Dry needling treats symptoms while acupuncture address underlying causes of pain. Pain in your shoulder can stem from an issue in your elbow or a problem near your spine. Essentially, Qi stagnation in a meridian can cause pain anywhere along that meridian, so it's not always useful to needle the site of the pain. Furthermore, what is causing the stagnation of Qi? Is there heat in the meridian? Cold? Blood stagnation, as well? Are you frequently straining muscles because they are not properly nourished by Blood and Yin? Is emotional constraint preventing the Qi from flowing properly? Dry needling isn't going to be able to treat Yin deficiency or Liver Qi constraint, nor can it be used as preventative medicine. That's why the effects of acupuncture tend to be stronger and longer-lasting. 

3) Dry needling is only used for orthopedic complaints, generally muscle pain. Acupuncture is awesome for pain, but of course it also treats conditions which would fall into the category of internal medicine such as digestive problems, high blood pressure, infertility, anxiety, flu, and on and on. 

4) Dry needling tries to excite the muscles into twitching, which can be uncomfortable or painful. Acupuncture is generally painless and very relaxing.

5) The level and quality of training is very different. PTs and chiropractors can perform dry needling with as few as 23 hours of training. This is basically a course or workshop in an adjunctive therapy very unlike the main techniques of these professions. The acupuncturists at Meridian Acupuncture undertook a 4-year Master's program in acupuncture and oriental medicine, learning many different needling techniques. More importantly, we have gained a full understanding of traditional Chinese medicine theory, allowing us to practice acupuncture needling within the context in which it was created, develop a diagnosis and treatment plan, and incorporate herbal medicine when appropriate.  

How Does this Affect the Medicine?

That's a tough question to answer. On the one hand, I personally don't agree with the principles and treatment philosophy behind dry needling. Compared to acupuncture, which has grown out of an established system rooted in 5000 years of tradition, dry needling just doesn't have as much to offer. The effects aren't as strong or long-lasting, and the root cause of the problem isn't even considered. Worse yet, the minimal training required for dry needling practice leaves me wondering if it isn't potentially dangerous to perform on a large patient base. Every patient who has told me about their dry needling experience always had a lot of criticism of the treatment, whether in regards to how painful it was, how limited the effectiveness was, or how uncomfortable they were with the practitioner.

On the other hand, surely there must be patients who get some, temporary pain relief, otherwise therapists would not be out there attempting to perform this type of acupuncture.  Presumably, then, some might leave thinking they've had good results with real, Chinese medicine-based acupuncture. This could make them more open to visiting an actual licensed acupuncturist for future problems. Dry needling practitioners can then potentially become unwitting ambassadors for Chinese medicine. My hope is that patients who receive dry needling and aren't completely turned off by it will then want to take the next step and consult the Chinese medicine experts.