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What’s The Difference Between Acupuncture and Dry Needling?

By Linda Gibbons, L.Ac.

Over the last couple of years I have had a number of inquiries from my patients and the public about dry needling and how it is different from acupuncture. The short answer is that there are some big differences, especially in the training and philosophy of the practitioners, but there also may not be such big differences when it comes to the actual needling. Herein lies a lot of the confusion that I hope to explain in this article. I feel that I am well-informed about this issue because I served on the board of the Colorado Acupuncture Association for 3 years until the fall of 2012 and during that time was involved in legislative affairs of Colorado acupuncturists, including the dry needling controversy.

Dry needling is a technique developed in the late 1970s by a physician who noticed that injections into painful muscles relieved pain regardless of the analgesic used. With this in mind, he started using empty hypodermic needles from syringes (“dry” needles instead of “wet”) to poke areas of knotted muscle tissue, or trigger points. Needling these trigger points elicits a local twitch response, which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of the muscle contract. 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. Nowadays, dry needlers don’t use empty syringes (a little painful?) but use the same type of needles as licensed acupuncturists. Acupuncture is a treatment modality that is a part of Chinese Medicine. Chinese medicine is thousands of years old and is based on achieving and maintaining health through balancing the meridians, or pathways of the body through which qi and blood move. Chinese medicine includes diet, exercise (such as Tai Chi and Qi Gong), herbal prescriptions, massage (known as Tui Na), moxibustion, and of course acupuncture.

Acupuncture is used to treat painful conditions regardless of the cause, but is also used to treat a myriad of internal conditions such as digestive disorders, infertility, high blood pressure, allergies, colds and flus, and even autoimmune diseases. As part of their training, acupuncturists also learn “trigger point” needling (now called dry needling by western medical practitioners) that is used in cases of tight or painful muscles conditions. In addition to needling local areas of pain, acupuncturists treat distal locations, meaning areas on the body away from the pain but connected by meridians and/ or connective tissue.

COMPARISONS BETWEEN ACUPUNCTURE AND DRY NEEDLING

Following are some direct comparisons between dry needling and acupuncture that I hope will help educate my readers.

Types of practitioners and education

I have had a few people tell me they get “acupuncture” from their physical therapist. The PT’s may be using acupuncture needles but there is a big difference in the amount and type of training they have had using needles compared to a true acupuncturist. The only practitioners that can refer to themselves as licensed acupuncturists, or L.Ac.s, in Colorado are those that have graduated from an accredited acupuncture school at the masters level, and have passed the national board exam in Chinese Medicine and Acupuncture. Most acupuncture schools require at least 2800 hours of training, with about 25% of these hours devoted to western medicine including anatomy and physiology. About halfway through acupuncture school, students start spending a significant amount of time in clinic as they practice needling patients in a supervised setting.

In 2005, the Colorado Department of Regulatory Agencies (DORA), in a controversial ruling, allowed physical therapists and also chiropractors to start performing dry needling after 46 hours of training. However, these practitioners are now doing dry needling on patients after taking a weekend course of only about 25 hours, so this ruling is not being enforced. These courses are not standardized and can vary widely in content and quality. Once they take the training they jump right into treating patients without further supervision. By state law, both acupuncturists and physical therapists are required to inform patients about the hours of training they have had in acupuncture or dry needling. If the practitioner does not voluntarily disclose this information please ask to see it.

Differences in treatment philosophy between dry needling and acupuncture

Dry needling focuses on treating musculo-skeletal pain by inserting acupuncture needles into the locally painful area and lifting and thrusting the needles until a “twitch” response is achieved. This method is effective at relieving muscle tightness but can also be very painful. Although dry needling started out being limited to the local area of pain only, my observation over the years is that PT’s are now needling in distal locations as well – something the acupuncture tradition has been doing for hundreds of years. Dry needling is supposed to only treat pain caused by musculo-skeletal conditions. Acupuncture treats musculo-skeletal pain as well as pain due to any cause. Acupuncture also treats other medical conditions as described in the beginning of this article.

Acupuncturists treat the pain locally, i.e. with trigger point acupuncture virtually identical to dry needling, but also may treat an area removed from the site. For example, carpal tunnel pain might be treated locally at the wrist but also in the shoulder or even on the opposite arm or leg. Needle insertion may be shallow or deep depending on the condition and usually involves little or no pain.

The western medical practitioners that use dry needling insist it is not acupuncture because they describe it in strict medical terminology that include muscles, tendons, and neurological descriptions and limit its use to treating orthopedic pain. Dry needling, being born out of the western medical modality, treats the symptoms only and ignores the root cause. In other words, dry needling is not a holistic treatment. Acupuncturists describe treatments in terms of identified acupuncture points, tender points called “ashi”, and/or meridians that affect the area of pain or disharmony. However, acupuncturists also have training in western medical anatomy and physiology and can and do treat patients using musculo-skeletal descriptors. Acupuncture, being an integral part of Chinese Medicine, treats both the symptoms and the root cause of a health problem, and is therefore approached from a holistic viewpoint.

What about insurance coverage?

Dry needling is often covered by medical insurance as part of a patient’s physical therapy. Acupuncture, however, is only covered when a person’s policy specifically covers acupuncture. The reasons have to do with our medical insurance system being totally dominated by western medical practices and the fact that dry needling is often disguised as “manual therapy” when treatments are submitted to insurance. The average patient doesn’t usually think about these things because they got needled, they may feel better, and their insurance covered it.

However, this disparity in insurance coverage is starting to negatively impact the acupuncture profession here in Colorado and elsewhere. Many of us in the acupuncture profession are working toward achieving parity with western medical practitioners in terms of getting insurance coverage for patients receiving acupuncture just as they do for dry needling.

The bottom line

My goal for writing this article is to educate as many people as possible about the differences between dry needling and acupuncture and to help dispel some of the confusion surrounding these terms. As an acupuncturist that has spent many years in school and in practice using an established, holistic system of medicine rooted in a rich tradition, it is difficult to watch dry needling become “American acupuncture” for many patients. Although patients can and do experience pain relief from dry needling, it is often painful and does not address the root of a patient’s health problem. Of great concern to me, and I hope to those who are reading this, is how little training dry needling practitioners get before they start treating patients and the lack of a standard curriculum. With more and more patients receiving dry needling I wonder about the dangers being presented to a large patient population. Patients who do respond well to dry needling may be more open to visiting a trained acupuncturist for future problems. Other patients might want to visit a trained acupuncturist after having excruciatingly painful dry needling treatments. My hope is that patients who receive dry needling will realize the potential of acupuncture and take the next step to consult a Chinese medicine expert. In fact, just the other day someone called my practice after having dry needling wanting to try acupuncture and Chinese Medicine. That’s a start!

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