Recently there has been an increased push by physical therapists to advertise and use a practice known as Dry Needling. This has become a topic of much debate between acupuncturists and physical therapists. At it’s core, dry needling is acupuncture- with much less training. Let’s investigate.
Dry Needling
“Dry Needling is a general term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle in the area of the body which produces pain and typically contains a ‘Trigger Point’”
Physical therapists who use dry needling will tell you it’s different from acupuncture. As an acupuncturist, I will tell you, that it’s not. Dry needling is acupuncture.
Take a look at the definition of acupuncture from the Massachusetts Board of Medicine:
“The practice of acupuncture: the practice of medicine based upon traditional oriental medical theories; primarily the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of electric current, and with or without the application of heat to the needles, skin, or both, in an attempt to relieve pain or improve bodily function. The needles used in acupuncture shall be solid filiform (ie: filament) instruments“
I have highlighted the important parts. According to these two definitions, dry needling is acupuncture. Same instrument- acupuncture needle; same application- insert said needle into the body.
My plan here is to help you understand why they are the same and to fully accomplish this, I need to explain away the perceived differences. And that’s where language and history intersect.
History
The history of Dry Needling dates back to the late 1970s. The term dry needling is used because the technique ‘derived’ from trigger point injections. Trigger point injections involved the injection of a liquid (a wet substance) into a trigger point using a hypodermic needle.
The main theory behind dry needling is that the needles are inserted into trigger points to cause a twitch reaction in the muscle, thereby releasing the trigger point and restoring the function of the muscle.
The reason I placed the word ‘derived’ in quotes is because dry needling is simply local acupuncture. Local acupuncture involves needling around the direct site of pain. This will often times result in the needling of trigger or motor points.
Another form of needling involves distal needling or needling away from the pain; for instance, there are points on the hands that are great for treating back pain.
One of the classic texts in Chinese Medicine, known as the Yellow Emperor’s Inner Classic discusses the use of tender or painful points to relieve pain, which were given the name ashi points. Ashi means ‘Ah yes’, as in, yes that’s the right spot. (In school we’d joke and say ashi really meant ‘oh sh*&’ because the points are tender when touched).
Needling a trigger point is the same exact thing as needling an Ashi point. The notion of needling an Ashi point (i.e., trigger point) is over 2000 years old and didn’t begin with dry needling.
In definition and in practice, acupuncture and dry needling appear to be the same thing.
Language And Theory
One of the big arguments for dry needling not being the same as acupuncture is the theory behind the practices.
The following definition comes directly from a physical therapy website advertising dry needling:
“Dry needling involves the insertion of needles into overactive muscle to release trigger points. The approach is based on western anatomical and neurophysiological principles and not to be confused with the Traditional Chinese Medicine technique of Acupuncture.”
This is the crux of the argument. Physical therapists will say that dry needling is not acupuncture because it is not based on the concepts of acupuncture such as qi, meridians or manipulating energy flow.
For the record, I have never manipulated a patient’s energy flow. I’ve never seen a meridian or seen qi. Fair enough? Good. Now to understand what I’m getting at, we need to look at the actual meanings of these terms and not the commonly misunderstood meanings.
Meridians And Points
Chinese medicine is not based on some out of this world superstitious mumbo-jumbo. The ancient Chinese had fully mapped the routes of the arteries, veins and major blood vessels. These were referred to as jing (distribution blood vessels) and luo (collateral branches).
Acupuncture ‘points’ were initially defined as nodes or critical junctures. The nodes appeared on the body surface near areas where the collateral branches of the distribution vessels supplied the body surface. The vessels also included the network of nerves in the body.
The nodes were not simply isolated anatomical structures but also included afferent (sensory) and efferent (motor) neural properties. Sensory neurons bring stimuli from the sensors to the central nervous system and efferent neurons transmit the response from the CNS to the muscles and glands.
In basic terms, acupuncture points were located on the superficial layer of the body, but were connected to deeper layers by the circulatory (vascular) system and nerve routes. You could say acupuncture is based on western anatomical and neurophysiological principles.
The difference in explanation is cultural and language based.
If you step into an acupuncturist’s office, it’s not uncommon to see an acupuncture point or meridian chart. These charts represent a game of anatomical connect the dots.
The individual nodes were connected to create the lines on the body map. These lines were then mistranslated as ‘meridians’. The nodes were then referred to as points. (some of this terminology comes from the attempt to export acupuncture during the cultural revolution in China, it has nothing to do with the original language or understanding of Chinese medicine).
Quoting from the book Biomedical Acupuncture for Pain Management, qualities of acupuncture points are identified, including:
- “The majority of Acupuncture points are located near nerves or major blood vessels, which are surrounded by nerve bundles.
- Arteries and veins course along the nerve trunks to form neurovascular bundles to reach muscle attachments. Acupuncture points are located where nerve trunks enter the muscle bundle.
- Acupuncture points form at locations where a nerve trunk penetrates the deep fascia (connective tissue) and emerges close to the surface”.1
These anatomical observations align with the original understanding of acupuncture ‘points’ and ‘meridians’.
Qi (Pronounced Chee)
The notion of qi as an invisible life force traveling along the meridians is another misunderstood concept. The original Chinese character for qi is a symbol for vapor, air and breath-referred to as vital air. It is representative of air from the atmosphere (inhaled oxygen) and breath.
The character for qi can also refer to function or functional activity. So when someone is said to have deficient qi, it refers to a lack of proper function, and not a lack of some invisible life force.
Summary
- This is a very complex topic that touches on many issues- defining the scope of practice for physical therapists, insurance billing rules and most importantly, practitioner training and patient safety.
- While I can appreciate that physical therapists want to use dry needling to help their patients, no matter how they try to explain it, they’re doing acupuncture. The problem is they’re doing it without the same amount of training as an acupuncturist. Most dry needling courses are weekend long seminars.
- Acupuncturists also have to pass the Acupuncture Board exams, and have to do continuing education to maintain our licenses as well.
What You Need To Know
- Acupuncture terminology and theory is very misunderstood in the West
- Acupuncture IS based on anatomical and physiological concepts
- Dry needling and acupuncture are the same thing, just explained in different terms
When searching for an acupuncturist online, look for the Lic. Ac (Licensed Acupuncturist) designation. You may see other abbreviations such as DAOM (Doctor of Acupuncture and Oriental Medicine) or MAOM (Masters of Acupuncture and Oriental Medicine). The DAOM and MAOM indicate the degree obtained in a full time acupuncture school.
To find an acupuncturist, you can visit the Practitioner Page of the National Certification Commission for Acupuncture & Oriental Medicine – the national licensing board for acupuncturists.
Is dry needling just another another name for acupuncture? I think that Shakespeare guy said it nicely: “a rose by any other name”….
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