Dry Needling

Dry needling was developed by Dr Janet Travell when she noticed that injections into painful muscles relieved pain irrespective of the analgesic used.

She would only use empty hypodermic needles to puncture tight muscle tissue, or trigger points. She argued that hypodermic needles were more effective than acupuncture needles because the acupuncture needles were far to thin. Over the years, therapists have switched to use the same solid, filiform needles that acupuncturists use.

The needling of these trigger points caused a local ‘twitch’ response where the muscle would involuntarily contract due to reflex 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 be quite painful.

Dry needling is presently performed by physical therapists who will generally attend a 1-2 day seminar which legally qualifies them to insert needles into the patient. There is additional courses and training that some of the therapists choose to participate in.

What is the difference between dry needling and acupuncture?

One of the most important things to note is that a physical therapist will generally complete a 1-2 day seminar prior to being qualified to insert needles into people. A qualified, registered Acupuncturist is required to complete a 4-5 year University degree where they are required to complete a minimum of 800 hours of clinical supervised practice.

Physical therapists administering dry needling are performing basic acupuncture. The technique of needling directly into an area that is painful on palpation is outlined in the earliest foundational text about Chinese Medicine and Acupuncture, The Huang Di Nei Jing (4^th Century BC).

Since the 4^th Century, Acupuncture has developed and evolved into a highly technical and refined process. Dry needling represents the most basic form of acupuncture techniques. Qualified, registered acupuncturists are readily able to perform this basic process and use the same deep manipulations as dry needling therapists. This is a lot of misunderstanding and miseducation of dry needling therapists at these courses. I’ve been advised by patients that their practitioner told them that acupuncturists can only treat internal organ system. This is incorrect. Acupuncturists are able to quite effectively treat both.

Benefits of Acupuncture over dry needling

Dry needling aims for basic trigger points and knotted muscle fibers whereas acupuncture has a much more highly refined system which is based on pathway systems within the body. It can also do the basic trigger point acupuncture where needles are inserted into knotty muscles. In Western medicine there is pathway systems such as blood circulation, oxygen circulation, and lymphatic system. Chinese Medicine also has its on pathway systems that travel through the body. By needling along these pathways (aka Meridians) often pain can be treated distally as well as locally. This is very beneficial when the area is tender.

Dry needling treats symptomatically whereas acupuncture addresses underlying causes of pain. For example, pain in your shoulder can result from an issue in your elbow or a problem near your spine. A lack of circulation in one area can travel down and affect another area along the pathway. This is why needling at the site of pain will often only temporarily relieve pain. Some muscle pain is caused from internal symptoms within the body. Chinese Medicine is able to treat the body holistically through acupuncture and herbal medicine.

Dry needling is only used for musculoskeletal complaints (generally muscle pain). Acupuncture is very effective in treating pain but it can also address other conditions such as; digestive problems, high blood pressure, infertility, anxiety, flu, etc.

Dry needling can be a very painful experience. Dry needling deliberately excites the muscle to induce a twitch which can be very painful prior to the muscle relaxing. Acupuncture is generally painless and very relaxing.

The quality, knowledge, and training is very different. Physical therapists can administer dry needling with just 1-2 days training. This is basically a short course to work as an adjunctive therapy. Qualified Acupuncturists (Traditional Chinese Medicine Practitioners) undertake a 4-5 year Masters degree in Acupuncture and Oriental medicine where they learn many different needling techniques. Acupuncturist receive over 800 hours of supervised clinical practice to ensure that they are able to practice acupuncture safely. In several states of America, dry needling has been banned due to an increased rate of pneumothorax (lung puncture) resulting from poorly trained physical therapists performing dry needling.

What does this mean for medicine?

Acupuncture has developed and evolved out of an established system rooted in 5000 years of tradition. Dry needling is less than 100 years old. Dry needling effects are not as strong or long lasting because it is generally treated very basically and symptomatically.

I have received mixed feedback with some patients reporting symptomatic relief from dry needling and others reporting that it further worsened their condition. A pro of dry needling is that it makes people more open to the idea of acupuncture. Although some patients have reported that their physical therapist reported that it is superior and different to acupuncture. This is incorrect. Dry needling is a very basic and primitive form of acupuncture. A possible con of dry needling is that if patients have a negative experience of dry needling, they may believe that this represents the acupuncture profession. Some physical therapists do not differentiate and advertise that they can do both. Anyone who has had a bad experience with dry needling should go and speak with a registered acupuncturist who can then provide further information on the difference between acupuncture and needling.