Dry needling can be easier to explain by first stating what it is not. Though there is an ongoing debate regarding the benefits of dry needling vs acupuncture, most agree that they are very different. Simply put, dry needling is similar to a small part of acupuncture entitled “ashi” acupuncture or trigger point acupuncture. This is the very origin of dry needling. However, the similarity in location and the fact that the epidermis is punctured to one degree or another is where the similarities end.
What is Acupuncture?
Acupuncture is an ancient system originating in China in which acupuncture needles are placed into several of over 500 specific points on the acupuncture meridians throughout the body. A protocol of points is customized to each individual according to their symptoms, the patterns of the disease or pain, and the etiology of the malady. Acupuncture has been proven to relieve a variety of health conditions, including Musculo-skeletal pain/injury, among many other pathologies.
The acupuncturist is trained for a minimum of 3.5 – 4 years in a master’s program with over 3500 hours of instruction (one additional year for a PD or Professional Doctorate in Acupuncture and a minimum of two additional years for a DAOM, Doctor of Acupuncture and Oriental Medicine). They are trained in both Eastern and Western medicine with a great emphasis on acupuncture, herbology, nutrition, gentle manipulation, and natural medicine – they’re taught to assess the body as a whole to “balance and harmonize” it back to “healthy patterns”.
Training for Dry Needling is typically 80-200 hours in addition to the PT, MD, or Chiropractic degree and is solely focused on the non-differentiated points on an area where the pain is felt (regardless of where it emanates from or other contributory factors).
Dry needling is solely focused on a new (1983 Janet Travell) set of simple principles wherein needles (larger than the average acupuncture needle) are inserted into tight and painful muscles and thrusted (in and out in rapid succession) to relieve the tension and pain in the area. Treatments are typically minutes or shorter. Ms. Travell , said to be the author of dry needling’s introductive book if not the founder of the treatment never used acupuncture needles as she considered them too thin to be effective.
The whole body approach of Eastern Medicine, the knowledge of the specific point locations, the contribution of the acupuncture meridians to the whole functioning of the body, the knowledge of the ideal depth, angle, and length/specific and optimum manipulation of the needles for the intended goals, and the advantage of knowledge of certain point combinations along with the “ashi” or trigger points are just some of the vast differences between the two definitions that are crucial for understanding when to utilize which approach. In Acupuncturist’s clinic, for instance, if a patient’s low back is chronically giving way to misalignment and ensuing pain – then, they will:
1) assess the local area, the spine, and the entire meridian (as well as dermatome and muscle groups involved) that may have been affected or even that caused the malady and all “blockages” will likely need to be removed in order for complete and permanent healing to take place and then, secondly,
2) any possible weakness from an underlying condition such as “Kidney Qi Deficiency” (a lowered / hampered function of the kidney from stress to serious disease) may be found to be the cause or contributing factor to the weakness in the surrounding muscles and without boosting the kidney function, the low back pain may not be able to resolve completely or at all. So you can glean from this already that chronic pain will need the bigger picture approach of acupuncture versus an acute pain situation.
Western medicines variations on Ms. Travell’s method, over the past 30 years, leaning into incorporating a bit more of the proven standard of acupuncture seems to be on the rise, especially with the development of the American Academy of Medical Acupuncture or AAMA (thousands of M.D.s and D.O.s united in learning more about Traditional Chinese Acupuncture and how it may be applied today along with Western Medicine. Many of its members are L.Ac. and Western trained Physicians who have also obtained the MSAOM. Its annual symposium consists of presenters who are often not M.D. nor D.O. in background, but, solely Lic. Ac, MSAOM and DAOM degree holders and East/West purviews are shared).
What else is different? Most practitioners of dry needling (solely) consider that to effectively relax the muscles they must use a 22-24 or 25 gauge hypodermic needle and do so in treatments. An acupuncture needle is typically about ¼ that size at 0.159 – 0.200 mm vs. 0.566 to 0.718 mm. As mentioned earlier, the treatment may only last a minute or two. The abrupt fasiculation of such a thick needle may hurt quite a bit, but, it is over with quickly.
Additionally, Traditional Chinese medicine’s Acupuncture commits to the practice of retaining needles for approximately 25-35 minutes and research shows that in doing so, the treatment outcome, without painful/extreme and rapid thrusting is superior . (https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.1781). It is clear to anyone having practiced acupuncture or who has received acupuncture that the release of the muscle does indeed happen, sometimes in a profound way, generally within minutes of a fairly gentle insertion of the need and that retention of the needle improves said sensation over approximately the following 20 – 40 minutes. As far as other measurable outcomes of e.g. organ stimulation, finely measured studies have shown (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336992/)
Which is better? This author, in various settings, has been asked to perform both. The speed at which dry needling can be completed lends itself as the obvious choice for certain purposes. It’s the smarter selection in a variety of circumstances such as
Dry Needling is better when Time is Limited:
- Battlefield / triage environments where it’s necessary to get soldiers back on the battlefield rapidly.
- Professional athletes, when in serious pain, need to be back in the game within minutes or when swimmers, for instance, are in the midst of several ‘heats’ and need rapid attention just to the overused muscles of that day.
- And it may be sufficient if an injury is small and Acute
It is recommended in all other instances that acupuncture be employed and that when time permits, the proven, overall balancing advantages of whole body acupuncture be applied for complete healing, restoration, and for the wisdom of future prevention of injury.
Acupuncture is the good choice when time permits, especially for:
- The word Chronic (more than 90 days) is used to describe pain
- When more than one area of the body is in need of pain relief
- When anything internal is in existance at the same time as pain that is appearing to be Musculo-skeletal
- When pain is from cranial, neuro-based, stroke-induced or otherwise not from a simple recent injury
The following is a very partial list of proven benefits of acupuncture (benefits of dry needling are generally touted from acupuncture studies, but, should not be confused with studies utilizing acupuncture needles, retained needles, points chosen using principles of Eastern Medicine/acupuncture, and the like, which the following have been)
The World Health Organization endorses acupuncture, and clinical studies have shown it to be a beneficial treatment for many conditions, including:
- Chronic pain: migraines, neck and back pain, tendonitis, sciatica, carpal tunnel syndrome, fibromyalgia and rheumatoid arthritis
- Digestive disorders: irritable bowel syndrome, colitis, gastritis and constipation
- Urinary and reproductive disorders: menstrual cramps, irregular or heavy periods, infertility and menopausal symptoms
- Psychological and emotional disorders: depression, anxiety, stress and insomnia
- Symptom management for the negative side effects of chemotherapy and radiation, including fatigue, generalized pain, dry mouth, peripheral neuropathy, nausea and vomiting
- Seasonal allergies
- High blood pressure
- Addictions to nicotine, alcohol and drugs
- Overweight or obesity, when coupled with diet and exercise