When most people hear the term “acupuncture” they think of needles being inserted into the skin. The term dry needling is often brought up for people suffering from pain as well and it also includes needles being inserted into the skin. Let’s take a deep dive into both.
Dry Needling vs. Acupuncture: Understanding the Differences with Respect
Dry needling is a technique that, in recent years, has been adopted by some non-acupuncture practitioners, such as physical therapists and medical doctors, in certain states. However, in California, athletic trainers and physical therapists are not legally allowed to perform dry needling. This method involves inserting thin, filiform needles—also known as acupuncture needles—into myofascial trigger points, commonly referred to as “knots,” to alleviate pain and improve muscle function.
One of the early pioneers of trigger point needling, Dr. Janet Travell, initially used hypodermic needles with injectate before experimenting with the technique without injectate, hence the term “dry needling.” When sports acupuncturist Whitfield Reaves studied with Dr. Travell, she acknowledged that the same results could be achieved with acupuncture needles. Over time, biomedical anatomical and neurophysiological principles have increasingly recognized the value of this technique for musculoskeletal pain and movement disorders.
The Rise of Dry Needling
Dry needling has gained traction within the medical community for its effectiveness in treating musculoskeletal pain. Research supports its benefits; a 2013 systematic review published in the Journal of Orthopaedic & Sports Physical Therapy found that dry needling can significantly reduce pain and improve function in patients with myofascial pain syndrome. Similarly, a 2017 study in the Journal of Manual & Manipulative Therapy reported that 85% of patients experienced pain relief after just one session of dry needling.
Acupuncture: Biohacking the Muscluloskeletal and Nervous System since 200 bce
Acupuncture, a cornerstone of Traditional Chinese Medicine (TCM), has been practiced for over 2,500 years, has also gained traction within the medical community for its effectiveness in treating musculoskeletal pain. Acupuncture incorporates a holistic understanding of health, integrating neuromyofascial relationships, movement patterns, and even emotional components. Interestingly, many trigger points locations correspond to traditional acupuncture points, careful palpation is key to determining correct needle placement and depth.
Acupuncture has been extensively studied and is recognized by the World Health Organization (WHO) as an effective treatment for various conditions, including chronic pain. A 2012 meta-analysis published in JAMA Internal Medicine concluded that acupuncture is more effective than no treatment or usual care for chronic pain, with about 50% of patients experiencing significant relief. A 2018 study in the Journal of Pain found that acupuncture could reduce the intensity of chronic pain by up to 30%.
Key Differences in Philosophy, Technique, and Training
While both dry needling and acupuncture involve the insertion of needles, their foundational philosophies and training requirements differ significantly.
Treatment Approach
Dry Needling and Acupuncture: Both target trigger points within muscles to release tension, improve blood flow, and reduce pain.
Acupuncture: Acupuncturists view trigger points as part of a broader system of correspondences. TCM has long understood the interdependence of movement patterns, bio-psycho-social influences on health, and holistic diagnostics. Practitioners assess both global and local patterns of dysfunction to address the root cause of pain.
Needle Technique
Dry Needling and Acupuncture: When needling a trigger point, dry needling practitioners are trained to elicit a local twitch response by pistoning a needle in and out. In TCM, this is referred to as “daqi” or the “arrival of qi.”
Acupuncture: Pistoning is one technique that acupuncturists learn, and a twitch response is one version of “daqi” that acupuncturists are trained to observe. In addition to a local treatment of a trigger point, an acupuncture treatment may also include distal points that enhance the therapeutic effect.
liotibial band syndrome is a great example: A practitioner trained in dry-needling will likely put a needle in the tight TFL muscle, or a tight vastus lateralus muscle, piston the needle and elicit twitch responses. An acupuncturist treating a tight IT band might also treat the trigger points, but will also assess muscle inhibition above or below the affected area, treat the motor point of an inhibited gluteal muscle, and use additional distal points on the gallbladder channel (e.g., GB 34 and GB 40) to influence motor control and movement patterns. Perhaps will also take into consideration chronicity and pain level and add “shu stream points on the corresponding channels.” Additionally, TCM considers emotional and psychological influences as underlying contributors to the condition, acupuncture points to up-regulate the parasympathetic nervous system may be added to the treatment.
Training and Certification
Dry Needling: Practitioners are typically physical therapists who complete additional training in dry needling. Certification requirements vary by state and organization. Some programs are extensive, while others require only a weekend workshop. That said, many skilled practitioners within the physical therapy field provide skilled and effective care.
Acupuncture: Acupuncturists undergo extensive training, typically requiring over 3,000 hours of study in acupuncture and TCM, including clinical practice. This education includes needling techniques, diagnostics, and an understanding of complex treatment strategies beyond musculoskeletal pain.
Why Two Different Terms?
The distinction between dry needling and acupuncture comes down to training and billing regulations. In some states, non-acupuncturists can take additional training to learn needling techniques, often utilizing a pistoning method with no needle retention and bill for the service provided. Acupuncturists learn dry needling techniques as part of a much broader education that integrates multiple diagnostic and treatment approaches.
Both professions have highly skilled providers, and it’s essential to understand their respective backgrounds when choosing a practitioner. We encourage patients to ask about their provider’s training and areas of expertise. The choice between dry needling and acupuncture ultimately depends on personal preferences, health goals, and the approach that resonates most with you.
As you explore your options for pain relief and wellness, consider: What approach aligns best with your needs?
