Is Dry Needling the Same as Acupuncture?

Recently acupuncturists in Washington State stopped physical therapists from adding dry needling to their scope of practice. Why are physical therapists—and, in some states, chiropractors—so adamant about putting needles in their patients? Quite frankly, because it works. That is to say, acupuncture works. This article will challenge your beliefs about dry needling and shed light on why it is a controversial subject.

What is dry needling?

How did dry needling get its name? Why not use wet needling or puncture point needling?

Dry needling has its origins in acupuncture. In 1938, John Kellgren, a professor at Manchester (UK) University, applied acupuncture concepts to illicit a muscle twitch response in tender points along the body. He found that by pressing on these trigger points and injecting analgesic with a hypodermic needle (wet needling), a patient’s pain could be reduced. Over time, practitioners found that the pain relief was not from the injection of analgesic but actually from the needle itself. As a result, the term for the treatment changed to dry needling, that is, using needles without a substance in the syringe (Physio, 2013). You read that correctly: dry needling originated with the use of hypodermic needles. Talk about painful! A pivotal paper published in 1941 suggested that needling without injection of a substance could be just as effective as needling with an analgesic to relieve pain. This paper was one of the first to make this claim and was the basis for the research that followed. Interestingly, the authors of the article stated that the origins of injection treatment for pain “dates back to the earliest descriptions of acupuncture” (as cited in Legge, n.d.).

For 40 painful years, hypodermic needles were utilized in treatment. Then in the 1970s, dry needling gained favor throughout Europe when acupuncture needles became the standard instrument for performing the technique because they were less painful than hypodermic needles and caused less bruising. Then in 1998, Myofascial Pain and Dysfunction: The Trigger Point Manual, a book by Janet G. Travell, MD, introduced dry needling in the US. Interestingly, Dr. Travell advocated for using hypodermic needles rather than acupuncture needles as they were bigger and “more effective.” Those who practice dry needling today use acupuncture needles.

What is the difference between dry needling and acupuncture?

How does dry needling differ from acupuncture? Both acupuncture and dry needling are techniques for decreasing pain, but they are not interchangeable. It’s like trying to use a car to haul dirt: you can pour all the dirt you want into a car, but it will not be as effective as hauling dirt in a truck. The way you use something does not necessarily define its best purpose.

Difference in technique. With dry needling, the practitioner places needles into trigger points at greater needle depth and thrusts or manipulates them to elicit a local trigger response. Trigger points are hyperirritable spots along muscle that, when pressed, create pain or tenderness. Trigger point dry needling inserts solid needles into those trigger points to elicit a twitch response, thus activating a series of reactions that reduce pain. Acupuncture practitioners, on the other hand, insert needles to a specific depth, depending on the area being needled, and manipulate gently until the patient feels something like a dull ache, a sensation acupuncturists call “deqi” (Brady, 2014). Interestingly, acupuncturists also use this trigger point technique; the areas along muscles that are tender are called “ashi” points and are typically needled to help decrease pain.

Difference in training. The area where much of the controversy lies is in the training. Acupuncturists could be considered needle specialists, due to the extent of their training. Acupuncturists are board-certified and have completed a master’s or doctorate level of training in the use of needles. Acupuncturists have between 1,350 and 2,500 hours or more of training at an accredited university, and 600 hours of those hours consist of clinical training. Before ever practicing on a patient, acupuncture students spend three or four quarters learning needle safety and technique, and observing upper-level graduate students. This training equates to about six quarters of a master’s degree education just to learn how to properly use needles. In addition, in order to become nationally certified, acupuncturists must graduate from an accredited university, pass a series of board exams, and pass an eight-hour clean needle technique exam. Only after meeting these requirements can an acupuncturist become a licensed provider and begin practice (https://www.ccaom.org/needle_faq.asp, n.d.).

Compare this rigorous training to the requirements for physical therapists and chiropractors who use needles in their practice. Continuing education classes are the only training required. That means the use of needles and how to safely use them is not required to become a physical therapist. In fact, some states allow physical therapists and chiropractors to take a weekend continuing education class on dry needling. If a state allows it, the practitioner is able to use dry needling on patients right away. One of the popular continuing education courses in dry needling for physical therapists offers a 27-hour introductory level training. At the end, the participant gets a certificate and can practice dry needling on their patients. Would you rather go to an acupuncturist who is trained for 600 hours in the practice of safe needling or one who simply took a 27-hour continuing education class?

The real issue is terminology and patient safety

Physical therapists claim that dry needling is not acupuncture. In professional papers, though, they use “acupuncture” when arguing in favor of dry needling and change terms when referring to needling techniques in their practice (Kalichman, 2010; Brady, 2014).

The needles themselves are another subject of debate. Physical therapists claim they are not doing acupuncture because they are not using acupuncture needles. To the contrary, according to the US Food and Drug Administration (FDA), filiform needles (needles used by acupuncturists) are for the sole purpose of performing acupuncture. The FDA addressed the use of filiform needles first in a 2015 report on an injury caused by a chiropractor performing dry needling. The patient suffered a pneumothorax. The FDA stated, “Chiropractors and physical therapists use acupuncture needles to perform a crude form of acupuncture called dry needling.” The FDA further stated, “An acupuncture practice act exists to maintain the highest credentials and skills needed to use acupuncture needles as regulated by the FDA. . . . This practice act is being bypassed by physical therapists and chiropractors with training that may be as little as 54 hours . . . in a continuing education course. . .” (FDA, MAUDE Adverse Event Report, 2016). The FDA also refers to filiform needles in the Code of Federal Regulations. Section 880.5580 of the code labels the filiform needle as a Class II medical device “intended to pierce the skin in the practice of acupuncture” (FDA, Title 21, Code of Federal Regulations, 2015).

Bottom line

Acupuncture has been around for thousands of years. It is defined by tradition and a clearly established set of principles. Dry needling is a relatively new term that has origins in and uses concepts similar to acupuncture, such as “ashi” and “trigger points.” Dry needling also uses filiform needles. Acupuncture spans thousands of years, is used around the world, and is widely accepted as an effective treatment for more than just pain. It has been approved as effective therapy for many conditions by several leading health organizations, including the National Institutes of Health, the Mayo Clinic, and the National Cancer Institute (Mayo Clinic, 2015).

To more clearly make the point (no pun intended), dry needling is acupuncture, and it should be performed by a licensed acupuncturist. Period. The world needs good physical therapists, and those who are the most skilled usually don’t have time to add dry needling to a physical therapy session. Let’s allow physical therapists to do what they do best, and leave acupuncturists to put needles in people safely and effectively. It’s about quality of care and patient safety.

After all, acupuncturists are needle specialists, and acupuncture works.

About the author:

Dr. Ellie Heintze, ND, LAc is a licensed naturopathic doctor and acupuncturist practicing in Seattle, WA. She specializes in migraine treatment and digestive disorders. Her clinic provides people with a starting point to take control of their health and digestion. Visit her website at startingpointacupuncture.com.

Sources:

Brady, S. (2014). Adverse events following trigger point dry needling: A prospective survey of chartered physiotherapists. Journal of Manual and Manipulative Therapy, 22(3), 134-140.

Council of Colleges of Acupuncture and Oriental Medicine. (n.d.) Clean needle technique course: FAQS. (n.d.). Retrieved March 1, 2016, from https://www.ccaom.org

Kalichman, L. (2010). Dry needling in the management of musculoskeletal pain. Journal of the American Board of Family Medicine, 23(5), 640-646.

Legge, D. (n.d.). A history of dry needling. Retrieved March 1, 2016, from www.theneedleeffect.com

Mayo Clinic. (2015, Feb 21). Tests and procedures: Acupuncture. Retrieved March 5, 2016, from www.mayoclinic.org

Physio, S. (2013). History of dry needling. Retrieved March 1, 2016, from www.dryneedlingcourses.com

Travell, J. G., et al. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual. Philadelphia: Lippincott Williams & Wilkins, 1998.

TryAcupuncture.org (n.d.). Olympic freeskier attributes collapsed lung to dry needling. Retrieved March 5, 2016, from https://www.tryacupuncture.org

US Food and Drug Administration (2015). Title 21, Code of Federal Regulations. Retrieved March 2, 2016, from https://www.accessdata.fda.gov

US Food and Drug Administration (2016). MAUDE adverse event report: Acupuncture (filiform) needle acupuncture needle. Retrieved March 2, 2016, from https://www.accessdata.fda.gov

Witt, C. (2009). Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed, 16, 91-97.