By Dr. Matthew Fellner, DACM, L.Ac.
Recently a colleague asked me if I do dry needling and proceeded to insist that dry needling is different somehow from Acupuncture. I tried my best to educate her that dry needling is actually a type of acupuncture that is performed by people who have very little training in the proper techniques of needle manipulation. I’m not sure if I came across as informative or snooty, but it made me want to write a little more about how to accurately assess what dry needling is, and how it is similar and different from traditional acupuncture. This is important because more physical therapists and chiropractors are being trained to do dry needling, and the public is receiving very little viable information that could help them make the most informed healthcare decisions.
Physio-pedia.com defines dry needling as such…Trigger-point dry needling is an invasive procedure where a fine needle or acupuncture needle is inserted into the skin and muscle. It is aimed at myofascial trigger points (MTrP) which are hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band. Trigger point dry needling can be carried out at superficial or deep tissue level.
The NJ department of Consumer affairs defines acupuncture as… the practice of Oriental medicine based on traditional Oriental medical theories, including stimulation of a certain point or points on or near the surface of the body by the insertion of special needles to prevent or modify the perception of pain or to normalize physiological functions including pain control and for the treatment of diseases or dysfunctions of the body.
As you can see the definitions are essentially the same, except that dry needling is much more specific, and acupuncture is broader and includes the principles of “Oriental” medicine. So even though they may appear different, dry needling is a more specified type of acupuncture. The method of achieving the therapeutic result is exactly the same. Acupuncturists learn various methods of treatment including dry needling, trigger point needling, myofascial release, etc. Additionally, dry needling is performed using the exact same needles that acupuncturists use. The difference of using traditional Oriental medicine theory is a very crucial piece of why dry needling alone can be very dangerous if a practitioner is not well versed in the deeply rooted principles of the traditional medicine. PT’s and chiropractors always point out that they have a significant amount of training in anatomy and physiology, which is 100% true. However, they often receive certification to perform dry needling after a weekend course. Acupuncturists are required to have 2500 hours of training in NJ. Without going into an entire lecture on the nuances of traditional Chinese medicine, it is worth noting that a significant part of an acupuncturists training revolves around understanding the myriad ways that a patient presents clinically. This includes considering things like overall constitution, strength, and physical viability. Not all illnesses and diseases present the same way, not all patients respond the same way, and certainly, not every treatment should be the same. Unfortunately, when dry needling is performed, it is done with the mindset of 1 size fits all. Every patient receives the same type of needling regardless of age, overall health, and constitution. This can make for outcomes that don’t achieve results, or worse, may exacerbate the condition. Dry needling tends to be very aggressive in nature and well suited for younger, healthier, athletic body types. But what about if a 75 year old woman has the same injury? What if she has a history of anemia and low blood pressure? These are considerations that would drastically change the needling strategy for an acupuncturist. That is part of the reason why we ask so many questions, and feel the pulse, and look at the tongue. All of those diagnostic methods that are part of the principles of traditional Chinese Medicine, which the PT’s & chiros consider unnecessary and different from dry needling, actually are crucial to establishing the proper type of treatment.
Even as a well-trained acupuncturist, I have made mistakes in the past. In my first year in practice I was treating a woman in her mid 40’s who had a history of migraine headaches. She also had chronically low blood pressure. She had a lot of stress and anxiety and tended to carry it in her neck and shoulders. I decided to do “dry needling” which was basically trigger points along the upper trapezius(both acupuncture[GB21] and dry needling[Spinal Accessory H3] use the exact same point in this area). The treatment must have been too aggressive because she didn’t come back for another treatment. When I called her, she said that the needling I did caused a severe migraine and she didn’t want to do it again. Well, I certainly learned my lesson. For her constitution and history, an aggressive form of needling was absolutely contraindicated. And now 16 years later, I am much more sharply attuned to what each patient needs.
Now every time I question a practitioner who uses dry needling, I always ask what situations would be inappropriate to use the more aggressive method. And not surprisingly, very few can answer in a way that shows any depth of knowledge or grasp of subtle differences in patient presentation. So, consider that the next time you are deciding where to get your acupuncture. A properly trained acupuncturist is significantly more skilled in both needling technique and the understanding of the situations that warrant the use of dry needling versus traditional acupuncture.