BY: JESSICA M. CLAYTON, D.AC., L.AC. – DECEMBER 3, 2019 – ACUPUCNTURE
The topic of Dry Needling has been discussed a lot in my treatment room recently. It has been an ongoing controversial issue between acupuncturists and physical therapists since I began acupuncture school. Besides the scope of practice argument that has been made through the modalities, the most important issue in my opinion is patient care, well-being and safety. I have had a surprising number of patients receive dry needling treatments from their physical therapists, massage therapists or chiropractors all returning to me reporting negative effects. Patients have stated that their experience with dry needling was very painful during the procedure and even experiencing more pain after the procedure or new symptoms arising around where the needling happened. I have remained relatively neutral on the topic when patients or friends have asked my thoughts in the past but after my patients experiences and delving a little deeper into the topic, I thought that it was necessary to write a blog addressing the concerns.
Most providers that offer dry needling claim that they are not performing acupuncture. This is misguided and inaccurate. Although acupuncture has been around for thousands of years, a lot of people – other health professionals included – are unaware how multifaceted it is. Acupuncture has many benefits, different styles and needling techniques to offer – dry needling being among them. Dry needling is a form of acupuncture and the distinction between the two comes largely in the name only.
To give a little more background; dry needling is a term that was popularized in the West by Janet Travell, MD. The term was created in order to distinguish it from ‘wet needling’ which referred to hypodermic injections. Dry needling was originally a hypodermic needle on an empty syringe inserted into the body without an injection. The meaning has now expanded to include monofilament, also known as filiform needles which are the needles that are traditionally used in acupuncture.
The current definition of dry needling is “a skilled technique by a physical therapist using filiform needles to penetrate the skin and/or underlying tissues to affect change in the body structures and functions of the evaluation and management of neuro-musculoskeletal conditions, pain, movement impairments and disability.” It is interesting to note that the definition of modern acupuncture when treating musculoskeletal disorders would be the exact same if ‘acupuncture’ were to replace ‘dry needling’ and ‘acupuncturist’ replaced ‘physical therapist.’ Acupuncturists use filiform needles to treat each of these conditions on a daily basis.
As I have done some research on the topic of dry needling there are three main claims that have been made to support the argument that dry needling is not a form of acupuncture. These claims are easily disproven from an acupuncturist’s perspective. They include:
* Claim #1: The areas of the body to be needled when using dry needling are myofascial trigger points and these are not acupuncture points:
Acupuncture points have been shown to be the same as the modern understanding of trigger and motor points. An early recognition of acupuncture dating back to the 7th Century (at least), involves using acupuncture and needling a local tender spot of a muscular type that may not be found or related to established acupuncture channels. This method is known as ‘ashi’ and the tender spots found by this method are known as ‘ashi points.’ Ashi points react to local pressure and create either a local or radiating pain which may or may not correspond to the channel based acupuncture point. A world-renowned pioneer in the field of pain research, Ronald Melzack, Ph.D., has identified a correlation between trigger points and the Chinese Medicine terminology and theory of ashi points. In 1977, he reported that, “trigger points and acupuncture points for pain [i.e. ashi points], though discovered independently, and labeled differently, represent the same phenomenon and can be explained in terms of the same neural mechanism” (Melzack, 1977). In 2008, it was found that of the 255 ‘common trigger points,’ 238 correspond anatomically to established, classical, channel based acupuncture points. This is a 93.3% degree of concordance (Dorsher, 2008). The points themselves are not the only attributes of Chinese Medicine to coincide with the trigger points of dry needling. Scientific evidence shows that fascia, fascial planes and myofascial pathways align with the channels or meridians of acupuncture. Fascia looks like sheets or bands and is the connective tissue that connects the muscles to each other and to other body structures. The myofascia is the connective tissue between muscles. In 2002, it was found that there is an 80% correspondence between the trajectories of acupuncture channels or meridians and the myofascial tissue planes. This relationship was hypothesized to be connected to the therapeutic benefits of acupuncture (Langevin, 2002). And finally, the Journal of Pain in 2009 published a study that showed when all 12 of the acupuncture meridians were compared to the anatomical corresponding trigger point regions, the referred pain patterns accurately highlighted the corresponding acupuncture meridians, particularly in the extremities (Dorsher, 2009).
* Claim #2: Dry Needling is new and therefore not Acupuncture:
Here’s the thing – acupuncture has been around for over 2,000 years and throughout the years has kept a lot of the terminology and language used from the Classics. Regardless of the conceptual language used, several of the traditional techniques and methods of acupuncture closely if not completely resemble dry needling approaches used today. These traditional methods and techniques are still being taught in modern acupuncture curriculums and continuing education courses for acupuncturists. The fundamental needling technique that is used in dry needling in order to receive a response is known as the ‘trigger point muscle twitch’ is identical to the most common acupuncture techniques that were first mentioned in the Chinese classics and have been used for centuries. The acupuncture needle manipulation techniques are known as the lifting and thrusting technique and the twirling technique. These are still the same basic techniques being taught in most forms of acupuncture, including dry needling. Another technique that is used in dry needling is known as the ‘trigger point method.’ This is when the needle is manipulated to surround an area being treated in a cone-like fashion. An acupuncture technique known as ‘surrounding or circling the dragon or wei ci’ technique is basically identical and is highlighted in The Yellow Emperor’s Inner Classic of Medicine – Huang Di Nei Jing – written 2,000 years ago. This technique is used to treat painful muscles, scars and muscles spasms known as Bi Syndrome just as it is still used today. Moving past the similarities in technique and needle manipulations, the response that physical therapists, massage therapists or chiropractors are looking for when using trigger point dry needling is a muscle fasciculation or twitch. This is an identical response that Chinese Medicine practitioners are looking for when needling known in Chinese literature as De Qi or the arrival of qi. This is described as the same twitch response that is achieved from trigger and motor point needling, as occurs in dry needling, and has been recognized and accepted as part of acupuncture for centuries. It is associated with a successful, appropriate response to acupuncture treatment. As shown, neither the area nor the technique of dry needling is new. Dry needling is a form of acupuncture.
* Claim #3: Dry Needling does not needle into specific acupuncture points and does not try to move energy. Because the intent of the invasive procedure is different, the procedure in and of itself is different:
Modalities that use dry needling other than acupuncturists maintain that trigger point dry needling does not have any similarities to acupuncture other than using the same tool. It would seem that these proponents are re-defining or unaware of the myriad of styles and techniques that acupuncture has to offer because they are de-emphasizing or excluding the use of ashi points that we have discussed above. It has been said that dry needling is different because it is based in Western anatomy. This argument fails to recognize that acupuncture schools teach both ‘western’ neurophysiology and anatomy concepts as well as ‘traditional’ meridian concepts – this means that acupuncturists are highly trained within both fields of medicine. Chinese Medicine utilizes neurophysiological principles and there is not a distinction between eastern and western acupuncture. A very important point to highlight here is that licensed acupuncturists typically receive AT LEAST 3,000 hours of education on needling, technique, etc. including hands on clinical hours. Dry needling courses currently being offered are only 55-116 hours total depending on the course. This is basically a few weekends crash course that is allowing other modalities to use needles on patients without specific training which I believe becomes a safety concern for the patients receiving trigger point dry needling from anyone other than an acupuncturist. Physical therapists and other modalities that are using dry needling are using acupuncture studies in order to support their dry needling claims. This is not only ethically questionable but it can be highly problematic they are using studies that highlight the therapeutic effects of acupuncture yet claiming that dry needling is not acupuncture when in fact it is.
Overall, acupuncture is a complex, multi-branched, dynamic therapeutic modality that consists of many different styles and types. Arguments stating that acupuncture is limited to a 2,000 year old paradigm and an antiquated understanding of specific acupuncture channels are inaccurate. Statements that the targeted areas of dry needling, trigger and motor points, are not acupuncture points are also untrue. Claims that dry needling is a new distinct therapy completely different from acupuncture are wildly false. It has been shown through research, classical documentation and hands on clinical experience that the needle manipulation and responses that are understood in dry needling have been used for centuries in acupuncture and Chinese Medicine. Acupuncture uses a wide range of interventions, therapies and theories including dry needling.
If you are interested in exploring the different options that acupuncture has to offer including dry needling, please seek out a licensed acupuncturist and stick to your physical therapist, massage therapist and chiropractor for the techniques that they have specialized training in within their areas of expertise.
Dorsher, PT, Fleckenstein J. Trigger Points and Classical Acupuncture Points, Part 1: Qualitative and Quantitate Anatomic Correspondences. German Journal of Acupuncture and Related Techniques 2008;51(3): 15-24.
Langevin, HM, Yangdow, JA. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record. 2002:257-265.
McIntyre, A. Dry Needling is Acupuncture, but Acupuncture is not Dry Needling. Washington East Asian Medicine Association. 2016.
Melzack, R, Stillwell, DM, Fox, EJ. Trigger Points and Acupuncture Points for Pain: Correlations and 5 Implications. Pain. 1977;3(1):3-23.