The difference between dry needling and acupuncture

Sometimes I am asked about the difference between acupuncture and dry needling, and the answer involves some interesting history and several important differences. I hope this article will give you enough information to make an informed decision about which treatment option to choose if you ever find yourself needing to make the choice. 

History and background of dry needling

If there is dry needling, is there such a thing as wet needling?
Yes, and it was an important step towards the development of dry needling.

In the 60’s two medical doctors, Dr. Janet Travell (who was the rheumatologist of President John F. Kennedy) and Dr. David G. Simons, were studying pain and developing the theory of trigger points and how those create pain. Their work included identifying where in muscle tissue trigger points usually develop and the pattern of pain they would refer into other areas of the body.  

Wet Needling: Not only did they come up with the conceptual framework which still offers one of the predominant theories of pain, they were also trying to figure out how to treat this type of pain. Their treatment method was to inject saline, corticosteroids, and analgesics, into the trigger points and they found that this was an effective way to lessen pain. This was WET needling.

Dry Needling: By the late 70’s a Czech physician, Dr. Karel Lewit, started doing research into needling trigger points without the use of injectable substances. His work emphasized that it was the needling effect itself that produced results and that this effect was distinct from that of the injected substances used in “wet” needling. And that’s where the term DRY needling came from. 

Modern application of an ancient technique

Dry needling is a very effective treatment for muscular pain and is the equivalent of an ancient technique used in Chinese Medicine in which ‘ashi’ points are needled to reduce pain. ‘Ashi’ points are points outside the 360+ classically defined acupuncture points and are tender areas that are identified by palpation, and which under current theories would be called trigger points.

Because treating tender areas with needles, is so effective, it was quickly adopted by osteopaths, chiropractors, and physical therapists as one of the tools they use to treat pain. And while dry needling is very similar to the ancient practice of needling ‘ashi’ points, there are several significant differences between acupuncture and dry needling.   

Difference in training

When it comes to how to treat pain with needles, the biggest difference between an acupuncturist and a practitioner using dry needling, is in the level of training.

A very cursory Google search will bring up weekend training programs for dry needling for physical therapists or chiropractors during which participants get about 27 hours of basic training in needling. These weekend workshops promise participants that they will be able to apply their new skill when they return to their offices on Monday morning. While a physical therapist or chiropractor comes into these workshops with an in-depth knowledge of anatomy, I still find it disconcerting to know how little practical experience they have in terms of sticking needles into their patients when they start applying this technique.

In contrast, an acupuncturist with a master’s degree in Traditional Chinese Medicine will have completed 2800+ hours of training, of which over 1400 hours are specifically acupuncture training. This includes learning the anatomical location of each point, how to needle each point with specific instructions on angle and depth of needling, and the function of each point.
Included in those 1400 hours of acupuncture-specific training, are close to 800 hours of supervised practical experience, which involves actually sticking needles into people while under the supervision of a licensed and experienced acupuncturist.

Why so much training?

Complete medical system vs. a treatment modality

Licensed acupuncturists practice a complete system of medicine, of which treating pain is only one component. Dry needling on the other hand should be considered one modality in a practitioner’s tool kit for treating pain. In a sense you could say that all acupuncture is dry needling but not all dry needling is acupuncture.

The scope of what an acupuncturist treats is much broader than what can be done with dry needling, and pain is only one of the many things an acupuncturist can treat. A licensed acupuncturist is trained to address many diseases and their work will include a complete medical history to evaluate imbalances in the body that create symptoms. On the other hand, when you receive dry needling, you are only being treated for pain. 

Difference in needling style produces different physical effects

Another important difference between acupuncture and dry needling are in how treatments are given.

Dry needling is a technique that usually involves a lot of twisting and thrusting of the needle once it is inserted into the tissue. The practitioner is often looking for the muscle to twitch in response to the needling and, as far as I understand, the goal is to fatigue the muscle so that it releases. The technique can be quite uncomfortable and can cause pain because of the strong stimulation.

While this is also a needling style that has been used for centuries in Traditional Chinese Medicine to treat painful ‘ashi’ points, I believe that when an acupuncturist performs this technique it is safer since they have studied the correct depth and angle of insertion of the needle to avoid doing damage to nerves and blood vessels in the area.

When receiving acupuncture – especially when it is not for treating pain, and especially if you are receiving treatment in the United States – there might not be much stimulation of the needle at all. Usually, needles are placed and then the patient is left to rests. This has a profound effect on settling the nervous system and supporting it to shift from a sympathetic dominance into parasympathetic dominance, which is essential for healing to occur.

To be fair, even when seeing an acupuncturist, they might employ a more intense style of needling to treat ‘ashi’ points, but you will still get the benefit of having needles retained for some time so that both the nervous system and muscles can start unwinding and softening.

In closing, my biggest concern about dry needling is that practitioners are often able to use this treatment tool with very little training. The incidents of injury from dry needling vs. from acupuncture is quite high since their short training period likely does not include much specific instruction on depth and angle of needling. When combined with a fairly rigorous and strong style of stimulating the needles, there is higher danger of damaging nerve or blood vessels that support the muscle being treated. Also, if you do have other health issues besides pain, then an acupuncturist who is trained in a complete medical system, can provide much more holistic support.