Have you heard the buzz about “dry needling” lately? In many parts of the U.S., health care practitioners are offering dry needling to help their patients find relief from pain. Read on to learn more about the differences between dry needling and acupuncture and what this means for you.

What is it?

Dry needling is the practice of inserting an acupuncture needle into a specific area of the body, usually a trigger point. Trigger points are bound areas of muscle fibers, or a knot, that signify pain and potentially other health issues.

While some form of this practice has been around for millennia as part of the acupuncture tradition, it was popularized by medical doctors Janet Travell and David Simons in the 1940s. The treatment was termed “dry needling” to distinguish it from “wet needling” or Trigger Point Injection (TPI) – the first type of trigger point therapy in which local anesthetic, saline, or a corticosteroid was injected into the muscle.

Dry needling uses acupuncture needles while TPI uses a hypodermic needle.

Is it Acupuncture?

Dry needling looks like acupuncture. However, there are two major distinctions patients should be aware of:

1: Dry needling is a localized treatment.

The core difference between acupuncture and dry needling is the system of medicine from which it comes.

Dry needling is primarily grounded in Western perspectives of medicine and health, and specifically the science of endorphin release. Generally, this approach states that when the body’s natural pain-killing chemicals are activated through acupuncture, we feel better. Adjunctive therapies such as exercise, stretching and massage are usually recommended to enhance treatment.

Acupuncture is rooted in East Asian principles of health, and is one of many therapies used to correct imbalances that cause pain. This approach seeks to treat not only the sinews, tendons and muscles, but to balance the organ system, bone health and other elements in the body such as temperature, qi, blood, yin and yang. Adjunctive therapies such as tui na massage, cupping, herbal medicine and diet and lifestyle modifications may be used as part of a complete treatment plan.

Critics of dry needling contend that it is a “watered-down” version of acupuncture. However, there is a second distinction that warrants attention.

2: Dry needling is not well-regulated.

At the time of this writing, the training requirements for dry needling are well below those of acupuncturists. Non-licensed acupuncturists performing dry needling may have as few as 300 hours or a weekend course.

The laws vary state to state. In many states, needle insertion is only within the scope of practice of acupuncturists and medical doctors. In others, practitioners with some training can perform dry needling.

Choosing Dry Needling or Acupuncture

When it comes to the practical decision of choosing one treatment therapy over the other, patients typically have a set of criteria – office location and hours, cost, practitioner experience, and a doctor’s referral, to name a few.

An added recommendation is to run your own verification process: check your practitioner’s education and certifications as well as your state’s recommendations.

Also note that acupuncturists may offer dry needling as the term becomes more mainstream. Regardless, the principles of treating both symptom and cause of pain (also known as branch-root medicine or ben and biao) are practiced by licensed acupuncturists.

While it’s beyond the scope of this article to present a complete overview of every health and wellness provider, we can share the following about acupuncture training and licensure:

  • Acupuncturists complete a minimum of 3,000 hours of theoretical and clinical training, are nationally certified in Clean Needle Technique (CNT) and licensed by their state acupuncture board or equivalent.
  • Though not required of all licensed acupuncturists, many are certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) which works to promote national standards of competency in the practice of acupuncture and Oriental medicine (AOM).
  • Clinical acupuncture training – including point selection, needle insertion, depth, angle and stimulation, as well as contraindications – typically starts within the first six months of study, lasting for the duration of a three to four-year master’s degree program.
  • While degree titles may vary somewhat, licensed acupuncturists hold either a Master of Science in Traditional Chinese Medicine (MSTCM) or a Doctorate in Acupuncture and Oriental Medicine (DAOM). Both degrees are accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), the U.S. Department of Education recognized accrediting agency for the field of acupuncture and Oriental medicine.

Thanks to these requirements, licensed acupuncturists are extremely knowledgeable about the vascular system, nerves and internal organs. They adhere to rigorous guidelines which are practiced and tested over the course of many years, and they use one-time, disposable, sterile acupuncture needles.

Author’s Comments:

Dry needling has come under much scrutiny from the acupuncture community, not simply as an encroachment of scope, but as a concern for public safety and for the potential misrepresentation of the profession in the world of health and wellness.

Cases of pneumothorax (lung collapse) and other complications have risen in recent years. Could this be attributed to the growing practice of dry needling? This is difficult to say, because even research publications are using terms “dry needling” and “acupuncture” interchangeably.

Traumatic Pneumothorax Following Acupuncture: A Case Series, for example, fails to differentiate the two practices. The abstract concludes: “We report three cases of traumatic pneumothorax following acupuncture/dry needling… between 2014 and 2016.”

Regulations

This brings us back to the second distinction: Dry needling is not well-regulated.

State and national regulating bodies are shouldered with the responsibility of ensuring public safety: we hire them to determine the medical and wellness profession’s scope of practice – that is, what health services a practitioner can and cannot perform.

For example, the Maryland Board of Physical Therapy Examiners requires just 80 hours of dry needle training, while The California Business and Professions Code Acupuncture License Act maintains:

…it is unlawful for any person other than a licensed acupuncturist, physician, surgeon, dentist, or podiatrist to practice acupuncture or use any acupuncture technique that involves the application of a needle to the human body.

It’s fair to say that health and wellness practitioners share a common goal of helping patients achieve pain-relief and lasting health.

For this reason, many practitioners hold dual licenses (naturopathy and acupuncture, for example) while others pursue training that goes far beyond the minimum requirement. Others focus 100% on their discipline, such as physical therapy, and have no interest in performing dry needling.

As in Chinese medical theory, the acupuncture and dry needling discussion bears many shades of gray; the goal is to strive for a balanced perspective.

For more information:

Acupuncture Profession Joint-Position Statement on Dry Needling in California (CSOMA, 2018)
NCCAOM® Dry Needling Position Statement
Dry needling versus acupuncture (The American Alliance for Professional Acupuncture Safety, 2016)