dry-needling

What’s the difference between dry-needling and acupuncture? It depends who you ask. Someone who thinks they are different may say that acupuncture is part of the Chinese Medicine paradigm of diagnosis and treatment, and involves putting needles into traditional point locations arranged as channels; wheras dry-needling is part of a western paradigm of treating muscles and tendons. But it’s not that simple, and a closer look shows that what some people call dry-needling is really acupuncture.

The western techniques of trigger point therapy started by injecting local anaesthetic, corticosteroid, or saline. But using just the syringe needle was found to work just as well. So this was called dry-needling as no fluid was injected. At some point a bright spark must have suggested using acupuncture needles rather than a syringe needle.

Trigger point therapy finds a tight, fibrous knot of muscle or a spot that causes referred pain and tries to release it. Dry needling is one way to attempt that release. But there’s nothing new here, or anything specifically western or scientific. What dry-needlers call a trigger point, we call an Ashi point, and this method has been part of our repertoire since the 6^th century.¹ Not surprisingly, the places where trigger points or ashi points are found often correspond with traditional point locations.² And when we diagnose and treat musculo-skeletal conditions we often don’t use the channels that Qi flows through (jingmai 經脈), as these are more useful for systemic conditions, but instead we think of the musculo-tendinous or sinew channels (jinmai 筋脈/ jingjin 經筋) that are conceptually similar to the anatomy chains or fascial slings that western physical therapists now use. So not only is the technique of dry-needling part of traditional acupuncture, so is a similar model that is used to decide where to put the needles.

Some dry-needlers claim that what they do is scientific and proven, while acupuncture is unscientific and woo-woo. But acupuncture at least has a model of how it works, while dry-needling has at best some dubious proposed mechanisms of action. A quick glance at physiopedia shows that there is very limited evidence for the effectiveness of dry-needling, and that it is far from ‘proven’.

Of course there is more to Chinese acupuncture than just dry-needling and it may be that sometimes a condition is treated best by other methods, such as using the theory of channels and traditional point locations.

Acupuncture is a western word from the 17^th century that describes using a needle to pierce the skin, which is its literal meaning (L. acus – needle). The word was first used to describe Chinese acupuncture because at the time there was no western acupuncture, so this association is circumstantial. Even if acupuncture is done without using a traditional Chinese paradigm it’s still piercing the skin with a needle, which is acupuncture. On the other hand the Chinese call it needling. The word that is translated as the action of doing acupuncture is ci 刺, to needle. The word for the modality that we call acupuncture is zhen ci 针刺, which means needle therapy. Sometimes the character for a needle 针 is translated as acupuncture.*

So dry-needling is just a type of acupuncture, which the Chinese call needling, and there is a similar process of diagnosis and treatment in Chinese acupuncture.

So why do people try to make out that they’re different? It’s political. In Australia acupuncture is regulated and so it is illegal for someone to claim to be an Acupuncturist or to do things that suggest being one (holding out), unless they are registered as an a Acupuncturist or endorsed as one.³ Registration as an Acupuncturist requires a qualification that is recognised by the government body that regulates health professionals, AHPRA. Such a qualification requires at least 400 hours of clinical training. So in Australia people who do acupuncture without being qualified call what they do dry-needling. On the one hand acupuncture is regulated in most US states, and in some states such as Oregon a court determined that dry-needling is acupuncture and that it could only be done legally by a qualified, registered acupuncturist. On the other, acupuncture isn’t regulated in New Zealand, so physical therapists just call what they do acupuncture.

In the end it doesn’t matter what it is called, but how well trained the person doing it is. Acupuncture is regulated not because it is associated with a traditional system of diagnosis and treatment but because it may be dangerous when performed by someone who is not properly trained. All therapists must ask a client if they can do acupuncture or dry-needling in order to obtain informed consent. When someone who isn’t an acupuncturist asks you this, find out how much training they have. Some physical therapists are well trained as part of their professional qualification, others aren’t, and often have only done a weekend course in dry-needling. If a person is a registered Acupuncturist you may be assured that they are properly trained.

*Another word that is often translated as acupuncture, zhen jiu 针灸, literally means needling and moxibustion.