For many years now patients have come to my clinic asking me what the difference between Acupuncture and Dry Needling were. In most of these cases my patients have received a form of needling from physiotherapists, chiropractors, and even massage therapists under the banner “Dry Needling” and a smaller percentage under the banner “Acupuncture”.
This post will briefly describe the differences and similarities between these two practices as well as propose some advice to those who wish to receive needling for their conditions. I would also like to ad that as I am an acupuncturist (a classical one at that) of course some bias will leak through my writing. This cannot be helped and what I write here should not be taken as gospel, please research each method and find the one that you think will suit you best.
In addition, there is some difficulty in writing and describing the difference between two medical paradigms. When one may talk about reducing inflammation or inoculating a lesion the other may say creating space in Jing Luo or extracting Bi from the Xue level. Terminology should not determine the efficacy of a method, in the end we are addressing the same body, just through a different lens. Why one method may work over another more than often comes down to the experience and education of the practitioner and not the medicine itself. The same can be said for any medical system.
Dating back to the Han Dynasty (206BCE – 220CE), Acupuncture has been one part of the primary medical system of East-Asia for over 2200 years. Based on the systematic medical theory of Chinese medicine, which primarily revolves around the understanding that human beings are a product of the natural environment around them, Acupuncture is a very complete medical intervention. Having such a rich history Acupuncture has literally thousands of years of clinical cases and empirical evidence to support it’s efficacy. Clinically, Acupuncture has been used for a number of disorders, including musculo-skeletal, gastrointestinal, psychological, gynaecological, respiratory, neurological, dermatological, and so on. So, what is involved in an Acupuncture treatment?
Many components determine whether we can call inserting needles into the body acupuncture, some are:
- The practitioner utilises the Chinese medical paradigm to determine the direction, location, and severity of the illness, particularly an intimate knowledge of the Jing-Luo system.
- From the above, specific palpation methods of pulse, channel and vessel, muscle and other tissues are used in conjunction with observation and specific questioning.
- In depth understanding of anatomy and physiology is a must (as is taught in all approved programs in Australia and most of the world).
- Acupuncture needles, usually called filiform needles, are inserted and manipulated to induce the desired therapeutic effect. Sometimes they are retained and sometimes they are not, depending on the presenting illness. In some styles of acupuncture other needles are used, such as non-insertion, 3 edged, and fire needles.
- More than often Acupuncture is combined with a heat treatment known as Moxabustion (the Chinese name for Acupuncture is zhēn jiǔ 针灸 which means to needle and heat or cauterise).
Acupuncture is also style specific which means that often practitioners will specialise in certain styles based on family or textual lineage, teachers, or country of origin. For instance, in my practice I follow the textual lineage of the Huangdi Neijing (黃帝内經) and that of my teacher Dr. Tai, others may practice Traditional Chinese Medicine (TCM) which is a foundational mixture of different textual lineages, while some incorporate the well known Japanese styles of Toyohari or Manaka acupuncture. They all have their value and they all require a great deal of time and dedication.
One common trait to all styles of acupuncture is the use of various regions, points or specific areas to target the needling. In most cases a practitioner will use a combination of localised needling (say for instance, at the site of an injury) and distal needling (along a specific bodily terrain or channel pathway). The use of tender or active areas (which are inclusive of trigger points as discussed below) is well known and used in Acupuncture. Ahshi points are often described in acupuncture as tender regions due to obstruction in a particular channel network (usually the Jing Mai, Jing Jin, or Jing Bie) as a result of Bi obstruction.
Acupuncture also takes time to learn and it is vital that any practitioner has undergone the correct training. Please refer to the Education section at the end of this post.
Dry Needling has it’s origins within acupuncture. One could say it is a modern day interpretation of one small part of what is already offered within the Chinese medical system. To avoid confusion I must say that it is important to realise that dry needling is acupuncture by another name, it is not the complete system of acupuncture, however, it is the insertion of acupuncture needles (filiform primarily) to induce a therapeutic result.
Dry needling is often taught, however, through the western medical paradigm. This is one of the key differences. Understanding of muscular regions, nerve pathways, and myofascial trigger points are an integral part of studying dry needling. Interestingly enough, they are also part of studying acupuncture at any tertiary education institution.
In the early to mid 20th century many physicians experimented with the use of injecting saline or mild analgesics into sensitive tissues as a means of pain relief. In some instances no substance was used at all and just needling was performed.
In general Dry Needling involves:
- Understanding the pathophysiology of myofascial pain and the use of trigger points.
- Knowledge of anatomy and physiology.
- Acupuncture needles, however, no use of moxabustion or classical techniques are employed. In addition, most dry needling courses focus on the use of the filiform needle, which is one of only nine used in classical acupuncture.
The primary difference between Acupuncture and Dry Needling is found within the name and within the education of the practitioner, as described below.
Education in medicine is obviously paramount to anything else. Knowledge breeds success. The educational standards between those that practice acupuncture and those that practice dry needling varies greatly.
In Australia the minimum requirement for the study of acupuncture and Chinese medicine is a 4 year undergraduate degree from one of a select few of tertiary institutions. As part of the award students are required to undertake hundreds of hours of clinical training (in house) and in most cases will undertake internships (external clinic) under already experienced practitioners. In many respects the hours required to learn Acupuncture properly is no different to the hours required to learn western medicine properly. It takes a certain intellect and certain discipline to achieve this.
In order to study or practice dry needling a weekend course or in some cases a series of weekend courses can be undertaken. Or if you are a medical practitioner, chiropractor, physio etc then it is deemed that you already have the knowledge and can practice without any training at all.
Yes, this sounds like my biased opinion, unfortunately it is not. It is due to a blatant disrespect by the modern medical community and the governments that follow it towards a 2200 year old and continually practiced medical tradition. Now, I am not saying that the current Chinese medical education is perfect, in fact it is far far from it. Most students graduate with a very diluted idea of what acupuncture is and could be. Only in post graduate studies and clinical experience do students start to see what Chinese medicine really is what is can actually do. And this only occurs if they seek it. I can only imagine what a few weekends or no training at all gives to the practitioner.
Why do I say that it is disrespectful? Well, acupuncture is not just the application of a tool. It is an expression of a culture and, as has been mentioned before, a complete medical system. Doing a weekend or even 6 month course in dry needling / acupuncture is no different to an Acupuncturist saying they will do a short course in Chiropractic or Physio or Surgery. It is a ridiculous statement (and would be violently opposed!).
So what is the solution?
Public education is key. Why would one choose a practitioner with minimal training and experience over someone with many years of training and experience? Would you go to your Acupuncturists for pain killer prescription? For a spinal adjustment? I hope not. Then why go to your GP / MD or Chiropractor for needling (whether it is called acupuncture or dry needling)? It just wouldn’t make sense. To solve this a number of changes could be made: dry needling could be developed as a style of acupuncture and taught as a post graduate course to those who have already completed the required undergraduate training in acupuncture or those wishing to learn needling methods could simply study it appropriately at a recognised educational institution.
Ensure that whomever you visit has done the appropriate training and more. Clinical internships, hospital work here and in China, post graduate studies, and of course appropriate modern medical knowledge – primarily for referrals when needed.
In addition, and in Australia from the 1st of July, Acupuncture and Chinese medicine will be a registered health profession. So make sure that your practitioner is registered by the board and accredited by the Australian Acupuncture & Chinese Medicine Association (AACMA).
If you have further questions or feel that certain comments in my post are incorrect please feel free to email me at firstname.lastname@example.org.
In good health,
David White Classical Acupuncture