Dry needling or acupuncture – what's the difference?
/(Dr Karen Chan; Acupuncturist, Physiotherapist)
I often get asked this question; and as a registered acupuncturist and a physiotherapist dry needler, I feel I can give an un-biased authentic view and explanation of the two.
What is dry needling?
Also known as myofascial trigger point needling, it is use of a filiform needle (the same used in acupuncture) inserted into the trigger points. Trigger points or myofascial trigger points are essentially sites of irritation within muscle fibres, which can form a “muscle knot” or band of tightness or discomfort.
This practice was first discussed by Janet Travell in the 1940s, in her book “Myofascial pain and dysfunction: the trigger point manual”.
It’s mostly used for pain e.g. knee pain, shoulder pain, low back pain, neck pain
These days you will find some physiotherapists, chiropractors or massage therapists who will perform dry needling as an adjunct to their treatment after doing a short course.
What evidence is there for dry needling?
To date there are varying degrees of evidence for dry needling, although the body of evidence is growing. There is some evidence for dry needling for localized musculoskeletal pain conditions; albeit short term of less than 6 months. There is a need for greater quality research with larger scale trials as generally research is deemed inconclusive.
What is traditional acupuncture?
Traditional Chinese acupuncture can be dated back for over 2000 years, making it one of the oldest health practices recorded.
It works by aiming to normalize the flow of energy, known as “qi”, and blood throughout the body to help stop any unwanted blockages along the body’s pathways, known as “meridians”. These blockages usually manifest as potential symptoms or conditions. Its aim is to restore the natural flow of balance to the body.
What evidence is there for acupuncture?
McDonald and Janz’s The Acupuncture Evidence Project (2017), is a review of the evidence supporting the efficacy of acupuncture in varying conditions. There is strong evidence (quality is moderate or high with reviews consistently showing statistically positive effects) for allergic rhinitis (perennial and seasonal), chemotherapy - induced nausea and vomiting (with anti-emetics), chronic low back pain, headache (tension type or chronic), knee osteoarthritis, migraine prevention, postoperative nausea and vomiting and postoperative pain.
There is moderate evidence (moderate to high quality, although insufficient to draw firm conclusions) on varying other conditions e.g. acute low back pain, anxiety, hypertension, insomnia, lateral elbow pain, menopausal hot flushes, temporomandibular joint pain, stroke rehabilitation, smoking cessation.
Koppleman (2018) also gives a good summary of an overview of the scientific evidence thus far and puts it into context in the current medical system. Have a read of it here.
Similarly to dry needling, the body of evidence of research is continuing to grow.
Is dry needling the same as acupuncture?
Dry needling can be viewed as a form or a small fraction of acupuncture. Trigger points in traditional Chinese medicine are viewed as what we term “Ashi” points. Ashi points are classified as palpable tender points. I often tell patients that true traditional Acupuncture is dry needling plus so much more.
Generally dry needling is used only for pain conditions, whereas acupuncturists use traditional acupuncture for all health conditions.
So be aware, some therapists will claim to do acupuncture or western acupuncture but really it is just dry needling. Don’t get me wrong: dry needling can still be of great benefit (especially if done in conjunction with some great manual therapy and prescribed exercises), but as long as you know “what you’ve signed up for” and that it is not traditional acupuncture. I feel this is often why I hear patients say that “acupuncture does not work”, because in fact they have not had it.
Benefits of seeing a registered acupuncturist:
Increased training: dry needling requires a minimum of 16 hours of training for allied health practitioners; acupuncturists require a minimum bachelor 4 years degree or a 3 years post graduate masters degree in acupuncture. Physiotherapists in Australia can do post graduate certificates in western acupuncture, however this does not make them an acupuncturist. The title of acupuncturist is strictly for those registered with the Chinese Medicine Board of Australia (CMBA) and have completed the intense training as mentioned above.
Less pain, increased techniques.
Stricter safety and infection control .
Generally more holistic nature, in which acupuncturists aim to help balance the body, mind and spirit and treat not only the symptoms, but also the underlying perceived cause of the problem.
Used for varying conditions or ailments whereas dry needling is generally only used for pain.
In a nutshell:
Dry needling is an adjunct treatment, usually used for pain conditions by qualified allied health professionals e.g. physios.
Acupuncture is the holistic approach of treatment for the whole body, including body, mind and spirit. It can be applied to target all varying conditions, not just pain. Acupuncturists are registered professionals with a minimum bachelor’s degree in training and are regulated by the Chinese Board of Medicine.
Both have some evidence of effectiveness. To date, there is stronger evidence for acupuncture for specific conditions.
Know what you are having as there is a difference between the two. Do not be afraid to ask your therapist.
Why not try our highly qualified physiotherapists for the dry needling or the dually qualified physiotherapists/acupuncturists (there are only a handful of these in the state) at the clinic for a more holistic approach?
Recommended Resources:
He C and Ma H (2017). Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials. J Pain Res 10: 1933-1942.
Hu HT, Gao H, Ma RJ, Zhao XF, Tian HF and Li L (2018). Is dry needling effective for low back pain. A systematic review and PRISMA- compliant-meta-analysis. Medicine 97 (26): e11225
Koppleman, M (2018). Acupuncture. An Overview of Scientific Evidence. Retrieved from https://www.evidencebasedacupuncture.org/present-research/acupuncture-scientific-evidence/
Leggit JC (2018): Musculoskeletal Therapies: Acupuncture, Dry Needling, Cupping. FP Essent Jul 470:27-31.
Liu L, Huang QM, Liu QG, Nguyen T, Li LH, Ma YT and Zhao JM (2018). Evidence for Dry Needling in the Management of Myofascial Trigger Points associated with Low Back Pain: A systematic review and Meta-analysis. Archives Physical Medicine and Rehabilitation 99 (1): 144-152
McDonald J, Janz S (2017). The Acupuncture Evidence Project: A Comparative Literature Review (Revised Edition). Brisbane: Australian Acupuncture and Chinese Medicine Association Ltd
