People often ask me, “Do you do ‘Dry Needling’?” I always answer in the affirmative because yes, my needles are dry. Similarly, I once treated a patient who had so much relief from his chronic pain that he asked “What medicine do you put on the needle?”.
These questions highlight the confusion about what Acupuncture is and what ‘Dry Needling’ is. There are many misconceptions about this topic. First of all, the needles are the same. They are stainless steel acupuncture needles made by the same manufacturers. They are filiform and solid unlike a hypodermic needle, which is hollow. They do not inject anything into the body, hence the term “dry”. There is no medicine, anti-inflammatory agent, or corticosteroid (ie cortisone) in or on the needle. The needle itself and where it is placed produces the therapeutic effect (for more on the many ways acupuncture works, watch this space!). There is no difference in the tools used for “Dry Needling” or Acupuncture. They are exactly the same.
Quite literally, the only difference between “Dry Needling” and Acupuncture is the discipline that the practitioner is licensed under.
The general goal is the same regardless of the terminology used by the practitioner. Depending on the state you live in, the requirements to be able to be use Acupuncture needles on a patient vary. A licensed Acupuncturist in the state of California is required to have a Master of Science or Doctorate in Chinese Medicine which includes a minimum 3,000 hours of education and clinical training including Anatomy, Needle Technique, Orthopedic Acupuncture technique, point location and function, and a requisite number of clinical hours in which the main method of treatment is the placement of needles on a patient. Chinese Medical Theory and Chinese Herbal Medicine are also included in this education. The focus of a Graduate Training program in Acupuncture is not so shockingly the accurate placement of needles on a human body in order to address the patient’s health issue. In California, Physical Therapists are not allowed to perform “Dry Needling” on their patients, which is also true in Oregon, Washington, New Jersey, New York and Pennsylvania. Conversely, many other states allow Physical Therapists to use acupuncture needles to “Dry Needle” without additional training or certification. Some disciplines are allowed to practice “Dry Needling” after a brief weekend certification course. Acupuncturists have far more training in needle insertion than any other discipline. The goal of the acupuncture treatment is directive in how and where these needles are inserted.
A common misconception that I have heard from PT’s who perform “Dry Needling” is that “Acupuncturists don’t go into the tissue, they only needle superficially.”
This couldn’t be further from the truth. Many acupuncturists use points in the hands and feet which tend to be superficial to treat certain ailments, but points all over the body are prescribed different depths and angles base on their anatomical location, and where the point is most effective in addressing the issue. Additionally, more modern disciplines like Sports Medicine Acupuncture, and Orthopedic Acupuncture use a combination of Chinese Medical Theory and modern inquiries into the location of Motor points on particular muscles. Definitionally, these points are the “site in the muscle having the lowest resistance to electrical conductivity” per Matt Callison, an acupuncturist and Sports Medicine expert who mapped these points meticulously using electrical stimulation. Mr. Callison’s pioneering work in marrying Eastern & Western resulted in discovering these sites where “the motor nerve enters muscle” and has the “greatest influence on electrical activity.” Needling these motor points can restore muscle spindles back to physiological function by accessing the electrical potentiality of the muscle (more on muscle physiology and spindle dysfunction in later posts). The depth into the tissue the needle is placed is determined by its location on the body. For instance, needling your Gluteus Maximus is going to be quite a bit deeper than your Bicep. Sometimes to access the motor point of a deeper muscle i.e. Tibialis Posterior), you need to go through a more superficial muscle (i.e. gastrocnemius). All of which to say, acupuncturists needle as deep into the tissue as is required to achieve a therapeutic effect, whether it is a large muscle group or a point on the wrist that treats asthma.
Acupuncture comes in many different styles, forms and specialties.
Some use a combination of specialties and lineages. If you come to see me one day and ask for support around digestive issues and, at another appointment, ask for help with back pain, you may get two entirely different styles of treatment! Additionally, just like there are Brain Surgeons and Orthopedic Surgeons, Pediatricians and Obstetricians, there are Acupuncturists who focus on conception and women’s health and acupuncturists who focus on orthopedic issues. When deciding on a provider, it’s best to state what it is you need help with and ask if they have a specialty to determine whether or not there is a fit. Asking an Acupuncturist if they do “Dry Needling” is like asking a Chef if they do “Hot cooking”. The answer of course is, “Yes.” but you may not get what you expect or want if you don’t order the right dish.