The Difference Between Acupuncture and Dry Needling
As physiotherapists become increasingly enamored with the modality of dry needling, I feel compelled as an acupuncturist to place this therapy within the broader discipline of traditional Chinese medicine (TCM) in order to give patients a context for understanding its efficacy.
Dry needling operates on the premise that myofascial chains connect the body from head to toe. They govern how soft tissues, such as muscles, tendons, and ligaments, interact with one another to form cohesive movement and structure. Fascia wraps around soft tissue in a way that follows the meridians of acupuncture. Researchers in South Korea in the 1960s rediscovered the meridians that were identified by the founders of traditional Chinese medicine. The researchers established these pathways as a unique anatomical network called the Bonghan system.
Fascia can be manipulated by massage therapists with different modalities that have varying success accessing deeper myofascial restrictions based upon the assertiveness and skill of the therapist. Acupuncture has the advantage of efficiently getting to deep trigger and motor points (neuromuscular junctions) using thin filiform needles that slide around tissue until reaching the desired depth.
At that juncture, one or two things typically occur. Patients will sometimes feel a deep achy sensation that I equate with an increase in circulation and slow release of built-up metabolic waste from the tissue. This sensation may persist while the needle rests in place (up to 40 minutes) and sometimes even a few hours after treatment.
The other response is a sudden and sometimes dramatic twitch response in the muscle, called a fasciculation. This is the muscle resetting itself to restore its proper firing pattering within the myofascial chain. Some patients will feel this sensation propagate away from the inserted needle and down an acupuncture meridian, frequently with such precision that the patient will perfectly trace the acupuncture meridian with a finger. Any well-trained acupuncturist is skilled at identifying and releasing muscular trigger points to elicit this effect, decreasing pain and increasing mobility. Many textbook acupuncture points are directly over trigger or motor points, whereas palpation identifies other tender spots.
Physiotherapists studying dry needling learn a system of treating trigger points popularized by Janet Travell, a physician and researcher of myofascial pain syndrome. Early experimenters like Travell coined the term “dry needling” when patients’ trigger points resolved upon insertion of a syringe without any pain-relieving medication (where typically something like procaine would be injected). In part, Travell rediscovered a subset of acupuncture, and to the credit of physical therapists who are skillfully applying dry needling, they are benefiting their patients.
However, dry needling has limitations because it is taken out of the context of TCM, which emphasizes both local and distal points that fully rectify myofascial chains. This is the system of meridians upon which acupuncture is based. Acupuncture is combined with other modalities, such as massage, cupping, gua sha, and heat therapy, to form a complete approach to holistically treating all aspects of structural imbalances while also being mindful of conditions that predispose musculoskeletal problems. TCM’s holistic grasp of internal medicine has practitioners looking for deficiencies (nutrients) and excesses (inflammation) that impair healing.
To summarize with a metaphor appropriate to a Wisconsin winter: Dry needling, or myofascial acupuncture, are akin to all-wheel drive in a car. Shifting into all-wheel drive enhances maneuverability just as mobility is increased in patients using these therapies. The holistic nature of TCM, however, is like putting snow tires on your car. If they have to choose only one, most drivers know that a quality set of snow tires will provide better traction and control than just all-wheel drive. Acupuncture offers both skilled manipulation of trigger points and an ancient, holistic system of healing that addresses every aspect of myofascial restriction.
I don’t take the hard position of some of my acupuncture colleagues that we should dissuade patients from seeking dry needling. Instead, I rest in the confidence of my skills and experience, knowing that more options are better when it comes to patient care. Sometimes you only need a brief shift into all-wheel drive to get up an icy hill. But sometimes you need all-wheel drive and snow tires for a long, hard winter—such is the nature with chronic musculoskeletal pain.