28 May Dry Needling or Acupuncture – What is the difference?
Its almost everyday that one of us gets asked this question or have a client tell me they received Acupuncture from their Chiropractor, physiotherapist, myotherapist or GP. So what’s the difference between Acupuncture performed by an Acupuncturist and the needling used by other modalities?
Actually surprisingly a lot and a little all at the same time! Confusing much!
Dry needling is a term that was derived in the early 1940s by a technique developed by Janet Travell and David Simons. Dry needling initially was the injection of substance such as orticosteroids, saline solution and analgesics into sites of trigger Points which are essentially a site of irritation within the muscle fibre which can form a knot or small area of muscle tightness, pain or contraction. Dry needling now mostly uses filiform needles commonly used in Acupuncture but often a larger gauge.
Did you know that Dry needling is also a small subpart of Acupuncture. More about that later.
Acupuncture typically described a form of needle therapy performed by an Acupuncturist. The needles are inserted into “neural nodes” (or as we call the in Chinese ‘Jie’) and the stimulation of these nodes affects both the central and peripheral nervous systems. It triggers the release of the body’s internal chemicals such as endorphins and encephalin, which have pain-relieving properties.
The main difference between Dry Needling and Acupuncture, is the areas of needle insertion even in the same condition and the duration of needle retention.
For more information about How Acupuncture works see our FAQ’s about Acupuncture page Here
Now I have cleared that up, lets continue; Acupuncture is often described in terms of energy by many, however this is simply not true. It is based on mistranslations in of one the fundamental texts into English a very long time ago, and has been debunked through research.
However the energy explanation still remains, and many use the energy model to indicate that Acupuncture has no scientific merit. It is often used discredit Acupuncture as not being scientific, or explain why dry needling is more science based. It is simply not true and actually misinformed.
It is important to note that sometimes as Acupuncturists’ we uses strange language when describing ailments even pain as you will see below. Of coarse firstly it is in Chinese, but also that Chinese medicine specific terminology is over 4600 years old and it would be like using Shakespearean era language today, It would seem odd and so it does. However it is far from unscientific (1).
In fact there are various different types of Acupuncture including the dry needling, which is called ‘Ah shi’ needling. Yep that’s right Dry needling is a part of Acupuncture. Remember when I said “surprisingly a lot and a little all at the same time! Confusing much!“.
The first reference of Ashi points (or trigger points) – which literally translates as ‘Ah yes!’ – was by Sun Simiao in his book Qian Jin Yao Fang (Thousand Ducat Formulas) in 652A.D (1). Common trigger points are still used by many Acupuncturists to achieve a twitch response which we term “de qi”. This is again an example of the strange language your Acupuncturist may use when describing the feeling of releasing tight muscle bands.
So what is dry needling used for?
Dry needling is commonly used for pain syndromes. Popularity of practitioners of other modalities to train in dry needling has increased over the last few years, as many can see the benefits of needling. For example Osteopathy Australia suggests that 40% of osteopaths use Dry needling or Acupuncture techniques. Common conditions where dry needling might be used include;
- Neck and shoulder pain
- Knee pain
- Headaches and migraine
- Tennis elbow
- Plantar fasciitis
- Carpal tunnel
- Low back pain
- Sciatica
- General pain relief
Unfortunately currently the evidence base for dry needling is currently limited, mostly to either studies where Acupuncture was actually being performed. A PubMed search of the terms, ‘dry needling’, ‘trigger point dry needling’, or ‘intramuscular needling’, limited to the English language, humans and spanning from the year 2000 to present, yields about 150 results. Of these, 12 are meta-analyses and 29 are systematic reviews (7).
In the next several years I hope to see more research done on Dry needling, as the benefits and applications are yet to be fully explored. Some research, even indicates that some forms of dry needling using a technique called pistoning or sparrow pecking (both of these techniques rely on in-and-out needle insertion, in other words, the needles don’t stay inserted in the skin for a period of time. The needles prick the trigger points and are then removed) in fact may have little benefit (4). The Research (4) is suggesting the the Acupuncture technique of longer needle retention between 10-30 minutes might be of more benefit is based on the best available literature.
Again the main point to understand that Dry needling is not a stand alone therapy, although unfortunately most trials use Dry needling in this way. Dry needling so works along side other treatments used by the practitioner.
Who can perform dry needling?
Anyone!
Yep that’s right anyone can perform Dry Needling in Australia.
So unfortunately not all practitioners are obligated to adhere to the strict codes set by the Australian Health Practitioner Registration Association (AHPRA) for Acupuncturists including Infection prevention and control guidelines. Physiotherapists, Osteopaths, or Chiropractors are all modalities that can train in Dry Needling but do not have currently have set infection control guidelines as typically these professions do not penetrate the skin.
Nor are the Dry Needling courses obligated to adhere to the guidelines. Most courses expect that participants have a level of anatomy training to participate in their 2 day course, so a massage therapist who has studied a short course could study to perform Dry needling.
Most local councils expect that Dry Needlers adhere to skin penetration laws similar to tattoo artists. This means that even AHPRA registered professionals who don’t have a infection control standard set by their board need to adhere to council regulations set by each council.
Who can perform Acupuncture?
Again anyone!
Anyone can perform any time of needling including Dry Needling, and call it Acupuncture!!!
Unfortunately, in Acupuncture is not a protected title which means that anyone can say they perform Acupuncture, even when in fact they are using Dry Needling techniques and not qualified. This is often confusing, and commonly seen. This is why so many clients say that have had Acupuncture before when referring to Dry Needling performed by anyone else but an Acupuncturist.
Acupuncture vs Acupuncturist?
The good news is the Acupuncturist is a protected tittle so if you see an Acupuncturist they will be registered and using traditional Acupuncture techniques. Registered acupuncturists have significantly more training in Acupuncture and dry needling as this is their primary modality not an add on. On average a registered acupuncturist with AHPRA would have approximately:
- 150 hours of Anatomy and Physiology outlining location of organs, nerve structures and arteries
- 100 hours of point location including how to needle in order to prevent issues such as organ puncture, nerve damage, artery damage and pain.
- 200 hours of needling training.
- 400 hours of supervised clinical practice (1)
Acupuncturist are required to adhere to regulation set by AHPRA including ongoing professional training and development, registration with an association, infection control standards and more. Many Acupuncturists call for Dry needling to be regulated under similar standards. In fact Australia became the first country in the western world to implement the statutory regulation of Acupuncture under a restriction of title system in the State of Victoria in 2001 (6).
How do I know if I am seeing a fully qualified Acupuncture practitioner and Dry Needling practitioner?
Make sure when you seek the services of an Acupuncturist practitioner that they are registered under the national scheme under Acupuncturist or Chinese medicine practitioner. If your practitioner is registered under AHPRA it is important to make sure it is for ‘Acupuncture’ or ‘Chinese medicine’ not ‘Physiotherapy’, ‘Chiropractic’ or other registered or non-registered professions.
You can find out here by doing a search of the practitioner name.
My opinion
So I am one of the least anti-Dry Needler’s you would probably find in the Acupuncture world. Many Acupuncturist feel that it is kind of a turf war that could see the end of the Acupuncturist profession.
Many course try to teach the underlying fundamentals of Traditional Chinese Medicine in a short course but call it by a different name. This means that unlicensed unregulated other health professions can be using traditional Acupuncture points as long as they don’t call themselves an Acupuncturist’s. Courses by the name of;
“Traditional Acupuncture”
“Medical Acupuncture”
“Integrative Acupuncture”
It is important to understand where Acupuncture and Dry Needling fit into health Care practises in Australia. As talked about above Dry needling is an adjunct therapy, which can be used for the listed conditions. Acupuncture has a wide Range of conditions, which it can benefit. Some have been studied and have clear benefits, but many conditions have not. If you are seeking needling techniques for conditions outside pain then it is important to understand the practitioners qualifications to know best if they can help you!
Never feel embarrassed to ask what type of training your therapists has undertaken with Dry Needling and Acupuncture
References
- http://evolvenaturalmedicine.com.au/dry-needling-newcastle/
- https://www.coburgchinesemedicine.com.au/acupuncture-blog/2018/4/4/dry-needling-northern-suburbs
- http://www.osteopathy.org.au/news.php/37/practice-briefing-on-dry-needling-techniques-in-osteopathic-practice
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117383/
- https://www.ahpra.gov.au
- http://www.ajacm.com.au/wp-content/uploads/2017/10/2011-Volume-6-Issue-2.pdf
- https://healthybutsmart.com/dry-needling-therapy
About the author
Lauren Surridge is the Acupuncturist, Chinese Herbalist and owner of Balanced Life Health Care. To find out more about Lauren click here and to make an appointment to see Lauren at her clinic in Ferntree Gully click here
