Is Dry Needling the Same as Acupuncture?

Do you practice dry needling? What is dry needling? Is dry needling the same as acupuncture?

These questions commonly come up in my practice and I felt it might be helpful to provide some insight into what the heck dry needling is so that folks can make the best decisions they can about their healthcare.

First let me provide some basic info about acupuncture.

Acupuncture can be defined as the stimulation of acupuncture points with solid filiform needles. Acupuncture point prescriptions are individually chosen for each patient to address health concerns based upon the paradigms of Chinese Medicine. Many acupuncture points are located at myofascial trigger points (this is important to note in the context of dry needling). Acupuncture has been used and refined over thousands of years in China, and, ultimately, carried across to other countries where it has been adapted culturally.

The practice of acupuncture in the U.S. is regulated by state laws. In general, to practice acupuncture one must be a licensed acupuncturist or a medical doctor. National board certification with the NCCAOM is required in New Hampshire (as it is in most states) to qualify for a license to practice acupuncture. In order to sit for this exam, one must have a minimum of 1905 hours of formal training in a 3-year Master degree program (FYI: medical doctors who practice acupuncture typically only receive 100-300 hours of specific training). Training involves extensive needling techniques so that the proper style can be identified and applied for each treatment. Gentle techniques with a “less is more” approach are commonly applied.

So, how does this relate to dry needling?

Dry needling can be defined as the stimulation of trigger points with solid, filiform needles, otherwise known as acupuncture needles. Dry needling is known to be an aggressive needling technique that some find to be uncomfortable, even intolerable. A number of my patients who have tried dry needling expressed trepidation when it came to initially working with an acupuncturist because they had such poor experiences with previous needle work. Professionals other than licensed acupuncturists who offer dry needling may have little training. I’ve come across a certification course for physical therapists and chiropractors that requires as few as 27 hours.

So yes, dry needling is acupuncture, but with a very limited therapeutic approach. Some physical therapists who use dry needling try to make the claim that it is different from acupuncture (because they would be practicing acupuncture without the proper medical license otherwise). However, the Huang Di neijing, a 2200 year old Chinese medical text, mentions the direct treatment of trigger points to address neuromusculoskeletal dysfunction. Since China first recorded this method 2200 years ago, acupuncture has been further refined and there are many styles used today. Some even successfully treat pain without sticking needles directly at the site of discomfort. These are great options when direct needling is painful or contraindicated, such as when there is physical trauma including post-surgery.

The American Medical Association would seem to agree with the premise that ‘dry needling’ is acupuncture. Dr. Russell W. H. Kridel, an AMA board member, released a statement regarding dry needling that said “lax regulation and nonexistent standards surround this invasive practice. For patients’ safety, practitioners should meet standards required for licensed acupuncturists and physicians.”

So why is the phrase ‘dry needling’ used if it’s actually acupuncture?

Acupuncture works really well, so other professionals are keen to use it in their practices. However, in order to practice acupuncture legally, one must be a licensed acupuncturist which requires years of education.

Some legislators have caught on to this, and several U.S. states, including California, Oregon, Washington State, Hawaii, and New York, have passed legislation prohibiting the use of dry needling. ‘Dry needling’ is a relatively new phrase and there is a lack of research supporting its safety and effectiveness. This isn’t the case for acupuncture; there are hundreds of studies that show the safety and effectiveness of acupuncture therapy. More Insurance plans cover acupuncture treatment than ever before. However, due to insufficient scientific evidence dry needling is considered experimental and a non-covered service.

Laws and regulations regarding dry needling have been changing consistently the past couple of decades. And some states have yet to take a stance on dry needling including Connecticut, Massachusetts, Michigan, Pennsylvania, Minnesota, Oklahoma, Wisconsin, and Missouri. There are only 30,000 licensed acupuncturists to 300,000 physical therapists in the U.S. and that’s a big difference in lobbying power and money so I wouldn’t be surprised if acupuncture continues to be successfully coopted by other professionals moving forward.

The more people who have access to acupuncture the better. I strongly encourage all those who are interested in practicing it to get sufficiently educated. And there are certainly some healthcare practitioners who don’t practice ‘dry needling’ acupuncture after little training because they realize they don’t know enough to do so responsibly. And there are some acupuncturists who are unconcerned with the idea of acupuncture being coopted by those with significantly less training.

I wouldn’t recommend seeking out ‘dry needling’ specifically. It is therapeutically limiting and may not even be the best acupuncture technique for you. Each person is different and what works really well clinically for one person may not be the best fit for another. Licensed acupuncturists are trained to evaluate and properly treat based upon Chinese Medicine which has been using acupuncture for thousands of years to treat health concerns and to promote wellness. If you are inspired to investigate trigger point stimulation talk to your friendly neighborhood acupuncturist about whether that is an appropriate treatment for you. Licensed acupuncturists specialize in acupuncture and are the most appropriate therapists to seek out under such circumstances.