Is there a difference between Dry Needling and Acupuncture?


Dry Needling:

The fundamental difference between Dry Needling and Acupuncture is that Dry Needling uses needles to deactivate painful trigger points. Trigger points are painful areas of specialized tissue in the muscles, fascia, and connective tissue.

Trigger points are latent in all of us, and are activated by trauma, poor posture, and overuse..When active trigger points are painful and also refer pain to other parts of the body. For example the painful point at the top of the shoulder, the Dr. Spock “death point” in Star Trek, can refer pain up to the side of the head.

Release active trigger points and referred pain disappears.

Dry needling can also be used for nerve entrapement syndromes, like Piriformis syndrome. I dry needle motor nerve entry points to release “locked tight” muscles and fascia. Now the muscles and fascia lengthen and stop compressing the nerves.

For an indepth discussion of Dry Needling, without comparison to acupuncture, look here



Classical Chinese acupuncture is based on the needling of acupunture “points” . Acupuncture points are small depressions on the acupuncture channels. The acupuncture channels were  first described in 200 BCE or so, in the Huang Di Nei Jing, or Yellow Emperor’s Inner Classic.

We use acupuncture to treat a wide variety of diseases and  pain. Acupuncture theory describes 12 main acupuncture channels thru which Qi flows. When Qi stagnates disease and pain forms. We treat diseases and pain with acupuncture by unblocking stuck Qi. We unblock the Qi by inserting needles into acupuncture points in the channels.

Acupuncture is part of a larger system of medicine called Chinese Medicine, or TCM. Chinese Medicine includes acupuncture, Chinese herbs, moxabustion, Qi Gung, and diet therapy.



 Dry Needling and Acupuncture–How Can They Be Combined?


There is no difference between dry needling  done by a Physical Therapist or an Acupuncturist, so long as they have both studied the art of using needles on trigger points.

The difference between dry needling and acupuncture, is that dry needling uses needles to stimulate and release myofascial trigger points. Trigger points are not on acupuncture channels, they are found in the muscles and fascia as described by western anatomists. Dry Needling uses the exact same needles as acupuncture does.

Acupuncture uses the very same kind of needle to open the flow of Qi in the channels of the body mapped out by ancient Chinese medical doctors. These channels are a construct; they are invisible, and relate to both the nerves and fascial sheaths of the body.

I like treating the whole person, and not just parts. I also prefer to treat the causes of disease, and not just the symptoms. So I sometimes combine dry needling with Classical Chinese acupuncture, to get to the root of the myofascial pain that is treated by dry needling.


What Must I Know to Do Dry Needling

Anyone, with any license, whether an MD or an Acupuncturist needs specialized study to do dry needling.  To do dry needling the therapist needs to know specific aspects of human anatomy–the relationship between muscles and the fascial sheaths; the specific location of primary triggerpoints; the method of finding primary and satellite trigger points; and finally the technique of releasing these trigger points and fascial structures with filiform needles (also knows as acupuncture needles).


Who Can Perform Dry Needling?


Dry Needling is done by licensed health professional with specialized study and training in dry needling.  These professionals must also have a license that enables them to insert needles into the body. In every state where acupuncturists are licensed, they can do dry needling. All medical doctors M.D.s can do dry needling, since they can also do injections and surgery. In some states Chiropractors, Physical Therapists, and even Dentists can do dry needling. Originally, physical therapist license did not allow them to penetrate the skin quite specifically; all their methods involved manual therapy to the outside of the body, and exercise therapy. In some states P.T.s can do acupuncture, and in other states only dry neeling.


The Dry Needling Advantage

The Advantage in using dry needling compared to manual methods like massage, or superficial acupuncture needling into acupuncture channels,  is that with dry needling the needle allows us to directly target inflamed and painful tissues in way that gets an immediate effect. This is because when you insert a needle into a trigger point, you immediately “deactivate” it. Now muscles and fascia that were “locked short” begin to lengthen, which brings relief from pain right away, like untying a shoe that was too tight, or loosening a belt that was notched too far.  The dry needling has now increased the range of motion of your joint that was restricted due to muscle tightness or scar tissue. This is why dry needling is so useful for back pain, neck pain, shoulder pain, and really any kind of joint pain.


The Acupuncture Advantage


Classical Chinese or Japanese acupuncture, on the other hand, does not address trigger points, the muscles, or fascial sheaths, directly, because most acupuncturists practice the very light insertion of needles into the Acupuncture channels, with a goal of “unblocking stagnant Qi.”

While all acupuncturists have learned basic anatomy as part of their education, this usually does not include in depth study of trigger points and fascial sheaths, nor how to needle them.

Furthermore, very few acupuncturists learn how to needle more deeply into the muscles, but prefer very light insertions just below the skin. This can be very very useful for many diseases of internal medicine, from digestive disorders to allergies to headaches, but its not effective for releasing trigger points and the fascia, because there is no needling into the trigger points.

While dry needling is the best method for releasing painful trigger points and stimulating motor points to releive pain, Classical Chinese acupuncture, along with Chinese herbal medicine, moxabustion, tui na, Qi gung, Principles of diet and nutrition, is a whole system of medicine.


When to Combine Dry Needling with Acupuncture

Also, there are many cases where I like to combine dry needling with acupuncture for the best of both worlds. For example, if I am releasing trigger points in the temporalis muscle in a person with tension headache, I also like to treat the cause of the active trigger point. In the case of tension headache it is generally what acupuncture theory calls Liver Qi Stagnation.

One can release the trigger point causing the headache pain, but unless you release the tension causing the trigger point, then the trigger points will reactive and the headache pain will return. Acupuncture unblocks the qi in the Liver and Gallbladder channels causing the headache pain, so the pain will not come back.

Acupuncture will also help you start to notice the habiltual nervous system states that cause you to carry so much tension in the first place. Very helpful


How Does Acupuncture Help Pain Then?

Acupuncture can help some pain conditions by having a very powerful overall relaxing affect, and by relaxing the structures of the body, including painful areas, but its  based on Chinese Medical and Acupuncture channel (meridian) theory, so its a very different method both in philosophy and technique from dry needling. In addition, acupuncture has a powerful effect on the parts of the brain that perceive pain. But acupuncture does not fundamentally change the structure of the muscles and fascia, the way dry needling does.

This is why with my patients here in San Diego, many of whom are athletic and into stregnth training of various type, not to mention rock climbing, surfing, and running, I most often use Dry Needling for Sports Injuries and chronic pain, and Acupuncture for Internal medicine like fertility disorders, menopausal imbalance, acne, eczema, allergies, IBS and gastritis.


 Acupuncture vs. Dry Needling–Summary of Differences


1. How the Points are located—Anatomical Location of Trigger Points and Fascial Sheaths vs.  Acupuncture Channel Theory


2. Needle Technique—Superficial penetration just below the skin vs. penetration into the the myofascial trigger points, tendons, and related structures


3. Size of Needles.  Most Acupuncturists in USA use thinner gauges such as .20 or .16, whereas Dry Needle therapy uses from .20 to .25, .28 and .30 guage.


To be sure, even the .30 gauge that I use on myself and on areas of the body with large tense muscles, are much finer than a hypodermic muscle, and is not painful, per se….







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