Dry needling has become a popular treatment technique in many physical therapy clinics and practices in the United States. Though not legal in all states, the American Physical Therapy Association (APTA) supports the use of dry needling as a type of “manual therapy” and a part of a physical therapist’s scope of practice (see:Guide to Physical Therapist Practice 3.0&Physical Therapists and the Performance of Dry Needling: An Educational Resource Paper)3,5
See Resource:APTA’s Map of State Legality of Dry Needling(Updated: September 3rd, 2020)
- In the U.S., dry needling is legal in 36 States, prohibited in 6 states, and 8 states have remained silent on its use/practice.
As I have begun using dry needling in my practice as a physical therapist, I have been reading more about the research behind it and thinking about its utility as a part of physical therapy treatments. I have also been having more conversations with patients regarding its use and one question that I get most frequently is this:
“What is the difference between dry needling and acupuncture?”
I would like to address this question more thoroughly and am fortunate to be able to include the expertise of Rob Balkind, MAc, a licensed acupuncturist who is certified in both acupuncture AND functional dry needling and uses both in his practice.Rob graduated with his Master’s in acupuncture from The Arizona School of Acupuncture and Oriental Medicine and has a background in massage therapy and exercise science and has been working with patients in clinical settings for over 20 years.
With insight from Rob and my own research on the topic, this is how I would describe the differences between the two treatment techniques:
Dry Needling vs. Acupuncture
- The Similarities:
- Equipment & Health Goals
- The Differences:
- Different Treatment Philosophies
- Different Techniques & Adjunct Treatments
- Different Training Requirements & Licensed Providers
Dry Needling vs. Acupuncture:
- The Similarities: Equipment & Health Goals
The Similarities: Same Equipment Used
The needles used for both dry needling and acupunctureare the same. Both techniques use solid, filiform needles that are sterile and often in single-use packages (though some technique includes inserting/removing and reusing needles on the same person (needles are usually not reused from person to person). These needles are solid due to the fact that neither treatment approach uses any injectable agent, but uses the needle itself as the treatment (i.e., no medication or saline is injected into the body tissue).
The Similarities: Health Goals
General treatment goals of dry needling and acupuncture may seem very similar on the surface. These may include: improving physical (and psychological) health and function, reducing pain and disability, and improving tissue health.
“In TCM the goal, just as in Western medicine, is creating a state of homeostasis. When we have achieved that balance in the system, there is no pain, no illness”-Rob Balkind, MAc
Goals of dry needling include treating muscle and connective tissue to improve tissue health, improve range of motion, and reduce pain and dysfunction. Within a physical therapy treatment framework this is integrated into a plan of care seeking to restore functional mobility for a person’s daily activities and return to recreation and sports.2
However, it is important to note that the proposed mechanisms and treatment philosophies are VERY different as are the techniques themselves and adjunct treatments, read on…
- The Differences: Treatment Philosophies
Dry Needlingis primarily used by physical therapists who are “movement experts” and treat based on observed neuromuscular system dysfunctions. Physical therapists usually rely heavily on exercise-based treatments, though may also use hands-on techniques as well as other modes of treatment including dry needling. Dry needlinghas been used within a few different treatment philosophies including a Trigger Point Model2,6,7,Radiculopathic Model (aka“Intramuscular Dry Needling”,Chan Gunn), and what has been termed “functional dry needling”, (taught by certifying agencies such as:Kinetacore).
The APTA describes it this way:
“Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments.”5
Dry needling can be used totreat restricted range of motion, scar tissue, and pain and canbe used with and without the addition of electrical stimulation.
Acupunctureis used by those trained in Traditional Chinese Medicine and acupuncture technique and is distinctly different from dry needling. TCM aims to treat based reducing “patterns of disharmony” or correcting imbalances.4Ted Kaptchuk, O.M.D., writes, “The basic idea behind acupuncture…is that the insertion of very fine needles into points along the Meridians can rebalance bodily disharmonies.”4
*To learn more about Traditional Chinese Medicine, I would highly recommend the very readable book from Dr. Kaptchuk:The Web That Has No Weaver: Understanding Chinese Medicine4.
Furthermore, it is useful to note that acupuncture is not the only treatment technique practiced within this school of thought.
“Acupuncture is just one treatment method within Traditional Chinese Medicine (TCM).” -Rob Balkind, MAc
“This is a complete system of medicine and any medical condition can be treated with it. That doesn’t mean that TCM is the best treatment for all medical conditions, it just means that they can be treated. If I have cancer, cut it out of me. If I have pneumonia give me antibiotics. TCM is great for treating allergies, asthma, digestive issues, gynecological problems, infertility, insomnia, stress, anxiety, depression, pain and other conditions.” -Rob Balkind, MAc
Thus, the two applications are based on different systems and the APTA goes to great lengths to elucidate this and the fact that physical therapists are NOT practicing acupuncture. According toPhysical Therapists and the Performance of Dry Needling: An Educational Resource Paper5:
“The practice of acupuncture by acupuncturists and the performance of dry needling by physical therapists differ in terms of historical, philosophical, indicative, and practical context.”
The performance of modern dry needling by physical therapists is based on western neuroanatomy and modern scientific study of the musculoskeletal and nervous system. Physical therapists that perform dry needling do not use traditional acupuncture theories or acupuncture terminology”5
The Differences: Different Techniques & Adjunct Treatments
The Differences: Different Techniques
Dry needlingcan take either the form of superficial or deep dry needling where depth of needle insertion (and treatment goals) differs. In both cases, the needle is inserted into the skin, but with deep dry needling the needle penetrates to the muscle and sometimes is inserted in connective tissue or down to the depth of bone. In both techniques, a functional or movement test is often used to assess response to the needling treatment and is performed before and after the dry needling treatment to assess patient response (i.e., determine if functional improvement has taken place, such as reduced pain or improved range of motion or strength).
Acupuncturecan utilize the placement of needles either superficially or deep within tissue. However, as noted above, needles are placed according to TCM principles. Furthermore, though Traditional Chinese Medicine may include movement practices such as tai chi or qi gong and advice for movement health, assessment based on movement system dysfunction is not often utilized in acupuncture treatments.
The Differences: Different Adjunct Treatments
When dry needling is used in physical therapy treatments, it is almost never used as an isolated treatment. Dry needling may be used in combination with manual therapy, exercise-based treatments, and often patient education on activity modifications.Acupuncture may be used in combination with other Traditional Chinese Medicine treatment techniques including (but not limited to) moxie, cupping, other forms of hands-on therapy, dietary/lifestyle advice, and herbal formulas.
The Differences: Different Training Requirements, & Licensed Providers
Dry Needling: Training Requirements & Licensed Providers:
Dry needlingcan be practiced by physical therapists, Traditional Chinese Medicine (TCM) doctors and chiropractors provided that they have been trained in the technique. Certification is usually designated by the certifying agency (e.g.,Optimal Dry Needling Solutions (ODNS), orKinetacore, the two agencies from which I have taken training courses on Dry Needling). Thus, there is currently no standard acronym in use to designate a certification in dry needling training.
Laws on the education requirements for physical therapists to practice dry needling vary based on state. Some states require no additional training to practice dry needling, while others require a certain minimum number of hours of specialized training (e.g., The Georgia State Board of Physical Therapy requires 50 hours of dry needling training and 1 hour of OSHA bloodborne pathogens training). The APTA helps to explain the training of physical therapists who seek to use dry needling as part of their treatment practices:
“The education of physical therapists includes anatomy, histology, physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, clinical sciences, clinical interventions, clinical applications, and screening. Much of the basic anatomical, physiological, and biomechanical knowledge that dry needling uses is taught as part of the core physical therapist education; the specific dry needling skills are supplemental to that knowledge.”5
Furthermore, The Federation of State Board of Physical Therapy (FSBPT) published a document in 2015 with recommendations for minimum skills necessary to safely practice dry needling as a physical therapist (See:“Analysis of Competencies for Dry Needling by Physical Therapists”)1Authors from the task force preparing this document state:
“86% of the knowledge requirements needed to be competent in dry needling is acquired during the course of PT entry-level education, including knowledge related to evaluation, assessment, diagnosis and plan of care development, documentation, safety, and professional responsibilities.
14% of the knowledge requirements related to competency in dry needling must be acquired through post-graduate education or specialized training in dry needling.”1
Acupuncture: Training Requirements & Licensed Providers:
Acupunctureis used by those trained in the technique and certification titles include:
- Licensed Acupuncturist (LAc)
- Masters in Acupuncture (MAc)
- Doctor of Acupuncture (DAc)
- *Note, TCM practitioners may also have certifications of OMD or DOM indicating: Doctor of Oriental Medicine
- Also, certain Chinese medicine training programs include training in acupuncture technique, such as Traditional Chinese Medicine (TCM) programs
“Acupuncturists go to school for 3 to 4 years to learn TCM. They spend a tremendous amount of time practicing theory and learning how to use this system of medicine.”-Rob Balkind, MAc
Brief Comments on “Scope of Practice”(i.e., who should be allowed to dry needle or perform acupuncture)
“The use of needles, per se, does not imply that one needling approach is equivalent to another or that one medical profession is infringing on the scope of practice of another.”1
Unfortunately, the climate of healthcare at the moment does not foster collaboration and often pits healthcare professionals from different domains against each other as they jockey for “market share” of healthcare dollars. Providers may feel that they must seek support for their sector of healthcare treatments in order to gain the maximum reimbursement from health insurance organizations (and may feel pressured to denigrate or devalue alternative treatments in the process).
“I feel that the scope of practice of DPT, DC, NP, PA, OT, and MD should include dry needling. It comes down to anatomy knowledge and training. These practitioners, with proper training, can safely and effectively use dry needling as a treatment option.” -Rob Balkind, MAc
Thanks so much to Rob for his contributions to this post and please feel free to post comments below.
-Leda McDaniel, PT, DPT
@SapiensMoves
References:
- Caramagno J, Adrian L, Mueller L, Purl J.Analysis of Competencies for Dry Needling by Physical Therapists Final Report. 2015. (Date Accessed: October 5th, 2019):https://www.fsbpt.org/Portals/0/documents/free-resources/DryNeedlingFinalReport_20150812.pdf
- “Description of Dry Needling in Clinical Practice: An Educational Resource Paper.” Produced by the APTA Public Policy, Practice, and Professional Affairs Unit: February, 2013.http://www.apta.org/StateIssues/DryNeedling/ClinicalPracticeResourcePaper/(Date Accessed: December 22nd, 2019).
- Guide to Physical Therapist Practice 3.0. Alexandria, VA: American Physical Therapy Association; 2014. Available at:http://guidetoptpractice.apta.org/. (Date Accessed: December 22nd, 2019).
- Kaptchuk, TJ. The web that has no weaver: understanding Chinese medicine. 2nded. McGraw-Hill: 2000.
- “Physical Therapists and the Performance of Dry Needling: An Educational Resource Paper.” Produced by the APTA Department of Practice and APTA State Government Affairs: January, 2012.http://www.apta.org/StateIssues/DryNeedling/ResourcePaper/(Date Accessed: December 22nd, 2019).
- Simons, D.G., Travell J.G., Simons, L.S.Myofascial pain and dysfunction: the trigger point manual. Volume 1. Upper half of body. 2nd ed.Baltimore, MD: Williams & Wilkins; 1999.
- Travell J.G., Simons, D.G.Myofascial pain and dysfunction: the trigger point manual. Volume 2. The lower extremities. 1sted.Philadelphia, PA: Lippincott, Williams & Wilkins; 1992.
