Episode 8: Acupuncture vs. Dry Needling – why the difference matters
Today’s podcast was prompted by a question from one of my lovely patients! They had been getting questions from friends regarding the difference between acupuncture and dry needling, and the chat we had inspired today’s episode. In my opinion, it’s an interesting and important question to cover, as despite the fact that both modalities use the same tools (acupuncture needles), the required training, regulation, protection of the public, and evidence-based research greatly differs between the two. It’s worth knowing the difference, so let’s get into the details.
Firstly, let’s briefly look at what is acupuncture and what is dry needling. Acupuncture is one of the key technologies employed by doctors of Chinese Medicine to support the body in its path to health. Acupuncture has been used for at least 8,000 years, with evidence of stone needles dating back to that time. Luckily, we now have very fine, sterile single-use needles, which are often painless! They are so fine that you could fit 8 of them into the width of 1 mm, and one of my young patients call them fairy wands 🙂
Over the millennia that acupuncture has been used, it has developed a very rich toolbox of different approaches for different situations and patients. Acupuncture can be used for a whole range of complaints, from internal medicine (in cases such as digestive or menstrual issues), to mental & emotional cases (like anxiety and stress) – anyone who has had an “acunap” on the treatment table will attest to how relaxing acupuncture is!
In addition to balancing the inner workings of the body, acupuncture has also been used for a whole range of musculoskeletal pain, injuries, trauma, fatigue and muscle soreness – and even postural adjustment, by releasing tight bands of tissues that are pulling the bones away from optimal positioning. Acupuncture has a myriad of approaches for treating pain and injuries, and a trained acupuncturist will choose the best approach for the patient. While one of our approaches can be to go directly for the tight or painful area, finding the trigger points in the muscle and connecting with those, in many cases this may be too painful, thereby further aggravating the issue – or it may even be contraindicated. For example, lower back and sacral pain is not uncommon in pregnancy, but needling and strong massage over the affected is contraindicated in pregnancy, as there is a potential risk of induction of early labour. Luckily we have a whole system of distal acupuncture (which is what I often practice in clinic) that uses distal (areas away form, or distant to, the pain) to provide pain relief and therapeutic benefit. So for the pregnant lady with back pain, there are points on the hand, arm, leg and head that I could safely choose to use, without any need to go anywhere near her back.
For times when we do want to work locally, we look for tight areas within the muscle that are tender to touch, and which can refer to other locations. These are called “Ah Shi” points, which translates as “Ah Yes, that’s it”. The referral patterns will very often following acupuncture pathways, and this is because Chinese Medicine has, for millennia, understood the planes of fascia – the connective tissue that covers and links not only organs and other tissues, but also all aspects of the musculoskeletal system. In fact, the acupuncture channels / pathways / meridians align with pathways of fascia in the body. Fascia is semi-conductive, and responds to stimulation with a metal acupuncture needle. This can explain why needling at the ankle can relieve pain further up the channel, at the low back, for example, as the lower leg connects to the thigh, then the glutes and then the muscles of the lower back.
Chinese Medicine hospitals are commonplace in China, Taiwan and other parts of Asia, and in recent decades, acupuncture has been more widely accepted into the Western mainstream – it has even been granted its own floor in the new branch of the Epworth Hospital in Melbourne! With this acceptance has come a growing body of research and a biomedical translation of how acupuncture works – at last look (early January 2020), there were 143,000 papers available on acupuncture, 84,000 of those in peer-reviewed journals. As I discussed in Episode 1 of this podcast, Chinese Medicine and Western biomedicine are talking about the same processes, just in a different language. So when Chinese Medicine talks about encouraging flow, boosting reserves of one thing while reducing or draining an excess of something else, biomedicine talks about the same thing, but using the language of neurotransmitters, gasotransmitters, hormones and chemical markers. All of these are the body’s biochemical messengers, and acupuncture has been shown to affect the free flow and relative levels of these (whether boosting or reducing) – basically supporting the body in moving towards homeostasis, or dynamic balance.
Over thousands of years, doctors of Chinese Medicine have refined their knowledge and linked various points with differing effects throughout the body – importantly, this has been confirmed in functional MRI (fMRI) scans, where specific parts of the brain consistently light up in response to related acupuncture points. So acupuncture offers so much more than just popping needles into sore areas.
So how about dry needling? Dry needling is a technique developed in the 1940s to treat muscular pain. The name “dry needling” was used to differentiate it from “wet needling”, where substances were injected into trigger points using hypodermic needles. Initially, thicker, hollow needles were used for dry needling, but dry needlers have now embraced the thinner, filiform acupuncture needles. Feeling for a tender point, they then insert the needle into the Ah Shi (Ah Yes, that’s it) point to elicit a twitch response.
It is not uncommon to see descriptions of dry needling touting the practice as evidence-based, or biomedically-based, in comparison to acupuncture, but this doesn’t match up to reality. As I mentioned earlier, acupuncture has been extensively studied and understood from a biomedical perspective as well as Chinese Medicine one, with over 143,000 research papers on the topic. By comparison, dry needling doesn’t even hit 3,000 (with just over 2,000 of those in peer-reviewed journals). So the argument that dry needling is more evidence-based or science-based doesn’t really hold up!
So now that we know the difference, why should it matter to you?
Well the main issue is concern around safety, regulation and the level of training required. My colleague Jeff at Evolve Natural Medicine wrote a great post on this (which I’ve included in my show notes) in which he collates some stats on the differing levels of training for each modality. A dry needler can get by with as little as 16 hours training (a single weekend) before starting to stick needles in people. By contrast, acupuncturists in Australia are required to complete a 4 year Bachelor of Health Science degree, which includes 150 hours of Anatomy and Physiology and a further 100 hours of acupuncture point location, and that is before we even get to the 200 hours of needling training and then the 400 hours of supervised clinical practice. That’s a lot of hours! And it should be. Some areas, such as the shoulder and upper torso, can only be needled at a shallow depth, as the lungs (and other vital organs) lie close below the surface. In the hundreds of hours of training we do, we learn about the safe depths of needling at all body areas, and in all body types. And it doesn’t stop once we graduate! Every year, as acupuncturists we are legally bound to further our skills in our profession with further training, keeping us sharp and up to date.
Unlike dry needling, which is not regulated or held to any standard by a government body, acupuncturists are regulated by AHPRA – the Australian Health Practitioner Regulation Agency – a government agency that nurses, dentists and other health practitioners who maintain a standard of practice are registered with, in the interests of public safety. For added safety, the title of “acupuncturist” is a protected title, meaning that only practitioners with the required Degree, and who meet with yearly up-skilling requirements, are allowed to call themselves by the title. Anyone who is offering acupuncture but is not a registered acupuncturist is acting illegally – it’s called “holding out” and is punishable by significant fines.
So, safety and vastly more training is one reason to choose acupuncture! Other reasons are that we have much more in our toolbox than just working with trigger points – this means that we can get to the root of the problem for better long-term outcomes, and with less pain, as we are not always aggravating an already upset area.
We always have a choice and our health and wellness is in our hands. To make sure you are seeing a registered and qualified acupuncturist, you can look up your practitioner on the AHPRA website (link in show notes). Make sure you choose “Chinese Medicine Practitioner” as the profession, and this will let you know if the person giving you acupuncture is legally qualified to do so.
Research & Links
Pert, A., Dionne, R., Ng, L., Bragin, E., Moody, T.W. and Pert, C.B (1981). Alterations in rat central nervous system endorphins following transauricular electro-acupuncture. Brain Research. 224: 83-93.
Zhang, Q., Li, A., Yue, J., Zhang, F., Sun, Z. and Li, X. (2015) Using functional magnetic resonance imaging to explore the possible mechanism of the action of acupuncture at Dazhong (KI 4) on the functional cerebral regions of healthy volunteers. Internal Medicine Journal, pp. 669-671
Seorim Min, Koh-Woon Kim, Won-Mo Jung, Min-Jung Lee, Yu-Kang Kim, Younbyoung Chae, Hyangsook Lee and Hi-Joon Park (2019) Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Frontiers in Neuroscience, March 2019, Vol. 13, Article 215
Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, Bai SJ, Kim YB, Lee YB, Sung KK, Lee BH, Shepp LA, Min KT (2006) Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurologica Scandinavia, 2006: 113: pp. 370–377
Hugh MacPherson, PhD, Richard Hammerschlag, PhD, Remy R. Coeytaux, MD, PhD, Robert T. Davis, MS, Richard E. Harris, PhD, Jiang-Ti Kong, MD, Helene M. Langevin, MD, Lixing Lao, PhD, Ryan J. Milley, MAcOM, Vitaly Napadow, PhD, Rosa N. Schnyer, DAOM, Elisabet Stener-Victorin, PhD, Claudia M. Witt, MD, MBA, and Peter M. Wayne, PhD (2016) Unanticipated Insights into Biomedicine from the Study of Acupuncture, The Journal Of Alternative And Complementary Medicine. Volume 22, Number 2, 2016, pp. 101–107
Andrew C Ahn, Junru Wu, Gary J Badger, Richard Hammerschlag and Helene M Langevin (2005) Electrical impedance along connective tissue planes associated with acupuncture meridians. BioMed Central Complementary and Alternative Medicine.
Young-Chang P. Arai, Yoshikazu Sakakima, Jun Kawanishi, Makoto Nishihara, Akihiro Ito, Yusuke Tawada, and Yuki Maruyama (2013) Auricular Acupuncture at the ‘‘Shenmen’’ and ‘‘Point Zero’’ Points Induced Parasympathetic Activation. Evidence-Based Complementary and Alternative Medicine.
Sheng-xing, M. (2017). Nitric Oxide Signaling Molecules in Acupuncture Points: Toward Mechanisms of Acupuncture.Chinese Journal of Integrative Medicine, 2017 Nov; 23(11): pp. 812–815.