​​Dry Needling or Acupuncture: What’s the difference?

The term Dry Needling came from the need to differentiate between the injection of fluid through a syringe (wet needling). Dry needling doesn’t involve the injection of any substance, just the insertion of the needle.

The term was first used by American, Dr Janet Travell in her book ‘Myofascial Pain and Disfunction: Trigger Point Manual’. Originally a Cardiologist, she became interested in Orthopaedics, in particular musculoskeletal pain, in the 1940’s when she and David Simons used the technique of injecting substances such as saline, corticosteroids and analgesics into tight bands of muscle or muscle knots to alleviate pain. Acknowledging that the effect of the over 3000-year-old Chinese tradition of placing a needle into certain areas (Ashi acupuncture) also produced pain relief, Dr Travell used the end of a hypodermic needle to similarly needle sore spots in muscles. There was little interest in this technique until there was a focus on Acupuncture in the 1970’s.

What is a Myofascial Trigger Point?
The term Myofascial Trigger point was defined by John Kellergen in 1938, as an area of sensitivity that when pressed created referred pain responses. Later Canadian, Chan Gunn, developed a technique called Intramuscular Stimulation in the 1970’s which related to needling tight muscle bands to create a nerve response or twitch.

Does Acupuncture use Trigger Points?
Acupuncture has been using trigger points for many thousands of years, this practice is called Ashi acupuncture and is one of many needling techniques used by Acupuncturists.

Indeed, Ashi acupuncture is the basis for dry needling. Ashi points have been defined in classical Chinese Medicine in 652AD in Sun Si Miao’s (581-682 CE) book Qian Jin Fang (Thousand Ducat Formulas) as points on the body’s fascia that are tender to touch and are literally translated as “Ah yes” points. In traditional Chinese acupuncture there are at least three categories of acupuncture points: Ashi points, classical meridian points, and extra meridian points.

Ashi points often include local or distal pain points, local atrophy areas or skin change areas. Stimulating these points is a common strategy in acupuncture for local and distal illnesses, not just neuromusculoskeletal and connective tissue disorders. With standard meridian and extra-meridian points used by Acupuncturists there are at least 1,655 defined acupoints, many of which overlay the areas which most commonly have Ashi points.

The Huang di Nei Jing (The Yellow Emperor’s Internal Canon), written in 100 BC talks of the needling technique for Ashi points producing a twitch which is called the ‘arrival of De Qi’. In other words, dry needling is not a new scientific technique developed in the 1930’s but is rather a term used to describe an acupuncture technique which has been used and described for thousands of years.

Is Dry Needling more scientific?
More recently dry needling was deemed by Western Medical practitioners as more scientific than the ancient Chinese practice of acupuncture, where the language is based in the traditions of Taoism rather than Western Medical terminology. This is a misunderstanding on their part rather than based in fact or evidence. Simply a difference of language used.

So, in short, the term Dry Needling could be seen as a rebranding of acupuncture, using the term English Bio-Medical term Trigger Point instead of the equivalent Chinese medicine term Ashi point. Indeed, Dr Travell admitted to the general-public, that dry needling is acupuncture when she stated in a newspaper that ‘the medical way of saying it is ‘acupuncture’.

There is currently no standardisation of dry needling, with a scarcity of extensive research in the field. Many studies published about dry needling are not randomised, contain small sample sizes, and have high dropout rates (Norris {2015}. “Dry Needling”. SportEX Dynamics. 44: 24-30.)

There is currently more high-quality evidence-based research on the mechanisms of acupuncture than that of dry needling. In fact, most recent evidence used to support the use of dry needling is based on acupuncture research and evidence.

Current research now shows that there are a wide range of health conditions which can benefit from the use of acupuncture as well as myofascial or pain management issues. Acupuncture is also recognised by the World Health Organisation as useful in the management of many health conditions.

What is a Registered Acupuncturist?
A registered Chinese Medicine Practitioner must have a four-year university degree or equivalent which covers Western Medical Bio Sciences as well as Chinese Medicine/Acupuncture and between 600 and 1000 hours of supervised clinical practice to call themselves Acupuncturists.

These practitioners are also required to do 20 hours of continuing professional development (CPD) each year and maintain high levels of insurance. Those doing dry needling may have as little as 16 hours of training in Ashi Acupuncture, have no requirement for supervised clinical practice or CPD. There are also no specific course standards or requirements needed to learn dry needling as it is not regulated.

Can anyone say they are Acupuncturists or are doing Acupuncture?
In Australia, Chinese Medicine Practitioners and Acupuncturists are regulated under AHPRA (Australian Health Practitioner Agency) and the Chinese Medicine Board. The title Acupuncturist is a protected title which means anyone not registered as such cannot call themselves Acupuncturists or suggest they are doing Acupuncture. To do so is called “holding out” or pretending to be registered to practice Acupuncture. Those who do so are in breach of the National Law and are reportable to AHPRA.

How do I know if my practitioner is a Registered Acupuncturist?
You will know if you are seeing a registered qualified Acupuncturist/Chinese Medicine Practitioner if they are registered as such with AHPRA (go to www.ahpra.gov.au and look at the practitioner registration under Acupuncture or Chinese Medicine). They will also have a CMBA number that on any receipt will have a number starting with CMR. That way you will know that you will be treated with Acupuncture by someone with the highest level of training.

So….
Would you rather have a Plumber deal with your electrical issues or a qualified Electrician?
Perhaps it’s better to have your Acupuncture treatment from an registered, qualified Acupuncturist.