Acupuncture and dry needling – what’s the difference?

I get asked this question all the time by my patients, and there are a few facets to the answer, so I thought it would be helpful to lay it all out here in a post. 

In brief, dry needling is a form of acupuncture, but the main points of difference are:

  • The system and intent in which it is applied; and
  • The level of training and experience with needles of the person applying the acupuncture.

There are several things to understand within each of these points, and I’ll go through these below. 

Dry needling is a form of acupuncture

Dry needling is a trigger-point therapy where fine needles are inserted into areas of tight muscle fibres, usually to achieve a twitch response in order to relieve pain.  The term ‘dry needling’ was coined by Dr Janet Travell in the 1940s in her book ‘Myofascial Pain and Dysfunction: Trigger Point Manual’.

Dry needling is a form of acupuncture, a modern term applied to a practice that has been described in Chinese medicine texts written more than 1300 years ago.  ‘Ashi’ points were described in Chinese medicine in 652 A.D. as points that are tender to touch.  Ashi translates as “Ah Yes!” It’s the point of muscle tension where your body is telling you that’s the place. Ashi points include (but are not limited to) ‘myofascial trigger points’ in modern terminology.

Acupuncture performed by an ‘Acupuncturist’ is a therapy of Chinese medicine; dry needling by a non-Acupuncturist is applied through a different lens

Dry needling is specific to using needles in cases of musculoskeletal pain. When practiced by a non-Acupuncturist (someone not trained in Chinese medicine) it is applied with an understanding of muscles and joints with a specific intent to generate a twitch response and/or help to relieve muscular tension.  In the right hands it can be very helpful and assist with an overall physical treatment. 

When acupuncture (including dry needling) is practiced by an Acupuncturist, we employ the knowledge of Chinese medicine which is based on a multi-layered channel system. This includes the sinew channels of muscles/tendons/ligaments as well as channel systems that are related to the many functions of the body and include connections with the organs.  When we look at a tight muscle band, we also look at the whole sinew channel of which it is one part, which may travel from the head all the way to the feet (which is why you might end up with needles in your ankle or toes for a back problem).

An Acupuncturist will consider a multitude of signs and symptoms, including feeling the pulse, before deciding on the course of needling and other therapies. Other therapies include moxibustion, cupping, guasha and dietary therapy.

Dry needling is just one technique an Acupuncturist might use to relieve muscular pain.  Personally, I very rarely use this form of needling.  Needles applied very shallowly with the intent to access the sinew/muscle layer of the body can be extremely effective for relieving pain and improving movement and function.

The intent and system within which a form of needling has been learned is important because this informs its appropriate use in practice.  An Acupuncturist works with the body’s flow of Qi and Blood, and we are trained to understand the interactions of Qi throughout the channel systems and organs. This means we apply acupuncture to assist in a variety of health presentations from pain through to digestive upset, fertility and menstrual disorders to pregnancy and birth preparation.  A ‘dry-needler’ has learned to use needles to facilitate a trigger-response or relieve muscle tightness and thus their use of needles within this context is appropriate. 

I once had a patient tell me that their chiropractor was using needles to help them prepare for birth, using points within the Chinese medicine system and not in a context of pain relief.  This is highly inappropriate because a dry-needling training does not equip one to understand the impact of needles on the body’s Qi, or to understand the subtly of the Chinese medicine system of channels, and such an application could well cause (unintended) harm.

Acupuncturists have more extensive training with needles

Chinese medicine and acupuncture are regulated under the Australian Health Practitioner Agency (AHPRA) and the Chinese Medicine Board of Australia (CMBA). As such, only those practitioners who are registered with AHPRA may claim to be ‘Acupuncturists’. To be a registered Acupuncturist or Chinese medicine practitioner requires completion of a four-year full-time University (or equivalent) degree in Chinese medicine, maintaining relevant insurances, membership with a professional body such as AACMA and ongoing continuing professional development. It is a breach of national law to claim to be an acupuncturist or to imply you are an acupuncturist without being registered.

Acupuncturists must complete 750+ clinical hours as part of their training.  The course also includes detailed instruction in needling technique and point location with focussed instruction on safe practice to prevent issues such as organ puncture and nerve damage.  A dry-needling practitioner may have as little as 16 hours of training in the use of needles.

In conclusion

Dry needling is a form of acupuncture and may be used appropriately to help relieve muscular tension. Before receiving needling from a practitioner, be clear on the training they have received and what their intent of treatment is.  Is your practitioner an Acupuncturist (Chinese medicine practitioner) registered with AHPRA?  What do they propose to use needles for in your treatment – muscular pain or something else? With the elements presented above, you should now be able to make an informed decision as to the appropriate use of needling for your condition.