I have written previously about the relation between dry and needling acupuncture, and about issues of training and practice. This brief article is intended to briefly highlight the differences between these practices and why incorporate both in my Classical Chinese medicine practice.
There are four major differences in technique between dry needling and local acupuncture treatment:
- Acupuncture uses relatively shallow needle insertion. The trigger point acupuncture style taught by my teacher Mark Seem uses relatively superficial needling techniques, with the perspective that connective tissue connections will allow relaxation of trigger points at a deeper level. By contrast, dry needling often uses deep needle insertion. This is important as trigger points are often located deep in the body and cannot always be accessed through superficial needling. An example is low back pain that is related to a trigger point in the quadratus lumborum muscle, which cannot be reached through traditional acupuncture techniques.
- Because of the deeper needle insertion that is common with dry needling, a detailed and clinically based understanding of anatomy is required. This allows for safe treatment of trigger points that are deep in the body or near nerves, blood vessels and organs. This is not typically the case with acupuncture, which does not approach these structures and relies on a more superficial understanding of anatomy. A properly trained dry needler can treat anywhere in the body. For example, it is safe to deeply needle the sterno-cleido mastoid muscles in the neck to treat migraine headaches with a proper understanding of neck anatomy. This can be complemented with acupuncture for more effective results.
- Dry needling can be applied anywhere there is muscle. While this is true of acupuncture as well, the trigger point acupuncture approach typically addresses limited areas where there are large, obvious and easy to treat trigger points. A good example of this would be the trapezius (shoulder) muscle, which when constricted can produce pain in the head, neck, upper back, shoulders, arms and hands. Dry needling can precisely treat even small, hard to locate trigger points.
- Dry needling is focused on complete release of all active trigger points. One trigger point may twitch many times before it is completely released, and there may be multiple trigger points within a given area. Acupuncture techniques typically do not address multiple points within a given area, and after one or two twitches the treatment is complete. Dry needling typically requires more contact time to work on the patient so that all trigger points can be released.
Classical acupuncture techniques offer a comprehensive approach to the treatment of myofascial (muscle and connective tissue) pain. I see dry needling as complementary to this approach. While more limited in overall scope than acupuncture, dry needling furthers the aspect of acupuncture that is related to local treatment of blockages in the muscles. Dry needling can be readily combined with classical acupuncture to achieve the best results.
In my own practice, I typically treat patients first with dry needling to release trigger points and muscular constrictions, and then use acupuncture during the same visit to consolidate the results and address other factors which may be contributing to the patient’s symptoms. For more on this subject, see Underlying Factors in the Treatment of Acute and Chronic Pain.