Dry Needling Training, Practice and Licensure

I have written previously about the relation between dry needling and acupuncture. My intention in this article is to point out the differences in training and application. Why? Because I’ve often found that when new patients call or come to my office for dry needling, they think they’ve already received dry needling treatment in the past. After treatment, they point out differences. This is because there are practitioners advertising dry needling services who are not, in actuality, practicing dry needling.

Trigger point dry needling is a clearly defined technique. Active trigger points (muscular knots) are identified through palpation and response; that is to say, a practitioner finds a spot that is knotty, hurts, and connects with or reproduces the pain pattern of the patient. The patient is then treated by inserting and manipulating a needle until a twitch response indicates the knot has been released.

Locally, in the states of New Jersey, Pennsylvania and New York, licensure of dry needling is restricted to acupuncturists and medical doctors. Chiropractors and physical therapists do not have dry needling in their legal scope of practice. In relation to this, there are four issues I wish to address.

1. Promotion of dry needling by physical therapists. A simple Google search will suggest that dry needling is readily available at physical therapy offices. At various times in the past, physical therapist were allowed to practice dry needling with proper training. However, in many states that is not the case now. Commonly, physical therapists will then focus on the “trigger point” aspect of “trigger point dry needling.” To be clear, the trigger point itself is the knot in the muscle, and dry needling is the treatment. There are other physical therapy methods for relieving trigger points, such as spray and stretch, myofascial release, and others. These are valid techniques, but they are not dry needling.

2. Promotion of dry needling by chiropractors. While historically few chiropractors have practiced dry needling, there have been some. As the legal scope of chiropractic practice is typically limited to spinal manipulation, trigger point treatment is generally not part of chiropractic treatment. While some practitioners use activators to treat muscular constriction, typically this approach is ineffective at relieving trigger points.

3. Promotion of dry needling by medical doctors. It is important to consider in this case the context for dry needling. Effective and safe practice of dry needling requires prolonged and intensive training, and its administration in the clinic is time and labor intensive. It is rare for medical doctor to have the time or inclination for these, particularly since their comprehensive scope of practice allows them to administer a wide variety of therapies. In addition, there is no insurance coding or coverage for dry needling. Overall, it has little place in the medical system. Trigger point treatment is a common approach in the related fields of pain management, physiatry, physical medicine and rehabilitation, and anesthesiology.

However, trigger point treatment and dry needling are not the same. The most common technique utilized by medical doctors is trigger point injections. A numbing agent such as lidocaine, or another drug such as cortisone, botox or pain medication is injected into a trigger point. This is known as wet needling, in contrast to dry needling in which no substance is injected and the needle is solid. The primary effect of relief from wet needling comes from the medication. Trigger points are not manipulated with the needle nor is the aim to release through twitch. Pain reduction can often be achieved and a local trigger point may be eliminated; however, it is not possible to treat more than a few spots in this manner. Dry needling addresses all trigger points that are contributing to a person’s pain, and typically there are many. Wet needling is a more limited treatment.

4. Promotion of dry needling by acupuncturists. Many acupuncturists are under the uninformed assumption that dry needling and acupuncture are the same thing. They aren’t. The origin of this misconception largely arises from the coining of the terms “trigger point acupuncture” and “acupuncture physical medicine” by my former teacher and founder of the Tri-State College of Acupuncture, Mark Seem.

In the late 1980’s and through to recent years, The Tri-State College of Acupuncture taught a French-Vietnamese style of acupuncture that was later informed by the work of Janet Travell, MD, who was largely responsible for the development of the modern field of dry needling. Channel and myofascial based acupuncture has been largely lost in modern TCM style acupuncture. This aspect of classical acupuncture similarly focuses, when treating pain, on the tendino-muscular channels using techniques such as sparrow pecking. In the classical acupuncture approach, there are overlaps between dry needling and local acupuncture treatment. The approach taught at Tri-State is rooted in this understanding, but the techniques vary significantly. Similarly, other approaches and coined terms such as “orthopedic acupuncture” and “sports acupuncture” have since arisen within the Western practice of acupuncture.

I practiced this trigger point acupuncture for more than two decades, thinking that what I was doing was the same as dry needling. It was not until I received dry needling treatment for a neck injury that I realized the differences. While I achieved good results treating patients, the effectiveness of my treatments increased dramatically once I started and completed training in dry needling. Having practiced both modalities, I feel qualified and experienced to comment on these.

One last issue to consider is certification. There are now several schools or companies that teach dry needling. I was trained at Myo-Pain Seminars. In addition, completion of a dry needling program allows one to take a written / practical examination that leads to board certification. You cannot practice acupuncture or herbal medicine or Western medicine or physical therapy or chiropractic or any other regulated medical practice without board certification. Dry needling should not be any different. As it is still in the early years of development as a profession, issues of board certification, licensure, insurance coverage, etc. are still being worked out. However, there are dedicated training programs and exams at this time.

Individuals seeking pain relief should understand the basic credentials and qualifications of the practitioner from which they are seeking or receiving treatment. With regard to dry needling specifically, given the issues for each profession that I have described above, the vast majority of properly credentialed and certified dry needlers are, in fact, physical therapists. However, in NJ, PA and NY there are not legally allowed to practice. As a result, physical therapists from these regions are not seeking training. Chiropractors cannot receive this training in most states. Medical doctors rarely venture into this field. And acupuncturists, thinking they are already doing dry needling, similarly do not seek out training.

At the time of the writing of this essay in August 2021, to the best of my knowledge I am the only certified and practicing practitioner of dry needling in the region. Advertising suggests otherwise, but this can be readily clarified by simply asking a given practitioner about their training and certification.

In order for the profession of dry needling to survive, it will need greater application and training programs. For now though, there are established paths to training and practice for qualified practitioners. In New Jersey, Pennsylvania and New York, this means acupuncturists and medical doctors. Regardless of advertising or coined terms, dry needling is dry needling and everything else is not dry needling. The various modalities and techniques all have value and are clinically useful, but patients seeking dry needling specifically should be clear about the training and qualifications of the provider, and treatment they are receiving.