Why Dry Needling Makes Sense Within the Framework of Chinese Medicine

When I entered my program in 1989, there were only three acupuncture schools on the East Coast of the United States. Acupuncture had been a recognized profession in the U.S. for only nine years then, and licensure in New Jersey had begun in 1983.

At the time, the predominant style of acupuncture taught in the US, and worldwide, was Traditional Chinese Medicine (TCM). TCM is actually a modern style of Chinese medicine, formalized in the 1950’s under the direction of Mao Zedong. Its purpose was to restore the practice of Chinese medicine in China and to spread it to the West.

As such, the standardization of Chinese medicine for the first time ever in its 2,500+ year history in China resulted in a system that was intended to resemble Western biomedicine. With regard to acupuncture specifically, this meant focus on what was then perceived as the more lofty, theoretical, internal aspect of acupuncture.

Acupuncture points were assigned standardized functions such as “tonifying the kidneys” and “rectifying the qi.” There was a de-emphasis on the more superficial and mechanical aspects of acupuncture, as these did not appear to be lofty enough to Chinese government officials to warrant respect and attention. The manual aspects of acupuncture – those that deal most directly with myofascial pain – were omitted.

I graduated from the now defunct Tri-State Institute of Traditional Chinese Acupuncture . This is relevant to the above because unique to all other schools in the country at the time, Tri-State’s founder and my teacher Mark Seem emphasized the tendino-muscular channels of acupuncture.

Acupuncture charts typically depict 14 meridians – the 12 primary meridians of Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Triple Heater, Gall Bladder and Liver, as well as the 2 extraordinary meridians, the Governing and Conception meridians, that have their own points. However, there are 73 meridians, not including the internal channel connections that are not generally classified as meridians themselves.

Each meridian includes a tendino-muscular level that runs through the muscle and connective tissue layers of the body. Diagnosis is largely palpatory (detectable through touch), and treatment is mostly local. The main idea is that the blocked qi results in localized stagnation and therefore pain. The therapeutic principle is to treat this directly.

There are 9 basic needling techniques in acupuncture that involve different subtle manipulations of the hands and needles to stimulate the acupuncture meridians and points in different ways. These are: Closing, Opening, Raising and Lowering/Exiting and Entering, Softening/Spreading, Gathering/Consolidating, Sparrow Pecking, Pulling Out, Pinning In, and Awakening the Source. Sparrow pecking involves, as the name suggests, moving the needle up and down to stimulate release of a local congested region, referred to in acupuncture as an “ashi” point.

Because this technique is part of a larger system of treatment, there is consideration to the meridian, region of the body, nature of the pain, constitution of the individual, etc. Differing hand manipulations achieve the desired result. And guess what? Sparrow pecking results in localized twitches and release of blocked points. Anyone who has had dry needling will likely say that’s how it feels when dry needling successfully releases a trigger point!

Yes, in the West, we refer to these blocked points as trigger points and to the technique itself as dry needling. But trigger point dry needling is similar to the sparrow pecking acupuncture technique. 

The field of dry needling and trigger point therapy was largely developed by Dr. Janet Travell , who was President Kennedy’s personal physician. My teacher Mark Seem discovered Dr. Travell’s work, noticed the similarities to acupuncture, and incorporated the knowledge of this field into the curriculum at Tri-State. I was fortunate to see Dr. Travell teach in New York in the early 1990s.

Trigger point therapy is not limited to the use of needles. Trigger points can be treated with massage, acupressure, physical therapy, electrical stimulation, and injections. In my own experience however, there is no technique as effective for treating and relieving trigger points as direct needling. As opposed to trigger point injections for example, where only one or two points may be treated, dry needling may identify and treat dozens of trigger points in a small region of the body.

The study of both dry needling and trigger points has revealed a wealth of information about the mechanism of pain. These fields also offer clinically valuable details regarding anatomy and needling techniques that are complementary to the perspective of acupuncture. While acupuncture is a licensed and standardized profession in the U.S.  , as of the writing of this article in February 2021 this is not the case for dry needling.

There is now a board certification that exists for dry needling, and each state has clear guidelines regarding which practitioners are allowed to practice. However, there is no regulation regarding the use of various terms used to describe the practice. For example, currently in New Jersey only MDs, DOs, and acupuncturists are legally allowed to practice dry needling. It is prohibited for physical therapists, chiropractors, or any other professional.

Something to know and consider when choosing a professional offering dry needling in his or her practice: any acupuncturist can use terminology such as “trigger point acupuncture” to describe what they do, even if they have had no training in dry needling, trigger point therapy, or sparrow pecking technique. Most doctors and acupuncturists themselves do not understand the specifics and details of these fields and techniques. It is common that someone comes to my office in search of dry needling, believing they have previously received it. With very few exceptions, this is not the case.

As an acupuncturist, I consider trigger point dry needling to be part of the larger system of acupuncture and Chinese medicine. For a physical therapist with a different fundamental orientation, it becomes a physical therapy technique. How dry needling is used is dependent on the primary therapy and orientation of the practitioner.

I have been in full-time clinical practice for close to 30 years and have inserted well over a million needles into patients. It is a simple principle that we get better at something the more we do it. For this reason, practitioners who use needles infrequently will have a disadvantage as their skill and experience will develop more gradually. I do not feel that dry needling should be restricted to acupuncturists, nor do I believe that acupuncturists should be allowed to advertise dry needling if they have not been properly trained in it. What I do feel is that patients should seek such treatment from fully trained, qualified, experienced practitioners, whatever their primary practice.

Properly applied, acupuncture and dry needling are effective techniques for relieving acute and chronic pain and restoring function to injured muscles, joints, tendons and ligaments. Conditions that are characterized by muscular tightness and trigger points, and that respond well to both acupuncture and dry needling, include neck pain, frozen shoulder, tennis elbow, carpal tunnel syndrome, low back pain, hip pain and sciatica.

I’ll be sharing more in the coming months about how dry needling and acupuncture complement each other, and I’ll focus on specific ailments or conditions beyond injuries that could benefit from dry needling. I’ve even found dry needling to be a good preventative measure for muscular pain that is caused by overuse, repetitive strain, lack of stretching and injury.