Dry Needling or Acupuncture – What’s the Difference?
What is dry needling?
In the 1940s Janet Travell and David Simons experimented with hypodermic needles, injecting substances into tender points in muscles and fascia in order to develop a physical therapy attempting to reduce the pain of these tender points. They did this using a variety of substances such as cortisone, saline solution, and
analgesic drugs. In hindsight we could term those techniques ‘wet needling’. Eventually they moved to other techniques that did not involve injecting liquids, and thus came up with the term ‘dry needling’ (as distinct from wet needling). The first published material that uses the term dry needling was in Dr Travell’s book ‘Myofascial Pain and Dysfunction: Trigger Point Manual’. Tender points and muscle knots were referred to in her book as ‘trigger points’.
What is a trigger point?
The term trigger point came before Dr Travell’s book, and was rendered by John Kellgren in his article in the British Medical Journal in February 1938. In common language these areas of tension and pain tend to be referred to by patients as muscle knots, or sore spots. Medically speaking they are areas of muscular tension that are painful when palpated. They are typically caused by musculoskeletal injury, or repetitive overuse syndromes.
Is dry needling different to acupuncture?
No. Dry needling is acupuncture. The difference is the practitioner. Therapeutic penetrative needling into sore spots, muscle knots, or trigger points, causing physiological responses that result in reduction in tension and pain are described in ancient classical and contemporary Chinese medicine literature. A well-known classic of ancient acupuncture, the ‘Yellow Emperor’s Internal Classic’ most likely written around 100BC, has a discourse on the response that occurs with such needling. What some call ‘trigger points’ are called ‘Ashi points’ in acupuncture terminology. It was the great Chinese medicine master Sun Si-Miao who first put the Ashi point in print in his ‘Beiji Qian Jin Yao Fang (Essential Formulas for Emergencies [Worth] a Thousand Pieces of Gold) during the Tang Dynasty some 1300 years ago.
Dry needling is just a poorly worded English phrase that describes an aspect of acupuncture that has been practiced continuously by generations of acupuncturist for at least 2000 years.
Why is it called dry needling? Why not call it acupuncture?
Over time acupuncture has migrated from the Orient to Western counties such as Australia, the United States, Canada, Britain, and Europe. In the last few decades acupuncture has become recognised as a legitimate health profession within Chinese medicine, and has become government regulated. This means that only practitioners with adequate qualifications can call themselves acupuncturists and provide acupuncture services.
Consequently another term was needed for non-acupuncturists, practitioners without acupuncture qualifications, who were intent on performing penetrative needling, using acupuncture needles, but wanting to rightly avoid using the term acupuncture and the consequential legal problems.
Travell’s term, ‘dry needling’ became the convenient alternative word to acupuncture. The most common types of practitioners who use acupuncture needles without acupuncture qualifications, and call it dry needling are chiropractors, physiotherapists, osteopaths, myotherapists and massage therapists.
Are trigger points and Ashi points the same?
Yes, they are. With the benefit of modern scientific knowledge, we know that neuromuscular junctions are where the nerve meets the muscle, and through which nerve impulses occur in muscle activation. These sites often form tight and tender areas that can be relieved through therapeutic needle insertion. These points have been called Ashi points for millennia, and trigger points for only several decades. However it is clear they are one in the same phenomenon.
What types of conditions is dry needling used for?
Some of the common conditions dry needling is used for include musculoskeletal issues such as:
Carpal tunnel syndrome
General pain relief
What are the benefits of seeing a registered Chinese medicine acupuncturist over a dry needling practitioner?
A more skilful touch and less pain.
Acupuncturists use therapeutic penetrative needling as their primary tool of practice. They spend four years in university developing painless needle insertion skills. Practitioners performing ‘dry needling’ do so merely as an adjunct to their primary professions such as chiropractic and physiotherapy, so there is a higher possibility of the needling being painful. At Colac Otway Chinese Medicine we use more gentle needle techniques to help you get better results than just dry needling. Improved safety, and much longer and more specific training in using acupuncture needles, means you are in safer hands.
Acupuncture is just one technique in Chinese medicine we can use for muscle pain and dysfunction. We also have additional tools including diet, Chinese herbal medicine, pain relief supplementation and exercise therapy.
How does the level of training for dry needling differ from acupuncture training?
Dry needling practitioners have often completed only a one day seminar, or a weekend course in ‘dry needling’. Some have done longer courses, however there are no nationwide minimum standards or training requirements for dry needling. The government’s Australian Health Practitioner Regulation Agency (AHPRA) does not endorse dry needling for its registered chiropractors, physiotherapists, osteopaths, or any of the other health professionals. Many individuals and organisations offer ‘dry needling’ courses, but none of them are accredited by AHPRA.
Registered acupuncturists are very well trained. They have a degree in health science, studying all of the important subjects that all health professionals study through their health science degrees. Acupuncture students study acupuncture and dry needling techniques concurrently through the four year course.
Typically, acupuncturists would cover the following as a minimum:
Anatomy and physiology, the structure of the body and how it works: 150 hours
Acupuncture point location including how to needle points all over the body safely avoiding damage to organs, nerves, arteries and other structures: 100 hours
Acupuncture and dry needling training: learning how to treat health and pain conditions using points all over the body, in a comfortable, safe and painless manner: 200 hours.
Supervised clinic practice: treating patients in clinics fully supervised and mentored: 400 hours.
What are the risks of acupuncture and dry needling?
With any form of skin penetration there are risks to the patient. Whether it be an injection from a nurse or doctor, a surgical procedure, or penetrative needling such as acupuncture, there are risks. However, the more training a practitioner has, there is less risk to the patient.
One such risk is bacterial infection. If a practitioner was to not follow proper aseptic technique when inserting needles, such as using new sterile needles and washing of hands, and other requirements, an infection could occur. The Australian Health Practitioner Regulation Agency’s (AHPRA) Chinese Medicine Board mandates all registered acupuncturists to strictly observe acupuncture infection control guidelines in order to protect members of the public seeking acupuncture therapy.
Unfortunately there are no infection control registration guidelines for non-acupuncture dry needling practitioners.
Another risk to be considered is if a practitioner were to insert a needle too deeply, or inappropriately, organ damage could occur. One of the worst case scenarios could be to puncture the lung when needling the upper back of the patient. Such a scenario could even lead to the death of the patient.
A registered acupuncturist is highly trained and is totally focused on such events not occurring. An important part of the four year study of acupuncture is learning maximum permissible insertion depths all over the body. Of course those maximum insertion depths vary from person to person depending on how slim or large they are. Chinese medicine has a system called ‘proportional anatomical measurement’. This system informs acupuncturist on the maximum safe insertion depths of needles at different parts of the body, and takes into account the size of the patient.
When comparing the risks between a registered acupuncturist and a practitioner who does dry needling as an add-on, it is clear that the one with the higher training, and relevant registration guidelines would be a much safer choice.
In any case, before a practitioner performs needling therapy on a patient, the therapist must gain ‘informed consent’ from the patient. The risks must be outlined to the patient, along with the qualifications of the practitioner. The patient can then give consent to the acupuncture or dry needling treatment. If your dry needling practitioner is not outlining these risks and explaining the level of qualifications relevant to their practice of dry needling, they are certainly not fulfilling their responsibilities.
Acupuncturist/Chiropractor/Physiotherapist/Osteopath – What’s the difference?
These are four examples of restricted titles of health professionals who provide physical therapies.
The Australian Health Practitioner Regulation Agency is the administrative umbrella body over the national boards that include the Chinese Medicine Board of Australia, the Chiropractic Board, the Physiotherapy Board and the Osteopathic Board, among others.
The government recognises that there is a diversity of health professions practicing in Australia.
Each board registers and regulates the relevant practitioners. The respective boards also set minimum standards for the courses that lead to the qualifications of practitioners that allow them to become registered practitioners.
The purpose of the scheme is to ensure public safety. When a member of the public wants to access professional health care such as physiotherapy, or chiropractic for example, by consulting registered practitioners the patient can be confident that the appropriate qualifications have been achieved by the practitioner.
The respective types of practitioners have quite distinct modalities: An osteopath practices osteopathy, a chiropractor practices chiropractic, a physiotherapist practices physiotherapy, and a Chinese medicine acupuncturist practices acupuncture. The educational and skill backgrounds of the respective professions are different, and it is a well accepted ethical principle that health professionals should practice therapies that lie within their particular scopes of practice of their profession. The purpose of the AHPRA scheme is that members of the public can access professional health care confident that the therapy performed on them is relevant to the accredited qualifications that the practitioner practices under.
Many registered acupuncturists, including myself, are of the opinion that the practice of ‘dry needling’ by various types of practitioners, without AHPRA accredited qualifications, is unethical, potentially dangerous, and outside the respective scopes of practice.
If an acupuncturist were to perform chiropractic manipulations without the proper accredited qualifications and registration, would that not be likewise unethical and potentially dangerous?
How do I determine if I am seeing a fully qualified acupuncture/dry needling practitioner?
When you seek the services of an acupuncture practitioner be sure that they are a registered acupuncturist under the federal government’s Australian Health Practitioner Regulation Agency’s (AHPRA) Chinese Medicine Board.
It is very simple to check your practitioner’s registration status. AHPRA has a public register of all health professionals. Go to www.ahpra.gov.au Click on the ‘register of practitioners’, type in the practitioner’s name, click ‘search’ and the details of the practitioners registration status will appear.
A registered acupuncturist will have a registration number starting with CMR. Feel free to ask your practitioner for this number as it will give you the confidence that this practitioner is in fact a qualified and trained acupuncturist, and you are in the safest hands.
Is the practitioner at Colac Otway Chinese Medicine a qualified acupuncturist registered by AHPRA’s Chinese Medicine Board of Australia?
Yes. Andrew Broomfield has been a registered acupuncturist since 2002. You can be confident that you will receive the highest level of safety and care at Colac Otway Chinese medicine in Colac, the Cob Clinic in Forrest, and at the Lorne Community Hospital.
For further information check out the public register of practitioners on the AHPRA website.
His registration number is CMR 0001739226Feel free to give him a call anytime: Office phone: (03) 52311 799,
or mobile 0438 816 170.