Dry Needling versus Acupuncture

The differences between two techniques that are often paired with physical therapy.

In some ways dry needling and acupuncture are very similar in that they both use small needles placed in the muscles. Because of the similarity in the needles, many of our patients ask "what is the difference between dry needling and accupuncture?"

Acupuncture is based in Traditional Chinese Medicine and has been around for about 3,000 years. By contrast, practitioners started using dry needling in the 1940s, based on the published work by Janet Travell and David Simons on myofascial trigger points. While acupuncture is only performed by licensed acupuncturists, dry needling can be done by physical therapists, physicians, or physicians assistants (who have completed the dry needling certification). It is most commonly done by physical therapists and is integrated into physical therapy sessions. 

Acupuncture relies on the concept of “meridians “ or pathways of energy, sometimes referred to as “qi.” Acupuncture relies on these pathways in order to determine where to place the needles. Interestingly, the placement does not always seem to align with the areas of pain. For example, an acupuncturist might place a needle in your hand in order to treat pain in your feet. While this might not seem to make sense, placing needles along specific pathways is actually very effective.

Dry needling is all about myofascial trigger points. In simple terms, these are knots in the muscle. Soft tissue mobilization (or massage therapy) can only affect superficial layers of muscle/soft tissue. Sometimes the injured or painful tissue is deeper in the muscle, in a place where only a needle can effectively reach. The goal of dry needling is to relax muscles that are tight and locked up. By placing the needle directly into the trigger point/knot, the muscle will twitch and spasm, until eventually it is forced to relax. Once the muscle is relaxed, it can function and generate power more effectively. In addition, the microtrauma created by the needle prompts the body to increase blood flow to the injured area, therefore bringing in a cascade of healing biochemicals and also flushing away pain-generating metabolic byproducts.

With dry needling, the placement of the needle is very much determined by trigger point/ specific area of pain. Therefore, you might have dry needling done in different spots each time, depending on which trigger points or muscles are causing problems. Sometimes the twitching muscles that respond to dry needling insertion can be uncomfortable but it is not typically painful. 

Both acupuncture and dry needling use very thin stainless steel needles, thinner than what you would find attached to any type of syringe. The needle insertion itself is typically not considered painful. Depending on the acupuncturist, the needles might be left in for up to 30 minutes. With dry needling, the needle is typically left in while it is actively stimulating the muscles, which can range from 30 seconds to several minutes. You might find yourself stiff/sore for up to a few days afterwards, but neither therapy should leave you with lasting pain. On the contrary, once the stiffness/soreness has worn off, you should find your pain to be reduced, range of motion increased, and that you are feeling stronger.