Dry Needling vs. Acupuncture

What’s the Difference?

This is a question that commonly arises from our patients when discussing incorporation of needling into a treatment plan. While both treatment approaches involve the use of needles and insertion into the skin, the similarities stop there.

Traditional Chinese Medicine

Acupuncture, one of the oldest medicinal approaches in the world, is` used in TCM, or Traditional Chinese Medicine. It most commonly involves needling specific points and leaving these needles in for a period of time (usually 15-30 minutes). These points are based on pathways of energy in your body known as meridians. This energy, referred to as Qi (chee), is very important for health and well-being. Disruption of your Qi flow results in disease, injury and pain. TCM acupuncture’s main goal is to help restore this flow and restore harmony in your body. When your energy is balanced, you are pain-free. The concept of restoring your balance (yin and yang are equal) is the main goal of TCM acupuncture. It is a natural treatment method that encourages self-healing of your body without the use of pharmacological agents.

Acupuncture Points

In a more practical sense, needling in TCM is done along very specific points in your body that are pre-set. There are more than 2000 points in your body, and these points run along the meridians mentioned prior. Acupuncturists and other health care practitioners who provide acupuncture are knowledgeable in the locations of these meridians and the points along them. Points are chosen based on patient presentation and their associated conditions. While there isn’t really a “cookbook” for point selection, certain points are commonly used for certain conditions, and sometimes needling away from the area of pain is just as (and often more) effective than needling directly in the region. This is all variable and involves clinical reasoning and experience.

Dry Needling

Dry needling is a very different type of modality. With this approach, trigger points (hyperirritable spot in a muscle that is associated with a palpable nodule in a taut band) are identified and targeted via needling. A trigger point that is needled has been identified by the practitioner as a salient contributor to the patient’s pain presentation, and palpation/compression of this point will reproduce some or all of the patient’s pain complaints. Sometimes, trigger points are also needled away from the direct area if the area being needled has been implicated in the issue (a muscle imbalance, for example). Dry needling involves needling of these trigger points in order to release or inactivate them and thus reduce or eliminate the patient’s pain complaints. Various theories exist regarding the pathophysiology of a trigger point and what exactly creates/perpetuates them.

Muscle Twitch

When needling, the therapist will use a pistoning motion with the needle in an attempt to target and release the trigger point. This will often (ideally) induce a twitch in the muscle, referred to as a local twitch response (LTR). This is clinically seen as the muscle “jumping” or quickly contracting involuntarily. This twitch response is ideal in that it promotes increased muscle lengthening, improved mobility and reduces pain. It is a sign we are getting what we want out of the treatment.

Stephanie Rhea, Registered Physiotherapist, dry needling the gastrocnemius (calf) muscle.

What to Expect

Practically, dry needling of one point usually only lasts around 5-10 seconds and is stopped when the desired effect is achieved (vs acupuncture where the needles are left in for a period of time). Dry needling is often uncomfortable, and post-treatment soreness is expected. This is a good sign in the sense that we achieved the desired release of the targeted points. This usually resolves in 24-48 hours after treatment. A feeling of fatigue and achiness are also common, as well as bruising. Soreness can also be felt with acupuncture, but this is not necessarily expected. Sometimes a little pin prick sensation can be felt with the needles going in, while at other times a dull achy sensation can be elicited around the needle region. Bruising can also occur with acupuncture, as well as some mild post-treatment soreness. Often a more immediate effect is seen with dry needling in the sense that range, muscle strength and muscle length as well as pain are often quickly improved. With acupuncture, this can also occur, but sometimes is a more gradual process. These are not hard and fast rules and everyone is different. Both treatments carry risks, and these would be discussed with your therapist during the informed consent portion of your visit.

Corey Ireland, Registered Physiotherapist performing dry needling on the low back.

Steven Georges, Registered Physiotherapist, performing dry needling on the upper fibres of trapezius.

A Physiotherapy Tool

As physiotherapists, one common theme is using needling (acupuncture or dry) as an adjunct to your treatment plan. Very rarely do we seldomly do needling as our only intervention- its effectiveness is often maximized when used as only one component of a comprehensive approach involving different things. Exercise, education, manual therapy, taping, etc. are all components to achieving a full recovery.

Want to Try?

If you are interested in either of these approaches, discuss with your physiotherapist which may be appropriate for you.  As with everything we do, all treatments are individualized and tailored to each person’s specific needs and issues.  Call or visit us at Ireland Manual Physiotherapy, and we will be happy to discuss all things physio, including these two exciting and effective interventions.

Authored by Steven Georges, BHK(Hons), MPT, CIDN, MCPA

Registered Physiotherapist and avid golfer

References

Johns Hopkins Medicine: Acupuncture.  https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture

Mejuto-Vazquez MJ, Salom-Moreno J, Ortega-Santiago R, Truyols-Dominguez S, Fernandez-de-Las-Pensas C.  Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial.  J Orthop Sports Phys Ther. 2014 Apr; 44(4): 252-60.

Simons, David G, Janet G Travell, and Lois S. Simons.  Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual.  Baltimore: Lippincott Williams & Wilkins, 1999.