How does Dry Needling compare to Medical Acupuncture?

 I can't tell you how often we get the question, "What is the difference between dry needling (DN) and medical acupuncture (MA)?" Simply put, DN is needling into muscles, while MA is needling along nerve and connective tissue pathways. DN is best for painful muscle knots, while MA employs a variety of needling techniques and needling locations that help with all kinds of pain syndromes and diseases of most origins. DN is a tool in the toolbox to help reduce pain, while acupuncture can be a standalone treatment for a variety of complicated diseases.

History of Dry Needling In the 1970s, Dr. Janet Travell, M.D. researched muscle knots to find that when needling certain ones, called trigger points, relief ensued. The therapy of needling trigger points/muscle knots isn't new in the slightest in the acupuncture world, but was then adopted by physical therapists, predominately. Some states do not allow anyone but licensed acupuncturists to do DN, however, in Colorado, DN from a PT is legal with extra training. While it makes me slightly uncomfortable to have beginner-level PTs DN more advanced points (around the ribs, lower neck, and armpits), ultimately I think their training is sufficient, and the patient just needs to understand that needling of any sort is an invasive and potentially dangerous therapy. Choosing your provider based on skill and experience is vital.

Some Common Questions I Get
—Different needles? The needles used in DN and MA are both acupuncture needles. There is no set length or gauge. The size of the needle depends on the area being needled.
—Science-based only? Some people say that DN is anatomy/science-based, while acupuncture is energy-based. This is very false. Licensed acupuncturists are trained in all facets of Western medicine and have the option to choose a niche in MA or energy medicine.
—Both work on pain? DN is better for acute pain, or pain due to overuse injuries, while MA (specifically) is best for any other type of pain (neuropathy, radiculopathy from nerve impingement, chronic pain, neuropathic pain).
—Training in DN? PTs have significantly fewer training hours in needling techniques and safety than acupuncturists (45 hours versus 1000+ hands-on), however the treatments PTs are employing with DN are not hugely complicated. Acupuncturists have far less training in anatomy and physiology than PTs but learn a myriad of different techniques when a simple pain protocol with DN might not be enough Some acupuncturists are not trained in DN. It's like playing a sport: You need to go to practice in the field and watch film on technique. In my opinion, there is never enough training! Always ask your provider what their training and experience is!
—Does it hurt more? A generalization is that physical therapists tend to needle a little more aggressively than acupuncturists do, and that can be one big reason why a person might choose acupuncture over DN.
—Can only PTs DN? Often, I hear that dry needling is "a therapy only done by physical therapists," which is incorrect. However, not all acupuncturists are proficient at orthopedic or pain treatments, so do ask any provider about their experience before signing up for an invasive procedure.
—Needle retention time? DN done by a PT typically has much shorter needle retention times. In MA, we retain needles for a minimum of 20 minutes, and research shows 12 minutes is the shortest duration for results, while 45 minutes or longer can cause no more increase in results. Most PTs retain needles for a short time solely based on the amount of time they're booked to see a patient. You might argue that MA done by an acupuncturist could be stronger based on needle retention time alone.
—Is MA more comprehensive? MA can treat pain from a myriad of issues such as cancer pain, diabetic neuropathies, pain from spinal impingement, pain from chronic issues, arthritis, or pain from no known cause. MA also shines in treating non-pain conditions such as digestive issues, sleep problems, stress management, autoimmune flares, and fertility problems, just to name a few.
Guidance for Deciding
—DN is only used for treating pain, especially acute pain or pain from overuse, and the needle is inserted where the person is reporting the pain (sometimes in neighboring muscles).
—Choose DN if you have pain/injury from doing something repetitive (working at a computer, doing a sport like golf, tennis, football, soccer, etc.). Or if you have an acute pain that started suddenly but is not an acute injury (twisted ankles and sprained wrists sometimes respond poorly to DN, while a recent sore back or neck might do well with DN).
—Choose MA if you have chronic pain, pain from unknown origin, organ pain (stomach aches, gallbladder pain), pain from disease, an acute injury that is swollen and painful, a torn muscle/tendon, chronic headaches, tendonitis, pain that comes with autoimmunity or stress.

Sometimes, we don't know if you're a good candidate for either until we try. When we see a patient at my clinic, we assess them for all types of pain origins and then decide on the spot what kind of treatment we think they might do best with. Then we follow up on how they responded, and further our treatment plan accordingly to get the patient better!