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[post_content] => I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
[post_title] => What's the Difference Between Dry Needling and Acupuncture?
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[post_content] => When I’m counseling clients with marital challenges, my orientation is to always try to save the relationship. Especially if the individuals are interested in growing, becoming more self-aware, and healing old wounds and patterns of dysfunction, there’s nothing like an intimate relationship to facilitate that process. Some of the main recurring themes of our conversations are commitment, intention, and integrity.
I don't mean to provoke blame or shame when I point out that nearly every relationship that ends in divorce begins with two sane and sober people making lifelong promises to each other in front of a room full of loving witnesses. Whether we realize it or not, I believe the essence of what most couples are vowing is, “I’m going to do whatever it takes to make this a healthy relationship.” Over time, we may forget our promise or rationalize breaking it because we’re not happy, we and our circumstances have changed, or the other person is annoying and smelly.
Of course, many people enter such a contract without giving it much thought. They feel in love and assume that feeling is enough. They don’t sincerely consider the inevitability of change, hardship, and annoyance. If only we could impress upon engaged couples how important it is to be completely present in this act of commitment. Forever means forever.
Yes, there are times when it’s best to part ways – especially when there’s abuse or when your partner has withdrawn and has no interest in maintaining the relationship – but most of the cases I see are salvageable; the primary issue is one of attitude. If both parties can recognize and honor the commitment they made, both parties want to save and improve the relationship, and both parties are willing to work at it, the relationship will likely survive and be all the stronger. Further, both people will inevitably grow through the process.
While it may require role modifications, improving communication, prioritizing intimacy, and other outward changes, an important starting point is being real with oneself about one’s commitment. Lifelong commitment implies not entertaining the idea of leaving unless all options for achieving a healthy relationship have been exhausted. But frequently we do think about exiting the relationship when it’s not to our liking, sometimes before we’ve tried much to improve the situation, and this can be a form of sabotage. Even if our partner doesn’t know we’re doing it, when we’re thinking this way – i.e., “I could end it” – we subtly withdraw, and the relationship suffers from it. We’re no longer all-in. The degradation can easily snowball.
When even one member of a relationship is all-in, the chances of success are good. Of course, it’s not healthy or sufficient if one person is consistently all-in and the other is chronically disengaged, but if there’s a loving recognition that the other party’s ability to participate waxes and wanes as they grapple with their own “stuff,” and we don’t take it personally, periods of imbalance are easier to repair. If, on the other hand, we respond to a partner’s deficit of engagement by pulling out in equal measure, we’re acting against the health of the relationship and our own best interests.
In truth, the staying together part is only the most superficial aspect of our commitment. I’m sure you’ve seen unhealthy relationships that were clearly causing both members to suffer, but they seemed to feel there was merit in sticking it out, even if they weren’t actively working to heal it. So, what did we actually commit to? Even if you never put words to it, it’s still possible to do so retroactively.
Whether you’re married, in a committed non-married relationship, or single but interested in a deep relationship, I encourage you to think and write about what kinds of qualities you’re committed to. If you’re currently in a relationship, what kind of attitude do you aim to have toward the relationship and your partner? What conditions tend to degrade your attitude? What helps to strengthen your commitment to show up fully and positively? We’ll explore this more next week.
Be well,
Peter
[post_title] => Relationship Repair Step One: Attitude Adjustment
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[post_content] => June 22nd is my wife Briana’s birthday. She’s the Dragontree’s founder and fearless leader.
On the way to art school at age 18, she was in a car accident and broke her neck. It changed the course of her life. She never made it to art school, instead spending the following six months in a brace at home in Montana. During her rehabilitation period she received massage and this kindled an interest in the healing arts.
She decided to go to massage school in Portland, and later to California College of Ayurveda to learn the traditional medical system of India. When we met, she was a massage therapist at a little spa in Portland and also a professional belly dancer. Less than a year later, she was opening her own spa. She was just 23 then.
I helped with the planning and painting, but she has always been the engine and visionary. I’ve watched her grow tremendously in the 20 years that we’ve been together. Besides her business acumen, she has an incredible knack for making spaces beautiful. She’s an amazing mother and wife. She is generous and kind and funny. She’s a pretty good guitar player, too.
The funny thing is, for probably the first 15 years we were together she had these moments of insecurity when she would ask me with despair in her voice, “What am I doing with my life?!” It was as if she saw herself as floundering and aimless.
It’s interesting how outsiders sometimes see our gifts more clearly than we do. In this case, my response came so easily. “Well,” I would say, “you have built spas where thousands of people have come to feel better. You’ve created programs and courses to educate, uplift, and support people’s healing. You’ve written books. You’ve provided jobs for probably a thousand people over the years. You’re a mother and wife. You beautify the world. You’re a great friend. You’re always trying to be your best self. You’re good at Boggle – though not as good as me. I think that’s a pretty good start.”
I’m not sure if what I said was helpful in a lasting way. But over time, and especially as she began to do more spiritual and coaching work, there was an ever-growing group of people who said to her, “You changed my life for the better.” And I think it started to sink in. She doesn’t ask me what she’s doing with her life anymore.
From all of us whose lives have been made better by our association with you, Briana Borten, HAPPY BIRTHDAY! We love you.
[post_title] => Happy Birthday, Briana!
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[post_content] => I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
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You are so right. I was often so worried about falling out of love and the heartache that I was afraid to love. I love so much now, it has opened me up to love even more. I have been able to bring so many wonderful relationships into my life. Some have ended, many more have begun.
That is such a beautiful gift you’re bringing into the world. Thank you.
Simply Beautiful!
My heart really resonates with your message. It’s actually a life-changer…..Thank you!
Lovely.
Thank you for this gift.
You book, Rituals of Transformation help me to live like that. Thank you for a beautifully written piece, especially on this day of love.
Melissa
This article speaks directly to my heart right now. Briana Borten, I wonder how you would apply this wisdom to my situation, because I have been trying to apply it myself without much success so far. (If this comment is too long, or if I’m not supposed to ask for advice, I apologize).
I have a boyfriend whom I love and appreciate deeply. But I am madly in love with another friend. My boyfriend is totally accepting of my second love, but my friend is not accepting of being second. As for me, I don’t know if I’d even like to have two boyfriends, but I can’t seem to choose between the two. I love them both.
So, I’ve been trying to tell my friend the message that you’ve written here. And I’ve been trying to live by it myself. But trying to stay open to each other keeps us in purgatory, because we keep feeling closer and I won’t leave my boyfriend. (My boyfriend and I have a happy, harmonious, loving and caring relationship, and we coexist well with each other.) Now my friend is shutting down his heart because loving me is too painful. It breaks my heart to see that and to not be able to share my love with him. I am in love with him, like you were in love with the dancers dancing, and I don’t know what to do. What would you tell him? What would you do if you were me?
I love that you love so much. It’s really beautiful. And, I understand your friends position of wanting their partner to be dedicated to just them, and not be second to another person in relationship. You can love someone and not be with them. You can set him free of the cords of desire so he can find the person that is right for him in partnership and still love him. Love isn’t a having. Love is a being.
I wish all three of you so much peace.
So on point… you have expressed what my heart so feels right now down to the core!! THANK YOU
You’re welcome.
Brought tears to my eyes. I’m looking forward to feeling unstuck, getting off of autoPilot, of living!!!
Thank you.