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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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In my early 20s I had a boss who would ask me every morning, “How goes the battle?” I had never heard that expression before, but recognized that he meant, “How’s it going?” At the time I was learning about neuro-linguistic programming and becoming attuned to people’s word choices, so it struck me as an interesting – and loaded – phrase. Then I began to notice how common it is for people to characterize life as a fight – an ongoing series of conflicts, something we need to slog through, with a risk of imminent danger and an us-versus-them mentality.
Even if we see ourselves as winning the battle, if we hold this perspective, there’s still a chance of getting ambushed, right up to the last minute. So, we must always have our guard up, sleep with one eye open, check our drink for poison, and so on. It causes chronic stress, and we’re never entirely free.
Meanwhile, there are people who see life in a more positive light – as a game, a gift, an opportunity to explore, connect, experience, and be of service. Are they naïve? Are they less successful? Are they blindsided by the unexpected? I don’t believe so. If anything, because their perspective isn’t innately stress-inducing, they have greater resources for adapting to whatever comes.
I encourage you to examine your relationship with the world. How would you sum up your story? What kind of words do you use, both to others and yourself, when you talk and think about your challenges and ambitions? How do you feel about others aiming for the same goals as you? What sorts of bodily feelings go along with this? For extra support in re-wiring yourself, check out our workbook, Freedom, and try doing it for a month.
If you do find that you’re harboring a “battle” mentality, I wonder if it’s possible for you to symbolically wave the white flag, saying to the world (and yourself), “I’m not at war with you.” I know the stakes feel very high sometimes, but what if. . . (1) you could clearly see that being in ongoing conflict is more detrimental than it is beneficial to you, and (2) you had an unwavering link to something you could trust, an assurance that you are fundamentally okay, no matter what.
We often speak of rousing our inner warrior and the term “warrior” comes up a lot in self-help books. The warrior archetype is deep in our collective consciousness. Everyone knows it. And there’s a good side to it. Often, we evoke the warrior archetype when we wish to inspire ourselves to be clear, sharp, and disciplined, to stand up for our values, to protect those in need, to be brave, to have integrity and honor. But the other side of being a warrior is, of course, that you’re at war.
How can we embody these virtues without the sense of perpetual conflict? We live according to archetypes all the time – father, mother, husband, wife, cop, healer, good guy, bad guy, peacekeeper, curmudgeon, artist – mostly without realizing it. The first step is to become aware of the archetypes we’re subconsciously abiding by. Just making it conscious starts the process of releasing us from an archetype’s limitations.
Second, we can begin to forge a picture of something better and freer than any single archetype – our own Highest Self. Who would you be if you were clear, lighthearted, determined, loving, creative, peaceful, spiritual, purposeful, artful, present, honest, forgiving, kind, and brave?
Contrary to what your mind might say, that’s not too many virtues for one person to possess. You’re already somewhere on the spectrum of embodying every one of them. Whatever you dub this most-evolved you – Highest Self, Noble Leader, Queen/King, Divine Being, etc. – know that this is something you can freely choose at any moment.
Spend some time visualizing and feeling into this Highest Self. Imagine that she/he is just waiting for permission to step into the driver’s seat. When your small mind takes over and your habits run you, the Highest Self is nudged into the backseat. It may take some conscious surrender to let go of your default program and allow the better You to be in charge.
Another visualization you might find useful is to see yourself in the center of a circle of many different versions of yourself – all the possible ways you could be. Look around and see if you can spot the one that is the clearest, highest expression of your virtuous essence. Make a choice, and step into that Self. Try doing this every morning for a week and see what changes.
Be well,
Peter
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Ah, the New Year. It’s fresh and innocent and undefined. Except for the things you already have scheduled for 2023. And everything you have already set into motion that is likely to continue to play out in the coming year and beyond. But besides that, it’s an empty canvas!
Last week I recommended keeping your resolutions simple – just choosing a single thing. This week I want to encourage you to put that into a context you define for this year by choosing a theme for 2023.
If you have our Dreambook, there’s a section on Theme of the Year and you can write it in there. If you don’t have the Dreambook, or even if you do but wish to make this a bit more special, I encourage you to write your theme on a nice piece of paper with a good pen and frame it or keep it in a place where you’ll see it every day.
Here are some questions to help guide you to your theme as you visualize a wonderful, productive, peaceful, playful, successful coming year.
Who do you want to BE this year? What aspect of your potential do you want to cultivate this year?
What will you bring to your community? How will you be a positive influence on your environment?
What will you be a channel for? How will you speak intentionally?
How will you grow this year? How will the world respond to your love and light?
Take plenty of time with this and consider writing your answers down to see what comes through. Out of all these inspirations, which feels like it’s coming from your Highest Self? Which feels the most compelling? Which would benefit both you and your community? What is the emerging theme?
Here are some examples: The Year of Loving Myself Completely. The Year of Living my Purpose. The Year of Learning to Trust. The Year of Shining my Light Upon the World. The Year of Owning My Power. The Year of Healing my Body. The Year of Playfulness. The Year of Lightheartedness. The Year of Remembering We’re All Connected. The Year of Forgiveness. The Year of Great Healing. The Year of Simplicity. The Year of Living Through My Heart.
After you refine your theme and write it down, try to read it ever morning, and if you’ve got a minute, feel into how life will be as you embody this theme, tell yourself, “I’m already on my way. Today I choose to stay conscious of this theme and to find ways to live it.”
Wishing you your best year yet,
Peter
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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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