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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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As a young adult living in Western Massachusetts, I had a handful of friends who attended Hampshire College. Hampshire is well known for being highly unconventional. There are no majors, no departments, and no grades. So much of the program is up to the student, including a final yearlong project. I could see why it was appealing, especially to people who didn’t seem to fit into typical academic institutions.
When I first heard these friends talk of the wonderfully freeform nature of their college experience, I was envious. In later years, as they found it increasingly challenging to keep themselves on course, I remember saying, “That kind of program wouldn’t work for me.” I realized, with no shame at all, that I needed way (way) more hand-holding. Only one of my Hampshire friends graduated. I guess they needed more hand-holding too.
There are a number of reasons we avoid getting help or taking direction:
- We’re too proud to admit we need help.
- We’re afraid of opening up, being vulnerable, or appearing weak.
- We think nobody is capable of helping us.
- We don’t want to be controlled or guided in a way we don’t like.
- We don’t want to be told what to do.
- We don’t want to be a burden.
- We don’t want to share the credit.
- We feel it’s less of an accomplishment if we get help.
- We believe we need to do things all by ourselves.
This last one is a common inherited belief, though nearly every impressive historical figure had a team of supporters. Yes, there’s a grain of truth to it: each of us is responsible for ourselves, our choices and actions. Each of us is responsible for how we show up in the world. Nobody can do the internal work for us. But it’s perfectly okay to get tons of help along the way. It doesn’t diminish the outcome. In fact, we connect and improve through the process when we let others in. This is true even when it comes to healing and spirituality. It’s time to let go of the “Lone Ranger complex.”
Guidance and mutual support are an important part of why our program, Sacred Expansion, has been so successful. We created Sacred Expansion as a prerequisite for our life coaching trainees, as we feel it’s important to “clean house” before guiding others. It was designed to help people get to know themselves more deeply, release old unhealthy patterns, and open to a state of greater intuition and trust – all within a group of others on the same journey.
It turned out to be so monumental for our early participants that we decided to make Sacred Expansion available as a stand-alone course. Enrollment is happening NOW! You’ll be lovingly led by my wife, Briana, through an exploration of yourself through the metaphors of the seasons. And you’ll come out of it with greater clarity and self-awareness, less baggage, a deeper connection to Spirit, and the tools to continue the process on your own. I encourage you to do it!
Also, I recommend you look back at that list of reasons we avoid getting help and see if there are any that ring a bell for you. If so, consider the following questions. Is this belief true? (E.g., Is it true that nobody could help me? Is it true that if I asked for help, it would compromise me in some critical way? Is it true that it’s less of an accomplishment if I get help?) And then meditate on what life might be like if you felt completely at ease and unembarrassed about asking for help and graciously receiving it?
Be well,
Peter
P.S. Early Bird pricing for Sacred Expansion is currently in progress. Sign up today and save $200! On August 17th, the price goes up, so if you want to join us, don't miss this opportunity!
Click here to enroll today!
[post_title] => Why Don't We Get The Help We Need?
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When I first delved into cognitive behavioral therapy (CBT) as a psychology major, I remember thinking, “This is an evolution for humans.” CBT focuses on examining and challenging one’s thoughts and beliefs, changing related behaviors, and building coping skills and emotional regulation.
Of course, there is a long philosophical tradition of examining the nature of human thought and behavior, but the advent of cognitive and behavioral psychology in the past couple centuries infused these concepts into mainstream culture in a profound way. It’s now common for people to talk about their thoughts as something separate from themselves, and to routinely employ behavior modification techniques in all areas of life.
I had a mentor in my early 20s who was a big advocate of CBT, and at the time I told her I had been exploring methods for healing the memories of traumatic events. I felt both rebuffed and inspired when she said, “You’re wasting your time. We don’t need to go back and relive our childhood or spend the rest of our life lying on some shrink’s couch analyzing everything that ever happened to us! All that matters is, right now, are you going to be at the mercy of your thoughts and automatic behaviors, or are you going to manage whatever comes up in a conscious, intentional way?”
I’ve thought a lot about this in the decades since. My mentor was of the mind that we don’t need to figure out why these painful or dysfunctional patterns keep coming up, we just need to change our response to them, and eventually we’ll transform our psychological makeup in a permanent way. I believe there is real value to this approach, and also . . . sometimes I think we need to go back.
When it comes to our healing and growth, here are three good reasons to revisit your past:
(1) If you’re constantly managing your response to a recurrent pattern, it might be more efficient to get to the root of the pattern and dismantle it (or at least mitigate it) so that it doesn’t come up much, if at all. Of course, you can also use cognitive and behavioral strategies if it does arise.
(2) There is potential for deeper self-awareness, insight, and growth through visiting your past and coming to understand the factors that went into making you who you are. These are opportunities to forgive, correct misunderstandings, reframe our stories, and revise or erase beliefs. While it’s totally possible for many people to be happy without going there, it’s probably not possible to be self-actualized without making peace with your past.
There are some caveats. Analyzing your past can be taken to a self-indulgent degree. It can retrigger old trauma. And most common, it can make us feel worse as we work through it (and experience it without resistance, perhaps for the first time) – though this usually gives way to greater freedom. Thus, it’s important to do this work when you’re feeling relatively stable, with a clear sense of why (what you hope to accomplish), and with the tools and/or support to do it in a way that’s likely to turn out well.
(3) Finally, some people seek total liberation from our programming, i.e., the ego. Once this urge awakens in us, it often never goes fully back to sleep. If you’re in this boat, you may find value in recapitulation.
I read about recapitulation in a Carlos Castaneda book when I was 18 and it seemed unfathomable. Castaneda, a Peruvian anthropologist-turned-apprentice of shamanism, was instructed by his teacher to write down his entire life story, from his very earliest memories, including every person he had ever met. This process, he was told, was necessary to free him from his worldly attachments. It took him years. I remember thinking, “I could never do that.”
Since then, I’ve encountered various forms of recapitulation in my other studies of shamanism, and I now feel it’s more doable than I previously believed. Could it take years? Absolutely. But you’ve got time, and it’s not an all-or-nothing proposition. Every time we release some piece of baggage, it’s like dropping a sandbag from a hot air balloon. We’re that much lighter and freer – even if we’re not “done.”
As we go through our history, we find countless moments that have a certain weight or charge. They exist in a state of incomplete resolution. Taken together they have a powerful influence on how we show up in the present. They can make us dwell in the past and fear the future. They can cause us to live within a fraction of the spectrum of what’s possible. In short, they limit our freedom. As we loosen our history’s grip on us, we thus loosen the grip of our ego, and we more readily access our true essence and potential.
I stumbled upon my own recapitulation process while doing somatic releasing practices. In a nutshell, all our history with a charge – everything that doesn’t sit neutrally in us – can be experienced through the body. There is a physical expression and felt experience to all of it. And in willingly visiting it, experiencing it without resistance, and accepting it, we promote its resolution.
If this is unfamiliar territory for you, just try this: Bring up something about your current life or your past that you wish were different. While holding this in mind, expand your awareness to include what you feel in your body. You will perceive a certain unease. As you meet it and even invite it, the unease loosens. (Sometimes this takes a little practice, especially if you’re not accustomed to feeling your feelings. If you’re interested in diving deeper into this process, check out our workbook called Freedom.)
When we do this work we inevitably find layers of holding. We release one layer and discover another layer, and so on. In my case, I began to recognize the layers faster than I could process them, so I started writing them down. Hundreds of cords, linking me to my past, pulling on me, distorting my present self. The list grew at the same rate that I crossed things off it. I’m not nearly done, but I feel much lighter.
I’m not saying a person can’t show up in a clean and authentic way until they release every conflict or resentment they’ve ever had. What I mean is that a thorough recapitulation facilitates ego liberation – something that’s beyond the scope of CBT and, frankly, not of interest to most people.
In my own process, I found that I was sometimes inspired to move my body in certain ways to assist the release of a sticky pattern, which is an integral part of some somatic therapies. Interestingly, it’s also a technique used in shamanic recapitulation. As Sandra Ingerman and Hank Wesselman explain in their book, Awakening to the Spirit World, we can facilitate the “unraveling” of a memory (or the emotional charge attached to it) by spinning. This can also be accomplished by turning the head or twisting the body from side to side, and the authors say they believe this is also why EMDR (Eye Movement Desensitization and Reprocessing) works. They recommend spinning or turning while breathing deep into the memory and its associated emotions, accepting it, and intending to release it.
I believe recapitulation also occurs to some extent automatically, especially when we’re ready for it: in dreaming; in meditation, when we are sometimes spontaneously presented with something from the past that needs to be “cleared”; in yoga and exercise; and very often under the influence of entheogenic (psychedelic) substances, especially when used intentionally as medicine. This is why psilocybin mushrooms are rapidly gaining a reputation as one of the most effective therapies for attaining peace at the end of life.
I’m curious to hear from readers about your experience with the different approaches I discussed. Have you used CBT, and did it help? Have you dug into your past to heal yourself? What methods did you use, and how did it go? Have you done a large scale recapitulation? What was the outcome? Please share.
Be well,
Peter
[post_title] => Are You Willing to Go All the Way Back?
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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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