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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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Optimism is a choice and it’s a possibility that available to all of us. If optimism hasn’t come naturally to you, it’s simply a consequence of habits of thinking which can be changed. Changing the way you think takes focused effort, but it works more quickly than you might guess. Plus, the fast return on your effort helps support your enthusiasm to keep at it.
The Dreambook – the life planner Briana and I created – is an excellent tool for implementing such a change. Simply following the method in the book will make you more optimistic. You’ll be doing things like: identifying your gifts, values, and purpose and consciously bringing them into your daily activities; clarifying your dreams and figuring out what truly makes you feel happy and productive; setting goals, breaking them down into manageable plans, and scheduling those plans in your calendar; prioritizing the things that feed your soul; expressing gratitude; and more.
Besides resulting in great tangible improvements, this structure builds self-trust and a positive outlook. It works.
Beyond the basic processes in the book, you can use its planning, scheduling, and tracking tools to work in scientifically proven tactics for supporting an optimistic mindset. Here are a few to try:
- Do kind things for people every day.
- Print out pictures of friends, family, inspiring people and put them in your space.
- Meditate. It supports peace, positivity, and perspective.
- Avoid negative media (and reduce media consumption overall).
- Spend money on fun and memorable experiences (rather than entirely on stuff)
- Treat your leisure time as a deliberate and purposeful activity. Go all-in, don’t be thinking about the “productive” things you could be doing instead.
- Routinely remind yourself of your strengths. If you can’t readily think of them, ask friends to help you identify them and write them down.
- Cultivate a “growth mindset” – believe in your ability to improve, and see failure as a learning experience.
- Maintain an environment that’s full of humor, happiness, and beauty and take little breaks throughout the day to notice these things.
- When stuck in a mundane task, figure out a way that it’s going to serve a higher purpose. Even if it seems relatively insignificant in itself, what does it enable that’s more important?
- As you begin a task take a moment to expect a positive outcome (using self-talk about your strengths and track record, or simply visualizing things going well). This primes you to perform well and spot opportunities.
- Focus on what’s working well in your life.
- Make a commitment to stop complaining.
- Write down what you’re grateful for daily.
- Give a genuine compliment to someone every day.
- Catch yourself in negative trains of thought; pick up your attention and put it on something else.
- Remember that a hardship is not a sign that everything is going wrong, or that it’s bound to snowball into more hardship. Every day people turn hardship into opportunity.
- Before speaking / posting, ask yourself: (1) Is it true? (2) Is it kind? (3) Is it necessary? (4) What is my purpose? (5) Does it improve upon the silence?
- Slow and deepen your breathing – this helps slow down your mind and promotes more evolved thinking.
- Sit / stand up straight. Don’t slouch.
- Journal about your positive experiences – this grows them and helps them sink in.
- Appreciate small changes in the right direction. Lots of small changes are more likely and more sustainable than one giant change, and they amount to the same degree of change.
- Exercise.
- Exchange touch more often. A hug, a pat on the shoulder, a handshake, a massage – we’re wired to associate welcome touch with feeling safe, calm, and connected.
- Make it harder for yourself to engage in behaviors that don’t serve you (e.g., put the candy out of reach).
- Make it easier for yourself to engage in behaviors that are good for you (e.g., put your exercise equipment in a place that’s easy to access and pre-determine when / where / how you’re going to exercise).
- Prioritize your relationships!
- Don’t get pessimistic by focusing on short-term downward trends; back up far enough to see the broader trend toward betterment.
- Read about the lives of impressive people.
- Believe in human potential, ingenuity, and compassion. We can accomplish incredible things.
Whew! That’s enough to completely revolutionize even the most cynical pessimist’s perspective.
I encourage you to copy/paste or print out that list and stick it in your 2022 Dreambook and work these approaches into your schedule. Pepper your pages with reminders. Give each one a good, consistent shot. Positive people don’t just have a better experience of life, they change the experience of those around them.
You rock,
Peter
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Last week I discussed our tendency to get attached to a single point of view, and how this often keeps us stuck. When we recognize the validity of other perspectives – and allow that both sides are within us (and also in our adversaries, be they real or imaginary) – this helps to neutralize the issue. For a deeper and more thorough exploration, we can look at the two sides of an issue intersected with the push and pull of desire and fear (or attraction and repulsion). It’s a process Leslie Temple Thurston simply calls “squares.”
Here are some examples. If you find them challenging, I encourage you to work through them. If not, I hope they help you understand how the exercise works and lead you to the patterns that are relevant to you.
In this first example, we’re looking at the intersection of desire and fear with that of being in control versus out of control. Wanting control is a primary human motivator. A great many of our upsets can be traced to an underlying fear of being out of control. But pursuing control may amplify the belief that we’re not in control. This can be a tricky catch-22 to work with. So if you have a strong desire to be in control (upper right quadrant), you’d do well to address yourself to the fear of being out of control (lower left). These are easy for most people to access.
Can you think of a situation that arouses the fear of being out of control? Holding that in mind, what happens in your body? Can you feel some physical unease? What happens if you don’t resist that feeling? What happens if you even invite it to be felt with your whole being, willingly allowing it spread over you? And what happens when you imagine opening yourself, like opening a closed fist that contains a butterfly, and let it peacefully depart? If this process diminished the intensity of the feeling, but not completely, try doing it several times in succession. For more on this form of body-centered releasing, check out our book, Freedom.
Less obvious – but not uncommon – is the fear of being in control (lower right quadrant). If you’re in control, does that mean whatever happens is your fault? Maybe being in control feels like too much responsibility. If control issues are significant for you, I encourage you to do the process described in the last paragraph with the idea of situation in which you are in control. What comes up?
Last, there’s the desire to be out of control (lower left quadrant). Though this may seem totally foreign to someone who’s rigidly clenching around every aspect of life, there’s always a hidden part that yearns for the relief of being out of control. Anyone who’s ever been to a college party at the end of finals has witnessed plenty of desire to be out of control.
Try visiting with all four quadrants and journaling about how each state exists in you. You might also have fun with the following variation – desire and fear of independence versus dependence.
This is a major dynamic in kids and adolescents, and it’s not helped by the fact that parents often give mixed messages. On the one hand, we may be telling our kids to stay attached to the family, don’t try to get your needs met by your inept peers, and keep coming to us for support and advice. On the other, we’re telling them to grow up, do more things for themselves, get themselves ready for school, figure out their homework, and navigate new situations with minimal guidance. When we see them shifting their attachment from the family to their peers, we often mistake this for independence, when they’ve actually become dependent on peers for approval and direction.
It's probably easy for them to access the desire to be independent, even if it’s scary, because our society puts so much value on it. If we can help them recognize the other three quadrants, it may help to neutralize some of the inner and outer forces, and allow them to be accepting of where they are and comfortable with striking a balance.
Of course these dynamics don’t necessarily end when adolescence does. We may find ourselves struggling with the dimensions of dependence and independence in our adult relationships, and when handicapped, ill, or elderly. Exploration and peacemaking with these states may support a peaceful resolution.
Be well,
Peter
P.S. If you find this exploration interesting, perhaps you’d enjoy guiding others through processes like these. Check out the Dragontree Coaching Program. In the advanced Illuminator training, we go even deeper into these processes.
[post_title] => Meeting the Part of Yourself That Wants to Be Out of Control
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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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