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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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Previously I wrote about how community is like medicine. Our circle of fellow humans goes through this amazing journey with us . . . encouraging us, witnessing us, screaming with us on the roller coasters, and holding our hand when we take our last breath. My orientation in that article was toward what community can do for us, but it’s at least as important to look at what we can do for our community.
I was reading about a Native American grief ritual described by Black Elk, and while the ritual itself was interesting, what stuck with me was his assertion that long-held grief isn’t good for a person or the community to which that person belongs. That is, when someone is mired in suffering, this can have a negative impact on their community.
You can probably think of plenty of examples where a glaring state of imbalance, such as rage or terror, could result in behaviors that are detrimental to others. But the effects of less dramatic, often chronic negative states are subtler. What happens – besides their own discomfort – when a person is trapped in depression, anxiety, or grief for years? One repercussion is that they have a diminished capacity to fully show up in their community. We might think, “Well, the community doesn’t really need me to be at my best,” but imagine going to a place where almost everyone was depressed, afraid, or angry. Such places do exist, of course, and you can feel it as a palpable mass degradation of the human spirit.
These days we may feel that we don’t have any real obligation to our community, which is so different from how humans have operated for most of our history. Today community may be seen as an entirely optional part of life. We can live in near isolation while anonymous members of our community manage the utilities that provide us with power, water, and internet, take away our garbage, maintain our roads, even deliver our groceries. It feels like independence, but in truth we’re more dependent than ever on an infrastructure other humans maintain – we just don’t know who those humans are.
We’ve lost our sense of responsibility to our community. It’s due in part to the feeling that our government is huge, remote, and corrupt. But if our response is to disengage, the situation can only get worse. If anything, the sense of disconnection from our elected representatives and neighbors should magnify the need to do what we can to make a positive difference. It’s not just an obligation, it’s also an opportunity. If we can recognize and accept that our quality of presence affects others, this may inspire us to be our best selves. And it’s not just a matter of what we do but also who we are and how we are. Becoming fundamentally well inside helps heal the community. Imagine how healthily a community of fundamentally well people manages challenges.
If you’ve been struggling, I don’t mean to make you feel guilty as well; that won’t help you or your community. Rather than focusing on the negative impact your unwellness might have on your community, consider that getting well is good for you and it’s good for your community. Sometimes it’s easier to do it for others than for yourself.
Years ago, I read A Course in Miracles with friends. If you’re unfamiliar with it, it’s a book on spiritual awakening with a section of scripture and a year-long workbook of daily lessons. It’s not for everyone, but I gained some valuable insights from going through it. One of those insights occurred when I encountered this passage: “Lesson 66: My happiness and my function are one.”
Whereas I had tended to think of my happiness as a personal thing – sometimes even a selfish thing – this spiritual book was telling me that being happy (true, causeless happiness) is one of the greatest things I can do for the world. As I meditated on it, I saw clearly that the happy people I’ve known were like lights in every setting they entered. Without even intending it, they had a therapeutic effect on everyone they encountered. Not only did they tend to uplift those around them, in an unspoken way they communicated that this is a possibility for you, too. Happiness is a perspective, a choice. If I can choose it, you can choose it.
Being happy makes us more peaceful, compassionate, and creative. It gives us the freedom to see a bigger picture, rather than focusing on what’s wrong or bad. Even just one happy person in a room full of scared people can change the whole atmosphere – and the choices that community makes.
So I encourage you to consider this week:
- Who am I and what role do I play in my various communities?
- How have I been affected by the genuinely happy people I’ve known?
- What do I believe stands between me and being one of those happy people?
- What happens when I make a conscious choice of how I’m going to show up in a given setting?
- When I give, what do I receive?
- How do I feel when I put myself in service to others?
- Where could I dedicate myself to more actively resolve any unhealthy patterns of thought, communication, or behavior?
- How will I be different as I heal, and how will I affect my community differently as I release my baggage?
- When will I choose happiness?
Be well,
Peter
[post_title] => The Best Thing You Can Do For the World is to Be Genuinely Happy
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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!
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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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