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perspective change

Learn to Bounce Forward from Adversity

It’s hard to quantify just how much humans have changed – how we relate to ourselves and our thoughts, how we get help, how we act in relationships, how we… Read More

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It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power. Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training. For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E. Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience. Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points. Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.) Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything. Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.). In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip). Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees. The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians. Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience. While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling. Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling. If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive. If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.) If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement. If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain. That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist. Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity. Be well, Dr. Peter Borten [post_title] => What's the Difference Between Dry Needling and Acupuncture? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => whats-the-difference-between-dry-needling-and-acupuncture [to_ping] => [pinged] => [post_modified] => 2022-05-31 22:37:05 [post_modified_gmt] => 2022-05-31 22:37:05 [post_content_filtered] => [post_parent] => 0 [guid] => https://thedragontree.com/?p=8675 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 1 [filter] => raw [webinar_id] => 0 ) [1] => WP_Post Object ( [ID] => 8838 [post_author] => 3 [post_date] => 2022-10-13 19:37:46 [post_date_gmt] => 2022-10-13 19:37:46 [post_content] => Although we weren’t thinking about it while writing it, our life planner, The Dreambook, is very much aligned with ideas of the Human Potential Movement (HPM). The movement focuses on helping people attain their full potential through numerous avenues, including self-awareness, honesty, openness, optimism, self-acceptance, mindfulness, and a willingness to be outside of one’s comfort zone. Wikipedia says a central premise of the HPM is that “people can experience a life of happiness, creativity, and fulfillment,” and that this naturally moves us to uplift our community and assist others to actualize their own potential. Although it’s often seen as having developed from the 1960s counterculture, the seeds of the HPM were planted much earlier. Close influences were psychologists such as William James, Carl Rogers, and Abraham Maslow. In particular, Maslow’s famous Hierarchy of Needs elucidated how humans are motivated. He claimed that we have tiers of needs, and that foundational tiers – e.g., food, shelter, safety – have to be managed before we can dedicate ourselves to higher tiers such as relationships and achievement. Maslow called the top tier self-actualization, the full realization of our potential. Well before these modern thinkers, Greek philosophers such as Socrates and Epictetus were teaching about human potential through the cultivation of virtue. Confucius, too, (500-ish years BCE) was a great champion of personal development and spoke of the relationship between one’s individual growth and the benefit to society, similarly to what is echoed above by the HPM. In The Great Learning he wrote: In ancient times, those who wished to make bright virtue brilliant in the world first ordered their states; those who wished to order their states first aligned their households; those who wished to align their households first refined their persons; those who wished to refine their persons first balanced their minds and hearts; those who wished to balance their minds and hearts first perfected the sincerity of their intentions; those who wished to perfect the sincerity of their intentions first extended their understanding; extending one’s understanding lies in the investigation of things. And “the investigation of things,” according to twelfth century philosopher Zhu Xi, means, “to exhaustively arrive at the principles of matters, missing no point as one reaches the ultimate.” Some would say it means to perceive the true nature of reality. I find this view beautifully holistic: that even for worldly aims (“to make bright virtue brilliant in the world”), we start with our basic orientation to reality, then bring this forward to the “sincerity of our intentions,” the balance of our hearts and minds, then to personal refinement, the alignment of our household, and then outward to our community. Depending on your disposition, these statements can feel inspiring or unreachably lofty. If making bright virtue brilliant in the world feels daunting, let’s look at the ideas of living to one’s potential in simpler terms. Confucius speaks first about the investigation of things – understanding the world. Doesn’t it make sense that in order to really grasp our potential we must understand the context in which it is expressed? This isn’t work anyone can do for us, and it requires humility, innocence, and openness. It means, in my opinion, approaching the world as a student would approach a master teacher – willing to be wrong and open to having our mind blown. If we look to cultures who live in close connection with nature (including Confucius’s culture), they’ll almost universally assert that it’s the sacred in us, interacting with the sacred of the world, that is the essence of life – not the masks and stories we’ve superimposed upon it. What is the sacred? That which can’t be depleted, exhausted, or diminished. What about the sincerity of intention Confucius mentions? We hope to nudge our readers toward sincere intention through the exploratory questions in the Connect section of the Dreambook. Figure out what brings you joy and gratification, regardless of what others might think. What raises your vibration? What makes you feel alive? What opens your heart? What makes you feel you’re aligned with the purpose your Highest Self wants for you? From here, establish structures to support the actualization of these intentions. Integrate them into your everyday life. Set goals, break them down into tasks, and put the tasks in your calendar. Practice integrity by honoring your agreements with yourself. Be reverent of the powerful words they are constructed from. Make sure your agreements are clear – always know what you’ve agreed to and where you stand on them. Notice what you accomplish and celebrate these achievements. Don’t complain. Be flexible. Maintain a clear inner vision of what you intend to bring into being. And routinely express gratitude. If this sounds like a lot to remember, that’s what a planner like the Dreambook is for – to keep you on track with the actualization of that incredible potential within you. We’re honored to witness you. Be well, Peter [post_title] => Are You Actually Actualizing? [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => are-you-actually-actualizing [to_ping] => [pinged] => [post_modified] => 2022-10-13 20:00:33 [post_modified_gmt] => 2022-10-13 20:00:33 [post_content_filtered] => [post_parent] => 0 [guid] => https://thedragontree.com/?p=8838 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw [webinar_id] => 0 ) [2] => WP_Post Object ( [ID] => 8727 [post_author] => 1 [post_date] => 2022-08-26 20:25:14 [post_date_gmt] => 2022-08-26 20:25:14 [post_content] => Imagine if you had the opportunity to create the perfect planet. What would you come up with? Let’s brainstorm together! To start, you’d probably want plenty of water. We all know that water is a fundamental prerequisite for life. So let’s make crystal clear water in springs and lakes and rivers for drinking and bathing and cleaning and growing plants. Then you’d probably like to have vast seas to hold more water as a source of precipitation to moisten the land. And these seas would also keep the planet cool and generate air movement. They could house infinitely fascinating creatures and would be full of mystery and beauty. Then you’d want stable land to live on and maybe you’d cover the land with soil – a miraculous substance that would feed the creatures that live upon it and is relatively easy to dig in. It would be smart and beautiful to cover most of the soil with an incredible carpet of vegetation. There would be grasses and other low-growing plants to hold the soil together and blanket it with a lovely softness and a variety of shapes and colors. And why not also make it capable of rippling in breezes and adorning the land with flowers? You would probably also want taller vegetation – elegant, noble trees. They would offer shade and shelter, create their own ecosystems, and support innumerable creatures. With their spreading, upright growth, they would seem to parallel the human journey, rooted in the earth and rising toward the heavens. All this plant matter would turn sunlight into biological life and provide the planet’s inhabitants with oxygen, food, lumber, clothing, paper, pigments, and nearly everything else we need. Of course, you’d want to share the planet with a great variety of animals, each of which would be lovely in its own way. They would be fascinating and inspiring and sometimes cuddly. They would be our companions, teachers, resources, and part of a perfect, balanced web of ecology. You would probably want to make the atmosphere just the right temperature and gas composition for all these lifeforms. It would be super smooth to breathe it. And maybe you’d choose to fill the soil with treasures – metals and minerals to fortify our bodies, and the raw materials for tools, glass, machines, jewelry, and microchips. If it were up to you, you would make it absolutely gorgeous, right? Maybe you’d choose glorious blue skies that would make you feel free and expansive, and they’d change color in the morning and evening. You’d perhaps fill the skies with an ever-changing display of clouds that would look like swishes and dollops of paint made by a giant paint brush. And they’d provide shelter from the hot sun and would deliver water to the creatures and the land. For interest, you’d make the land rise up in places to create chains of mountains, some of them covered with snow, and there would be lush valleys and canyons between. You would throw out the occasional rainbow as a sweet surprise. Maybe you’d create some kind of natural laser light show for people to watch at night, called aurora borealis. Could you imagine if such a place existed?! You would look around at all of it and say, "This is perfect! It’s the greatest imaginable treasure!” And you’d feel lucky and grateful. You’d feel inspired and awestruck. You’d feel in love with the magic and majesty of it all. You’d feel honored to get to live in such a place, and reverent of the power and grace and grandeur evident in such a place. You’d feel taken care of. You’d feel home. Let’s all remember this and treat the planet like the miracle it is. Be well, Peter [post_title] => The Miracle Planet [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => the-miracle-planet [to_ping] => [pinged] => [post_modified] => 2022-08-26 20:25:14 [post_modified_gmt] => 2022-08-26 20:25:14 [post_content_filtered] => [post_parent] => 0 [guid] => https://thedragontree.com/?p=8727 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 4 [filter] => raw [webinar_id] => 0 ) ) [post_count] => 3 [current_post] => -1 [before_loop] => 1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 8675 [post_author] => 3 [post_date] => 2022-05-31 22:37:05 [post_date_gmt] => 2022-05-31 22:37:05 [post_content] => I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way. “Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power. Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training. For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E. Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience. Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points. Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.) Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything. Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.). In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip). Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees. The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians. Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience. While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling. Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling. If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive. If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.) If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement. If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain. That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist. Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity. Be well, Dr. Peter Borten [post_title] => What's the Difference Between Dry Needling and Acupuncture? 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