Dry Needling vs. Acupuncture: Key Differences Explained

Acupuncture and dry needling may look similar to the untrained eye, but they are two distinct practices. Acupuncture has been used for thousands of years as part of traditional Chinese medicine (TCM), while dry needling (also known as intramuscular stimulation) is a relatively modern practice that first appeared in 1941. Acupuncture primarily aims to address various physical ailments and promote overall wellness by targeting specific acupoints, whereas dry needling primarily targets trigger points within muscles to reduce pain and muscle tightness.

Here is everything you need to know about acupuncture, dry needling, and the differences between the two.

Dry needling vs. acupuncture: what’s the difference?

Here, we’ll compare the key differences between acupuncture and dry needling. This includes the conditions they aim to treat, their different techniques, and their philosophy.

Dry needling

Dry needling uses thin, stainless steel needles for muscular pain relief. It is used mainly in musculoskeletal conditions, such as low back pain, Achilles tendinitis, tennis elbow, and whiplash. Let's quickly go through some of the techniques used in dry needling.

Trigger point technique

Needles are placed into trigger points, which are areas of hard or knotted muscle. This is thought to relieve muscle spasms, pain, and release the muscle knot.

Non-trigger point technique

For this technique, needles are inserted in a wider area around the point of pain instead of directly on it. This can be combined with the trigger point technique. The idea behind this technique is that the painful area may be a result of a broader issue with the nervous system or nearby muscles, which can be treated with dry needling.

In-and-out techniques

As the name suggests, these techniques involve moving needles in and out of the body, so the needles prick the trigger point (or target area) and are then quickly removed. Pistoning is a type of in-and-out dry needling technique where the needle is rapidly moved up and down during treatment.

Acupuncture

Acupuncture is based on a different philosophy from dry needling, with deep roots in traditional Chinese medicine (TCM). The belief system behind acupuncture is that pain or illness occurs due to interrupted Qi, your body’s healing energy. Acupuncturists aim to return your energy flow to a balanced state by removing blockages.

Acupuncture has been used for thousands of years to treat a wide range of conditions, including:

  • Musculoskeletal conditions (such as painful muscles and joints)
  • Nervous system conditions (such as chronic pain)
  • Reproductive conditions (such as infertility)
  • Mental and behavioral disorders
  • Digestive conditions
  • Injuries
  • Poisoning

There is a vast array of acupuncture techniques, with some of the main ones discussed below.

Traditional Chinese medicine acupuncture

This is the most commonly used and well-known style of acupuncture. Training as a traditional Chinese medicine acupuncturist takes several years of study, in which trainees learn all about Qi, meridians, and how to treat a huge range of conditions using acupuncture. In TCM, meridians are strings connecting acupuncture points in your body, which are considered to be passageways through which Qi energy flows.

Western medical acupuncture

Western medical acupuncture, a contemporary offshoot of traditional acupuncture, operates similarly but aligns its outcomes with the principles of Western medicine. According to Western medical acupuncture, inserting needles can stimulate the nervous system and potentially reduce inflammation, relieve pain, improve blood circulation, and promote homeostasis (a state of balance between your body’s systems). These benefits are supported by some limited research on TCM acupuncture.

Physical therapists often take a course to qualify in Western medical acupuncture, as its philosophy aligns well with physical therapy treatment.

Electroacupuncture

Electroacupuncture can be used alongside many other styles of acupuncture aiming to improve your health, including traditional Chinese medicine acupuncture and Western medical acupuncture. It employs electrical stimulation applied through acupuncture needles to deliver currents directly into the body.

Thanks to the needles, the current can penetrate deeper into the body than other types of electrotherapy, such as transcutaneous electrical nerve stimulation (TENS). This technique is used for pain management and other conditions.

How does it feel?

Acupuncture is usually not painful. You may feel the sensation of the needle piercing your skin, but the needles are so thin that it usually causes minimal discomfort. You may not feel the needles inserted at all, but you may feel a mild ache when the needle reaches the correct depth.

On the other hand, dry needling is more likely to be painful. Although dry needling also uses very thin needles, they are inserted directly into painful trigger points, which may recreate any painful symptoms you experience. Techniques such as pistoning may increase pain during treatment. You may also experience a muscle twitch of the tight muscle as it is being treated.

Benefits of dry needling and acupuncture

Dry needling and acupuncture each have unique proposed benefits. Here are the benefits of each:

Dry needling benefits

  • Quicker treatment sessions
  • May relieve pain caused by trigger points
  • May improve flexibility and range of motion by easing trigger points
  • May lower inflammation, increase blood flow, and trigger endorphin release

Acupuncture benefits

  • Aims to treat a huge range of conditions and illnesses
  • More research behind acupuncture
  • May treat multiple conditions at the same time
  • May lower inflammation, increase blood flow, and trigger the release of endorphins

It's important to mention, however, that most evidence is anecdotal, and there is still limited clinical research on these possible benefits.

Risks and contraindications of dry needling and acupuncture

Contraindications for dry needling and acupuncture are very similar. There are several absolute contraindications for both, such as a needle phobia, an unwilling patient, a patient unable to give consent, and a history of adverse reactions to injections.

In addition to absolute contraindications, there are also many relative contraindications for both practices, meaning that some people with these conditions may not be able to have acupuncture or dry needling. Relative contraindications include vascular disease, diabetes, pregnancy, epilepsy, and taking certain medications.

Dry needling risks

  • No formal training requirements for healthcare professionals
  • A misplaced needle could cause a punctured lung (pneumothorax)
  • Bleeding, bruising, and temporary soreness are common
  • Infection risk if needles aren't sterile
  • Effects may not last as long as acupuncture

Acupuncture risks

  • A misplaced needle could cause a punctured lung (pneumothorax)
  • Bleeding, bruising, and temporary soreness are possible but less common than dry needling
  • Infection risk if needles aren’t sterile

Who performs dry needling and acupuncture?

Dry needling is often used by physical therapists and sports injury therapists as part of their treatment. There are no formal training requirements for healthcare professionals to practice dry needling, although many physical therapists receive training to use it as a treatment.

Acupuncture is performed by acupuncturists and trained healthcare professionals such as physical therapists. Most states in the U.S. allow acupuncture only when it is performed by a licensed acupuncturist.

If you're still struggling to choose between acupuncture and dry needling, consider the information provided above. Each practice may offer unique benefits, and the best choice for you will depend on your symptoms and preferences. Speak to a healthcare professional for personal advice on choosing the right treatment.

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