Q: What is the difference between Dry Needling and Acupuncture?

A question I get often in the clinic is “What is the difference between Dry Needling and Acupuncture?”. At first glance, these two techniques/modalities appear to be similar, but there are some key differences, and I thought I would share my typical response on the blog here.

These two techniques use the same tool, but with different purposes and methodology. The needle is the exact same - in fact our needles are acupuncture needles. They are very thin and flexible, much, much smaller than that used for injections or immunizations. This explains why most patients don’t notice much when the needle actually breaks the skin. 

Acupuncture treatment philosophy follows the flow of “Chi” or energy, throughout the body, mapped out by the ancient Chinese. Based on a patient’s symptoms, the practitioner will decide where to place the needles to help with the flow of Chi through the body, therefore improving dysfunction. Under this treatment philosophy, there are points all over the body that correlate to each organ, muscle/joint, certain areas of pain, and much more. Typically, this is a “surface technique” wherein the needle merely breaks the skin but does not travel any deeper into the tissues of the body. The needles are typically left in for a defined amount of time per the practitioner’s discretion. There are some techniques that do go deeper, called “intramuscular acupuncture”, but not all acupuncturists utilize those techniques. 

Dry Needling, or more specifically, Trigger Point Dry Needling, is based off of a myofascial pain model, mapped out by a series of experiments. Trigger points are tight areas of dysfunctional muscle tissue, often called a “knot” in common language. They can be palpated and feel like a knot or ball is stuck within the muscle. They can be painful or tender to the touch and restrict the muscles length and strength. Most notably, trigger points can do something called refer pain, or cause pain in a different location of the body. For example, here is the referred pain model of the Gastrocnemius, one of the calf muscles. 

When deciding where to dry needle, your PT will ask you about your symptoms in terms of where they are located, what it feels like, and the pattern of pain/discomfort. This tells us which muscles might be involved and decide if dry needling will be appropriate. The practitioner will then palpate (assess and feel the muscle) to look for trigger points by searching for the aforementioned “knots”. As the patient, you may even feel the referred pain as the PT is palpating. Then, the PT will place the needle in the dysfunctional area of muscle, which may cause an involuntary muscle twitch and/or a crampy feeling. Here is one of the major differences between dry needling and acupuncture - dry needling is a deeper technique and the depth of the technique depends on the depth of the target muscle.This is one of the major benefits of dry needling - we are able to treat muscles that are deeper than we are able to reach with soft tissue work.  Depending on the technique, the practitioner may leave the needle in for a while, or just take it out immediately. This varies by the training the practitioner has received. Oftentimes there is an immediate improvement in the size and tenderness of the trigger point, and we can also observe improvements in muscle length as well. 

Some PT’s also use a technique that utilizes electrical stimulation along with dry needling. This technique involves placing the needles according to specific protocols depending upon the patient’s pain presentation and then placing electrodes on the needles. This will cause a rhythmic pulsing of the muscle. This works well for people who either don’t tolerate the other technique well, or just prefer this technique instead. The use of this technique very much depends on the PT’s training. 

A note on efficacy: both dry needling and acupuncture are beneficial depending on clinical presentation and symptoms that the practitioner is endeavoring to treat. Studies have shown that there is a nervous system effect just by breaking the skin with a needle, so this could partially explain the efficacy of both techniques. Everyone responds to treatment differently, so has long as your health care practitioner is listening to you and your needs, both can fit into a wellness routine as you see fit. 

Keep going, you’ve got this!

Dr. Kacy Seynders, PT, DPT, OCS