Acupuncture vs. Dry Needling: What's the Difference?

If you've ever gone to get acupuncture, you might wonder how a PT or a chiropractor or even a physician who hasn't done even a year of training in acupuncture can perform acupuncture, but then they call it dry needling. You might be wondering, well this is an acupuncture needle that's doing acupuncture to me and my acupuncturist or Chinese medicine practitioner or doctor does acupuncture to me, so why does one person call this dry needling and why does another call this acupuncture? Well that's what we're talking about in this video here today. Hey guys, Dr. Alex Hine, author of the health book Master of the Day and doctor of acupuncture and Chinese medicine. So before we jump into this video, two very important links right below the video. The first is if you'd like to become a patient of mine locally in Los Angeles or virtually via telemedicine, you can reach my private practice with the link and the information right below this video. And the second is I put together a free guide which is four daily rituals that potentially help you add years to your life with Chinese medicine. So that is right below this video. So let's take a look at the Wikipedia entry for dry needling because it's a good general overview. Now it's funny, the very first line mentions that it is a pseudoscientific technique only referencing one website which is, no surprise, let's see, science-based medicine, the skeptics website. Now I know tons of physicians that use dry needling, that's neither here nor there, but here's what it says. It says that dry needling, also known as trigger point dry needling and intramuscular stimulation, is a technique used by various healthcare practitioners including PTs, physicians, chiropractors, among others. It involves the use of either solid filiform needles or hollow core hypodermic needles for therapy of muscle pain including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points but can also be used to target connective tissue, neural ailments, and muscular ailments. So PTs do quite a lot of dry needling as well but I think at face value dry needling, most of the time that I see it in the marketplace right where other patients can go, is typically using acupuncture needles and there are some subtle but very important differences that I see. So number one, you could argue that dry needling is just acupuncture because it basically is in most of the ways that I see it practiced, not everyone, but most of the ways it is using an acupuncture needle to put into the body to treat something. Most of the time it's done by people practicing various orthopedic forms of medicine whether it's a PT or a chiropractor usually treating musculoskeletal complaints. So fundamentally you could say it's the same thing because at face value it is the same thing but there are a few various differences. So number one, one of the main differences is that in dry needling you tend to see a lot more local needling and a lot more needling of trigger points which is very different from Chinese medicine because in Chinese medicine even for pain the most skilled doctors are not necessarily needling locally where the pain is and I think most skilled body workers understand that if there's neck pain or low back pain very often that is not the area you're treating to produce clinical pain relief. Now most inexperienced acupuncturists in the same way most inexperienced body workers if there's neck pain they put a bunch of needles in your neck, if there's knee pain they put a bunch of needles in your knee, if there's back pain they put a bunch of needles in your low back. That is almost always a sign purely doing that of an inexperienced practitioner. Very very skilled acupuncturists are rarely focusing specifically on the area where there's pain. They may do some local needles, they may do local needling in the area but very commonly you see skilled doctors doing what's called distal needling which means due to these fascial planes that's why someone can needle the ankle or around the knee and get pain relief in the back. For example the bladder channel runs along the whole back the spinal erector muscles goes up to the skull the base of the skull over the head all the way down to the ankle and that's why some of the key points in the history of Chinese medicine used for low back pain yes there are some local points but some of the most famous ones are in the back of the knee or in the back of the calf or around the ankle. So a big fundamental difference is that most of the time when I see people do dry needling there is some distal work done but a lot of it is focused locally or in trigger points local relatively local to the area. I don't see most people doing dry needling for example trying to needle the calf for low back pain. I see that a lot less commonly than with people practicing Chinese medicine. So first and foremost you tend to see more Chinese medicine practitioners doing really a medical diagnosis. What is the pattern that is leading to that pain? For example I mean there are many causes of physical pain right that are not just local to the muscle there for example we see a pattern what we call kidney qi deficiency let's call it kidney function deficiency and it shows up let's say the middle-aged man who's having nighttime urination or you know sexual performance issues libido issues erectile dysfunction a little bit of heart disease and a little bit of high blood pressure and he also has back pain. Well for us when he has that nighttime urination libido issues low back that's all in one diagnosis of what we call kidney qi deficiency and you can treat that whole pattern even with a formula and not put in a needle and treat the low back pain. So very often I think the difference in Chinese medicine and in if you're just doing dry needling is that dry needling tends to be more musculoskeletally focused whereas for Chinese medicine we tend to treat a pattern and the pattern can include but not be just limited to for example low back pain or knee pain or neck pain. It's very interesting to see where skilled Chinese medicine doctors will put needles if you have neck pain. They may only put one or two on your neck or none at all in the neck but can produce incredible results for neck pain and that's very very interesting and very very mysterious to people that are not that familiar with Chinese medicine. So difference number one is really the methods of treatment and diagnosis. Two I would say is a lot of dry needling tends to be more aggressive and deeper needling than Chinese medicine. So in Japan for example there's a whole lineage of Japanese acupuncture that's very very very superficial and only goes a few millimeters into the skin and doesn't really penetrate deep into the muscle but this can produce pain relief for a lot of people as well and it's not sticking you know a massive needle deep into the muscle and aggressively needling a trigger point until there's relief. I mean so many patients are very sensitive and I myself will never go to someone who does deep aggressive needling like that. It's relatively common, more common as I've seen with dry needling but again you could say acupuncture is just dry needling. I mean some techniques we have you know needling assure points are basically local points that are tender or painful. That's definitely dry needling but if you're a good Chinese medicine practitioner you tend to see that the skilled ones are not just needling locally and putting a needle where the pain is. Otherwise there would be no sense in getting a doctorate and spending four years studying this. You could just look at a little spreadsheet every day and treat back pain and it's not that easy. So in my mind those are two of the biggest differences between dry needling and acupuncture. Acupuncture involves Chinese medical theory. You know this means that for back pain we're not just looking at the back. I know that sounds confusing to some people but we're looking at all the other channels that can be related and what patterns can be creating low back pain. Digestive problems can cause low back pain. Women's health issues can cause low back pain. So there are also internal medicine causes that you could treat with acupuncture or musculoskeletal causes. I tend to see dry needling mostly for physical pain so musculoskeletal pain but again the big picture is there's no Chinese medical theory surrounding it of treating a pattern that is a cluster of symptoms that tend to be not just the musculoskeletal pain if that makes sense. So my two cents, there's definitely a turf war here because a lot of practitioners that are not Chinese medicine practitioners have lobbied to be able to use that practice because it works and patients want it and so a lot of PTs and chiropractors and even physicians, orthopedic doctors will do that as well. So this is one of those turf wars within Chinese medicine within our field but in my mind the 10,000 foot view of the difference is that's how I see the two being different but they can both help and there are definitely techniques in Chinese medicine that we would call dry needling, needling locally but usually skilled doctors are not just doing that. That's what I have for you today guys, that is what I see as the difference between the two. I've put together two related videos on this topic and don't forget you can always reach out down below or check out that free guide I put together.