​This question comes up a lot, and as more variations of each practice continually emerge, it becomes increasingly difficult to answer.....
 
A SIMPLE, one line answer (at the risk of overgeneralization) that many have used….acupuncture is aimed at the treatment of disease states and pain through insertion of needling specific points on the body’s surface with the intention of changing a person’s energy flow (or Qi), whereas dry needling aims to make changes to the target tissue by inserting needles specifically into that tissue.
 
Over time, the practices have started to gravitate toward similarity, as various forms of acupuncture have become more westernized and dry needling has incorporated more eastern thinking.
 
There are many forms of acupuncture practiced globally, although historians trace all roots back to China, with acupuncture documented as early as the second century. Like any practice, it has evolved over the years, but those rooted in traditional Chinese medicine are most familiar to people in the western world.
 
One example of the latter..some dry needling approaches teach using alcohol swabs on the skin prior to treatment, whereas others have adopted the eastern thinking that swabbing the skin with alcohol might could kill “good” bacteria.
 

​More on the fundamental differences: One tenet of Traditional Chinese Medicine is that many conditions in the body result from disruptions to balance of qi, which is literally translated as “vital force.” Acupuncture emerged and continues to this day as one approach to restore body balance through realignment of qi. By strategically placing needles into acupressure points along meridians (or channels), through which qi is thought to flow, acupuncture will restore the balance of qi and manage pain or whatever other symptoms are being targeted.
 
Dry needling, sometimes referred to as trigger point dry needling, has traditionally been based on inserting needles to disrupt trigger points, which we could define as taut, localized ischemic bands. In layman’s terms, think of a “knot” in the muscle with limited blood flow. As dry needling has evolved, we’ve begun to appreciate more global effects of DN beyond simply breaking up these trigger points. When we stick a needle in the body, the effects are felt throughout many systems, not simply in the soft tissue it physically contacts.
 
Uses basically the same needles. They might differ in the specifics of which needles are used more often though. Needles can vary in length and texture, with different needle qualities having both plusses and minuses.
 
Generally speaking, you’ll see acupuncture using more needles and keeping them in for longer. It is not uncommon for needles to remain 20-30 minutes, or even longer. Many DN approaches practice a more “get in, get out” strategy; going directly for a trigger point with one or a few needles and then removing it when the acute twitch response has subsided, whereas acupuncture does not seek to make changes to tissue. But again, more and more dry needling approaches are teaching longer insertion durations as the role of the nervous system (not simply the target tissue) gains greater acceptance.
 
Neurophysiological considerations…while we know from ultrasound imagery that the insertion of a needle into the body causes some disruption to the body’s structure, modern thinking in the dry needling world also appreciates how this process can also have profound effects throughout the nervous system as a whole, from the release of chemicals known to decrease pain sensitivity.
 
Generally, DN inserts the needles deeper than acupuncture because the target tissue often lies far beneath the surface; there are some techniques even specifically targeted to “peck” the bone.
 
Both can be paired with electrical stimulation for an added treatment effect.
 
One criticism that has been leveled at dry needling from the alternative medicine community has been that dry needling as practiced by physical therapists is “only taught in weekend courses.” This critique represents a very superficial understanding of the educational pathway. Physical therapy education, which is now exclusively delivered at the doctoral level in the United States, includes intensive lab-based instruction in anatomy and physiology (again, at the doctoral level). Many physical therapy programs share the EXACT same anatomy lab facilities as MD/DO programs housed at the same institution.

For additional reading see, Notes from Structure and Function Dry Needling course

Allan Phillips, PT, DPT
Ventana Physiotherapy
Oro Valley, Arizona

Stuff I liked…

• Integration of eastern thinking and acupuncture, if not explicitly, then certainly implicitly (notably, the idea that overcleaning the sites can kill “good” bacteria and “adverse” reactions to needling such as nausea/disorientation/vomiting may actually be a good thing as a sign of the body trying to recalibrate itself.)
• No resheathing of the needles..needles are cheap, no need to risk an accidental stick
• It was a good anatomy review in general…and a good reminder how much there still is to learn!
• Needle technique isn’t that difficult. Knowing where to stick and needle and where/when to NOT stick a needle is more important
• Helped me think deeper about the SMFA…for example, treating one of Stecco’s fascial points, if you follow the SFMA breakouts from multisegmental rotation, there’s a good chance you’ll wind up in one of these places….then you recheck your work. Good to have a movement baseline
• Did not insist on bottoming out (through feel not end feel)
• Brings the perspective of downregulating/upregulating the nervous system in context of athlete’s competitive schedule (broader perspective than just hunting down trigger points, which has been an unfortunately narrow misinterpretation of DN)
• Deemphasis on trigger point hunting and bottoming out seems to result in less residual soreness