There is a lot of confusion about the difference between acupuncture and dry needling. While the techniques can overlap, there is an important distinction: acupuncturists are extensively trained in the use of needles.
Needling is not a small part of acupuncture training. It is at the center of the profession.
As an acupuncturist, I completed thousands of hours of education and clinical training, including extensive training in acupuncture techniques, anatomy, physiology, point location, needling depth and angle, needle manipulation, patient response, safety, and clinical assessment.
This means I am not simply trained in where to put a needle. I am trained in how to use a needle, how different tissues respond to needling, how much stimulation a patient can tolerate, and how to modify treatment based on the individual person sitting in front of me.
There is a misconception that acupuncture is only about placing needles into traditional acupuncture points, while dry needling is what you use when you want to treat muscles.
In my practice, I do both.
I regularly needle into muscles and areas around muscle insertions, tendons, fascia, and trigger points. I use techniques designed to release muscles and address myofascial restrictions. I also use electrical stimulation when appropriate.
These techniques can be extremely effective for musculoskeletal pain, muscle tension, restricted movement, and sports injuries.
The difference is that I can combine this local work with a much broader acupuncture treatment.
I don't have to choose between treating the muscle and treating the whole person.
Needling directly into a tight or painful muscle can create a strong sensation. Some people experience an ache, twitch, pressure, or temporary soreness. Some patients respond very well to this. Others are extremely needle-sensitive.
I have many different ways to approach a patient who is sensitive to needles. I can use acupuncture points away from the painful area, adjust the number and depth of needles, change the amount of stimulation, and work with the nervous system before moving into more local treatment.
There are also acupuncture points and treatment strategies that can be used to help reduce pain and sensitivity during treatment.
So if a patient comes in saying, "I hate needles," that does not automatically mean acupuncture isn't appropriate for them.
I can modify the treatment to their nervous system and their tolerance rather than simply pushing through the discomfort.
I don't believe that treatment has to be painful to be effective.
I do dry needling, too. I absolutely use what is commonly referred to as dry needling.
One example is the neck. I will often use local dry needling toward the end of an acupuncture treatment when I determine that the muscles would benefit from it.
By that point, I have already assessed the patient and may have used acupuncture points throughout the body to address their particular presentation. I can then use local needling to work directly on the tight or painful muscles.
I may also incorporate electrical stimulation, myofascial techniques, trigger point work, or other manual techniques.
The local needle sensation can help release the muscle and reduce pain, while the acupuncture treatment as a whole can leave the patient feeling deeply relaxed. Before I decide to use more aggressive local needling, I want to know whether the patient is actually going to benefit from it.
Some people tolerate a lot of stimulation and respond well to strong local treatment. Others are much more reactive.
Traditional Chinese Medicine also looks at the person's overall constitution and current pattern rather than treating a painful body part in isolation.
If someone is already highly inflamed, depleted, overstimulated, or particularly sensitive, adding a lot of local stimulation may not be the right approach that day.
I might begin with distal acupuncture points, use fewer needles, use gentler stimulation, or address the nervous system before doing local muscular work.
The treatment should work with the person, not against them.
How this differs from a dry needling course
Physical therapists can receive additional training in dry needling, but that training is generally an additional technique within their physical therapy education.
Acupuncturists, on the other hand, spend their professional education learning how to needle.
That includes thousands of hours of formal education and supervised clinical training, with needling skills developed over years rather than learned as a single technique added onto another profession.
I'm thinking about the tissue I'm entering, the patient's sensitivity, the depth and direction of the needle, how much stimulation is appropriate, what other points may support the treatment, and how the patient's entire system is responding.
Local treatment + whole-body treatment
I can treat the painful muscle directly while also treating the larger pattern contributing to the patient's symptoms.
It is a whole-person treatment that can include very specific local muscular work.
