5 Crucial Differences Between Acupuncture & Dry Needling

Do you suffer from aches and pains?

Is a musculoskeletal condition like a shoulder problem, low back or neck discomfort, headaches, or arthritis getting you down?

You might have heard that needling may help (it can!), but find yourself unsure about the differences between acupuncture vs dry needling.

Or you might be ready to start care but don’t know which treatment is best for you.

These two therapeutic approaches have some similarities. But there are significant differences, too. Differences that alter the treatment method, rationale, and outcomes. These points are essential. So, let’s explore 5 crucial differences so you can make the best decision for your health.

1.) Origins and Philosophy of Needling

While origins and philosophy may, on the surface, seem to be a less important aspect, the opposite is true. Where and when a therapy originates from, and the critical thought that underpins its foundation impacts its methods and delivery. You guessed it, this alters a patient’s experience and results.

The origins and philosophy of these two treatment modalities sit poles apart. Let’s take a deeper look.

The origins and philosophy of acupuncture

Acupuncture is an ancient treatment based on traditional medical practices dating back roughly 20 centuries. Steeped in the empirical knowledge and philosophy of Chinese medicine and culture, acupuncture is informed by millennia of wisdom — passed down from teacher to student in perpetuity.

Some of the teaching texts are over 2000 years old. To put that into context, it wasn’t until 1804 that the first contemporary pharmaceutical medicine was produced.

Traditional Chinese Medicine (TCM) acupuncture includes a variety of needling practices, as well as related techniques like micro-bleeding and moxibustion.

These needling practices aren’t a one-size-fits-all model. Treatment may include needling meridian points — specific spots within the energy pathways that flow through the body.

Fine needles may also be directed at sensitive, tender muscle knots. These spots are called Ashi points (literally translated as Ah Yes!) The time-honoured book Prescriptions Worth A Thousand In Gold For Every Emergency, written in 652 AD, described this method. The author, Sun Si-Miao, suggests needling and moxa at ashi points to effectively manage pain.

There is a stunning breadth and depth of knowledge in TCM that modern medicine can only dream of.

The origins and philosophy of dry needling

Treating tender muscles and knots is likely as old as human history. For thousands of years, people worldwide have sought out therapies like massage.

In the 20th century, medical science became interested in painful muscle knots. This led researchers to consider: could the insertion of needles help to relax a muscle and offer respite from pain?

Enter dry needling…

This treatment approach — and its name — has curious beginnings. In the late 1930s, a doctor and researcher named John Kellgren found that injecting a saltwater solution into a muscle could trigger pain. This led to an obvious question: Could injecting anaesthetic into tender points provide relief?

Researchers around the globe took up the mantle. The resolute answer? Yes, injecting sore spots can provide relief. For obvious reasons, a needle introducing a pain-relieving fluid into the body was dubbed wet needling.

The next step was to assess whether the same results could be seen without the anaesthetic. Was the needle itself enough? The answer here was also yes.

After a few earlier studies, JD Paulett published an article in the Lancet journal in 1947, where he coined the term dry needling. The birth of a philosophically younger needling practice was born.

It would seem dry needling is a rediscovery of Ashi point needling; however, this singular approach isn’t steeped in the wisdom and breadth of acupuncture’s lineage. Yet, dry needlers have significantly and notably contributed to the research base of acupuncture’s use to relieve pain.

In this way, there are fuzzier edges in acupuncture vs dry needling.

2.) What is the Scope of Practice?

The scope of practice is diverse for these two approaches. But before we dive into this point in greater detail, it’s essential to understand the term’s definition. According to Queensland Health:

The full scope of practice of a profession includes the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within that profession are educated, competent and authorised to perform. The full scope of a profession is set by professional standards and in some cases legislation.

The scope of practice then refers to the extent to which a practitioner can safely, competently, and professionally deliver expert care within their profession’s boundaries.

When it comes to acupuncture, modern research focuses the scope of practice on the conditions it is scientifically suited to treat. The Acupuncture Evidence Project found “evidence for the effectiveness of acupuncture for 117 conditions.”

As research expands, so does the list of proven benefits of this therapy. 

The conditions with the most robust evidence of benefit include migraine prevention, tension headaches, hay fever (allergic rhinitis), postoperative nausea and vomiting, chemotherapy-induced nausea and vomiting, chronic low back pain, knee osteoarthritis, and post-operative pain.

Dry needling, on the other hand, is more limited. This approach targets tender points — sometimes called trigger points  — intending to provide pain relief.

3.) What Research Evidence is There?

It’s tempting to start this conversation with an acupuncture vs dry needling bent. However, both treatment approaches are supported by scientific proof.

As one would expect, acupuncture has extensive supporting evidence. Vast research has been conducted in Asia, and there is growing, in-depth research in the West. Australia included!

Acupuncture has various types of supporting evidence — for example, RCTs and systematic reviews.

Randomised controlled trials (RCT), considered the gold standard in modern research, pit two (or more) groups against one another. One group receives a “sugar pill,” or placebo. The other receives the treatment. The results can then be compared to see if the treatment was effective.

Systematic reviews are thorough, dependable overviews of existing evidence. They combine numerous studies, often RCTs, to gain greater insight. This produces meticulous, unbiased research that allows us to make robust recommendations.

What about research into dry needling?

If you search Google Scholar, you’ll find that dry needling returns around 53,300 results. While this is nowhere near the acupuncture level (722,000), it’s still substantial and essential. And yes, it has the potential to provide much-needed pain relief.

There is agreement that acupuncture and dry needling provide short-term pain relief. In addition to acute problems and pain, acupuncture has shown benefits for some chronic or long-term conditions. Through a process called modulation, repeated treatments transform short-term changes into lasting ones. Pretty cool, hey!

Because acupuncture has been using needles to soothe tender knots for an aeon, this therapy incorporates dry needling. Remember the Ah Yes point?

But because dry needling — for all its benefits — is based on tender points alone and lacks the scope of practice and research evidence that acupuncture has, these therapies are distinct. Acupuncture is a holistic therapy; dry needling has a limited musculoskeletal focus.

4.) Training and Regulation (and Why It Matters)

What about credentials, I hear you ask?

Good health is the foundation of a healthy life. It should never be compromised. So, asking about acupuncture vs dry needling regarding training and regulation is necessary.

To become a Registered Acupuncturist in Australia, you need a three-year bachelor-level qualification or postgraduate Master’s. The government’s Australian Health Practitioner Regulation Agency (AHPRA) is responsible for ensuring that acupuncturists meet the expected standard for qualification and training. If this bar isn’t met and passed, someone cannot register. Only acupuncturists can legally claim to perform acupuncture.

While acupuncture is safe when performed in the hands of an appropriately trained practitioner, there are legitimate safety concerns when practicing needling. This is particularly true when deep needling is applied.

If you have any queries about the credentials of a potential therapist, I recommend you check the practitioner registry.

But what about dry needlers?

Dry needlers may have a variety of other qualifications: chiropractors, osteopaths, medical doctors, and physiotherapists, for example. Or not. Dry needling is often a certificate program that can be completed in a few days to several months.

As with any pursuit, the longer and deeper your training and the more experienced you are, the better your skills.

Before you undergo treatment, ensuring your therapist is suitably trained and registered is wise.

5.) Needling Technique and Strategy: The Ins and Outs

Different therapists use different techniques and strategies. There are variations within professions and between professions. The two tables below will help to clarify the differences between technique and strategy.

 Table 1: Aspects of Technique

Table 2: Aspects of Strategy

The acupuncture vs dry needling takeaway

Therapists trained in acupuncture and dry needling have the potential to offer exceptional service and promote pain relief for a variety of pain conditions. There’s no denying that needling is a fantastic, evidence-based treatment.

But let’s directly answer the question we posed at the beginning: should you choose acupuncture vs dry needling?

While both approaches hold promise, acupuncture has the high training standards guaranteed by registration with AHPRA. It’s supported by robust and broad research, focuses on a holistic approach that understands the deeply interconnected systems of the body, and can treat more than muscular knots alone. The depth of knowledge about needling may translate into increased safety and efficacy.

So, acupuncture has many advantages over dry needling.

Employing a comprehensive selection of tools from my acupuncture toolkit, I craft treatments that are designed to meet the unique needs of each individual. If you are seeking a Registered Acupuncturist, I invite you to get in touch for a consultation.

Author

Adam Hjort is a Registered Acupuncturist and member of Australian Acupuncture & Chinese Medicine Association (AACMA). He has been practicing since 2010 and maintains a clinic dedicated to the treatment of pain located in Ashmore, Gold Coast. This article was last updated 14th December 2023.