Dry Needling

Dry Needling Versus Acupuncture: The Ongoing Debate

Since the day I began performing dry needling, I have been asked the following question countless times: “what is the difference between acupuncture and dry needling”?  I used to say “well, acupuncture is rooted in eastern medicine and dry needling is rooted in western medicine.” It wasn’t until I read the following article by Zhou that I realized how wrong this answer was. If you read one commentary on how dry needling and acupuncture live together, it should be this one.

Acupunct Med 2015;33:485-490 doi:10.1136/acupmed-2015-010911

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Although Western medical acupuncture (WMA) is commonly practiced in the UK, a particular approach called dry needling (DN) is becoming increasingly popular in other countries. The legitimacy of the use of DN by conventional non-physician healthcare professionals is questioned by acupuncturists. This article describes the ongoing debate over the practice of DN between physical therapists and acupuncturists, with a particular emphasis on the USA. DN and acupuncture share many similarities but may differ in certain aspects. Currently, little information is available from the literature regarding the relationship between the two needling techniques. Through reviewing their origins, theory, and practice, we found that DN and acupuncture overlap in terms of needling technique with solid filiform needles as well as some fundamental theories. Both WMA and DN are based on modern biomedical understandings of the human body, although DN arguably represents only one subcategory of WMA. The increasing volume of research into needling therapy explains its growing popularity in the musculoskeletal field including sports medicine. To resolve the debate over DN practice, we call for the establishment of a regulatory body to accredit DN courses and a formal, comprehensive educational component and training for healthcare professionals who are not physicians or acupuncturists. Because of the close relationship between DN and acupuncture, collaboration rather than dispute between acupuncturists and other healthcare professionals should be encouraged with respect to education, research, and practice for the benefit of patients with musculoskeletal conditions who require needling therapy.

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Western medical acupuncture (WMA) is a therapeutic modality involving the insertion of solid filiform needles. It is a modern adaptation of traditional acupuncture (TA) using current biomedical understanding and research evidence. WMA is widely practised by conventionally trained healthcare providers including physicians, chiropractors, and physical therapists (PTs). Although WMA is relatively commonplace in the UK and Sweden, a particular approach called dry needling (DN), which is mainly practised by PTs, is becoming increasingly popular in other major western countries. WMA, DN and TA are all needling procedures that involve penetration of the skin with solid filiform needles with therapeutic intent. DN is a technique that PTs and other healthcare professionals use to treat various painful conditions of the musculoskeletal system, usually myofascial pain syndrome, whereas TA is a technique used by professional acupuncturists. Compared with DN, both TA and WMA have a broader range of indications including musculoskeletal pain, and gastrointestinal and neurological disorders. Patients and healthcare professionals may be confused about the relationship between DN and acupuncture as they seem to share similarities and yet may differ in certain aspects. Currently, little information is available from the literature regarding the similarities and differences between these two needling techniques. In this article, we aim to: (1) explore the professional controversies surrounding the practice of DN; (2) review the origins, theory, and practice of DN and acupuncture; and (3) seek potential solutions in response to the ongoing debate.

The ongoing debate
The dispute about the legitimacy of DN practice by healthcare professionals who are not physicians or acupuncturists has been ongoing now for more than a decade, particularly in the USA. Here, we focus on the debate between acupuncturists and PTs regarding DN practice. Acupuncturists oppose the practice of DN by PTs because they perceive DN to be a form of acupuncture, which they feel should not fall into the scope of practice of PTs and other practitioners, such as chiropractors. They also argue that, with minimal training, PTs are unlikely to be able to master the technique and thus may endanger patient safety and wellbeing. In response, PTs claim that DN is not acupuncture because, although both acupuncture and DN are needling techniques, DN is based on modern biomedical science rather than TA theories or terminology.

However, DN and acupuncture clearly overlap to some extent in view of their most common indication (musculoskeletal pain) and their use of solid filiform needles. Additionally, with the single exception of cases of pneumothorax due to inappropriate and/or unlawful practice, which is also reported in acupuncture practice, no significant patient safety events have been reported in relation to the practice of DN. Thanks to accumulating evidence for its applicability, utility, and lack of side effects (which are minimal to none), the practice of DN is becoming increasingly popular among conventionally trained healthcare providers around the world, especially among PTs in the USA. DN is the de facto practice of PTs in many countries and states across the USA, yet it is unavailable in others, which further convolutes the debate of who can and should practise DN.

The other argument lies in the training of PTs in DN. The practice of acupuncture by trained clinicians requires enhanced experience. In most states and countries, the practice of acupuncture requires hundreds and often thousands of hours of acupuncture education in specialised educational programmes. In the USA, the practice of acupuncture requires state licensure, which is based on passing national level examinations and maintaining good professional records. The practice of acupuncture is governed by the acupuncture or medical board of the state education department in most states across the USA.

By contrast, current training of DN for PTs in the USA is done only through continuing education or certificate programmes, which are not strictly regulated and have few (if any) standards that need to be complied with. With these non-formal training programmes in DN, acupuncturists argue that PTs’ exposure, experience and skills in needling therapy are likely to be limited. Additionally, evaluation systems for the practice of DN by PTs are currently unavailable, and standards for healthcare governing administrations and policymakers are not yet established.

Dry needling
History of DN

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  • Contributors KZ conceived the idea and drafted the article. MSB provided constructive guidance and feedback. YM co-authored a portion of the article.
  • Competing interests None declared.
  • Provenance and peer review Not commissioned; externally peer reviewed.


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  1. Kehua Zhou
  2. Yan Ma
  3. Michael S Brogan

+Author Affiliations

  1. Department of Health Care Studies, Daemen College, Amherst, New York, USA
  2. Daemen College Physical Therapy Wound Care Clinic, Daemen College, Amherst, New York, USA
  3. Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  4. Internal Medicine and Sleep Center, Eye Hospital, China Academy of Chinese Medical Science, Beijing, China
  5. Department of Physical Therapy, Daemen College, Amherst, New York, USA
  6. Correspondence to Dr.  Kehua Zhou, Department of Health Care Studies, Daemen College, 4380 Main Street, Amherst, NY 14226, USA; kzhou@daemen.edu

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