Written with the input of Christine Knight, LAc and Subhuti Dharmananda, Ph.D.
What is the difference between dry needling and acupuncture? As dry needling becomes a more common practice in many outpatient physical therapy clinics, many patients ask this question. There are many similarities between the two, but each is a unique technique performed by different skilled providers.
The Tool:
What is a “dry needle”? A “dry needle” is simply a needle that does not contain any medication, and so does not inject medicine into the skin. Both acupuncture and dry needling utilize a very thin, solid filiform needle as shown below.
The Technique:
Dry Needling:
Dry needling technique performed by physical therapists is used for pain and movement impairments, and the target is trigger points, which are hyperirritable spots, usually in muscle tissue that can be associated with aching, stiffness and even referred pain (pain that is present in other areas).
Modern trigger point dry needling has its origins in the work of Karel Lewit of Czechoslovakia, who published a paper on the subject in 1979. There is some evidence of similar research done in the 1940s.
Acupuncture:
Acupuncture technique can also be considered “dry needling” and that is simply one of the many techniques used in acupuncture.
The use of meridians and qi are common in acupuncture practice but “sports medicine” acupuncture specifically came from the use of the dry needling techniques for martial artists in China who needed treatment for these sport injuries.
In addition, ancient acupuncture practice and theory may have existed as early as the 2nd century BC, but the more systemized approach has evidence dating to the late Qing times (AD 1644–1911) with the development of fine steel needles.
Is specialized training required?
Dry Needling:
Physical Therapists must be certified in Dry Needling technique in addition to their entry-level education (Doctoral or Master’s Degree). The exact requirements vary a little bit by state, as each state has their own specific requirements. Some states do not allow Physical Therapists to perform dry needling at all. There are currently 6 states in which the law specifically prohibits dry needling performed by physical therapists.
Acupuncture:
Acupuncturists can practice after completing a master’s degree at an accredited school and passing their licensing examination. There is no additional training or certification required, as acupuncture and herbal clinical training is included in the program.
What to Expect During the Session:
Dry Needling:
Physical Therapists will typically use soft tissue massage or joint mobilization as well as exercise in conjunction with dry needling, as it is not as effective as a stand alone treatment. The physical therapist will perform a thorough subjective and physical examination before the dry needling treatment and most clinics have you sign a separate consent waiver. Dry needling may be performed in a private treatment room, or in a larger open space, depending on the clinic and patient preference.
Acupuncture:
Acupuncturists typically treat in private treatment rooms, sometimes turning down the lights or playing soft music to aid in relaxation. Acupuncturists are also able to prescribe herbs that can be taken internally or applied topically to support the effects of their treatments. Heat application, body work and fire cupping can also be adjuncts to acupuncture therapy.
How many needles?
This depends on the training and theory for both acupuncture and physical therapy performed dry needling. Some therapists may only use 1-2 needles during the first session to introduce a new treatment modality. Six to 15 needles may be used for larger areas and in later treatment sessions.The needles may be left in up to 15 minutes or may be only for about 5 seconds if the desired effect is achieved.
What does it feel like? Does it hurt?
Soreness and achiness are expected. The actual treatment is not meant to be painful, but it may be uncomfortable, depending on the patient’s sensitivity level or expectations.
What is the Cost?
Dry Needling:
The cost depends on the state and your insurance. Many major insurances will pay for dry needling included under a regular outpatient visit. Some clinics will charge only for the cost of the equipment, $5-10 per session.
Acupuncture:
Some insurers will cover the cost of acupuncture, usually a set amount of visits per year. The out of pocket costs vary, and may be as low as $35 per visit at a community acupuncture clinic depending upon individual copays or one with a sliding fee. The usual out of pocket cost at a private practice clinic is typically double that amount.
What to Expect After Your Session:
Some patients experience temporary physical or mental changes such as grogginess, fatigue, or soreness. If these symptoms occur, an individual should wait before driving home from the appointment.
What do they treat?
Treatment of chronic pain
Acute pain to improve function
Reset the local system by achieving contraction of specific muscle that may be contributing to pain
Movement quality improving tissue health and brain health (retraining the brain
Acupuncture:
Acute pain
Sports injuries
Fertility, pre, during, post-pregnancy
Posture
How long does it last?
Effects can last minutes to hours to days in both techniques. This depends on the patient, what they do after the treatment/session, and what they are seeking to treat.
So, which service should I choose?
This depends on you as an individual. Some patients swear by acupuncture to cure multiple ailments, while others have not found it to be helpful. Some providers may also be more skilled than others. The same goes for dry needling and physical therapy. There are many factors to consider including patient expectations, provider skill and training as well as accessibility and cost. Another option is to find a wellness clinic that hosts both physical therapists and acupuncturists. This way your providers can collaborate and provide different techniques that complement each other.
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