So what exactly is dry needling?

This is a super common question I get at least once a week.

Put simply, dry needling is one specific technique of acupuncture limited to treating myofascial/muscle pain that can be performed by some additional practitioners besides licensed acupuncturists.

It’s not a new, modern form of acupuncture. It’s been practiced for well over two thousand years.

All acupuncture, including dry needling, uses sterile, single-use filiform needles that are discarded in a biohazard container afterwards. These are “dry” in that they are solid, not hollow like a “wet” hypodermic needle used for giving medicines or drawing blood.

So then why isn’t dry needling just called acupuncture?

Three main reasons – scope of practice, insurance, and technique.

Scope of Practice
All licensed practitioners – doctors, nurses, physical therapists, chiropractors, acupuncturists, etc.- have what’s called a “scope of practice” for their particular field.

This is a legal description of what training is required and what techniques, procedures, etc. they can and cannot do as part of their work. Scope of practice varies from state to state so I will only refer to what I know of the Illinois scopes of practice.

Dry needling has been allowed to be performed by other practitioner types, in addition to Licensed Acupuncturists, as long as they go through additional certification training – physical therapists being the most common – and so this technique needed a different name and definition to be able to detail it within their scope of practice.

Insurance Billing
When insurance is billed, the practitioner has to put a procedure code called a CPT code on the insurance claim form. CPT codes have a specific description that includes the treatment method and/or the clock time involved.

Dry needling was also given a different name so it could be very specific for insurance billing, distinct from acupuncture.

The codes for dry needling reflect how many muscles are needled (1-2, or 3 or more). The codes for acupuncture reflect how much time is involved and whether or not e-stim was used.

Who can perform dry needling?

Licensed Acupuncturists (LAc) (this is me)
LAc’s have the most comprehensive training in all forms of acupuncture, including dry needling. In our schooling, it’s also referred to as “ashi point” needling, and is a standard part of our training.

An LAc must complete a minimum of 3 years of postgraduate education and training, including a minimum of 660 hours of supervised clinical experience, and then pass the national board exams. My program at Pacific College of Health and Science was a four-year program because I chose to combine training in Chinese herbal medicine as well.

Physical Therapists (PT)
Not all PTs are trained in dry needling and currently the courses are offered as optional continuing education after they have finished their degree.

PT training in dry needling in Illinois includes at least 50 hours of education, plus at least 200 supervised treatments.

Occasionally some PTs do go through a separate, full acupuncture program but I find that to be less common in this area, more often you’ll see the shorter dry needling training.

Chiropractors (DC)
This can be a little more confusing…
• Some DCs have done a complete 3+ year acupuncture program and can choose from the full variety of points and techniques.
• Some DCs have completed a Chiropractic Acupuncture Certification between 100 to 300 hours depending on their particular state and which program they choose. This allows them to do some additional techniques or use additional methods of point selection beyond dry needling.
• Some DCs have completed a dry needling course of about 50 hours.

There are other practitioners allowed to train for acupuncture or for dry needling, such as medical doctors and nurses but it is less common in our area so I’m not going to outline their training here.

Dry Needling Technique

Let’s put the legal stuff aside now and get back to the technique of dry needling. Trigger warning – If you are squeamish with the talk of needles, please jump down two sections.

In dry needling, the acupuncture needle is inserted into the motor point of a muscle.

A motor point is a specific type of trigger point where the nerve innervates the muscle = where the nerve goes into the muscle to tell it what to do.

This will cause a twitch or a jump in the muscle.

The needle is then immediately removed. It is not retained and there is no rest time with the needle in.
It’s like a reset for the muscle whether it’s tight or weak.

If a muscle is overly tight, it will help it to relax. Like how guided progressive relaxation works – if you squeeze a muscle first, then it relaxes better than if you tried to just coax the muscle to relax.

If a muscle is weak and not “firing” well, this will give it a command to function better.

I consider dry needling to be a branch treatment (like on a tree) – it might or might not get to the root of the issue but it can relieve some symptoms and help pain feel better.

Cautions with Dry Needling

There are of course some cautions with dry needling.

As with all acupuncture, there is a risk of bruising.

Dry needling is typically a deeper form of acupuncture so there needs to be even more caution when doing points over the trunk.

This can be a strong stimulation to a point so you may feel some soreness at that point for a day or two.

In one treatment there should only be one to a few muscles needled. Doing too many muscles at one time is overwhelming to the body.

If you are mildly needle-phobic, you might want to try acupuncture with me. I have some very gentle techniques, including a couple of different ways to do acupressure without the use of needles.

If you are majorly needle-phobic to the level of going into needle shock (sweaty, fainting, etc), then you should stick to acupressure (non-needle) only.

Should you get dry needling done by your PT?

If you are currently in physical therapy, your PT is trained in it and offers it as a modality, and you want to try it – sure, go for it. Here’s what to know…

The treatment should be for pain only and they should be doing from one to a few muscles, local to the area being treated. There should be no far-away (distal) points and no ear points. No e-stim can be used on these points and the needle should be immediately removed. They will then move on to other PT techniques for addressing the movement of the muscles and joints.

The whole goal of anything is that YOU feel better. Why not try all methods that might help?

If the dry needling at PT helps you, that’s great.

If it doesn’t help you or it doesn’t feel good to you, then try acupuncture with me.

Acupuncture Treatment

An acupuncture treatment (what I do) focuses on the full bio-psycho-social aspects of health. This is a medical way of saying “body, mind, and spirit.”

What I mentioned earlier about root and branch symptom… it’s great to have a muscle release, but it helps to also work on the underlying reasons of why it’s there in the first place or why it keeps coming back.

Personally I consider dry needling from your PT and acupuncture from me as a “both… and…”, not an “either… or….”

Your PT can help calm symptoms in a certain area of pain. I can then help you with some of the underlying issues like systemic inflammation, stress, sleep, anxiety, depression, GI or respiratory symptoms that contribute to you not feeling good, etc.

All treatments involving the use of acupuncture needles have a two-step process – how to choose the points you are going to do and what technique to use on those points.

The big umbrella word “acupuncture” has a bunch of options I can choose from.

As we are going over your symptoms at the beginning of the session, part of my brain is busy making decisions about which points I’ll need to do and the best way to do them for you today.

Point Selection Examples
These are some of the method names I use to decide the point choices:

Dry needling/orthopedic/ashi points, traditional Chinese medicine/zang-fu theory, five-element theory, mirror & imaging, auricular (ear) points, scalp points, Master Tung points/myofascial lines, Dr. Tan Balance Method, and more.

Point Technique Examples
Once I’ve chosen which points I’m going to do, then I choose how:

Dry needling, classical manual needle techniques with retention (my most common choice), e-stim, moxibustion, ear seeds, teishin & point stimulator (no needles), and more.

Don’t worry – you don’t need to know or remember any of these. I’m just showing how varied acupuncture is.

Example treatment process in my clinic…

Let me give you a practical example of how I approach a treatment. If I do any dry needling it is almost always in combination with other techniques. I find it helps to treat both branch and root at the same time.

Treatment 1:
Mary is a 52-year-old woman whose top 3 concerns today are elbow pain, hot flashes, and anxiety.

Her elbow pain started last week after a strength training class. She’s been getting about 10-12 hot flashes during the day for the past year. She has had anxiety for years, but it started worsening a few months ago after taking on a new position at work.

My acupuncture point selection might include:
An auricular (ear) point – there is a branch of the vagus nerve that goes to the outside of the ear. The vagus nerve is in charge of our parasympathetic system – our “rest & digest” system – and when activated it gets us out of “fight or flight” mode so more healing and inner repair can happen.

Dry needling – 1 or 2 muscles around the elbow to relieve pain. Then I either remove these needles or back them off so they don’t keep stimulating the motor point.

Zang-fu theory – Several points on the arms and legs known to support a pattern in traditional Chinese medicine (TCM) called “Heart-Kidney Disharmony” to help cool the hot flashes and calm the anxiety.

I then let Mary rest anywhere from 15 to 30 minutes depending on her comfort level. (Shorter if she tends to be restless; longer if she enjoys having a little acu-nap.)

Unless she asks, I don’t explain why I’m choosing each point.

What’s important to Mary is she is getting a treatment that will help her and she has time to relax & unwind from her busy life which makes the treatment more effective.

Treatment 2:
Mary returns the following week. Her anxiety is less intense; her hot flashes went from about 10-12 a day to around 6 or 7 with less sweat; and her elbow pain is resolved as it was an acute symptom after an exercise class.

Her top 3 concerns today are: hot flashes, anxiety, and wrist pain at the side of the thumb (known as “texting thumb”).

She responded well to the first treatment, so I continue a similar point protocol for the TCM pattern identified last time. I also include the auricular (ear) point. And then I choose to dry needle two muscles commonly involved with texting thumb.

Treatment 3:
Mary returns again the following week. She had a flare of anxiety after a particularly stressful situation at work that led to a panic attack, but it subsided much quicker than before and didn’t leave an anxiety “hangover”. That same day she had several more hot flashes, but overall had fewer during the week. Her texting thumb pain was about 25% better – she was on her phone more this week playing a game when trying to unwind before bed.

This treatment was very similar to treatment 2.

Mary’s case is a good example of how the body-mind-spirit is all connected and why a full acupuncture treatment is important.

I could just treat her thumb, but why is the thumb pain happening? Playing the game on her phone is an attempt to self-soothe and calm anxiety from her current work situation. And though she is at a stage of life where hot flashes are common, they clearly worsen when feeling stressed and anxious.

Acupuncture can’t solve her work situation, but it can build up her resilience to the stress, while giving relief to some of her symptoms.

If you have questions about acupuncture and dry needling, or how I might be able to help you, please send me an email from the Contact page and I’ll get back to you in the next few days.

If you’d like to schedule an acupuncture treatment, click Book Now to find an appointment time.

References:

Physical Therapy Practice Act for Illinois
Medical Practice Act for Chiropractors
Chiropractic acupuncture training hours by state
NCCAOM Dry Needling Position Statement