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The Difference Between Acupuncture And Dry Needling


I first wrote about dry needling in my February 2015 newsletter, and since then there have been a lot of developments, including physical therapists adding dry needling to their scope of practice in 2022. I think it's really important for everyone to understand the difference between acupuncture and dry needling, especially since these things look the same to most laypeople but in reality the technique and the training are vastly different. Let me start by sharing the definition of dry needling as defined by the New Jersey Board of Physical Therapy Examiners:



"Dry needling" means a physical intervention that uses a dry, filiform needle, without medication or other deliverable, to penetrate the skin and stimulate underlying muscular tissue, connective tissues, or myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments. "Dry needling" shall not mean the stimulation of auricular or distal points or the practice of acupuncture as defined by section 2 of P.L.1983, c.7 (C.45:2C-2).



Below is the definition of acupuncture as designed by the New Jersey Acupuncture Examining Board



"Acupuncture" means the practice of Oriental medicine based on traditional Oriental medical theories, including stimulation of a certain point or points on or near the surface of the body by the insertion of special needles to prevent or modify the perception of pain or to normalize physiological functions including pain control and for the treatment of diseases or dysfunctions of the body. "Acupuncture" includes the techniques electroacupuncture, mechanical stimulation, adjunctive therapies, and moxibustion.



What's interesting is that the definition of acupuncture includes the term "special needles", which is not defined by NJAEB, but notice that NJBPTE states that dry needling "uses a dry, filiform needles, without medication or other deliverable". Dry means not passing a substance through the needle (unlike hypodermic needles, which passes substances like a vaccine or B12 into the body). For the NJBPTE to state "without medication or other deliverable" is a bit redundant. However, filiform needles are in fact acupuncture needles. Both are made from surgical grade-stainless steel (in rare cases, gold needles have been used in acupuncture practice for patients sensitive to certain metals). Both have a handle so that the shaft of the needle isn't touched (which is important for cleanliness). If you do a Google search of "acupuncture needles", this is a screenshot of what comes up.




And if you do a Google search of "filiform needles", this is a screenshot of what comes up.


 



Notice that some of the images are the same.



But most importantly is the difference in training that is required to perform acupuncture versus dry needling in New Jersey. To be able to perform acupuncture, the practitioner needs to complete 2,500 hours of training. On top of that, the practitioner must be licensed by the state, which requires a 4 year Bachelor's Degree, passing 4 modules of the national exam, and passing the state exam. In order for a licensed physical therapist to perform dry needling, they need a minimum 80 hours of training in dry needling. That's a stark difference in training.



The argument I've heard over the years is that physical therapists are also required to have a lot of education in order to be licensed by the state, which I completely recognize. However, of the 2,500 hours of education that's required to become licensed to practice acupuncture in New Jersey, significantly more than 80 of those hours is dedicated to learning how to administer acupuncture safely and effectively. The education focuses on East Asian meridian systems including the muscle channels, which may involve stimulating underlying muscular tissue, connective tissues, and myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments....and yes, those words are the same as those found in the NJBPTE definition of dry needling.



I've had patients share that they've had dry needling, and that their experience was painful. They've shared that acupuncture is much for relaxing and comfortable. Additionally, the World Health Organization recommends acupuncture for the treatment of over 100 conditions whereas they do not recognize dry needling.



I know physical therapy to be extremely valuable for patients, but when given a choice between acupuncture and dry needling, I think the image below illustrates which technique is more comprehensive.




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