Acupuncture vs. Dry Needling: What EXACTLY is the difference?!?!

When I first started practicing as a sports medicine acupuncturist in Boulder over six years ago, I was wondering the same thing. I was like wait……physical therapists (PTs) can use needles now too? I had been working with athletes in the Minneapolis/St. Paul for six years previously and had never heard of this technique before. 

Being a continuing education junkie, I decided to find out for myself. I am currently the only acupuncturist that has been granted special permission from the owner and creator of a well-known program to take their Dry Needling class. Their training is the one that most of the PTs who do dry needling in Colorado take. It was a three day weekend, and I was the only acupuncturist in a group of about 40 physical therapists and chiropractors.

On day one: we were needling bananas. Bananas!!! I found this a bit remedial and comical. I, a licensed acupuncturist who has been inserting needles into people as a full-time career for over twelve years, was needling a banana. But I “stuck” the weekend out. I learned a few different ways/angles to needle muscles, got some very nasty bruises, and met some awesome fellow anatomy geeks that are also gifted and caring practitioners. 

What did I learn?

Did I learn anything new that I haven’t learned before in all my sports acupuncture and injection therapy training? NO. Did I get to communicate my point of view to a bunch of other practitioners that are also interested in helping people with needles? YES 

Here’s the skinny from one of the very few practitioners that have taken the time to learn both styles of needling: Acupuncture and Dry needling. I’m talking about myself, of course! I feel the difference between the two modalities all comes down to a difference in education.

I have mad respect for physical therapists, but…

I respect PTs entirely as they have helped me with my own injuries. Credit goes to physical therapists as they are masters of analysis and diagnosis of dysfunction with the physical human body. Their doctoral-level PT programs are usually 2-2.5 years in length. When PT’s perform dry needling, they often incorporate their analytical and diagnostic skills into their treatments. This is great because it helps them monitor progress and show the patient exactly how the treatment is helping their patients. 

The downside: They are only required to take a one-weekend course before they can practice using needles on the general public. Remember, I mentioned that class for dry needling I took? Well, we started on bananas on Friday, and they then moved on to real life, full-price paying, human patients in their clinics on Monday. The physical therapists’ practice act in Colorado mandates that they should have 46 hours of face to face class time to practice dry needling. This three-day weekend course was not even 46 hours, and the instructors still encourage the students to enhance their skills by practicing on the general public that first week after the course. There are currently no regulations, major nationwide standardized exams, or overseeing body for dry needlers. In general, dry needling techniques are much deeper, and more aggressive. Therefore, they are more dangerous than the methods most traditionally trained licensed acupuncturists would commonly use, although a large percentage of acupuncturists also have training in trigger point, sports medicine, and/or orthopedic acupuncture depending on where they go to school and whom they train with. I teach sports acupuncture at Southwest Acupuncture College in Boulder and we use acupuncture techniques identical to dry needling, but with the essential proficiency and finesse that are acquired only after needling hundreds of patients during years of supervised training while still in school. Physical therapists have done a fantastic job of popularizing the use of needles to treat the body. This is because there are far more physical therapists (PTs) than licensed acupuncturists (LAcs) in the US and most likely the rest of the world, and they also tend to have closer ties with the western medical institution. I see this as both good and bad for acupuncturists. 

Acupuncture is Science-Based

Acupuncturists are REQUIRED to learn western medicine in addition to eastern medicine, and what they do is ABSOLUTELY steeped in science.  There are thousands of published, peer-reviewed, scientifically based research studies that prove this. The common misconception that acupuncture is not science-based is one I’d love to clear up.  Acupuncturists aren’t just energy manipulating, needle slinging, woo-woo weirdos that went to some trade school.  They often spend many hours over several terms in cadaver lab needling real human tissue and learning how to safely needle the body. This time is utilized so they know what it feels like to needle something they aren’t supposed to (i.e., a lung, nerve, or internal organ). An acupuncturist’s education includes learning and understanding major red flags. We know when to refer out to other medical providers for additional basic-care or further testing, as well as for more severe circumstances. 

How much education & training does an acupuncturist have?

Acupuncturists have at least a 3-4 year master’s degree (soon to be converted to a doctoral degree), have taken three different national board exams in both eastern and western medicine, and often one in herbal therapy as well. In Colorado, they are licensed by the state by DORA (Department of Regulatory Agencies). This is the same agency that gives licenses to Medical Doctors (MDs), Chiropractors (DCs), Physical Therapists (PTs), etc. Many acupuncturists are now extending their education to attain a doctoral degree in acupuncture. This education is in addition to their undergraduate degree, their 3-4 year master’s training programs, and passing national board exams. All these steps are required before obtaining an acupuncture license. Acupuncturists are required to treat over 250 patients during their internships before they are released to treat the general public. This training spans over the educational years, not a weekend with bananas and a few willing colleague guinea pigs. 

Acupuncturists are trained to treat the body for internal medicine, pain, as well as almost any physical and/or mental health issue. We use a different style of diagnosis where we don’t necessarily need to know exactly why the patient is having a problem in a western medical diagnostic paradigm per se. Acupuncturists believe there is a beautifully woven web of interconnectedness between all aspects of the body. This interconnectedness includes the body, mind, AND spirit. Western medicine is only starting to scrape the surface on drawing a connection between these elements. 

Do acupuncturists have a level of understanding beyond western medicine?

Remember when the “interstitium” was recently discovered back in March of 2019 by the western world? That is a concept that has been taught to acupuncturists for centuries. It is called the triple warmer or san jiao to an acupuncturist, and it is often involved in our diagnosis and treatment. It is now common knowledge but hasn’t always been so, that gut health is essential for good mental health. Acupuncturists have known this for thousands of years. It’s one of the reasons we ask about your digestion and bowel movements. 

Acupuncture terms may sound like a different language

Traditional Chinese Medicine (TCM) terms and diagnoses generally sound like gibberish to a layperson. That is why I have made it a promise to myself to try to explain what I do in western medical terms because that is the language that most of us all know and use. I see myself as an acupuncturist that has done extra training in physical and orthopedic type diagnostic testing. Physical therapists that do dry needling are great at diagnosing an injury and prescribing exercises to help you heal and get back to activities faster. However, their training in using needles is nothing near as regulated, as rigorous, lengthy, nor as detailed as it is for acupuncturists. Many acupuncturists not specifically trained in sports medicine or orthopedic acupuncture are not great at diagnosing injuries in western medical terms. I think it would be great if we could all help each other out and refer to each other as needed. If a patient stumps me, or they are not getting great results after a few treatments, I connect those patients to a physical therapist for further analysis.  

Time tested techniques

The bottom line is Traditional Chinese Medicine techniques WORK because they are time tested and have been implemented for centuries all over the world. Therefore, of course, dry needling works because acupuncture and dry needling are very, very closely related. Many sports medicine acupuncturists (including myself) would even say they are one and the same. You will never hear a PT describe it that way because they legally can’t. 

Outside PT’s scope of practice?

To perform acupuncture without going through the training and regulations required of us licensed acupuncturists would mean a physical therapist is practicing outside of their scope. Different practitioners may use different terminology to explain what they do with needles. Still, it definitely does not make their technique some completely different or brand new type of therapy, in my opinion. Nobody is reinventing the wheel here. 

I feel like everyone is dipping into TCM techniques right now.

It feels like everyone is dipping their fingers in the world of TCM right now. Whether it’s PTs doing dry needling, massage therapists practicing cupping (myofascial decompression), or chiropractors using Graston Technique (gua sha to us), or western medical doctors looking for alternatives to pharmaceuticals and using more herbal remedies. Even the George W Bush Foundation is doing loads of research on using Artemisia annua or wormwood (an herb commonly used in Chinese Herbal Medicine) to treat and protect against malaria right now in other parts of the world.

If you have any questions about how Traditional Chinese Medicine or Dry Needling can help you don’t hesitate to reach out to me, Lindsay Long

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Lindsay Long L.Ac., C.SMA®, FDN