Acupuncture & Dry Needling: Clarifying Myths & Misinformation

​MYTH
​"Dry Needling" is not acupuncture. 

FACT: Dry needling techniques are a subset of techniques used in orthopedic or myofascial acupuncture systems. Dry needling uses acupuncture needles, and originators of dry needling identify it as acupuncture. This said, not all techniques being promoted as dry needling would be considered safe and competent by trained acupuncture practitioners, and the public should be wary.

MYTH
Physical Therapists are qualified to perform acupuncture/dry needling because they have advanced knowledge and training in anatomy.

FACT: While physical therapists are highly trained experts in their field of physical rehabilitation, their education does not effectively include invasive techniques that penetrate the skin surface nor the vast body of information on using needling therapeutically. Licensed acupuncturists must have a degree from an accredited acupuncture school that requires more than 1300 hours of acupuncture specific training for entry-level competency. This includes anatomy relevant to safe acupuncture practice and supervised clinical training.

Licensed acupuncturists also receive 450 hours or more of biomedical training. The applicant must subsequently pass five national psychometric exams to ensure minimal competency in needling, while the physical therapy community is promulgating entry into this field with as little as 12-27 hours of unaccredited coursework. This level of disparity in training is likely to lead to patient injury. Additionally, the lack of standards is leading to the rapid expansion of a practice likely to harm more patients than help them.

MYTH
​Dry needling has defined standards typical of a professional level practice.

FACT: There are no objectively determined standards of education, curriculum, standardized national examination, or requisite knowledge, skills, and abilities (KSAs) in place for dry needling. There are no standards for clinical mentorship. In short, there is no current definition of the practice referred to as dry needling and no standardized system of demonstrating either minimal competency or safety.

MYTH
​Dry needling is based on anatomy while acupuncture is based on energy.

FACT: Classical acupuncture theory is based on the observation of humans in their environments, and treatment theory therefore reflects real-world situations that lead to injuries or illnesses that are identical to those observed in modern medicine. While classical theory organizes real-world information about the body differently than western science, it nonetheless describes the same organism with the same pathologies, and therefore bases diagnoses and treatments on anatomy which are compatible with western models. Mechanistic models of acupuncture’s effects have been researched along with the effects of acupuncture needle stimulation on the nervous system, muscles, and connective tissue. Acupuncture channels reflect clinically observable and anatomically relevant interrelationships between body structures, including kinematic relationships.

MYTH
​Dry needling uses trigger points - points that are uniquely sensitive to touch; acupuncture does not.

FACT: It has been estimated that 95% of trigger points correspond to acupuncture points. “Ashi point” needling is acupuncture trigger point needling, and this is described in Chinese medical texts dating from 200 BCE – 200 CE. For over 2000 years, Chinese medicine has treated these painful areas with acupuncture, tui na massage, heat, cupping, gua sha, and other methods. Trigger points are not a new discovery.

MYTH
​Dry needling involves deep insertion while acupuncture does not.

FACT: Many acupuncture points are needled with deep insertion technique. Each acupuncture point has specific indications for how it should be stimulated, and both shallow and deep techniques are used on many points.

MYTH
​The scientific literature provides evidence supporting dry needling but not acupuncture.

FACT: Meta-analyses of acupuncture data received for a total of 20,827 patients from 39 trials conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. Acupuncture is currently one of the most widely studied medical interventions, and much of the literature used to justify the clinical legitimacy of dry needling is drawn from acupuncture research studies.

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This article was written by the American Society of Acupuncturists and sponsored by Llasa OMS.

1. Hamvas S, Havasi M, Szőke H, Gabor P, Hegyi G (2017) Different Techniques of Acupuncture–Part of the Traditional Chinese Medicine
and “Evidence Based Medicine”. J Tradit Med Clin Natur, 6:202. 
2. Dommerholt, J., & Fernández-de-las-Peñas, C. (2013). Trigger Point Dry Needling: An evidence and clinical-based approach. Oxford: Churchill Livingstone, p. 61.
3. Jun M-H, Kim Y-M, Kim JU. Modern acupuncture-like stimulation methods: A literature review. Integrative Medicine Research. 2015;4(4):195-219. doi:10.1016/j.imr.2015.09.005.
4. http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTAStandard-
sEvidence.pdf
5. Accreditation. Retrieved from https://www.acaom.edu/about-acaom/accreditation/
6. NCCAOM and NCCAOM Academy of Diplomates. (2017, August). National Certification Commission for Acupuncture and Oriental
Medicine. Retrieved from http://www.asacu.org/resources/publications/
7. Kruger, J., & Dunning, D. (2009). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated
self-assessments. Psychology, 1(6), 30-46.
8. Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., ... & Makris, N. (2005). The integrated response of the human
cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-496.
9. Dorsher, P. T. (2008, May 15). Can Classical Acupuncture Points and Trigger Points Be Compared in the Treatment of Pain Disorders?
Birch’s Analysis Revisited. Retrieved from https://www.liebertpub.com/doi/10.1089/acm.2007.0810
10. Lund, I., & Lundeberg, T. (2016). Mechanisms of acupuncture. Acupuncture and Related Therapies, 4(4), 26-30.
11. Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., et al., & Acupuncture Trialists’ Collaboration.
(2017). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5):455-474.
12. Ibid., Dorsher, P. T. (2008, May 15).
13. Napadow, V., Ahn, A., Longhurst, J., Lao, L., Stener-Victorin, E., Harris, R., & Langevin, H. M. (2008). The status and future of
acupuncture mechanism research. The Journal of Alternative and Complementary Medicine, 14(7), 861-869.
14. Braun, M., Schwickert, M., Nielsen, A., Brunnhuber, S., Dobos, G., Musial, F., ... & Michalsen, A. (2011). Effectiveness of traditional Chi-
nese “gua sha” therapy in patients with chronic neck pain: A randomized controlled trial. Pain Medicine, 12(3), 362-369.
15. Deadman, P., Al-Khafaji, M., Baker, K. A Manual of Acupuncture, 2nd Edition. Eastland Press, 2007.
16. Ibid., Vickers, A. J., Vertosick, E. A., et al.
17. Kligler, B., Nielsen, A., Kohrherr, C., Schmid, T., Waltermaurer, E., Perez, E., & Merrell, W. (2017). Acupuncture therapy in a group setting for chronic pain. Pain Medicine, 19(2), 393-403. Chicago.
18. McDonald, J., & Janz, S. (2017). The Acupuncture Evidence Project: A Comparative Literature Review. Australian Acupuncture and Chinese Medicine Association Ltd.
19. Kruger, J., & Dunning, D. (2009). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated
self-assessments. Psychology, 1(6), 30-46.
20. Ibid., McDonald, J., & Janz, S. (2017).
21. https://www.evidencebasedacupuncture.org/