Dry Needling *IS* Acupuncture

I woke up this morning to another article about an athlete’s career ending because they got a pneumothorax (lung puncture) after receiving dry needling from a physical therapist.

This upsets me.

This upsets me because:

1) this injury is happening way too often,

2) gives all of us in the needling professions a bad look, and

3) is completely avoidable with proper education.

What is dry needling?

At its conception, it was a technique developed in the 1940s by Dr. Janet Travell and certainly others before her, that used an empty (dry) hypodermic needle to release tight muscles by poking a trigger point in the muscle belly until the muscle “jumped” and released. The needle was used to poke trigger points repeatedly but was never left in the body.

In acupuncture school, we learned and needled trigger points according to the Travell method. In the 1970s, Dr. C. Gunn developed the concept that myofascial pain is caused by a disease or dysfunction of the central nervous system, something that did not target trigger points, but nerve roots as the pain generator. Acupuncturists call these points along the spine “hua tuo jia ji” points.

Here’s something I find interesting: the third generation of dry needling techniques was developed by two Chinese doctors who co-wrote a book in 1999 about needling points to produce homeostasis in the human body titled Scientific Acupuncture for Healthcare Professionals. Even the developers of dry needling call it acupuncture, something modern-day dry needlers seem to overlook.

And why?

Because unless they have attended an accredited acupuncture school, they are not allowed to say they practice acupuncture, yet I see and hear all sorts of stories about needles being retained instead of just poked into muscle bellies and nerve roots, and electrical stimulation being used on these retained needles. Guess what? This is acupuncture.

Because physical therapists and chiropractors do not have acupuncture in their scope of practice they insist over and over again that what they are doing is dry needling so that they don’t get into trouble with their licensing board. Their training is minimal- usually, a weekend course often without needling practice on an actual human, and without being clean needle certified.

Before obtaining national certification and licensing in many states, acupuncturists must have attended an accredited acupuncture college and completed a master’s degree, be nationally certified in Clean Needle Techniques, must take multiple classes on inserting needles at the right angle, depth, and direction, and which areas of the body to avoid needling known as “endangerment sites,” and must have completed a minimum of 660 clinical hours needling patients. We must also complete continuing education credits in order to keep our national certification.

Here’s something the public is mostly unaware of: according to the International Statistical Classification of Diseases (the organization that makes diagnostic codes for insurance billing), within the ICD-10, the current coding system, there is no diagnostic code for dry needling but there is for acupuncture. Technically, anyone billing insurance for dry needling is committing insurance fraud because they are using a code for “manual therapy” for insurance reimbursement. When the ICD-11 goes into effect there will be a dry needling code, but that isn’t happening for a while.

I’ve seen social media posts of needling through clothing, needles dangerously deep on the chest and upper back, several needles jammed into one area in the wrong direction, and needling with electric stimulation done incorrectly. Attempts to engage with these folks results in them getting angry and defending their work, so I’ve taken the role of educating the public on the differences in and qualifications of professional needlers.

Recently I had a physical therapist walk into my office and ask me to sell them ear seeds, proudly telling me they were for a demonstration on dry needling, cupping, and ear seeding (all practices under the umbrella of acupuncture modalities). This person truly thought I would be impressed. Instead, I said, “all you need now is the acupuncture license.” They said, “dry needling isn’t acupuncture.” I replied, “It is, but your license and scope of practice do not allow you to call it that. We’ve been doing what you’re calling dry needling for decades.” They bought the ear seeds and left. I did not feel bad about what I said.

The point of this though is not to bash other professions, but to point out the similarities between acupuncture and dry needling and the differences in the education of needling professionals in hopes of helping patients choose wisely when looking for any type of needling.