What Is the Difference Between Dry Needling and Acupuncture?

From the 1980s up until 2020, there was a ridiculous legal war where acupuncture boards were suing Physical Therapy (PT) boards, claiming that Physical Therapists (PTs) were performing acupuncture and not Dry Needling (DN). This is an absurd claim on multiple levels, and it is actually quite self-deprecating for acupuncturists. I really like acupuncture, and there are a lot of amazing things that skilled acupuncturists can do that skilled Dry Needlers cannot and vise versa. The reality of the situation is there are never going to be too many medical professionals using needles in these ways compared to the number of patients requiring treatment. In the United States, acupuncture and DN are not in any way mainstream techniques, and there are simply not that many people who perform DN or acupuncture in this country. The more quality practitioners there are, the more mainstream these techniques will become, thus benefiting everyone.

In 2020, Medicare and the AMA introduced two new CPT codes specifically for DN: 20560 and 20561. Prior to these codes, there were no specific CPT codes for DN. This was one of the talking points in the legal battles, and in some states, acupuncture boards were able to stop PTs from needling. These include CA, OR, WA, NJ, NY, and HI. I have spoken with the board in Oregon, and they let me know that they are in the process of repealing the law prohibiting PTs from needling. This should be the case in the other states that currently do not allow PTs to needle. Now that the AMA and Medicare have specifically differentiated between DN and acupuncture, the argument that PTs were performing acupuncture is moot.

Again, I really like acupuncture, I just disagree with their arguments here. The entire argument acupuncturists made, and are making, that PTs were actually performing acupuncture and not DN is a counterproductive argument for acupuncture. This argument implies that anyone who has an acupuncture needle in their hand can perform acupuncture on a patient. I certainly would not suggest that I can perform acupuncture on my patients as I have never taken an acupuncture course. That would be absurd. Just as I would not say I am performing plastic surgery simply because I had a scalpel in my hand. Neither argument holds water.

What Are the Primary Types of Acupuncture?

OK, enough of that. Acupuncture and DN are both awesome. That’s it, super easy. They are very different, and many of those differences are on base, philosophical levels. Before we get into that, it is important to understand there are two primary types of acupuncture when referencing the literature:

Traditional Chinese Medicine (TCM): The theory of balancing energy meridians throughout the body by inserting needles into certain points that can be found in an acupuncture point-chart.
“Western Medical Acupuncture”: This version combines the old-school TCM and more new-school, western medical knowledge.

For the rest of this discussion, I will be referring to acupuncture and TCM synonymously.

I love reading acupuncture research, and I think it is very helpful for PTs who needle to read acupuncture research. Acupuncture provides an alternate base theory behind using needles. I find acupuncture fascinating, and I would love to go over to Asia and study with the old-school, traditional acupuncturists. It would be awesome. Reading acupuncture research really opens your mind to new needling thought processes if you have only thought about needling from a PT or other standpoint. I have had many PTs tell me that I should not read acupuncture research, and I have always been confused by this. If we all learn from each other, everyone will improve their skills, and treatment will become more effective. This is beneficial for everyone, practitioners and patients alike.

The Base Difference Between DN + Acupuncture

There are base differences in the theory between DN and acupuncture:

Acupuncture is based on a theoretical system of 12 meridians: 6 yin and 6 yang. These are loosely defined as energy channels traveling throughout the body. Traditional acupuncturists balance these energy lines by inserting needles into very specific points throughout the body.
DN is based on intimate knowledge and understanding of anatomy throughout the body, not on a theoretical concept.

While I personally believe that meridians exist, DN looks at it through another lens. When I insert needles into patients, I hold a 3-D color picture in my head of all the tissues the needle is passing through, where the areas to avoid are, where the major neurovascular structures are, where the muscles attach, how they function when normal and abnormal, etc. That’s the main difference.

I also think about the resulting biomechanical changes occurring secondary to what I am feeling with my hands and the tip of the needle and how to restore homeostasis to the best of my ability. I think about the proximity of my needles to various ANS centers and how to utilize this knowledge to my advantage. In this way, I can achieve an increase in the typical overall effect of DN and acupuncture, a decrease in sympathetic, and an increase in parasympathetic tone. I think about all this stuff and more every time I put a needle into someone.

The Importance of Learning

The act of inserting needles into the body is simple. Anyone can do this. This does not mean, however, that simply because you are inserting a needle into someone that you are performing DN or acupuncture. To perform either of these techniques competently takes years of prior information gathering and knowledge creation. Otherwise, you are just poking people with sharp pieces of metal.

In the USA, all accredited Physical Therapy programs are Doctoral level. Acupuncture programs are typically Masters level programs. This is why the argument that PTs are performing acupuncture is not a competent argument. It implies that anyone with a needle can perform acupuncture. I certainly would not infer that anyone with a needle can perform DN, as that would demean my entire educational background and years of hard work. Again, both techniques require a huge amount of background knowledge to perform effectively, and that background knowledge is vastly different.

The more medical professionals that competently and effectively utilize needles, the better off everyone will be. More patients will receive pain-relieving and function-improving treatment without the need for pharmaceuticals and with better long-term outcomes. Therefore, our professions will become more mainstream, and everyone will benefit. The debate and legal battle over who can use needles has been detrimental to both acupuncturists and Physical Therapists alike. We all need to work together, combine our different knowledge bases, and improve therapeutic interventions for the mutual benefit of everyone.

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