Dry Needling vs. Acupuncture: Which One to Use?

Acupunture Needle

Because there are so many unknowns about Acupuncture (in the West), I wanted to do another post (with videos!) that discusses when to use which technique. Please note that this is based on my opinion and I'm sure that my acupuncture friends would disagree with me. However, I have a unique perspective on this being both an Acupuncturist and a Physical Therapist.

Dry needling can be used by either Physical Therapists or Acupuncturists.  When I took my dry needling class a bazillion years ago, one of my instructors was an Acupuncturist (though, most were Physical Therapists). 

However, as someone who has been through Acupuncture school, I can firmly attest that there is zero information taught both scholastically and in the clinic for dry needling.  So if an acupuncturist is offering up dry needling, I would make sure they have extra training. 

Physical Therapists, on the other hand, are schooled for YEARS on the body.  That’s all they study…anatomy and kinesiology.  Dry needling is also offered in some Doctor of Physical Therapy programs.  So if you’re going to ask me, dry needling is best left to physical therapists. 

OK…that’s my soapbox for now. 

Dry needling is an orthopedic technique.  It should be used for orthopedic problems (generally).  However, problems like headaches and tinnitus can actually have orthopedic roots.  Therefore, select other “non-ortho” issues may be helped with dry needling. 

When you are dry needled, the needle goes directly into the muscle and generally a technique called ‘pistoning’ ensues.  It’s shown below in the video, where the practitioner moves the needle up & down to try and release the muscle tissue. 

Dry Needling of the Calf Muscles

I generally tell my patients that dry needling is like a massage…on steroids.  It does an AMAZING job at releasing muscle tissue.  But there’s a cost.  The cost is that it’s uncomfortable bordering on painful.  It just depends on the patient as to how they classify it.  It’s typically completely worth the pain but not everyone does well with it.  Talk with your practitioner to make sure that you’re a good candidate. 

(As a small aside, there is a “bell curve” to the side effects of dry needling.  Most people are sore for the day and fine the next day.  However, on either side of the bell, there are people who walk out of the office without any discomfort or pain and there are people who walk out and are sore for days on end.)

Acupuncture can be an orthopedic technique; however, I would counter that its talents lie in other areas.  I have yet to see PURE, TRADITIONAL acupuncture work for orthopedic problems.  It usually must be in combination with some sort of dry needling to be effective. 

To me, acupuncture is an amazing technique more for gut issues, menstruation problems, side effects from peri/menopause, infertility, erectile dysfunction, stress, anxiety etc.  I used to say anything from headaches to hiccups. 

As shown below, acupuncture points are put throughout the body for any issue.  Even headache patients will most likely get points on the hands and feet.  The points are designated as to location and depth.  They are specific.  They may be moved around or stimulated but they’re not typically at the muscle layer and therefore are typically not at all painful.  The needles are similar; however, dry needling needles are typically a bit thicker because they’re going into unhappy muscle tissue.  (And by thicker, I mean that it’s still ridiculously thin). 

Acupuncture Treatment

So, dry needling vs. acupuncture…when to use what?  If I had a purely orthopedic problem, I would be looking for a Physical Therapist.  But if I’m dealing with bloat, constipation, acne or stress, I would 100% say see an Acupuncturist.