Dry Needling Vs Acupuncture By Matthew Craig & Ben West

Dry Needling vs. Acupuncture

For over 2000 years acupunctural Chinese medicine has been used to treat a wide range of medical conditions, ranging from the common headache, to aiding in the cessation of cigarette addiction. However in terms of treating musculoskeletal conditions, which treatment is considered superior when it comes to the effectiveness and evidence based? It’s time to answer this question once and for all!

Dry Neeedling

 

 

 

 

 

 

 

 

 

During 2004–05, 31% (6 million) of the Australian population reported having a long-term disease involving the musculoskeletal system and connective tissues.[1]
Both Acupuncture and Dry Needling have long been considered useful modalities to provide pain relief and assisting in injury rehabilitation. But what is the difference between them or are they the same with just two different names?

What is the difference…isn’t it the same type of needle?

Yes it is the exact SAME needle in both approaches, however:
ACUPUNCTURE = Chinese Traditional Medicine
DRY NEEDLING = Western Medicine

So, it is largely the philosophy of each approach that is significantly different between the two methods.                                                                            

Qi Points

“QI Points”

Ying Yang

“Ying + Yang” Harmony

        

 

 

 

 

 

 

 

 

Trad Med

Traditional Medicine

 

 

 

 

 

 

 

 

 

Essentially the techniques differ in their needle placements. Acupuncture is determined by the traditional Chinese Meridian body map. The reasoning behind the method is based on Qi (pronounced “chee”) AKA “life energy”. If the Qi becomes blocked or congested in the body then it fails to maintain harmony, leading to disease or illness. [2]

Dry needle placement involves inserting at points of the myofascial pain resulting in pain relief, loss of tension and tightness. The needle placement can be “deep” (into muscle) or “superficial” (into skin). [3]

DRY NEEDLING…What is it?

Dry Needling is the progressive evidence based branch of acupuncture, offered most commonly in western medicine. It’s a technique used for relaxing overactive muscles or connective tissues, which may or may not contain active trigger points. A trigger point is a “hyper-irritable spot in a muscle”[4]

It may be caused by:

    • Acute or chronic overloading of muscles
    • Poor balance
    • Fatigue
    • Postural abnormalities
    • Lack of exercise
    • Weak muscles

 

The trigger point may be painful when touched and can give rise to characteristic referred pain patterns and tenderness. Trigger points are commonly seen in both acute and chronic pain conditions. The physiotherapists at bounceREHAB have used Dry Needling for many years and follow strict protocols developed by the Australian Physiotherapy Association (APA). Dry Needling can be utilized as a stand-alone treatment or as an effective adjunct to other physiotherapy or medical treatments. Generally, it can be used to lessen musculoskeletal pain and improve injury recovery time.

How does it work?

The exact mechanisms of Dry Needling are complex. While we know a lot about the neurobiology and immune responses from dry needling, there are still many questions that modern science and medicine are not able to answer. However, there is an overwhelming body of scientific evidence that supports the positive effect that inserting a needle has on the bio-electrical and bio- chemical communications, which take place in our nervous and immune systems.

These include:

  • Inhibiting the transmission of pain signals in our spinal cord [5]
  • Increasing the release of our own pain relieving “opioid” chemicals within our brains. [6]

The pain relieving effect of Dry Needling is gaining strong support in mainstream western medicine, with many hospitals, private practices and compensable bodies (Medicare, Health funds, Workers Comp, CTP third party) supporting its use under the guidance of a Physiotherapist.

Trigger 1

 How does it work
The science behind dry needling

We know that inserting a needle into a trigger point can cause favorable biochemical changes, which assist in reducing pain.

These include:

  • Increased capillary permeability and rapid local vasodilation – aids in histamine release improving the bodies healing response particularly in relation to muscle tendons as they have a limited blood supply. [7]
  • Fibroblastic activity level increase –  stimulating the body to produce fibroblasts, a cell that produces layers of fibrosis or scar tissue.[8]
  • Prolonged stimulation of A-delta fibres may activate inhibitory dorsal interneurons – inhibit the flow of pain information to/from the brain.[9]
Brain Respont
Common Questions or FAQ’s

How long does it take?
Peter.E.Baldry, an expert in the use of superficial dry needling recommends the needle to be inserted for 5 minutes, however variables such as the differing muscles groups and the twitch response produced can vary treatment times.

Trigger 3

   Trigger 2

How deep does the needle insert?

The advantages of Dry Needling allows for treatment of certain parts of the muscle to be targeted at a deeper level when compared to soft tissue massage.

In general:

  • Deep Dry Needling ranges from 15-70mm.
  • Superficial Dry Needling is from 2-5mm.

Research suggests that deep Dry Needling has greater therapeutic effects in contrast to superficial needling when targeting trigger points. However, superficial Dry Needling has been shown to produce positive neurobiological benefits when treating areas of potential risk (around the lungs and large blood vessels). [10]

What is the twitch response?

The twitch response is a spinal cord reflex, which produces an uncontrolled palpable or visible muscle contraction. The local twitch response causes beneficial therapeutic alterations in the length and tension of muscle fibres. [11]

Does it hurt?
Most patients do not feel the insertion of the needle as the needles are quite thin. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock while others feel it more like a cramping sensation.

How safe is Dry Needling?
Dry Needling is considered to be a very safe method of treatment when used by a fully qualified physiotherapist. However, it is important to note that under some circumstance Dry Needling may not be appropriate.

Inappropriate use of Dry Needling:[12]

  • Pregnancy
  • Malignant tumors
  • Bleeding disorders
  • History of fainting
  • History of convulsions
  • Precautions need to be taken when needling over body organs (lungs, blood vessels etc).

If have any of the conditions listed above or are unsure about Dry Needling then please ask your physiotherapist prior to treatment.

Evidence for Dry Needling
  • Increases blood flow to muscle[13]
  • Reduces spasticity caused by stroke[14]
  • Neck and shoulder mysofascial trigger point release[15]
  • Reduce headache pain[16]
  • Temporomandibular (jaw) myofascial pain[17]
  • Improve neck movement and pain[18]
  • Improve low back pain[19]
  • Fibromyalgia (widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues) [20]
  • Positive expectation and outlook increases analgesic affect[21]
  • Analgesic effect in arthritic joints.[22]
Does this mean acupuncture is just as effective?

As mentioned previously the exact same needle is used in both dry needling and acupuncture. However, the key difference is in the distinct philosophical approaches that affect the outcome of the treatment. There are many peer reviewed journal articles on Acupuncture and numerous systematic reviews, however their conclusions are far from uniform. In summary, studies undertaken in Acupuncture suggest that this treatment is not as effective for musculoskeletal conditions when compared to Dry Needling.

Conclusion:

So there you have it! To sum up briefly dry needling is:

  • Very safe and an affective treatment for musculoskeletal conditions
  • Used to compliment a comprehensive manual physiotherapy approach.
  • Causes little to no pain
  • Same needle as Acupuncture, however approached from an evidence based biomedical western understanding.
bounceREHAB Physiotherapy Fees

Initial Assessment (45mins) $135
Initial Assessment (30mins) $105

Standard Treatment (30mins) $95
Express Treatment (15mins) $60
Call (02) 9571 7606 for an appointment or email admin@bouncerehab.com.au for more information

Dry Needling Vs Acupuncture Written by:

Matthew Craig (Principal Physiotherapist at bounceREHAB)
&
Ben West (final year Physiotherapist, Newcastle University)


Evidence for dry needling:

13. “Study suggest dry needling enhances the blood flow in the stimulated region of the trapezius muscle”.

Cagnie, B., Barbe, T., De Ridder, E., Van Oosterwijck, J., Cools, A., & Danneels, L. (2012). The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of Manipulative

14. “Results suggest that a single session of deep dry needling decreases spasticity and widespread pressure sensitivity in individuals with poststroke spasticity”.

Salom-Moreno, J., Sánchez-Mila, Z., Ortega-Santiago, R., Palacios-Ceña, M., Truyol-Domínguez, S., & Fernández-de-las-Peñas, C. (2014). Changes in spasticity, widespread pressure pain sensitivity, and baropodometry after the application of dry needling in patients who have had a stroke: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics, 37(8), 569.

15.“Dry needling can be recommended to relieve MTrP pain of neck and shoulders”.

Liu, L., Huang, Q., Liu, Q., Ye, G., Bo, C., Chen, M., & Li, P. (2015). Effectiveness of dry neeedling for myofascial trigger points associated with neck and shoulder pain: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation,

16. “May be used as addition to physiotherapy headache management”.

France, S., Bown, J., Nowosilskyj, M., Mott, M., Rand, S., & Walters, J. (2014). Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: A systematic review. Cephalalgia, 34(12), 994-1003.

17. “Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points”.

Dıraçoğlu, D., Vural, M., Karan, A., & Aksoy, C. (2012). Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: A double-blind, randomized, placebo controlled study. Journal of Back and Musculoskeletal Rehabilitation, 25(4), 285.

18. “The study showed that dry needling decreases neck pain intensity and widespread pressure sensitivity, and also increases active cervical range of motion in patients with acute mechanical neck pain”.

Mejuto-Vázquez, M. J., Salom-Moreno, J., Ortega-Santiago, R., Truyols-Domínguez, S., & Fernández-de-Las-Peñas, C. (2014). Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: A randomized clinical trial. The Journal of Orthopaedic and Sports Physical Therapy, 44(4), 252.

19. “Relieves pain and improves function better than the conventional therapies alone”.

Furlan AD, van Tulder MW, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005;(1):CD001351.

20. “Patients severely affected by fibromyalgia can obtain short-term improvements following weekly dry needling for 6 weeks”.

Casanueva, B., Rivas, P., Rodero, B., Quintial, C., Llorca, J., & González-Gay, M. A. (2014). Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatology International, 34(6), 861-866.

21. “Positive expectation can significantly enhance acupuncture analgesia effects as evidenced by decreased subjective pain rating as well as objective fMRI signal changes during application of calibrated noxious stimuli”.

Kong, J., Kaptchuk, T. J., Polich, G., Kirsch, I., Vangel, M., Zyloney, C., . . . Gollub, R. L. (2009). An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment. NeuroImage, 47(3), 1066-1076.

22. “These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than standard acupuncture therapy”

Itoh, K., Hirota, S., Katsumi, Y., Ochi, H., & Kitakoji, H. (2008). Trigger point acupuncture for treatment of knee osteoarthritis–a preliminary RCT for a pragmatic trial. Acupuncture in Medicine : Journal of the British Medical Acupuncture Society, 26(1), 17.

Additional references:

1. Australian Bureau of Statistics. (2006). Prevalence: Musculoskeletal conditions in Australia: A snapshot 2004-2005. Retrieved February 8, 2015, from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4823.0.55.001/

2. Australian acupuncture and Chinese medicine association Ltd. (Australia). (2015). What is qi & how does it affect the body?: Acupuncture. Retrieved February 8, 2015, from http://www.acupuncture.org.au/Health_Services/Acupuncture.aspx

3. Australian acupuncture and Chinese medicine assosciation Ltd. (Australia). (2015). What is “dry needling” : Dry needling. Retrieved February 8, 2015, from http://www.acupuncture.org.au/Health_Services/Dry_Needling.aspx

4. Alvarez, D. J., & Rockwell, P. G. (2002). Trigger points: Diagnosis and management. American Family Physician, 65(4), 653.

 5. Allcare physiotherapy. (Australia). (2014). How does it work? : Dry Needling fact sheet. Retrieved February 8, 2015, from http://www.allcarephysio.com.au/assets/258/ALLCARE%20Dry%20Needling%20Fact%20Sheet.pdf

 6. Allcare physiotherapy. (Australia). (2014). How does it work? : Dry Needling fact sheet. Retrieved February 8, 2015, from http://www.allcarephysio.com.au/assets/258/ALLCARE%20Dry%20Needling%20Fact%20Sheet.pdf

7. Sandberg M., Lundeberg T., Lindberg L.-G. & Gerdle B. (2003) Effects of acupuncture on skin and muscle blood flow in healthy subjects. European Journal of Applied Physiology 90 (1–2), 114–119.

8. H. M. Langevin, N. A. Bouffard, G. J. Badger, D. L. Churchill, and A. K. Howe, “Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism,” Journal of Cellular Physiology, vol. 207, no. 3, pp. 767–774, 2006.

9. Bradnam, L. V. (2011). A biopsychosocial clinical reasoning model for western acupuncture. Physical Therapy Reviews, 16(2), 138-146.

 10. Kalichman, L., & Vulfsons, S. (2010). Dry needling in the management of musculoskeletal pain. Journal of the American Board of Family Medicine : JABFM, 23(5), 640-646.

 11. Hong, C. Z. (1994). Persistence of local twitch response with loss of conduction to and from the spinal cord. Archives of Physical Medicine and Rehabilitation, 75(1), 12.

 12. Word Health Organisation. (1999). Contraindications: Guidelines on basic training and safety in acupuncture. Retrieved 8 February, 2015, from http://whqlibdoc.who.int/hq/1999/WHO_EDM_TRM_99.1.pdf