Acupuncture, The Original Dry Needling

The quick takeaway is…

  • dry needling
  • trigger point dry needling
  • manual trigger point therapy (when using dry needling)
  • intramuscular dry needling
  • intramuscular therapy (when using dry needling)
  • intramuscular stimulation (when using dry needling)
  • motor point needling
  • dry needling acupuncture

… are ALL Acupuncture!

 

You may be surprised to learn that the word “Acupuncture” is a made up word. You may also be surprised to find there is no such word in Chinese.  This needling art originated in China and was not called “Acupuncture” but rather Zhen Jiu (Chinese people speak Chinese, after all.)  This Chinese term literally translates as Needle & Fire. But given the visual image this brings to mind some helpful British MDs in the 1800s labeled it with a more friendly Latin medical term.  Comprised of two Latin roots, Acus and Punctura, the term Acupuncture, is literally translated as: To puncture with a needle.  So this could be a broad term for any medical art that uses a solid, non-injection type needle for insertion into the skin for therapeutic purposes.  Thus, Dry Needling is in fact a type of Acupuncture.

Although many people commonly refer to Acupuncture needles as “pins”, the correct medical terminology is “needle”.  The needles used in Dry Needling are the same needles that are used for Acupuncture.  (Although some enterprising acupuncture needle manufacturers are now also labeling some boxes as Dry Needling Needles so that Chiropractors, Physical Therapists, and Massage Therapists performing “Dry Needling” will not have to be seen using needles labeled for Acupuncture.  Ah, capitalism!)

A recent (12/15/2015) letter in a publication of the British Medical Journal sums it up this way: “Historically, dry needling is acupuncture. In China, especially in the East, the term dry needling (gan zhen) has been a folk name for acupuncture since Western medicine arrived in China in the late 1800s when the term of dry needling was created in order to differentiate it from the needles used for injections by Western trained doctors. Many people in China still refer to acupuncture as dry needling, especially after acupuncture point injection therapy and aquapuncture therapy were developed in China in the early 1950s. The term dry needling ( gan zhen ) has already become a synonym for acupuncture used by many Chinese practitioners. For example, when searching using the Chinese term gan zhen in the Amazon book department (http://www.amazon.cn), all results are acupuncture books. With their combined education in both Western and Chinese medicine, modern acupuncturists from China are well equipped with knowledge and skills not only in TCM but also conventional medicine. Because of heterogeneous understanding and emphasis in training at different academic schools or different styles of practice, various types of acupuncture have developed all over the world, including: Fu’ s acupuncture, scalp acupuncture, wrist and ankle acupuncture, abdominal acupuncture and others, which undoubtedly include dry needling. Because of the rapid development of science and technology, and significant progress in modern research into acupuncture, the potential therapeutic mechanisms of acupuncture have been explored and include Pavlovian conditioned reflexes, nerve segment theory, gate theory concepts of acupuncture are based on modern biomedicine. Clearly, traditional acupuncture is being explained by modern science. Dry needling is not only a subcategory of Western medical acupuncture but also an integral part of acupuncture per se. Although not all Western medicine practitioners may agree, dry needling is an important part of traditional acupuncture.”

The proponents of dry needling claim that dry needling is not acupuncture because it works by a different mechanism than acupuncture.  This is simply not true.  How could the proper insertion of the same needle into the same point on the same body work differently just because one person called it a different name than someone else?  Traditional Chinese people did not have all the bio-medical words we have today. Consequently, they could not, and did not, explain the mechanism of action of Acupuncture in modern medical terms.  So, just because a group who wants to include needling in their practice redefines it in modern bio-medical terms and relabels it with another name…doesn’t make it something different.

As Gertrude Stein once said:  A rose is a rose is a rose…

Regarding Training:

In order to be licensed to perform the medical treatment of Acupuncture the practitioner is required to attend an accredited institution that required thousands of hours of training over the course of 3+ years.  This typically results in a Master’s degree level certification. Some practitioners have chosen to take further education that results in a Doctoral level certification.  It is anticipated that as the profession matures, over the next few years educational institutions will transition to the longer, more in depth Doctoral curriculum and students will all graduate with a doctoral level degree.  Additionally, states can differ in the detailed specifics of their licensing and continuing education requirements, however it is expected that this will be more uniform over the years to come.  It is important to note that, even at the current Master’s level, those practitioners of any dry needling art that have the L. Ac designation have significantly more hours of training than those who don’t.

Below is an excerpt from the Council of Colleges of Acupuncture and Oriental white paper on Dry Needling regarding the typical training for licensed acupuncturists.    

Today over 50 accredited first-professional colleges teach a diversity of styles of health care utilizing acupuncture, Chinese herbology, manual techniques such as tuina (Chinese therapeutic massage), nutrition, and exercise/breathing therapy. Individuals who attain this degree undergo a rigorous training program at a minimum standard of three academic years that contains 450 hours in biomedical science (biology, anatomy, physiology, western pathology, and pharmacology), 90 hours in patient counseling and practice management, and 1365 hours in acupuncture. Of the 1365 hours in acupuncture, 660 hours must be clinical hours.

In contrast, medical doctors in various states (SC included) can take 300 hours of post graduate accredited courses in order to legally perform acupuncture.  Physical therapists in SC and elsewhere have decided that they can practice dry needling with as little as 25 hours of training but they are not licensed to practice “acupuncture”.  However, practitioners who are licensed to practice acupuncture are also licensed to practice Dry Needling because it is a form of acupuncture used for pain management.

 

Below are quotes from expert sources about the term now coined as “dry needling”:

  • The  BlueCross Medical Policy Manual states the following:

This procedure should be reported with the unlisted physical medicine code.  Do not report dry needling with the CPT codes used to report trigger point injections(s). Dry needling for musculoskeletal conditions is considered experimental/investigational as it does not meet TEC criteria #2.5.

What does this mean to you?  Dry needling is not covered by BlueCross BlueShield.  It should be charged as a cash payment by you for the uncovered service.  If it is billed to insurance the practitioner billing under a physical therapy code is committing insurance fraud.  Be informed and be aware because a determination of fraudulent practice could make you financially liable for your past treatments.

 

  • The World Health Organization defines trigger points, another term for dry needling, as a subset of Acupuncture points.

 WHO defines trigger point as a subset of Acupuncture points.  Therefore, Dry Needling of trigger points is also as a subset of Acupuncture.

CITATION:  Hoyt, J. “Acupuncture, Dry Needling and Intramuscular Manual Therapy:  Understanding Acupuncture’s Therapeutic Role in America.” Coalition for Safe Acupuncture Practice. Abstract. (2012): 15. CCAM Research Partners Press.

 

Be smart, be informed, be aware.  A practitioner with 24 or 50 or even 100 hours has not had the level of supervised clinical training that a licensed acupuncturist or medical doctor has received.  A 24 hour weekend training class means that the  practitioner with this level of education is counting on YOU to be the test patient on whom they practice their newly learned skills.    Even if your are told that your treatment will be covered by insurance…Is this what you really want?

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