Few issues in the Chinese medicine profession have caused more of a conflict than that of “dry needling.” This relatively new technique used by Physical Therapists for acute and chronic sports injuries involves inserting a solid filiform needle into the body in order to treat acute and chronic sports injuries. It is said to “reset” the length of a muscle (shortening or lengthening) in a way that reduces pain and restores the muscle to more normal functioning. It is named so because it is a needle that is not a hypodermic needle filled with any number of fluid substances. This “technique” is the very definition of acupuncture (invasive) but is being called an intramuscular manual therapy (non-invasive) in order to be included in that scope of practice.
In “dry needling”, the specific motor points are inserted with an acupuncture needle and then appropriately manipulated by rotating or using a deep pistoning up and down movement for therapeutic purposes. In the practice of acupuncture these motor points were identified as something called “ashi” points and the manipulation, a technique called “lifting and thrusting” was discussed 2,000 years ago in an extant text called The Yellow Emperor’s Classic. “Ashi” points are described as being found in the central aspect of the area where the motor nerve enters the muscle, i.e. motor points. These motor points are sometimes the same as trigger points or as anatomical acupuncture points—and sometimes not. (Please refer to the earlier work of Janet Travell regarding the concept of trigger points.)
The variable state-to-state licensure laws regarding medical professionals has led to lengthy legislative action in order to confront and resolve each state’s position. “Dry needling” by Physical Therapists is legal in Colorado. There are many other states in which it is not and some who are still in the process of deciding. Colorado State requirements are that a Physical Therapist complete 46 hours of face-to-face course studying (not online) with at least 2 years of prior practice as a Physical Therapist; an MD or DO can practice acupuncture without any formal training; a DC can practice with 100 hours of training, and an Acupuncturist must have graduated from an ACAOM (Accreditation Commission for Acupuncture and Oriental Medicine) approved school with a minimum of 3 years of education that includes at least 660 hours of clinically supervised practice as well as passing the NCCAOM (National Certification Commission of Acupuncture and Oriental Medicine) exams. As you can see, for practitioners of Chinese medicine, acupuncture is a lot more complicated than a simple pain relief technique.
The real concerns are in patient education and safety. The patient seldom knows the differences in education and experience. Of course, any medical profession has been adequately trained in basic anatomy and physiology in a way that would allow proper location of the specific points taught in these programs in order to assist in pain relief. The concerns regarding “dry needling” come into play when this deep, often painful needling technique is applied to an area that cannot safely receive that level of manipulation and in this there have been reports of injury including pneumothorax. It can also leave a novice with the experience that all acupuncture treatments must be that painful and can discourage an individual from seeking more comprehensive treatments for their health.
In my office, I have seen variable results from patients who have experienced “dry needling” and returned to my office to work on other issues and levels of their health. There is documented success amongst the athletic community in support of the effectiveness of “dry needling.” I have had the following reports in my office: All of the patients say that it is a very painful procedure. The patients I would consider very fit, strong and nutritionally healthy seem to experience good results in a few days of initial treatment for the stated injury. Others, varying results, or none at all.
So far, the Physical Therapists that my patients have worked with are aware of their limitations in using this procedure. In my opinion, I believe the lack of results in my more deficient, chronically compromised patients goes back to the idea that “you can’t get blood from a stone.” These patients simply don’t have the proper hydration, nutritional foundation or support system in their tissues to quickly bounce back to a level of health that they didn’t have to begin with. And, it would be dangerous to do so because they would immediately go back to what they were doing to cause it in the first place and be another “accident waiting to happen.” Sometimes, there is a wisdom in the body…
I believe in following that which compels us. That means the consequences of those choices are also ours. One must be informed in order to make an informed decision. Know your practitioner. Ask questions. Confirm credentials. Get second opinions. Know yourself and become proactive where your health is concerned.
Anita Alexandra is an acupuncturist and Chinese Herbalist with 16+ years of experience. She works at Chiropractic Health and Acupuncture, 619 Main Street, Frisco. (970-668-3299) http://www.CHAfrisco.com