Over the last few years the term "dry needling" has been getting a lot of attention as a "new" type of medical treatment that works pretty well for alleviating muscle pain, soreness, tightness, and fatigue. So what exactly is it?
Dry needling is merely a very old and basic method of acupuncture that has been recently updated with modern terminology and theories, and rebranded as a new medical procedure. For thousands of years, what is now being called "dry needling" has been known to acupuncturists as the ashi (阿是) method. The word ashi literally translates into English as "it hurts!".
Basically, the method involves finding areas on the body where it hurts, and then inserting acupuncture needles into these areas and stimulating the needles to help release muscle and tissue fibers to assist with alleviating pain and discomfort.
Origins of Dry Needling
The needling of hyper-irritable areas or palpable nodules in muscle fascia has existed since at least the era when the very first acupuncture book was compiled in China sometime between 440 BC- 220 CE. The book, known as the Huangdi Neijing (Yellow Emperor's Inner Classic), describes in detail how to discover and needle into these tender and knotted spots, or ashi points, to eliminate pain. This method has been known and taught to acupuncturist for millennia as the ashi method, and is usually learned within the first year of hands-on training.
But the origins of the use of the term "dry needling" can be traced to a much later time that coincides with the invention and use of hypodermic needles.
The term "dry needling" was first used in China sometime around the late 19th Century with the arrival of Western medicine. For about 2000 years prior, the Chinese had continuously developed their own unique system of therapeutic needling methods known simply as zhen (针), which translates into English as “needling”. In contrast to hypodermic needling, zhen uses very thin solid needles for treatment. To avoid confusion, the Chinese added the word gan (干), or “dry”, to zhen (needling) to differentiate it from the hypodermic needles that were recently introduced to inject or withdrawal fluid, or "wet" material, into and from the body. Since then, ganzhen, or "dry needling", has been a folk name for acupuncture in China.
Ironically, about a century before hypodermic needles were introduced in China, zhen techniques became the inspiration for the further development of syringes in Europe.
Basic therapeutic needling techniques had been imported from China and Japan into Europe since as early as the 16th Century and named acupunctura (Latin acus for "needle", and punctura for "to pierce with"). By the 18th and 19th Century, medical texts discussing acupuncture's effectiveness in the treatment of pain were widely circulated throughout European medical communities.
As word spread around, so did the idea that acupuncture could be even better at alleviating pain if drugs could be injected into the same area through a hollowed needle. By the mid-19th century, the hypodermic needle was introduced and went on to become one of the most important tools used in modern medical treatment.
Dry Needling is Rudimentary Acupuncture
For over 100 years now, the term "dry needling" has been used interchangeably with acupuncture to describe any basic or advanced therapeutic needling techniques that use solid filiform (hair-like) needles instead of hypodermic syringes.
Decades ago, with limited knowledge of traditional acupuncture and its history, the term "dry needling" was used by a few US doctors to describe basic acupuncture methods using empty hypodermic needles to alleviate pain.
But nowadays, when you hear people use the term "dry needling", they are generally referring to the use of ultra thin, solid, flexible acupuncture needles and a very basic needling technique known traditionally by acupuncturists as the ashi method.
As mentioned above, the ashi method is a very basic and extremely useful needling technique that has been used by acupuncturists for a very long time, literally thousands of years. The whole technique can be summarized as a basic therapeutic needling method where you simply insert a filiform needle where "it hurts" (ashi). Although in practice it is that simple, it is very effective in alleviating pain.
Since when the very first Westerners were introduced to therapeutic needling in Asia, acupuncturists have taught the ashi method to them. More recently in the US, acupuncturists have taught the ashi method to other medical professionals including MDs, chiropractors and physical therapists. In an effort to validate and teach the method, and distance it from pre-scientific theories of traditional acupuncture, it has been infused with Western medical concepts and terminology, including the adoption of the term "dry needling". As a result, "dry needling" has come to represent a modernized version of the ashi method.
The big difference is in terms of the theory surrounding how these knotted painful areas form and how therapeutic needling works to alleviate them.
The Phenomenon of Basic Procedural Acupuncture
Traditionally speaking, these painful and knotted areas in the body are believed to form from the obstruction and pooling (bi 痹) of the flow of blood (xuě 血) and vital life-force energy (qi 气) in the tissue. When these areas are needled, the sensation of numbness, distension, twitching, or electrical tingling that is felt by the patient (deqi 得气) confirms the stagnate pool of blood and vital life-force energy has been released and its normal flow restored, thereby alleviating pain.
On the other hand, modern research suggests these areas form from a series of chemical reactions initated by the nervous system. It has been proposed that these chemical reactions first compress local blood supply and restrict the energy needs of the local region, causing local contraction and knotting of fibers that pull on tendons and ligaments associated with the muscle. Some believe this knotting of muscle, known as myofascial trigger points (TrPs), in turn produces other chemicals that interact with nerves and cause localized pain. The involuntary muscle reflex (local twitch response, or LTR) that sometimes occurs in the area during needling is believed to deactivate the contracted muscle fibers and relieve pain.
The interesting thing is that despite these theories being completely different and born at different points in history, both appear to be describing the same phenomenon.
For example, modern defined "trigger points" have a correspondence rate upwards of 95% with traditionally defined acupuncture points that were discovered thousands of years ago!
And similar to traditional acupuncture theory, the modern scientific theory of needling trigger points has also been repeatedly refuted and invalidated using scientific evidence-based rationale.
The emerging modern theory of therapeutic needling, whether called acupuncture, the ashi method, dry needling, etc, lacks a good amount of scientific credibility. Despite decades of research and clinical trials in the US, China, Japan, Korea, Germany, England, France, Australia, and elsewhere, the placebo effect remains the only plausible scientific explanation for what happens whereby needling into these sensitive areas reduces pain.
In the end, needling therapeutically into painful areas of the body remains a very basic procedural acupuncture technique that does not rely on any traditional nor modern scientific theory for it to work in relieving pain.
The Practice of Basic Dry Needling
The ashi method ("dry needling") is generally practiced in two distinct ways, each incorporating unique needling techniques and the use of ultra thin solid filiform needles that are inserted into these tender or knotted areas of the body.
The first way involves inserting a single filiform needle into the affected area and quickly lifting and thrusting it (ti cha 提插) repeatedly, up and down, to elicit a response that releases surrounding obstructed tissue that is causing pain and discomfort (bi syndrome). Often additional needling techniques are added to the lifting-thrusting technique whereby the needle is repeatedly reinserted diagonally in four directions (hui ci 恢刺)— left, right, forward and behind— or diagonally only towards the muscle attachments in a “fan” or “cone” like fashion (he gu ci 合谷刺).
By quickly and repeatedly lifting and thrusting the filiform needle in and around the knotted area and surrounding tissue, the idea is to create very small but significant amounts of trauma to not only release the tissue, but also alert the body that the area surrounding the needle needs to be repaired.
While this approach is generally effective, it should be noted that it is also typically very painful, poses a higher risk of injury and trauma, and is usually unnecessary to get good results.
The second way, and in my opinion a much better approach, is to first insert the filiform needle into the affected area and only lifting-thrusting it gently until an inital response occurs. After the initial response, the needle is gently twisted and rotated (nian zhuan 捻转) until a second response occurs. Once the initial set of responses have come to pass, the needle is then gently moved out and rotated until another response occurs, then gently moved in and rotated until another response occurs, and so on until the desired effect is achieved.
Sometimes, if the pain is fixed on a small and somewhat deep spot, the ranked needling technique (qi ci 齐刺) is used whereby two more needles are added very close to the first needle on each side and inserted towards the affected area.
If there is pain that is relatively superficial on a larger area of tissue, four additional needles are added in four directions, all inserted towards the affected area and surrounding the first needle inserted (yang ci 扬刺).
If the pain is cramping in nature or there are spasms, a variation of the muscle needling technique (he gu ci 合谷刺) is used instead whereby two more needles are inserted diagonally towards the muscle attachments in a cone-like fashion.
This second way is how I prefer to use basic "dry needling" (ashi method) in my practice as it is generally a very safe and low-pain or painless experience for the patient, and it typically produces very good results.
Acheiving Effective Dry Needling
When I perform the ashi method ("dry needling") I'm looking for a few things to occur.
One of the main things I'm looking for is a twitching in the muscle that is needled. Sometimes the twitch is very subtle and the patient must confirm it. But in either case, while it is not necessary for successful outcomes, when a twitch response occurs it generally is a good sign that I got the area that I needed to needle.
Another response I'm typically looking for is an achy or throbbing feeling, or tingling or itchy sensation at the site of needle insertion. For some people this sometimes feels like a magnetic pull, or a heating or cooling sensation. Sometimes it is a feeling of deep pain or pain that refers to another area. Either way, this usually indicates that something good is happening and the client is responding to the needling.
At times there will also be muscle twitch responses and other sensations away from the initial site of needling, which I often will follow around the body and also needle using the successive or trigger needling technique (bao ci 报刺) until there is no more twitching or other sensations anywhere. This can be described as running the problem out of the body.
The other thing I'm looking for is a red flash at the site of needling, which shows a histamine and heparin response. This is generally a good response that lets me know the immune system is waking up and has been activated to start cleaning things up at the site of needle insertion. In some cases there is no red flash, which generally (but not always) indicates a more chronic condition involving a suppressed or sluggish immune system and poor blood circulation at the site of needling.
So there you have it. There's the scoop on "dry needling" (ashi method) and now you know the basics of what it is and what its used for.
If you're interested in learning more about whether or not the gentler type of "dry needling" described above can help you, feel free to contact me today and I'll be more than happy to help you get started with treatment.
- Cohen M.L., and Quintner J.L. (2008). The horse is dead: let myofascial pain syndrome rest in peace. Pain Medicine, 9(4), 464–465.
- Cohen M.L., and Quintner J.L. (1993). Fibromyalgia syndrome, a problem of tautology. The Lancet, 342(8876), 906–909.
- Fan, A.Y., and He, H. (2015). Dry needling is acupuncture. Acupuncture in Medicine, 34(3), 241.
- Fan, A.Y., et al. (2016). Evidence that dry needling is the intent to bypass regulation to practice acupuncture in the United States. Journal of Complimentary and Alternative Medicine, 22(8), 591–593.
- Fan, A. Y., et. al. (2017). Evidence and expert opinions: Dry needling versus acupuncture (I): The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016.” Chinese Journal of Integrative Medicine, 23(1), 3–9.
- Jin G.Y., and Jin, J.X. (2007). Contemporary Medical Acupuncture: Systems approach. Beijing: Higher Education Press.
- Lu, D.P., and Lu, G.P. (2013). An historical review and perspective on the impact of acupuncture on U.S. medicine and society. Medical Acupuncture, 25(5), 311–316.
- Ma, Y. (2011). Biomedical acupuncture for sports and trauma rehabilitation: Dry needling techniques. Churchill Livingstone.
- Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and students of medicine. NewYork: Appleton.
- Perreault, T., Dunning, J., and Butts, R. (2017). The local twitch response during trigger point dry needling: Is it necessary for successful outcomes? Journal of Bodywork and Movement Therapies, 21(4), 940-947.
- Quintner J.L., and Cohen M.L. (1999). Fibromyalgia falls foul of a fallacy. The Lancet, 353(9158),1092-1094.
- Quintner J.L., Bove, G.M., and Cohen M.L. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology, 54(3), 392-399.
- Quintner J.L., Bove, G.M., and Cohen M.L. (2015). Response to Dommerholt and Gerwin: Did we miss the point? Journal of Bodywork and Movement Therapies, 19(3),394-395.
- Ringer, S. (1878). A handbook of therapeutics (6th ed.). London: H.K. Lewis.
- Seem, M. (1993). A new American acupuncture: Acupuncture osteopathy, the myofascial release of the bodymind. Blue Poppy Press.
- Shah JP, Thaker N, Heimur J, et al. (2015). Myofascial trigger points then and now: a historical and scientific perspective. PM&R, 7(7), 746-761.
- Stux, G., and Hammerschlag, R. (Eds.). (2001). Clinical Acupuncture: Scientific basis. Springer.
- Travel, J.G., and Simons, D.G. (1983). Myofascial pain dysfunction: The trigger point manual. Lippincott Willimas and Wilkins.
- Vangermeerch, L., and Pei-Lin, S. (1994). Bi-syndrome or rheumatic disorders treated by traditional Chinese medicine. Belgium: SATAS.
- Veith I. (1975). Sir William Osler-acupuncturist. Bulletin of the New York Academy of Medicine, 51(3), 393–400.
- White, A. and Ernst, E. (2004). A brief history of acupuncture. Rheumatology, 43(5), 662–663.
- Whitefield, R., (2009). The Acupuncture handbook of sports injuries and pain: A four step approach to treatment. Hidden Needle Press.
- Xinnong, C. (Ed.). (1999). Chinese Acupuncture and Moxibustion. Beijing: Foreign Languages Press.
- Zhou, K., et. al. (2015). Dry needling versus acupuncture: the ongoing debate. Acupuncture in Medicine, 33(6), 485-490