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, dry needling has been known to acupuncturists as the ashi 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 written in China sometime between 440 BC- 220 CE. This 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, from the body.
Ironically, about a century before hypodermic needles were introduced in China, zhen became the inspiration for the invention of the hypodermic needle 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 books 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. Soon after, the hypodermic needle was invented and went on to become one of the most important tools used in modern medical treatment.
Dry Needling is Rudimentary Acupuncture
For sometime now, the term "dry needling" has been used interchangeably with acupuncture to describe any basic or advanced needling techniques that use solid filiform (hair-like) needles instead of hypodermic syringes. A while back, the term dry needling was used by a few US doctors to describe basic acupuncture methods using 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 needling method where you basically insert a 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, 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 Practice of Basic Dry Needling
Basic dry needling is generally practiced using two distinct types of needle stimulation. Each way incorporates the use of ultra thin solid filiform needles that are inserted into these tender or knotted areas of the body. These areas are commonly referred to in medical circles as myofascial trigger points (TrPs).
The first involves using filiform needles and quickly thrusting them, deeply and repeatedly, up and down, into these sensitive areas to elicit a twitch reponse that releases surrounding tissue that is causing pain and discomfort. By quickly and repeatedly thrusting the filiform needle up and down into the knotted area and surrouding tissue, the idea is to create a small but significant amount 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 very effective, it should be noted that it is also generally very painful and usually unnecessary.
The second way, and in my opinion a much better approach, is to gently insert the filiform needle only until the twitch response occurs, then the needle is gently rotated until the tissue twitches again. After the initial set of twitch responses, the filiform needle is then gently moved up until the tissue twitches again, then gently down, then gently rotated, and so on until the twitching stops. This way is the way I prefer to use basic dry needling in my practice as it produces really good results and is generally a low-pain or painless experience for the patient.
Acheiving Effective Dry Needling
In either approach, when I perform basic dry needling I'm looking for a couple of things to occur.
The first thing I want to see happen is the muscle twitch response described above. When I see the twitch response, it means I got the area that I needed to needle. Sometimes there are muscle twitch responses away from the initial site of needling, which I will follow around the body and also needle until there is no more twitching anywhere. This can be described as running the problem out of the body.
The next thing I'm looking for is a red flash, 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 typically indicates a more chronic condition involving a suprressed or sluggish immune system and poor blood circulation at the site of needling.
The other thing I'm 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. Either way, this usually indicates that something good is happening and the client is responding to the needling.
So there you have it. There's the scoop on dry needling and now you know what it is and what its used for.
If you want to get the gentler type of basic dry needling described here feel free to contact me today and I'll be more than happy to help you get started with treatment.
- 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.
- Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and students of medicine. NewYork: Appleton.
- 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.
- 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 inuries and pain: A four step approach to treatment. Hidden Needle Press.
- Ma, Y. (2011). Biomedical acupuncture for sports and trauma rehabilitation: Dry needling techniques. Churchill Livingstone.
- 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