Acupuncture & Dry Needling

In the realm of alternative medicine, two practices often come to the forefront when discussing pain management and holistic healing: acupuncture and dry needling. While both involve the insertion of thin needles into the skin, they stem from distinct philosophies and methodologies. In this month’s blog we wanted to delve deeper into the differences between these two modalities to understand their unique approaches and benefits.

Acupuncture: Ancient Tradition and Vital Energy

The origin of acupuncture is generally accepted to have been developed during the Han Dynasty, dating from 206 BC to 221 AD China. The earliest text to have described acupuncture as a system of diagnosis and treatment was the The Yellow Emperor’s Classic of Internal Medicine (100 BC). The text is likely to be a compilation of traditions handed down over centuries and presented in the terms of the prevailing era’s Taoist philosophy (White & Ernst 2004). It describes the concepts of meridians (channels) through which the Qi (vital energy or life force) flows through the human body. When the body moves away from a state of ideal health, needles can be placed along meridian points specific to an individual and their ailments. These meridian points tap into, and rebalance Qi which correctly restores the individuals health. The Huangdi Neijing Suwen, a seminal text in traditional Chinese medicine, discusses the causes of illness and premature death. It also illuminates a theory of an “idealised state of human health”, contrasting it with the reality of sickness and early mortality when we deviate from this state.  During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. In it are clear descriptions of the full set of 365 points that represent openings to the channels through which needles could be inserted to modify the flow of Qi energy (Kaplan, 1997). 

In Traditional Chinese Medicine (TCM) philosophy, treatment approaches are categorised into 2 distinct branches. The application of needles for the purpose of achieving health improvement / an idealised state of health through Qi-regulation, is known as the ’root treatment’ (zhibenfa). While applying treatment/needles to target symptoms is known as the branch treatment (zhibiaofa). (Birch 2019)

It should be noted that knowledge of health and disease in China developed purely from observation of living subjects because dissection was forbidden, and the subject of anatomy did not exist.

Acupuncture in the Western World 

During the European Middle Ages, especially from 1500 to 1700, the Dutch East India Company, while pursuing merchant trading in China and Japan, brought Chinese acupuncture procedures back to their homelands in Europe (Lu, 2013). Interestingly, a major medical development that resulted from this was the development of the modern day western hypodermic needle, which was adapted from Chinese acupuncture needles.  Acupuncture thereafter became slowly and progressively adopted across the globe with most western countries now having acupuncture as a form of medical intervention. 

In Australia, Acupuncture was introduced as early as the 1880s, and has now cemented itself as a prominent form of alternative medicine in Australia. In particular, the past 2 decades has seen rapid growth in acupuncture adoption and acceptance in our country. Three of our university’s now offer undergraduate and three postgraduate programs that are approved by the Chinese Medicine Board of Australia. Our general population have strongly accepted Acupuncture, with over 10% having received acupuncture treatment and 80% of general medical practitioners (GP’s) referring their patients to acupuncture service (Zheng 2014). Additionally, all private health insurance schemes provide rebates to patients receiving acupuncture treatment. 

In more recent decades, western medical research has set out to understand Acupuncture, to make sense of the effects acupuncture has on the human body and to explain the benefits in terms of western medicines approach. Recent biomedical technology has begun unveiling the mechanisms of acupuncture with studies finding that acupuncture has a significant effect on the central nervous system (CNS), the autonomic nervous system (ANS) the hypothalamic-pituitary-adrenal (HPA) axis. The effects of acupuncture appears to be directly related to the modulation of neurotransmitter and hormones. Neurotransmission of dopamine, opioids, serotonin, norepinephrine, orexin and endocannabinoid are now know to be significantly modulated by acupuncture (Lin et al. 2022). These neurotransmitters have many influences on the human body including analgesia for pain, immune regulation, and psychological health. 

When is acupuncture effective? 

We checked out the latest evidence of the effectiveness of acupuncture on the following conditions.

Chronic Pain 

A Meta-Analysis of 20,827 patients from 39 trials concluded that “Acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time” (Vickers et al. 2018).

Chronic Low Back Pain 

A Meta-Analysis of 33 randomised controlled trials (RCTs) concluded that “Acupuncture effectively alleviates chronic low back pain” (Manheimer et al. 2005).

Neck Pain and Dysfunction

A Meta-Analysis of 10000 participants from 27 clinical trials looking at whiplash, chronic neck pain, neck arthritis and nerve pain concluded that “Acupuncture relieves pain better than sham acupuncture, and that those who received acupuncture report less pain and disability at short‐term follow‐up. Moderate‐quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short‐term follow‐up” (Trinh et al. 2016).

Headache and Migraine

A systematic review of 2349 participants from 12 clinical trials concluded that “acupuncture is effective for treating frequent acute or chronic tension‐type headaches and migraines”. (Linde et al. 2016).

Arthritis

A Meta-Analysis and systematic review of 1763 participants across 12 Studies concluded that “acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life” (Manyanga et al. 2014)

Chronic Shoulder Pain

A Meta-Analysis of 9 studies which included over 350 participants concluded that “acupuncture is more effective than drug therapy and no treatment for chronic shoulder pain” (Wang et al. 2016)

Fertility

A Systematic Review of over 50 recent clinical trials investigated the role of acupuncture in infertility. In conclusion, most of the existing studies suggest a positive effect of acupuncture in infertility treatment. The study also goes on to say that acupuncture is effective for both female and male fertility in natural and in vitro fertilisation (IVF) settings (Huang et al. 2011)

Depression 

A Meta-Analysis of 8 clinical trials concluded that “Acupuncture is an effective treatment that could significantly reduce the severity of disease in patients with depression” (Wang et al. 2008).

Menopause

A Meta Analysis of 12 studies confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause (Hsiao-Yean et al. 2015). 

Another Meta Analysis of over 100 studies had similar findings concluding that “Evidence from RCTs supports the use of acupuncture as an adjunctive or stand-alone treatment for reducing vasomotor symptoms and improving health related quality of Life outcomes” (Befus, 2018). 

Dry Needling: Targeting Musculoskeletal Dysfunction

Unlike acupuncture, dry needling does not adhere to the concept of Qi or meridians. Instead, it focuses on the physiological mechanisms of muscular dysfunction and pain. While it shares the tool of thin needles with acupuncture, its approach and objectives are distinct.

Dry needling is a more recent addition than acupuncture to the realm of alternative therapies. Developed within the context of modern Western medicine, dry needling primarily targets muscular trigger points, knots, or tight bands of muscle and connective tissue that can cause pain and dysfunction. Dry needling can also be used to stimulate underactive and weak muscles.

During a dry needling session, practitioners insert needles directly into these trigger points, which can often elicit a twitch response from the muscle. Sometimes this can be uncomfortable. Dry needling releases muscle tension and promotes relaxation, ultimately relieving pain, improving range of motion and overall function.

Primarily used for musculoskeletal conditions such as back pain, neck pain, and sports injuries, dry needling can provide immediate relief by releasing muscle tension and improving blood flow to affected areas. It is often integrated into physical therapy or rehabilitation programs to enhance recovery and optimise functional outcomes.

When is Dry Needling Effective

We checked out the latest evidence of the effectiveness of Dry Needling on the following conditions.

Low Back Pain

A Systematic review of 1233 patients with low back pain within 16 RCTs concluded that “Dry needling is more effective for alleviating pain and disability at postintervention in low back pain” (Han-Tong et al. 2018).

Shoulder Injury

A Systematic review of 402 patients with shoulder pain across 94 studies concluded that “Dry needling is effective and safe in reducing the pain and disability produced by Subacromial Syndrome” (Blanco-Díaz et al. 2022).

Musculoskeletal Pain

A systematic review and meta-analysis of 13 RCTs of over 2000 patients with musculoskeletal pain concludes that “dry needling performed by physical therapists is more effective than no treatment, sham dry needling, and other treatments for reducing pain in patients presenting with musculoskeletal pain in the immediate to 12-week follow-up period” (Gattie et al. 2017)

Myofascial Trigger Points (MTPs)

A systematic review of 19 RCTs suggests that there is benefit from dry needling for myofascial trigger points in multiple body areas and concluded broad applicability of dry needling treatment for multiple muscle groups (Boyles et al. 2015).

Another systematic review concluded that “several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs)”. (Dunning et al. 2014).

Tendons and Tendinopathy 

A Review of the effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. Regions studied which showed significant improvement where the wrist common extensors (Tennis Elbow), patellar tendon, rotator cuff, and tendons around the hips. It is clear from the research that tendon needling is highly beneficial for pain and function. With statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. (Stoychev et al. 2020).

How Often is Acupuncture and Dry Needling Recommended?

Although frequency of treatment is dependent upon each individual and their ailments, according to the above research clients are recommended acupuncture: 1-2 x per week for 4-6 weeks during symptomatic periods and 1 x / 4 - 6 weeks during management phases. 

Summing Up….

While both modalities have their strengths, the choice between acupuncture and dry needling ultimately depends on individual needs, preferences, and the nature of the condition being treated. Some individuals may benefit from the holistic approach of acupuncture, while others may find relief through the targeted precision of dry needling. The research shows excellent support for the use in Acupuncture and Dry Needling for a wide range of health conditions which cause pain and dysfunction. At Gold Coast Physiotherapy, our clinicians are trained in both Western Dry Needling and Eastern Acupuncture and above all, our clinicians place the needs and goals of our clients first. Afterall, our client’s success is our success.  

In conclusion, acupuncture and dry needling represent distinct yet valuable approaches to pain management and healing. Whether you're seeking to rebalance your body's energy flow or target specific muscular/connective tissue dysfunction, both modalities offer paths toward improved health and well-being. As always, it's essential to explore and understand these options in consultation with qualified practitioners to determine the most suitable approach for your unique needs.

References

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Kaplan G. (1997). A brief history of acupuncture’s journey to the West. 

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Birch S. (2019). Treating the patient not the symptoms: Acupuncture to improve overall health - Evidence, acceptance and strategies. Integrative Medicine Research. 8(1):33-41. doi: 10.1016/j.imr.2018.07.005. 

Manheimer, E., White, A., Berman, B., Forys, K., & Ernst, E. (2005). Meta-Analysis: Acupuncture for Low Back Pain. Annals of Internal Medicine. Volume 142(8).

https://doi.org/10.7326/0003-4819-142-8-200504190-00014

Wang, H., Qi, H., Wang, B., Cui, Y., Zhu, L., Rong, Z. Chen, H. (2008). Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? Journal of Affective Disorders, Volume 111(2–3). Pages 125-134. https://doi.org/10.1016/j.jad.2008.04.020.

Vickers, A., Vertosick, E., Lewith, G., MacPherson, H., Foster, N., Sherman, K., Irnich, D., Witt, C., Linde, K. (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain. Volume 19(5), Pages 455-474.

https://doi.org/10.1016/j.jpain.2017.11.005.

Hsiao-Yean ., Chieh-Hsin, P., Yuh-Kae, S., Bor-Cheng, H., Pei-Shan T. (2015). Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause 22(2):p 234-244. DOI: 10.1097/GME.0000000000000260

Befus, D., Coeytaux, R., Goldstein, K., McDuffie, J.,  Shepherd-Banigan, M., Goode, A., Kosinski, A., Van Noord, M., Adam, S., Masilamani, V., Nagi, A., & Williams, J. (2018). Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine. Volume 24(4). 

https://doi.org/10.1089/acm.2016.0408

Huang, D., Huang, G., Lu, F. Dieterle, S., Neuer A., & Greb R. (2011). Acupuncture for infertility: Is it an effective therapy?. Chinese Journal of Intergrative Medicine. 17(1), 386–395. https://doi.org/10.1007/s11655-011-0611-8

Trinh, K., Graham, N., Irnich, D., Cameron I., Forget, M. (2016). Acupuncture for neck disorders: Cochrane Database of Systematic Reviews. Volume 5(1). Pages 1465-1858.

https://doi.org//10.1002/14651858.CD004870.pub4

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring ,M., Shin, B., Vickers, A., & White, A. (2016). Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews. 

Manyanga, T., Froese, M., Zarychanski, R., Abou-Setta, A., Friesen, C., Tennenhouse M., Shay, B. (2014) Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Alternative Medicine. 14(312).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158087/

Wang, K., Zhang, LJ., Lu, F., Lu, YH., Yang, CH. (2016). Can Ashi points stimulation have specific effects on shoulder pain? A systematic review of randomized controlled trials. Chinese Journal of Integrative Medicine. Volume 22 pages 467–472.

https://pubmed.ncbi.nlm.nih.gov/26129899/

Lin, JG., Kotha, P., Chen, YH. (2022). Understandings of acupuncture application and mechanisms. American Journal of Translational Research.14(3):1469-1481. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991130/

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Gattie, E., Cleland, J., & Snodgrass, S. (2017). The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. Volume 47(3). Pages133-149. https://www.jospt.org/doi/10.2519/jospt.2017.7096

Boyles, R., Fowler, R., Ramsey, D., & Burrows, E. (2015). Effectiveness of trigger point dry needling for multiple body regions: a systematic review. Journal of Manual & Manipulative Therapy, Volume 23(5), 276–293. https://doi.org/10.1179/2042618615Y.0000000014

Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252–265. https://doi.org/10.1179/108331913X13844245102034

Blanco-Díaz, M., Ruiz-Redondo, R., Escobio-Prieto, I., De la Fuente-Costa, M., Albornoz-Cabello, M., Casaña, J. (2022). A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome. Biology. Volume 11, 243. 

https://doi.org/10.3390/biology11020243

Han-Tong, H., Hong, G., Rui-Jie, M., Xiao-Feng, Z., Hong-Fang, T., Lu, L. (2018). Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis. Medicine. Volume 97(26). Pages e11225. DOI: 10.1097/MD.0000000000011225

Stoychev, V., Finestone, A.S. & Kalichman, L. (2020). Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Current Reviews of Musculoskeletal Medicine. 13, pages 133–140. https://doi.org/10.1007/s12178-020-09608-0