Acupuncture or Dry Needling: How Do You Get the Best Care?

By Hopi Wilder, O.M.D.

Many patients who come to my office have tried “acupuncture” with a physical therapist, chiropractor, or M.D.—and they may or may not have liked it. If they didn’t, they often begin to distrust acupuncture in general. Many mistakenly believe dry needling is essentially the same thing. Yet after receiving just a couple of acupuncture treatments at Wilder Health, they quickly see the difference.

Acupuncturists in Nevada must earn a Master of Science degree in Oriental Medicine, in which acupuncture—piercing the skin for therapeutic purposes—is one of the primary modalities. The hours required for national certification vary by state, but most fall in the range of what I completed. I received 3,092.5 hours of didactic training as part of a four-year university program.

Clinical training begins in the first year of school. We are taught precise location, depth, and angle of needling, along with Clean Needle Technique. We are tested rigorously on organ locations and how to avoid injuring them. By the end of our training, we have completed 1,262.5 supervised clinical hours before we can call ourselves professionals.

Who would you want piercing your skin: someone with 150 hours of training (only 25 of them live) or someone with well over a thousand hours? Your physical therapist, doctor, or chiropractor may have a strong anatomical understanding of the body, but there is far more to acupuncture than simply inserting a needle.

A practitioner with over 1,000 hours of clinical training is far less likely to cause a pneumothorax (a punctured lung). Recently, a physical therapist punctured a well-known athlete’s lung, after which several PT practices in Reno promptly dropped dry needling from their services. This was a pragmatic decision. While pneumothoraxes are not usually life-threatening, they require a hospital visit to reinflate the lung and generate negative publicity.

Dry needling practitioners claim they are not practicing acupuncture, yet they benefit from strong professional lobbies. Although acupuncture’s scope of practice is not always well protected, we know what we do works exceptionally well—and now other professions are copying it. Many have spoken out, but to little effect. It feels deeply disrespectful that professionals with a fraction of our training are permitted to do what we do. This would never be tolerated if the roles were reversed.

You don’t see acupuncturists taking a 150-hour course and then suddenly performing neck manipulations. You don’t see acupuncturists receiving automatic orthopedic surgeon referrals like physical therapists do. And you don’t see acupuncturists prescribing medications—although we are required to understand drug-herb interactions, side effects, and nutrient depletions. Acupuncturists built our success from a small, fringe community of Chinese immigrants in California into a globally accepted modality. Now other professionals are being allowed to copy that hard-won success with minimal training.

Dry needling is based on trigger point therapy, a system developed by Dr. Janet Travell and Dr. David Simons. In that approach, trigger points in muscles are injected with saline or lidocaine using hypodermic needles, followed by cold spray and stretching for pain relief. Acupuncturists trained in sports medicine also study trigger point therapy, but we use fine acupuncture needles rather than hypodermic ones. Practitioners performing “dry needling” are essentially copying acupuncture’s highly effective approach to pain relief.

To be fair, not all acupuncturists specialize in pain relief, but it is what we are best known for. I was fortunate to complete a 25-year apprenticeship with the late Michael Turk, L.Ac., an orthopedic acupuncturist, pioneer in the field, and author of Pain’s Healing Secret. Many acupuncturists who focus on pain management and musculoskeletal issues train in the sports medicine branch of acupuncture.

Even acupuncturists who do not specifically study sports medicine learn an ancient system that uses specific points along pathways of energy—called meridians—running through the body. These points have well-documented traditional functions for treating pain and disease, refined and used continuously for thousands of years. Learning to work with these points is like accessing a biohack: when you can properly redirect the body’s electrical flow, patients improve.

This is not magic. It is grounded in the work of many scholars, including Western medical professionals. Dr. Daniel Keown, a licensed acupuncturist, explores this in his book The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine. He explains how acupuncture meridians correspond to the fascial networks of the body. Fascia is the Saran Wrap–like, collagen-filled tissue that wraps and compartmentalizes everything in the body. It also creates and conducts electricity.

Acupuncture points influence the fascia because they are often located at neuromuscular junctions. While trigger points target muscles specifically, they work well alongside acupuncture points. Acupuncture points can release and restore the body by influencing this electrical network. We now know fascia is electrical because it is composed of collagen—a semi-conductor that both insulates and conducts electricity.

As author Eileen McKusick explains in Electric Body, Electric Health, everything in the body is electric. Every cell, pumping three sodium ions out in exchange for two potassium ions, generates a tiny electrical charge. Acupuncturists call this Qi. Working with Qi—or the body’s electricity—is a remarkably effective and elegant way to treat pain and disease. We are not just meat sacks walking around; we are generators of electric energy.

Acupuncturists’ years of rigorous training and extensive clinical hours alone are excellent reasons for patients to choose us over dry needling practitioners. The care and safety we bring to our work are reflected in our success rates over millennia. Today, practitioners with very little training eye that success with envy and want to jump on board. My advice to them is simple: go back to school. Take the time to earn a proper license in acupuncture before treating patients.

To prospective patients, my advice is this: recognize that acupuncture influences far more than just muscles. We work with the body’s electrical system via specific acupuncture points that effect the fascial networks. That is the real secret to our success.