Dry-Needling; I can’t believe it’s not
Acupuncture
Acupuncture and Dry-Needling are 2 vastly
different practices, but to the everyday patient, they seem kind of the same,
both involving the insertion of small needles into the skin to relieve an
ailment. So what is the difference?
THE BASICS
ACUPUNCTURE; The practice of inserting fine
needles into the skin and muscles of the body to benefit health and relieve a
variety of ailments.
Acupuncture
works within the framework of Traditional Chinese Medicine (TCM); a whole
health system. Acupuncture has been practiced for over 2000 years and has a
long history of efficacy. As acupuncture works on a holistic and broad model,
it is used to treat a wide variety of illnesses, ranging from pain, to
disorders of the digestive, reproductive, psycho-emotional, respiratory system,
and more.
In
Australia, Acupuncturists are registered with the Australian Health
Practitioner Regulation Agency as Chinese Medicine Practitioners. They are
required to have a minimum Bachelor degree, usually taking about 4 years and
requiring over 400 hours of clinical practice, or a 3 years graduate-entry
Masters qualification (or equivalent).
DRY-NEEDLING (aka myofascial dry-needling,
intra-muscular stimulation); involves the insertion of fine needles
(acupuncture needles are used) into the skin and muscles to relieve pain.
Depending
on the technique, these needles may be inserted deeply into the muscles, or
superficially into the skin above a trigger point (trigger points are those
knots your massage therapist tries to beat out of you). The technique began in
the 70’s when it was observed that inserting a solid needle into the skin above
a trigger point was just as effective at relieving pain as injecting an
analgesic into the point, hence ‘dry-needling’ rather than ‘wet-needling’.
Most
often practiced by Physical Therapists such as Chiropractors, Physiotherapists,
and Remedial Massage Therapists, the minimum amount of study to become a
qualified dry-needler is 2 days, with a
pre-requisite physical therapy or medical degree.
Physical Therapists who practice
dry-needling (DN) maintain that they aren’t doing acupuncture because DN
utilizes the theory of biomedicine (circulation, prostaglandins, inflammation,
fascial release, etc) and not of TCM. However the actual mechanism of action of
DN, biomedically speaking, is still unclear, and based more on clinical
observation than anything else. In fact, most of the research behind DN is
actually acupuncture research.
Now to the real point…
THE RISKS:
- An Australian study found that the risk of pneumothorax
(piercing the lung) when acupuncture was administered by medical
practitioners was twice that of when performed by traditionally trained
acupuncturists (Bensoussan, 2000).
- Between 2000-2011 there have been 86 fatalities worldwide
related to acupuncture/dry-needling (none in Australia, incidentally). All
articles conclude that these deaths could have been avoided with adequate
training (Janz, 2011).
- The World Health Organization Guidelines on Acupuncture
recommend doing acupressure instead of acupuncture if the practitioner is
not prepared to complete a full 2500 hr programme of study because of the
high risk associated with a brief training time (WHO GBT 1999). Most DN
training courses in Australia fall between 16-36 hours, with little of
this being practical. Thus placing them firmly in the ‘high risk’
category.
Since 2012 in Australia, the title
‘Acupuncturist’ is reserved for those who hold the relevant qualifications.
However, there are no regulations on those who practice ‘dry-needling’.
Incidentally, the practice of needling
trigger points to relieve local pain is well known in TCM. They are called Ah
Shi points and have long been used in Acupuncture as part of wider treatment of
meridian points and organ pathology.
When asked if they have had acupuncture
before, many of my new patients will respond with, “oh yeah my physio does a
little bit of acupuncture”. While it’s possible that your physio is also a
qualified Chinese Medicine Practitioner, it’s more likely that they actually do
‘a little bit of dry-needling’, and as we can see, the difference in training and risk is vast, while the actual clinical technique is very similar.
As one of my patients so eloquently put it,
“Isn’t saying ‘I do a little bit of acupuncture’ like saying ‘I do a little bit
of surgery’? You’re either a surgeon or you’re not a surgeon, right?”
….Well yes, quite.
And you’re either an acupuncturist or your
not an acupuncturist as far as I and the research is concerned.
It’s important to be educated. Next time
you are offered any form of invasive therapy such as needling, enquire as to
the practitioner’s qualifications and experience before consenting to the
procedure.
Helena Nyssen
Ba. Applied Science (TCM)
Dip. Remedial Massage
Helena is a registered Chinese Medicine
Practitioner, and Remedial Massage Therapist at Journey Healthcare in
Leichhardt NSW. You can visit Journey Healthcare at www.journeyhealthcare.ntpages.com.au
or call on 0404 0505 13. We look forward to hearing from you!
References
Janz,
S., Adams, J. (2011). Acupuncture by another name. Australian Journal of
Chinese Medicine, 6(2), 3-11.
World
Health Organization. Guidelines on Basic Training and Safety in Acupuncture.
1999 [cited April 9 2011]. Available from:
<http://apps.who.int/medicinedocs/en/d/Jwhozip56e/>.
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