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Dry needling vs. acupuncture: What the research says

 Last reviewed Thu 31 May 2018

By Jenna Fletcher



Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT


Dry needling and acupuncture involve puncturing the skin with thin needles for therapeutic purposes. While a shared aim is to provide relief from pain, the practices are otherwise very different.

Practitioners of dry needling attempt to release tension from knots and pressure points in muscles. Acupuncturists insert needles to release endorphins and affect the nervous system. Traditionally, acupuncture was used to align a person's energy, or chi.

While researchers have studied acupuncture as a complementary treatment for many conditions, dry needling is a newer practice, and the evidence is less comprehensive. Also, strict guidelines are in place for acupuncturists, but dry needling is not regulated.

In this article, learn more about the differences between these practices and what their benefits may be.


Dry needling vs. acupuncture

These practices share some similarities, and both claim to provide therapeutic relief from pain. However, they involve different methods and should not be confused.

  • People have used acupuncture for centuries, and it is now well regulated.
  •  Dry needling has been developed more recently, and there are no official guidelines.
  • Acupuncture can be used for a variety of medical conditions. The primary philosophy is that a body can be healed when chi, or healing energy, is released.
  • Dry needling is designed to relieve tightness and pain in muscles. Practitioners believe that inserting a needle directly into a knot or pressure point will release tension in the surrounding muscle.


What is dry needling?

The primary aim is to relieve muscle pain and cramping, but it may also help to improve a person's flexibility.

A practitioner inserts short, thin, stainless steel filiform needles into pressure points. Also called trigger points, these are tight areas or knots in the muscles. The needles contain no liquid, and nothing is injected.

Sports therapists and other physical therapists typically perform dry needling. Due to a lack of regulation and guidelines, a person can perform dry needling with minimal training and no license.

It is often very difficult to tell whether a practitioner has been trained, has adequate experience, or is performing the procedure correctly.

The most common practice is to leave a filiform needle in the muscle for 10–30 minutes.  However, there are two less common types of dry needling:

  • The in and out technique, during which a practitioner inserts a filiform needle into a trigger point and removes it right away. Results of a 2014 review suggest that this form of dry needling provides no benefits.
  • The non-trigger points technique, during which a practitioner inserts needles into surrounding muscle, instead of a knot or pressure point.


Scientific studies on dry needling are limited, though the body of research is growing. So far, some research has been positive, A study published in 2013 showed that dry needling was more effective than placebo treatment.  However, results of research in which no placebo was used have been less promising.  In a study from 2012, dry needling was found to be less effective than platelet-rich plasma injections at treating rotator cuff injuries.  Authors of a 2017 study concluded that stretching was just as effective as dry needling in improving flexibility.

Dry needling may be more effective than receiving no treatment, but more conventional and cost-effective methods, such as stretching and massage therapy, may be better at relieving muscle pain.


What is acupuncture?

  •  Acupuncture is used to relieve stress, pain, and discomfort.
  • Acupuncture is an ancient technique developed in China.
  • Proponents claim that it can relieve stress, pain, and discomfort by opening up a person's energy flow, or chi.

Medical acupuncture involves using long, thin needles to stimulate nerves in the muscles and under the skin.  This can result in the production of endorphins, which may relieve some symptoms.

Acupuncture is used to alleviate a wide range of symptoms, commonly including:

 To practice acupuncture, a person needs to be licensed and undergo extensive training. A master acupuncture therapist will undergo 3 or more years of training.  They will learn to identify symptoms, diagnose conditions, and use correct techniques with needles.

A senior member of a national board will supervise new practitioners.  Before receiving a license, a new practitioner must pass examinations from the national board, and they must continue to pass examinations each year after receiving a license.**

A wide body of research supports the use of acupuncture to treat many medical conditions, including migraines, depression, and arthritis.

A 2017 study found that regular acupuncture could help to prevent migraines, and a review from 2012 indicated that acupuncture may treat migraines as effectively as other medical options.

More research is needed to determine whether acupuncture can help to treat arthritis, but some people find that it can reduce associated pain.

Results of a 2018 review show that acupuncture may reduce the severity of depression in some people when used alongside traditional treatments.

Anyone interesting in trying acupuncture should speak with a doctor about finding a registered practitioner.



 Both needling practices can lead to temporary soreness and bruising around the insertion area.

Dry needling is usually considered safe if the practitioner uses sterile needles. Otherwise, a person is at risk of contracting blood-borne pathogens.

Further risks associated with dry needling are mild and relatively common. They include:

  • temporary soreness at insertion sites
  • bleeding at the sites
  • bruising at or around the sites

 People who receive acupuncture rarely experience side effects. When they occur, they often include bleeding, bruising, and mild pain.



Both dry needling and acupuncture may help to relieve muscle aches, pains, and tightness.

Acupuncture is a well-regulated procedure. Needles are inserted at strategic points to stimulate the flow of energy throughout the body. While some evidence is inconclusive, acupuncture is widely recognized as helpful in treating certain ailments.

Dry needling was developed much more recently. With no formal regulations in place, a person has a much higher risk of experiencing side effects. There has been little research, but some people find that this practice reduces pain.

Before trying dry needling or acupuncture, consult a doctor and research available practitioners.


** Currently the apprentice style education is very rarely licensed which is what appears to have been described here.  The common method of education is a 3-4 graduate degree that includes supervised internship with patients and then national board exams to qualify for the state license to practice. 







This article can be found on QUARTZ




Is dry needling a safe acupuncture replacement, or a shortcut around years of essential training?

By Christine Haughney  May 23, 2017



Torin Yater Wallace, a 21-year-old Olympic freeskier and lover of extreme sports, has suffered his share of broken bones and hospital visits. But none of those injuries rivaled the pain he felt after he believes a physical therapist punctured his lung just before the 2014 Winter Olympics. The therapist was trying to help his shoulder pain with an increasingly popular type of therapy called dry needling.

“Collapsing my lung was one of the worst things medically,” Yater-Wallace said. “And I’ve gone through so many different broken bones. I would hate for anyone to go through what I did from going to a physical therapy appointment.”

But dry needling hasn’t just been a problem for Olympians. Steven Torres, a 30-year-old hairstylist and avid weight lifter from New Jersey who suffers from shoulder pain, questioned the benefits of dry needling after a physical therapist bore needles into his body that caused bleeding.

“They kind of just explained it was relaxing the muscles,” Torres said. “It did not help, not one bit.”

As patients continue to search for ways to ease their pain, physical therapists are offering them relief by applying dry needles to the body with a process they call dry needling. It has become so popular among practicing physical therapists that training companies like Kentucky-based Kinetacore have taught roughly 6,000 physical therapists in recent years, the company’s chief executive Edo Zylstra has told the press. Its popularity is also growing among future physical therapists as schools like Columbia University include it in the doctoral physical-therapy curriculum.

But the rise of dry needling troubles acupuncturists who say that it’s just acupuncture without the years of training. Acupuncturists typically complete three-year graduate programs, whereas physical therapists start dry needling after a weekend course. Acupuncturists are having their worst fears about dry needling confirmed as they watch physical therapists and patients post their dry-needling experiences on social media. One troubling tweet featured a photo of a Columbia University doctoral physical-therapy student with a banana she stuck with needles and wrote “when you’re too nervous to stab yourself so you have to dry needle a banana.”

“Dry needling is acupuncture. This is a huge public-safety issue,” said James Shinol, acting president of Acupuncture Society of New York, who is a member of the group’s task force to combat dry needling in New York State.

The battle about whether it’s legal for physical therapists to use needles for therapy is playing out across the nation. Six* states, including New York and California, have banned it entirely. Both patients who have had bad dry needling and local acupuncture societies have been filing lawsuits. Brent Foster, an Oregon-based lawyer, has worked on six lawsuits involving dry needling since 2014 and only sees inquiries about potential cases growing.

“Over the last year, there has been a major upsurge in interest,” Foster says, who has added three of his six cases since last summer.

There have been some wins for acupuncturists. This past summer, the American Medical Association issued a statement that only licensed acupuncturists and doctors should be able to perform acupuncture. Courts in California and Washington State have banned Kinetacore from teaching workshops there.

Dry needling is expanding largely because the physical-therapy industry is far larger and more influential than the acupuncture community.  In New York State, there were 22,077 licensed physical therapists compared to 4,146 acupuncturists in 2015, according to the New York State Office of the Professions. Physical therapists also have more influence in Washington, DC; the American Physical Therapy Association has a $43.5 million budget and represents more than 95,000 members, according to its website. By comparison, the American Association of Acupuncture and Oriental Medicine does not even have a contact phone number on its website. (**update: (651) 631-0204**)

Mona Lee Yuan, a licensed acupuncturist and physical therapist from New York, has been working with both state and national groups to stop physical therapists from performing dry needling. But she recognizes it may be difficult.

“Because of the vast numbers of PTs in the United States, numbers matter,” Yuan said. “They are able to do more. They have more funds for lobbying.”

There’s also a push to continue teaching dry needling even in states like New York, where it is illegal. Acupuncture groups have been contacting the New York State Board of Education and Columbia University asking why it can still teach dry needling to its doctoral physical-therapy students when it’s banned in the state. In a July 26, 2016 email that Melissa Begg, vice provost for Columbia’s academic programs, sent to state officials, she wrote that because dry needling is allowed in 19 states, “we therefore introduce the topic to our students so that they are aware of it, should they return to practice in a state where it is permissible.” Karin Eskenazi-Tzamarot, a Columbia University Medical Center spokeswoman wrote in an email that “we don’t have any plans to modify our doctoral PT program.”

Because the physical-therapy industry is so much larger, dry needling cases also aren’t as big of a problem as they seem to be to the far smaller acupuncture community. A Jan. 2016 report released by the HealthCare Providers Service Organization, which provides malpractice insurance to physical therapists, noted that while there was only one complaint about dry needling in its 2011 report, it handled “several dry-needling-related claims” in the years that followed. The study highlighted four cases where patients were hospitalized.


But Justin Elliott, vice president of government affairs for the American Physical Therapy Association, noted in an email that the 25 dry needling complaints made between 2011 and 2015 made up less than 1% of the industry’s overall 3,877 complaints.

In the end, the biggest victims of this are patients. Acupuncturists argue that they’re receiving dangerous care. Physical therapists rebut they’re helping heal patients.

“There’s no shortage of patients who need health care services.” Elliott said. “We need to stop these turf battles.”


Please note: An earlier version of this article listed the number of states that ban dry needling as eight. The sentence has been corrected.