October 27, 2014
What looks like acupuncture, feels like acupuncture and employs the same instruments as acupuncture but is practiced by physical therapists (PTs)?
Dry needling is defined by the American Physical Therapy Association as “a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Dry needling (DN) is a technique used to treat dysfunctions in skeletal muscle, fascia and connective tissue, and diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation.”1
The PT description of DN resembles that of scientific medical acupuncture: “The performance of modern dry needling by physical therapists is based on Western neuroanatomy and modern scientific study of the musculoskeletal and nervous system.”2
A big difference between PTs and medical acupuncturists is that physician and veterinarian medical acupuncturists treat not only pain and myofascial dysfunction but also address digestive, immunologic, cardiopulmonary and a host of other disorders.
As with acupuncture, DN requires clean needling technique and awareness of underlying anatomy to avoid complications such as major vessel or organ puncture. Like acupuncture, DN involves palpating for tenderness and taut bands.
In both cases, the practitioner is seeking to deactivate trigger points and release myofascial restrictions responsible for referred pain and nerve compression. And finally, PTs may introduce electrical stimulation in order to augment the effects—the same way an acupuncturist would.
However, PTs cannot call this “acupuncture” in states that disallow it. Nonetheless, this may benefit PTs because they can utilize the technique without being burdened by the baggage that Chinese medicine-style acupuncture brings. PTs already enjoy broader acceptance by conventional practitioners than that afforded to most acupuncturists; even clinicians in the scientific camp face the ongoing challenge of distancing themselves from myths and make-believe.
What are some of these myths? See if you’ve heard them, and even believed them, before hearing the scientific explanation.
Myth: “Acupuncture works by moving Qi, the body’s vivifying energy.”
Fact: The Chinese word “qi” or “chi” literally means “air” or “breath”—not “energy.” The notion that acupuncture moves energy arose from a mistranslation of “qi” into the word “energy” in the early 20th century.3
This “energy” often alluded to in books on Chinese medicine and New Age healing perpetuates this error, referring to acupuncture as “energy medicine” rather than recognizing its rational basis: a system that invokes neuromodulation and mechanotransduction of impulses throughout connective tissue.
Myth: “Acupuncturists need to perform a Traditional Chinese Medicine (TCM) examination, including tongue and pulse diagnosis.”
Fact: Chinese medicine practitioners may claim that an acupuncturist needs to perform the folkloric approaches of tongue and pulse diagnosis before treating patients in order to get an “accurate” picture of the patient’s problems. In reality, neither tongue nor pulse diagnosis has been shown, through research, to be either necessary or reliable for effective treatment with acupuncture or dry needling.4
According to an interview with Adrian White, MD, editor in chief of Acupuncture in Medicine, “Shrouding acupuncture in the mystery of Chinese philosophy has … prevented health care professionals from providing acupuncture themselves.”
White stated: “[They] already know how to diagnose, and they already know a great deal about anatomy and physiology, so they can easily learn to practice acupuncture safely and effectively.”5
There are seemingly endless other unfounded ideas that circulate among belief-based acupuncturists. These include claims such as needles made from different metals producing distinctive clinical outcomes, that twirling or inserting needles in one direction or another makes energy increase or decrease at a site6 and that certain patterns of tender points along a horse’s body are indicative of infectious illness such as herpes7 and equine protozoal myeloencephalitis.8
Of course, the skeptics have their own myths:
Myth: “Any benefits attributable to acupuncture arise as a result of it being a highly ritualized placebo.”
Fact: Denying that acupuncture/dry needling has beneficial effects on the nervous, musculoskeletal and other systems ignores many scientific studies and systematic reviews accruing in acupuncture’s favor.9
Myth: “Acupuncture points and channels do not exist.”
Fact: Acupuncture points and channels are not discrete anatomical structures but merely represent specific sites along nerves, vessels and myofascial cleavage planes.10
While scientific medical acupuncturists may welcome the camaraderie of other like-minded colleagues performing DN, the political landscape shows that TCM acupuncturists aren’t so happy. They see DN as identical acupuncture and therefore part and parcel of standard acupuncture practice.11 Already at odds with physician acupuncturists in some states and veterinarians in others, they perceive this “intrusion” of physical therapists into the needling domain as an “assault” and “very real threat” to TCM-style acupuncture.12
Perhaps at the heart of the turf battle over needling lies a desperate fear of losing patients to science-based practitioners who achieve reliable, clinically significant results without the accoutrements of Chinese medicine.13,14 Perhaps consumers are outgrowing their fascination with the exotic in favor of what works to treat their pain—efficiently, effectively and scientifically.
1 American Physical Therapy Association. Description of dry needling in clinical practice: an educational resource paper. Accessed at http://www.aaompt.org/documents/DryNeedlinginPTClinicalPracticeEducationalResourcePaper.pdf on 08-17-14.
2 American Physical Therapy Association. Physical therapists & the performance of dry needling. January 2012. P. 4.
3 Kresser C. Chinese medicine demystified (Part III): the “energy meridian” model debunked. Accessed at http://chriskresser.com/chinese-medicine-demystified-part-iii-the-energy-meridian-model-debunked on 08-17-14.
4 Robinson NG. TCM and the Chinese New Year. Veterinary Practice News. April 17, 2009. Accessed at http://www.veterinarypracticenews.com/April-2009/TCM-And-The-Chinese-New-Year/ on 08-17-14.
5 BMJ Online. Acupuncture is grounded in science, not myth and magic – British Medical Journal. March 13, 2009. Accessed at http://www.medicalnewstoday.com/releases/142119.php on 08-17-14.
6 Xie H and Preast V. Xie’s Veterinary Acupuncture. Ames, IA: Blackwell Publishing, 2007. Pp. 236-7.
7 Chvala S, Nowotny N, Kotzab E, et al. Use of the meridian test for the detection of equine herpesvirus type 1 infection in horses with decreased performance. J Am Vet Med Assoc. 2004;225:554-559.
8 Fenger CK, Granstrom DE, Langemeier JL, et al. Equine protozoal myeloencephalitis: acupuncture diagnosis. AAEP Proceedings. 1997; 43:327-329.
9 Robinson N. Veterinary medical acupuncturists point to science. Veterinary Practice News. March 27, 2013. Accessed at http://www.veterinarypracticenews.com/Medicine/Veterinary-Medical-Acupuncturists-Point-To-Science/ on 08-17-14.
10 Robinson N. The scientific basis of acupuncture pathways. Veterinary Practice News. September 30, 2013. Accessed at http://www.veterinarypracticenews.com/Medicine/The-Scientific-Basis-Of-Acupuncture-Pathways/ on 08-17-14.
11 Wisconsin Society of Certified Acupuncturists. The illegal and unsafe practice of acupuncture under the term “dry needling”: 10 facts you should know. Accessed at http://acupuncturewisconsin.org/dry-needling-10-facts-you-should-know-2/ on 08-17-14.
12 Rogel MJ. AOM under attack: lessons from active Illinois practitioners. Acupuncture Today. August 2012. Volume 13, Issue 8. Accessed at http://www.acupuncturetoday.com/mpacms/at/article.php?id=32608 on 08-17-14.
13 Thompson K. Can I complain a little? Acupuncture Technology News. May 7, 2012. Accessed at http://www.miridiatech.com/news/2012/05/can-i-complain-a-little/ on 08-17-14.
14 Doherty K. Cultivating a prosperity mentality. Acupuncture Today. October, 2007. Volume 8, Issue 10. Accessed at http://www.acupuncturetoday.com/mpacms/at/article.php?id=31603 on 08-17-14.
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