To the best of my understanding, dry needling, which is practiced by physical therapists, typically involves the insertion of acupuncture needles into and around trigger points. I think trigger points can help a muscle release and decrease local inflammation, but I think treatments are more effective when combined with other acupuncture points. So in my practice, I usually combine local trigger points, hua tuo jia ji points that are located on either side of the spine, and more distal channel points near the hands and feet. By stimulating hua tuo jia ji points I hope to treat the entire dermatome of that particular level of the spine. Distal points along the channel (around wrists and ankles) have been shown on fMRI to have a stronger impact on the central nervous system than local points. Some evidence suggests that acupuncture is more effective than dry needling, perhaps because distal points are not included in dry needling.
I have also been told by some patients and physical therapists that dry needling can be intense and painful. Some styles of acupuncture are more aggressive as well. My needling style is more gentle and not at all painful, yet still completely effective.
My favorite self-care resources
I find that acupuncture does a good job preparing the muscles and other tissues for other types of bodywork. The effects of massage, chiropractic, and physical therapy are often enhanced when combined with acupuncture. I encourage my patients to look for trigger points on their own bodies, and use different at home techniques like foam rolling. I find patients who do such work usually maker faster progress, and in the long run, they are able to do their own maintenance.
Our bodies need maintenance or they break down. If you’re interested in doing some trigger point work on yourself or other myofascial release, check out The Trigger Point Therapy Workbook or The Roll Model. Fitness enthusiasts will like the work of Dr. Kelly Starrett and his daily mobility prescriptions. Check out mobilitywod.com and Becoming a Supple Leopard.
I love the work of Dr. Loren Fishman, a medical doctor and yoga therapist who practices rehabilitative medicine. Dr. Fishman has several helpful books on yoga, including a book on arthritis and a book on back pain. His latest book “Healing Yoga” covers many topics, and includes a yoga protocol he has used successfully to treat hundreds of patients with torn rotator cuff injuries.
Mindfulness-based meditation can be very helpful for more chronic or severe pain, or pain that is exacerbated by stress. “Full Catastrophe Living” by Jon Kabat Zinn is a great place to start. That book helped me years ago after a back injury. I had terrible burning, stretching pain across my upper back that kept me awake for hours at night. I tried every conventional and alternative therapy I could think of, but nothing gave me much relief. After reading this book, I would stop and closely observe my back pain, moment to moment. This seems counterintuitive. Usually when we are in pain, we try and avoid it or block it. I realized by watching the pain very closely that it did fluctuate. Also, when I thought about the pain, or when I felt upset about the pain, it became much worse. This realization allowed me to have greater equanimity about the injury. It still took another month or two to completely heal, but the pain no longer controlled my life. Kabat Zinn’s audio CD “Mindfulness Meditation for Pain Relief” is great for those people who want to jump into a practice without reading a book.
I treat many patients with either acute or chronic pain problems, including back pain, neck pain, shoulder pain, sciatica, osteoarthritis, and plantar fasciitis. In many cases I combine acupuncture with cupping therapy and a little bit of tui na massage. The combination of these three modalities provides the best results, particularly for neck and back pain and plantar fasciitis. In short, acupuncture excels at the treatment of pain, and the majority of my patients see relief in a relatively short amount of time.
How does acupuncture work for pain?
A large scale meta-analysis published in the Journal of the American Medical Association in 2012 demonstrated that acupuncture is more effective than traditional Western care for chronic headache, low back pain and osteoarthritis. You can read the entire study here.
Despite a lot of research, the mechanisms of acupuncture are not fully understood. One fascinating area of research is the effect of acupuncture on connective tissue. When an acupuncture needle is inserted into the connective tissue, cells wrap around the needle stretch, sending out signals to surrounding cells in a process called mechanotransduction. A growing number of researchers believe that chronic pain may be caused by changes in the connective tissue. Connective tissues contain sensory nerve endings that can transmit pain when the tissues are stretched in the presence of inflammation. Ultrasound studies have demonstrated that the connective tissues that surround the muscles of the back are thicker in people with chronic low back pain. You can read more about this research in the article, “The Science of Stretch”. Other studies of acupuncture on subjects during fMRIs have shown changes in brain activation, suggesting that acupuncture has an effect on the central nervous system, and might also modulate the brain’s perception of pain.
Is acupuncture different from dry-needling?