What’s The Difference Between Dry Needling and Acupuncture?

Though both use needles, the ways dry needling and acupuncture work are actually different. Here's what you need to know about these recovery and injury treatment methods.

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When it comes to recovery methods, some athletes go for the sharpest tool possible: needles. Once the domain of holistic wellness, acupuncture and dry needling have come into the mainstream as a bona fide recovery methods for endurance athletes. On the surface these two treatment modalities may seem the same, but in reality they work in different ways. What’s the difference between acupuncture and dry needling, and how each one might fit into an endurance athlete’s training and recovery regimen? What happens during an acupuncture or dry needling appointment, and how can a good practitioner be located? Let’s take a stab at your acupuncture vs. dry needling questions.

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Acupuncture for endurance athletes

Acupuncture is based on the ancient Chinese theory that health results from the alignment of qi, which means “vital energy.” Traditional beliefs are that qi flows along channels known as meridians, with blockages or excesses leading to disruptions in wellness. Acupuncture aims to restore health by inserting needles into specific points (approximately 350 exist) along the 14 meridians to allow the proper flow of qi.

According to licensed acupuncturist Charlie Sylvester of Acumedizen, acupuncture has been used to treat a wide variety of conditions, including pain, asthma, hypertension, IBS, anxiety, and headaches. More recently, traditional Chinese acupuncture has been adapted into a more evidence-based Western medical acupuncture, which aims at stimulating the nervous system, vs. solely relying upon traditional acupuncture points. This approach has been mostly used to treat myofascial pain, and has indications for addressing various causes of nausea, as well.

Sports acupuncture blends both traditional Chinese acupuncture and sports medicine techniques (that, according to Sylvester, overlap with dry needling), addressing both local impairments, as well as underlying systemic issues and overall health. The exact physiological mechanism of how acupuncture works has not been definitively determined—various hypotheses include hormonal changes, physical pressure, natural opioid release, nervous system changes, and even the placebo effect. But what we do know is that stress hormones are reduced by acupuncture, the parasympathetic (“rest and digest”) nervous system is activated, and inflammation seems to be reduced.

What happens at an acupuncture appointment?

At an acupuncture appointment, the practitioner will begin by taking a thorough history, addressing all systemic concerns, including mental and emotional states, followed by a physical exam.

Fine, sterile needles are inserted into targeted points along the meridian pathways with a light tap to insert the tip of the needle into the surface of the skin—most of the time, you probably won’t even feel the needle going in—and left in place for about 10-20 minutes. A “tugging” of the needle in the skin may be felt, and the patient may experience numbness or mild radicular symptoms, which are considered desirable. According to Sylvester, points may be targeted at certain organs, depending upon patient symptoms, and other therapies such as cupping or herbal remedies may be included.

Acupuncture can be considered by athletes for both mental and physical benefits. While an athlete experiencing a more specific issue may wish to seek out dry needling (more to follow), the stress reduction and overall systemic health benefits of acupuncture across a variety of conditions can help more globally. Just avoid acupuncture right before that hard workout; Sylvester advises against strenuous exercise after treatments.

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How to find a sports acupuncturist near you

Acupuncturists are highly trained, completing 2,000 to 3,000 hours of training in 3- to 4-year Masters-level programs, followed by state licensure exams as required. Acupuncturists may work as solo practitioners, or within interdisciplinary settings, such as naturopathic offices, pain clinics, or primary care settings. A good place to start your search for a licensed acupuncturist is to visit the National Certification Commission for Acupuncture and Oriental Medicine. While “sports acupuncture” is a general term with no clear guidelines, triathletes likely would still want to seek out practitioners marketing themselves to athletic populations for comprehensive care. Some acupuncturists, such as Sylvester, have experience working with professional sports teams, and are well-versed in the needs of all athletes.

Dry needing for endurance athletes

In contrast to traditional acupuncture, dry needling is a newer procedure most commonly performed by physical therapists, though chiropractors, physicians, and acupuncturists also may also become trained in the procedure. The process involves inserting a fine needle (without medications, hence the “dry” designation) through skin and subcutaneous tissue into targeted tissues in order to decrease pain and improve motion.

According to physical therapist and triathlete Caitlin Sapp, PT, DPT, CIDN, of Crew Racing & Rehab, tissues can include muscles, tendons, ligaments, or nerve pathways. A common target are muscular trigger points, which are hyper-irritable, palpable nodules that develop within taut bands of tissue within muscles in response to stress from repetitive loading or prolonged postures.

“Dry needling can be extremely effective in aiding an athlete’s recovery,” Sapp said. “The response of the intervention is happening at the level of the tissue.” Dry needling is thought to elicit nervous system changes both locally and centrally that reduce sensitivity, improve range of motion, decrease muscle tone, and decrease painDry needling has also been found to be a safe and effective treatment for chronic tendinopathies by helping to disrupt degenerative processes and encourage healing. According to Sapp, dry needling creates very small traumas within target tissues, which serves to trigger healing responses.

“The physical therapist inserts the needle and the body thinks, Oh no, I have been injured,” Sapp said, “so what happens is that the body responds by increasing blood flow, tissue perfusion, and all the healing capacities the body needs to restore and recover.”

What happens at a dry needling appointment?

At a dry needling appointment, the practitioner will start out by taking a history, and performing a physical exam to identify movement impairments and palpate for trigger points. During dry needling, a fine needle will be inserted through the skin into targeted tissues. The patient might feel a small pinch as the needle is inserted through the skin, followed by soreness, aching, or a muscle twitch as it pierces into the muscle.

The depth of insertion and length that the needle is left in can vary, depending upon location and duration of pain. Dry needling is often accompanied by other treatments to maintain range of motion and alignment, such as strengthening and mobility exercises, done separately from the needling procedure itself.

Dry needling for tendinopathies is done differently, with the needle being inserted and removed repeatedly, usually about 20-50 times. According to Sapp, treatment can fit into an athlete’s regime in multiple circumstances: “Most athletes don’t get too much post-treatment soreness, hence it’s great before your big event. It can also aid in recovery after a race or large training block.”

Sapp also recommends dry needling for running-related soft tissue injuries (muscle, tendon, or ligament problems) as “a great tool to have in your treatment as a way to reduce pain and irritation.”

How to find a dry needling appointment near you

In order to find a practitioner, first check state regulations. While the American Physical Therapy Association considers dry needling to be within the scope of practice for physical therapists, state laws and regulations vary, with most states allowing it, some prohibiting it, and others having no clear opinion. Regardless, dry needling is generally not included in entry-level curriculums, so be sure to read website bios, and seek out a practitioner who has completed continuing education coursework in the area. Look for clinics that advertise to athletes, and whose scheduling allows for one-on-one time between therapists and patients. A therapist who specializes in treating endurance athletes is also a plus-again, research local clinics, or ask for recommendations among local triathlon or running clubs.

While getting stuck with needles might not seem like the most pleasant experience on the surface, when it comes to sports and recovery, the benefits can be many! Consider needs, and think about giving acupuncture or dry needling a try in order to help keep your body happy.

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