Trigger Point Dry-Needling and Acupuncture
The Trigger Point Needling Debate
Many practitioners of Trigger Point Dry Needling (TDN) assert that their treatment methods are entirely different from the methods of Acupuncture in Traditional Chinese Medicine (TCM). In this article we will explore the similarities and differences between these modalities and why one treatment method may be more helpful than the other for specific conditions.
To begin, TDN and TCM acupuncture have a great deal of similarity. Both methods utilize thin, sterile needles, called filiform (or acupuncture) needles. In both methods, filiform needles are inserted into the skin and muscle layers and are the primary tool used to provoke a change in the patient's body. When inserted, filiform needles have been shown to stimulate muscular neurons and neuro-vascular complexes in the body, thereby provoking the body into changing its current functional state.
Another commonality is that both acupuncture and TDN treatments are often based on palpating areas of tension to find the best or most appropriate points for treatment. A palpation method is almost always done before TDN treatment and with a TCM acupuncture approach. Although the palpation methods vary widely, practitioners of both methods locate exact points based on palpation the skin and musculature, looking for areas muscle tension and areas that lack tonicity. After appropriate points are found, both methods use acupuncture needles to release areas of tension with a variety of needling techniques (more on technique later).
While Trigger Point Needling focuses on Western Anatomy as a model for point selection, acupuncture relies on both Western Anatomy and the classical meridian model. TDN practitioners will generally locate points based on a specific muscle's anatomy and in reference to the muscle belly, insertion and attachment points. In addition, muscle function and range of action is considered when selecting points. To start, TCM practitioners will look for pain syndromes and how they relate to the meridian or channel system. In TCM theory there are 12 main meridians that run up and down the body. Although these meridians are different from strict Western anatomy mappings, there is a great deal of correlation between the TCM channels with nerve, artery and muscular pathways. TCM practitioners are not restricted to this meridian system and it is important to note that the Chinese were certainly very aware of human anatomy and mapped the meridians accordingly. As such, many TCM practitioners use an anatomical model for point selection in much the same way as TDN practitioners.
Do you think Physical Therapists should be allowed to practice Dry-Needling in certain states?
Methods and Techniques
The next topic of discussion is around methods for treatment and techniques used. While there are differences between treatment methods used, there are many similarities as well. TDN practitioners typically use a needling method where larger needles are employed with a rather strong technique to get a muscle belly to "fire" and release. When needling is done in this manner, the "trigger point" within a muscle belly will respond to the stimulation of a needle by a twitch response that can often be seen visibly and felt easily by both the patient and practitioner. In addition, the needles are not retained for long during TDN treatments. The needle stimulation is generally only 30-60 seconds after which time the needle is withdrawn and another point is selected.
TCM practitioners do not often employ the strong "trigger-point" technique described above, but they are certainly not exempted from doing so. It is important to note that there is a huge range of treatment styles for TCM practitioners. Some use a very light technique, as in Japanese acupuncture, where the patient may not feel any needling sensation during treatment. In contrast, other TCM practitioners use a stronger stimulation method where the needles are "lifted and thrusted" until the patient experiences a distinct sensation of warmth, heaviness or distension at the point. TCM practitioners generally retain the needles for 10-45 minutes, depending on the condition, while the patient is left to relax. Allowing the patient to relax with the needles in place is a way to get the body to have a stronger and more prolonged response to the treatment.
The last topic of discussion is which conditions are best addressed by each method. TDN is most commonly used for sports injury, body pain and muscular imbalance. Usually, TDN is employed for conditions like neck or shoulder pain, and performed in conjunction with physical therapy. Traditional acupuncture represents a medical system with 3000+ years of history, and can be used for a wide variety of diseases and ailments, both physical and mental/emotional. The National Institutes of Health (NIH) has determined that acupuncture is a safe and effective treatment for a variety of common health conditions including body pain (musculoskeletal), breathing problems (allergies, asthma, infections), skin & dermatology (acne, psoriasis, eczema) and digestive gastrointestinal (IBS, constipation, abdominal pain, hepatitis). Additional concerns well-treated by acupuncture include: headache, anxiety, depression, insomnia, and auto-immune diseases.
Based on the discussion above, it should be clear that there are a great many similarities and differences between Trigger Point Dry-Needling (TDN) and TCM Acupuncture. While the needles used are the same, the treatment techniques and point locations sometimes differ. In addition, the conditions treated with TDN are quite limited compared to the range of conditions that can be treated with traditional acupuncture. Although there is some discussion on whether TDN should be practiced outside of the context of traditional acupuncture, it can be hoped that a great many people will get benefit from both methods, provided the levels of training are sufficient to ensure patient safety.