A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling. She told me it was painful and that instead of giving her relief, it actually flared up her neck condition even worse.
Curious about the chiropractor, I read his website which said, "needling is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle."
"It is not the same as acupuncture, an aspect of traditional Chinese medicine, which is based on the metaphysical theory of normalizing energy flow in the body. Dry Needling is a Western medical technique that is based on scientific studies and knowledge."
Dry Needling
These descriptions of dry needling and acupuncture are on par with what can be found consistently on chiropractors' and physical therapists' websites, and it demonstrates a fundamental lack of understanding and perhaps a desire to undermine the scientific validity of acupuncture, which is both based on a foundation of ancient physiological wisdom and backed by modern evidence-based research.
In the U.S., to become a licensed acupuncturist, one must receive thousands of hours of training to earn a Master of Science, wherein they learn how to safely needle patients. On any area of the body, a trained acupuncturist can tell you how deeply a needle can safely be inserted, how intensely the needle can safely be stimulated and if intense stimulation is necessary at all.
In many states, physical therapists and chiropractors are granted permission to perform dry needling after a weekend course (consisting of just 26 hours), yet acupuncturists are often faced with less trust by the public due to the widespread lie that acupuncture is not supported by science or an evidence-based medicine. In fact, a simple search in the Cochrane Library or Pubmed will reveal thousands of positive studies that support the validity of acupuncture and Chinese medicine.
Scope of Practice
The purpose of this article is not to knock chiropractic medicine or physical therapy. All of these modalities offer valuable healing to the wide array of healing that patients need. I frequently refer my own patients to local practitioners when I believe my patients' needs happen to extend outside of my scope. I practice with the fundamental belief that my colleagues in different healing professions are not my competitors, however valuable members of a team on which we each play valuable roles.
However, when a physical therapist or a chiropractor uses a filiform needle (the same that is used for acupuncture), and claim that they are practicing a different modality merely because they use different terminology, to describe identical techniques to those acupuncturists use, I do take issue with this. Not because they become my competition, but because it creates a public safety issue.
A Faulty Theory
Let's take a look at the aforementioned chiropractor's comparative descriptions of needling. He said acupuncture is, "based on the metaphysical theory of normalizing energy flow in the body." The word "metaphysical" denotes something supernatural. While acupuncture is indeed extremely complex, at large, practitioners of traditional Chinese medicine would agree that our theories are far from supernatural. Every detail of the body is mapped out by a channel system.
This aspect of Chinese medicine may be where acupuncturists lose support, because it sounds as though we are describing theoretical channels that have never been proven to exist. On the contrary, we are discussing the spaces between varying aspects of physical anatomy where body fluids flow; these are the spaces between tendons, sinews, arteries, veins and bones. Due to the very anatomy that we share as humans, these channels are the same on everyone.
Education is Key
Many people who are ignorant to the definition of acupuncture will tell you that acupuncture is different from dry needling, because in acupuncture, you needle "distally," or away from an injury, and with dry needling, you needle locally and not on acupuncture points, rather on trigger points.
For example, the term "trigger points," as they are often described in modern medicine, have been used by acupuncturists for thousands of years, and are called ashi points in Chinese medicine. I won't even bother to describe what they are, as the chiropractor already did a wonderful job describing this aspect of acupuncture, only he and others claim it is apart from our medicine, which it is not.
He said that acupuncture normalizes "energy flow in the body." This very elusive vernacular is unfortunately often used to describe acupuncture. However, modern acupuncture literature describes the physiological benefits of traditional Chinese medicine, with modern scientific terminology. The usage of words like "qi" or "energy," are traditional words that in modern medicine, may equate nicely to the word function.
At the Core of Needling
Placing a needle in the body elicits a cerebral response, wherein blood rushes to the site of the needle insertion in order to improve specific bodily functions. The moment a needle is inserted into the body, the practitioner (regardless of what title their license has) is performing acupuncture. Dry needling is supposed to be used specifically to release trigger points; however, it is already well defined that acupuncture performs this function in addition to internal medicine. Acupuncture's inclusion in treatment of internal medicine however, does not exclude the treatment of musculoskeletal conditions.
Descriptions like the above are a flagrant denial of the validity of a lineage that has endured millennia because it works. The advantage of acupuncture is being denied, because it is profitable for other medical professionals to claim it as their own and name it something else. The same has been done with other modalities that fall under the scope of Chinese medicine, including gua sha (termed "Graston technique" by chiropractors) and cupping.
Most acupuncturists I have spoken with do not feel as incensed over these other modalities, as they do not pose the same public safety risk as needling. On the other hand, it is a remarkable compliment to Chinese medicine that other professions are using our techniques, because they work and because there is nothing metaphysical or abstract about what we do. Regardless, it is professional plagiarism and lacks integrity and does not keep public safety at the forefront where it belongs.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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