The Growing Role of Dry Needling in Pain Management
Dry needling has rapidly gained popularity as a treatment for musculoskeletal pain. Originally developed by Western medical practitioners to address trigger points, it shares significant overlap with orthopedic acupuncture techniques. However, as dry needling becomes more widespread – particularly among physical therapists – acupuncturists face a critical moment:
- Nearly 40 states now allow physical therapists (PTs) to perform dry needling, with more expected to follow.
- Physical therapists outnumber acupuncturists nearly 10 to one in the U.S. If just 10% of PTs become certified in dry needling, they would match the entire acupuncture workforce in size.
- Demand for dry needling is rising, with increased Google search interest, growing research publications, and endorsements from professional athletes.
Despite these trends, licensed acupuncturists remain the most qualified providers of dry needling. With thousands of hours of hands-on training in needle techniques, anatomy and palpation, we are uniquely positioned as the true experts in therapeutic needling.
This Has Been Decades in the Making
The expansion of dry needling by non-acupuncturists is not new – it’s the result of decades of missed opportunities. While acupuncture has always included trigger-point needling techniques, the profession did not claim this space early enough, allowing others to step in. Now, the legal landscape is unlikely to change; most states that have permitted dry needling for PTs will not reverse course. The focus must now shift to positioning acupuncturists as the foremost experts in this technique, rather than fighting to restrict others.
One key lesson from PTs is that patients trust providers not because of training hours, but because of communication. PTs have shown that even with minimal dry needling training, patients will accept and value the treatment as long as it’s explained in a way that makes sense to them.
Unfortunately, acupuncture often fails in this area, relying on esoteric language and metaphors that make it harder for patients to grasp its benefits. If acupuncturists want to reclaim leadership in dry needling, we must focus not just on skill, but also on clear, accessible communication.
Acupuncturists Have Been Talking About This for Years – But Nothing Has Changed
For years, Acupuncture Today has published articles warning about the spread of dry needling by non-acupuncturists. Many have argued for stronger legislative efforts, tighter regulations or better public education. Yet the landscape has only gotten worse for acupuncturists:
- More states have legalized dry needling for PTs.
- More patients associate dry needling with physical therapy instead of acupuncture.
- More healthcare providers refer patients to PTs for needling instead of to acupuncturists.
- There are new insurance codes that reimburse dry needling treatments.
Talking about the problem hasn’t changed the outcome. If anything, it has given us a false sense of taking action. Instead of continuing to debate whether dry needling belongs to acupuncture, we need to actively claim our role as the best-qualified providers. That starts with better training, clearer messaging and a unified professional stance that dry needling is an essential part of acupuncture practice.
Internal Divisions Are Holding Acupuncturists Back
If you’ve ever spent time in an acupuncturist Facebook group, you’ve probably seen the endless debates and infighting over dry needling. Some practitioners argue that embracing dry needling is “selling out,” while others insist it is simply part of what acupuncture has always done. Meanwhile, patients – and other healthcare providers – don’t care about these debates. They just want results.
While the acupuncture profession has been busy arguing over terminology and ownership, PTs, chiropractors and even athletic trainers have been moving forward, positioning themselves as the primary providers of dry needling. The reality is that patients are choosing providers who confidently explain how and why dry needling works – not based on who has the most hours of training.
Instead of fighting over whether dry needling “belongs” in acupuncture, acupuncturists should unite around the fact that we are the most qualified professionals to perform it. If we don’t take ownership, others will continue to take the lead while we remain on the sidelines.
Acupuncture vs. Dry Needling: Key Similarities and Differences
While both acupuncture and dry needling use thin filiform acupuncture needles, they differ in approach:
- Acupuncture (including orthopedic styles) treats a range of conditions, integrating systemic and local points for long-term balance and overall physiological regulation.
- Dry needling specifically targets myofascial trigger points, often used within a physical therapy session for localized pain relief and neuromuscular dysfunction.
However, while many acupuncturists already use trigger-point needling techniques, such as ah shi needling, it is important to recognize that dry needling is more than just needling painful spots. Dry needling operates within its own distinct treatment paradigm, which includes:
- A structured approach to diagnosis, based on identifying trigger point etiology, referral patterns, and muscle dysfunctions rather than meridian-based pathology
- A focus on neuromuscular dysfunction, emphasizing the relationship between muscles, movement patterns and biomechanical imbalances
- Specific techniques for trigger-point deactivation, including precise palpation, eliciting local twitch responses, and understanding the physiological effects of needling on muscle tone and motor inhibition
Simply performing ah shi needling or inserting needles into painful areas does not equate to full training in dry needling. While the mechanical action of the needle may be similar, the diagnostic framework, treatment strategy, and clinical reasoning behind dry needling require specialized training in myofascial pain syndromes, biomechanics, and muscle referral patterns.
Acupuncturists who wish to fully integrate dry needling into their practice should ensure they have training in its specific methodologies to maximize effectiveness and communicate treatment rationale in a way that aligns with both patients’ and other healthcare providers’ expectations.
Why Acupuncturists Should Take the Lead
Acupuncturists have the deepest training in needle techniques, far surpassing the limited coursework required for PTs to perform dry needling:
- Education and Expertise: Acupuncture programs provide thousands of hours of hands-on needling instruction, compared to as little as 20-80 hours in some PT dry needling courses.
- Patient Safety: Licensed acupuncturists are rigorously trained in needle safety, anatomy, and depth control, reducing risks like pneumothorax or nerve injury.
- Holistic Skillset: Acupuncturists treat not just isolated muscles, but also underlying dysfunctions, making treatments more comprehensive.
A Call to Action: Acupuncturists Must Embrace Dry Needling
To maintain leadership in needle-based therapies, the acupuncture profession must proactively integrate dry needling into training and practice.
For individual practitioners:
- Get trained in orthopedic acupuncture and trigger-point dry needling techniques if not already.
- Use clear language – patients search for “dry needling,” so make it easy for them to find you.
- Market expertise – highlight advanced needling skills in clinic materials and online.
For the profession:
- Incorporate dry needling into acupuncture school curricula to ensure all new graduates are proficient.
- Push for dry needling to be recognized as part of acupuncture licensing and board exams.
- Engage in public education and advocacy to position acupuncturists as the go-to providers for all therapeutic needling.
Final Thoughts
Dry needling is not a passing trend – it is becoming a mainstream pain management tool. If acupuncturists do not take ownership of this skill, others will fill the gap. By embracing dry needling within our scope, we can solidify acupuncture as the gold standard in needling therapies and ensure patients receive care from the most qualified providers.
The acupuncture profession has spent too much time fighting about dry needling while others have capitalized on its growth. Acupuncturists have been publishing warnings about this issue for years – yet the situation has only gotten worse. Patients don’t care about our internal debates; they care about finding effective pain relief. If we don’t claim our expertise in dry needling, we risk becoming irrelevant in one of the fastest-growing areas of musculoskeletal pain treatment.
Now is the time to step up and lead.
Resources
- State Laws and Regulations Governing Dry Needling Performed by PTs. American Physical Therapy Association (APTA), 2025.
- Occupational employment and wage statistics for physical therapists. Bureau of Labor Statistics, 2023.
- Gattie E, Cleland JA, Snodgrass S. A survey of American physical therapists’ current practice of dry needling: practice patterns and adverse events. Musculoskel Sci Practice, 2020;50:102255.
- Temel MH, Erden Y, Bağcıer F. Public interest in dry needling: a Google Trends analysis. J Bodyw Mov Ther, 2024;40(5):953-958.
- NCCAOM Dry Needling Position Statement. National Certification Commission for Acupuncture and Oriental Medicine, 2017.
