Did you know we can do Dry Needling?
It’s true, the needling techniques used in Dry Needling are among the first we learn in school. Dry Needling is an Acupuncture technique and as such should be performed only by professionals with an appropriate level of training such as a licensed acupuncturist or medical acupuncturist. Knowledge of anatomy and physiology is only one portion of the required skill set to safely and effectively use needles as a therapeutic tool. It is not a skill set that can be mastered in just a few hours.1
Acupuncturists understand the physiological basis for acupuncture as well as the underlying East Asian Medical Systems theory that underpins traditional treatment approaches (diagnosis, needling techniques, etc). Just because our licensure scope of practice isn’t full of biomedical definitions of acupuncture, it doesn’t mean that we don’t understand the physiological effect of our needles on our patients' bodies. A close examination of the acupuncture research literature easily shows the validity of this. Some acupuncture points and trigger points can be described using almost identical language when using biomedical definitions of these structures:
Trigger Point is a sensitive area in the muscle or connective tissue (fascia) that becomes painful when compressed. Pressing on a trigger point can cause referred pain and can help identify the external area in the body generating the pain.
Ashi acupuncture involves treating areas causing pain and dysfunction that are usually unknown to the patient, and which actually constitute the root cause of their physical pain or dysfunction. Adopting Ashi acupuncture as the primary treatment method when treating physical pain, numbness, tingling or burning due to inhibited circulation or nerve impingement, as well as a range of motion issues, is critical to clinical success.2
The term Ashi - literally 'Ah yes!' - Qian Jin Yao Fang (Thousand Ducat Formulas): ‘In terms of the method of Ashi, in speaking of a person who has a condition of pain, when squeezing, if there is a spot inside [we] do not ask if it is a [recognised] acupuncture point, because [we] located a painful spot and they said, “Ah yes!”. Needling and moxa-ing [the points] have proven effective in the past, thus they are called Ashi points.3
Use of Ashi or Trigger Points has been part of accepted acupuncture practice for over 4,000 years - the advent of biomedical terminology to describe them does not negate the long-standing history of these points as part of acupuncture practice. Simply needling a trigger point without addressing the underlying pattern of the patient (as is done in “dry needling” by those without in-depth training) can lead to poor outcomes for patients. Further, without appropriate training the idea that a “twitch” response is necessary for therapeutic benefit can lead to unnecessarily deep and aggressive needle techniques, undue pain and risk of injury to the patient. Lastly, without an understanding of acupuncture theory, efficacy of such techniques is often short-lived.
This issue is also complicated by the fact that most research into acupuncture and dry needling uses the same points, so it’s important to understand that many “trigger points” coincide with mapped acupuncture points and have actions far beyond the release of simple muscle tension.
“Trigger points can be verified objectively using magnetic resonance or ultrasound elastography or with intramuscular electromyography,”4 - As can acupuncture points - it is unclear in this article if trigger points are described as having the same anatomical structure as acupuncture points.
To get the most out of your “dry needling”, it is important to see a practitioner who understands the deeper framework behind these points, when to safely use trigger point needling, and when to use the other techniques and points to address any underlying issues causing the dysfunction in the first place.
Sources:
1AAMA Policy on Dry Needling | NCCAOM
2http://www.liveoakacupuncture.com/wp-content/uploads/2015/09/JCM-Ashi-Points-Article.pdf
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