What Is "Dry-needling"?
A purportedly new & emerging Western technique applied to musculoskeletal "trigger points" that are traditionally used in physical therapy, chiropractic, and massage and called "Ashi" points in Chinese Medicine. DN may also include the medical treatment of traditional acupuncture points.
Defining statutory & ethical regulation - the debate:
A concern is that Medicare/ Medicaid covers DN by physical therapists, but not Acupuncture Medicine by Doctors of Oriental Medicine. The public, not really understanding the differential between the two, defaults to what Medicare/ Medicaid pays for- thinking DL IS acupuncture!
While DN uses the tool of acupuncture (the filiform needle), it does NOT represent or replace the expertise of an trained & licensed Acupuncture Professional when acupuncture points are treated medically. Physical therapists are required to take a 4-day seminar in DL. Doctors of Oriental Medicine are required 3000+ hours of study in Chinese Medical Theory, acupuncture & herbal pharmacology; and Western Physicians are required a 300 to 500 hour certification in Medical Acupuncture (neuro- anatomical).
American Medical Association [AMA) Policy on DN:
" Physical therapists and other non-physicians practicing Dry-needling should – at a minimum – have standards that are similar to the ones for training, certification, and continuing education that exist for acupuncture ...[there are] Lax regulation and nonexistent standards surround this invasive practice [performed by physical therapists]. For patients' safety, practitioners should meet standards required for licensed acupuncturists and physicians".
CCAOM Policy on DN:
"Any intervention utilizing DN is the practice of acupuncture, regardless of the language utilized in describing the technique. Using a different name for the same technique does not create a new technique. The renaming of acupuncture to DN, and the adaptation of DN to provide total body treatment by physical therapists poses the greatest risk to the public, as it circumvents established standards for identical practice, i.e., acupuncture, without the rigorous training of acupuncture and the licensing of such".
Our Position on DN:
In Chinese Medicine, trigger points are called "Ashi", which are stimulated using skilled needled and/or non-needle techniques [Scratch or Touch Needling, Chisel Needle, Stuck Needle, Fire Needle etc. to move Wei qi, release fascia, break blood stasis etc.]
The expertise of the Acupuncture Professional in using these techniques is determined by the patent's diagnosis, underlying conditions & constitution, Chinese Medical Theory, and no less than 2500 years of scholarly debate & documented clinical application starting around 230 AD - birth of Christ [Nix, n.d.]. It is not a NEW invention.
What remains elusive to rationale for DL by a physical therapist, are the many ways acupuncture points & meridians interact. Theories of interaction (e.g. Luo, Sinew, Divergency, 6 System etc.) remain the expertise of professionally and classically-trained acupuncturists. Without such knowledge, acupuncture does not work to maximum efficacy in more ways than just pain management.
Manaka, Itaya & Birch (1995).