Dry Needling Course

Yun-tao Ma, PhD, Lic Ac
Director American Dry Needling Institute

We came home from teaching Dry needling Course in Great Britain and found two
e-mails, posted on the same day. One was an enquiry from an oil contractor, who wrote: ”Do you know of anyone practicing dry needle therapy in the Houston/Galveston, Texas area? I have had great results from treatment I received while on an extended stay in Thailand. “

The other was from an acupuncturist: “As a licensed acupuncturist I have an issue with non-licensed individuals (PT) being taught how to needle patients without the proper TCM training. What is the purpose of TCM training and licensing if we allow anyone to needle patients? … I have spent thousands of dollars on my education in order to practice Chinese medicine. Pretty soon everyone is going to be needling patients and TCM is not going to have any value..I am going to see if there is anything that can be done to protect what we do as practitioners of TCM.”

What a contrast! The first letter is from a patient who needs an effective Dry Needling treatment which is not available in Texas. The second reflects a position common to some practitioners of Traditional Chinese Medicine (TCM) due to the fact that more and more healthcare practitioners are legally allowed to practice various needling techniques

We believe it is time to clarify the current situation. There are three points that need to be made up front. First, acupuncture is not the private property of one particular group of practitioners. Second, Traditional Chinese Medicine is not only one system of medicine that uses needling; not only are there strong needling traditions in other Asian cultures such as Japan, Korea, Vietnam and so on, but needling has also been discovered in a purely Western anatomical and physiological context, for instance in the application of needles to neuromuscular trigger points in the work of Travell and Simons dating from the ‘60s and ‘70s. And thirdly, in classical TCM, acupuncture represents only a small part of the total clinical approach – my estimate would be 20-30%.

Let’s look at this in more detail. “Acupuncture” today means different things to different practitioners. Acupuncture as used in the TCM system is based on ancient Chinese concepts of meridian systems, draws on TCM theories of physiology, relies on Chinese diagnostic methods such as tongue and pulse assessment, and uses a variety of needle manipulation techniques. In addition to study of the “classics”, how a student actually practices depends on what a particular school or master chooses to emphasize.

For example, more than 80 different types of Qi were mentioned in the Yellow Emperor’s Cannon of Internal Medicine and more than 120 types of Qi in Nan Jing. TCM acupuncture is based on understanding of a model of human anatomy and pathophysiology which is rooted in Chinese philosophy 2500 years ago. The complexity of the TCM system with its many concepts is why it takes 3-4 years full-time training to qualify as a TCM practitioner. Again, the acupuncture component of a TCM course is relatively small, compared to the amount of time spent in the study of different TCM theories of meridians, or channels, and their energetics; and on the associated energetics and therapeutic uses of food, herbal medicines and physical movements and therapies.

Despite the differences among the varied theoretical models employed in “ancient” or traditional systems, the benefits of acupuncture shine through. Similarly, modern research shows us that acupuncture is effective for many conditions even when it is employed without reference to meridians and/or systems of connected points.

It is therefore valid to question why a practitioner who wants to help patients with acupuncture should have to study an entire – and irrelevant to the purpose – system of medicine. TCM trained practitioners should not forget that they study not “acupuncture” but the whole TCM system, including deep understanding of herbal medicine. Let’s be clear, we are NOT saying that TCM is irrelevant. It is an extremely valuable system – but it is far more than just acupuncture. What we have to accept is that modern research into biochemistry, physiology and neurology shows that the full-scale study of TCM is not necessary to health practitioners be able to practice non-TCM acupuncture.

In fact, the medical doctors, chiropractors, osteopaths and physical therapists who are increasingly using acupuncture – particularly for pain management – often do not even use acupuncture terminology, but refer to dry needling of myofascial or neuromuscular trigger points, for example. This is a world-wide phenomenon, already in use in the USA, UK, Australia, Canada, Germany, France and many other countries.

Dry needling was introduced by Dr Janet Travell starting in the 1940s. Since then, numerous laboratory and clinical studies have enriched dry needling techniques and a different terminology for these techniques have been created; for example trigger point needling, dry needling technique, medical acupuncture, intramuscular stimulation (IMS) and biomedical acupuncture are all in use.

This is not surprising when you consider that dry needling is not based on the TCM model in any way.

The biomedical acupuncture model — aka Western acupuncture — is based on 21st century understanding of human anatomy and pathophysiology and on modern scientific research into the mechanism of acupuncture, drawing heavily on leading-edge neurological research using modern imaging techniques such as Functional MRIs of the brain. Not surprisingly, this form of acupuncture is practiced not by TCM practitioners, but mostly by practitioners such as MDs, DOs, DCs and PTs, who have sufficient background in traditional Western medical sciences to enable them to understand the very different theoretical framework, diagnostic criteria and practical application of biomedical acupuncture.

Both TCM acupuncture and Biomedical acupuncture work very effectively because both systems are firmly based on the indestructible and practically immortal mechanism of acupuncture. These systems do not conflict with each other, even though their theories, acupoint systems, needling techniques, technical terms and interpretations are quite different.
It is just like Chinese chopsticks and Western knives and forks, which are different by form but perfectly serve the same purpose: effectively delivering food. Like chopsticks and forks, TCM acupunctures and non-TCM acupunctures have different historical origins and medical approaches. They require different trainings and different backgrounds.

Many of my TCM practitioner friends happily practice their TCM acupunctures and herbal medicine and experience only one problem – not being able to accept new patients because they are too busy.

Many MD, DC and PT practitioners build up their own modern biomedical acupuncture practice within their clinical framework on the foundation of their conventional training. None claims to practice TCM; they tend not to prescribe TCM herbal remedies nor try to compete with TCM practitioners.

They include modern acupuncture to increase the effectiveness of their practices and do it mostly in the context of pain management, which they already practice. Their years of training in Western scientific medical theory enables them to understand modern biomedical acupuncture.

We are never tired of repeating our mantra: the patient is the one we serve. Acupuncture first and foremost belongs to the patients. Patients will choose the practitioner who provides the most effective treatment. This is the only criterion. Some patients will go to TCM practitioners to benefit from TCM acupuncture and herbal remedies, others will continue to visit MDs, DOs, DCs and PTs and benefit from dry needling in addition to standard treatments.

Both systems work; they are simply rooted in different cultures.

It would be helpful for TCM practitioners to understand that a practitioner using acupuncture for pain management and trauma rehabilitation is not practicing Traditional Chinese Medicine and would never claim to do so.

Therefore there is no need for TCM acupuncturists to worry that TCM can lose its “market share” simply because other healthcare practitioners are using needles. However, there is no doubt that practitioners with better skills who get the best results, will get more business. That’s the way it’s always been.

Progress could not be stopped

Globalization is a historical trend that no one can reverse. In the 19th century Western medicine was brought to China and TCM doctors refused to accept this “Western beast”. As time passed, TCM doctors gradually accepted western medicine and tried to find connections between TCM and Western medicine even though TCM had better clinical results in many cases at that time.

Today this trend continues. In China, 80% of the medical doctors practice Western medicine. All TCM hospitals have modern medical equipment. A colleague has just informed me that a month ago the president of Guanzhou TCM university came to the US and bought $5 million worth of the latest medical equipment, including MRI, and sent TCM personnel over for training. Chinese TCM authorities have a very clear understanding that modernization of TCM is inevitable. If they don’t do it, someone else will.

During our biomedical acupuncture courses all around the world, MD, DO, DC, PT, and TCM acupuncturists have found that they do not experience any conflict between the TCM model and the Biomedical Acupuncture model and that in fact they can learn from each other. After courses they stay in touch and refer patients to each other.

We shouldn’t forget that acupuncture is especially effective for soft tissue dysfunction, especially for soft tissue pain. Half of our bodyweight is soft tissue, and almost all pathological conditions, more or less, influence the function of soft tissues, especially the muscles and fascia. This is why acupuncture helps such a broad spectrum of pathologic conditions, from pain management to drug abuse. You will get better therapeutic results only if you understand the mechanisms during and after the needling. Acupuncture belongs to the patients who need cure and relief.