Many clients see me in the clinic dry needling and comment “I did not know that you did acupuncture here.” I always have to correct them and tell them that I am not an acupuncturist but a physical therapist and I do Trigger Point Dry Needling (TPDN). This then sparks the conversation of what is the difference between acupuncture and TPDN. In light of the recent lawsuit by the acupuncture board against the Colorado Board of Physical Therapy, trying to revoke the ability for PT’s to be able to perform TPDN, I felt this is a good topic of this month’s blog.
What is Trigger Point Dry Needling (TPDN)?
To best answer this I need to describe what an actual trigger point (TP) is. This is an irritable spot within the muscle that is either spontaneously felt (active) or upon palpation becomes irritable under the spot or referred throughout the muscle. These are in lay terms “knots” in our muscles. These TPs become ischemic (decreased blood supply) and hypoxic (decreased oxygen [O2] supply). Obviously if the blood is how we get O2 to the muscle and if the blood is not flowing as well to the muscle, it becomes a vicious cycle that must be stopped. Another way to think about it is imagine you have a sponge on your hand and you close your fist around it. You then place your hand in water and want the sponge to soak up the water. Well in order to do that you have to open the fist and allow for water to flow in the sponge. In this analogy your hand/fist is the TP and the sponge is the ischemic/hypoxic muscle tissue.
So what am I trying to say here? In order to restore the blood flow to the area then we can place thin filiform needles into the TP creating a small lesion in the muscle tissue. This increases the blood flow to the muscle at the spot of the TP alleviating the TP.
How is this different from acupuncture?
Short answer is the philosophy and approach taken. We as Doctors of Physical Therapy (DPT) spend 3 years on this doctorate level degree learning anatomy and physiology. We are taught in the western medicine philosophies and TPDN is based on western neuroanatomy studies and the musculoskeletal system. Now again as stated above, I am not an acupuncturist, but my understanding is that acupuncture is based on traditional ancient Chinese medicine and they would like to preserve the theories and principles in which they are taught. The “Chi” or energy throughout the body is what acupuncture is trying to normalize or restore. They do this by placing thin filiform needles throughout the different meridian points from head to toe.
Similarities: the needle
Differences: everything else
What to look for in a PT who performs TPDN.
Every state requirement is a little different as to how a PT should be trained or if they can perform TPDN at all. Here in the state of Colorado our current requirements are as followed. A PT must be practicing for at least 2 years before being able to take the required courses.
A PT must take 2 courses equaling at least 46 hours of hands on training.
When performing TPDN you must sign a consent form informing you of the possible side effects and risks of the treatment.
I would like to conclude by saying that not all therapists learn the same technique and one can have a bad experience to TPDN. For example, I had a competitive cheerleader who had a partially torn plantar fascia (PF). She was needled by another therapist using a “pistoning” technique into the PF which elicited increased pain and discomfort. She had such a bad experience that she actually did not even want to see that PT anymore. When she came to me and I discussed TPDN to increase blood flow to the area and use electric stimulation in the needles to help reduce pain she initially said “NO”! I then explained to her that in order to do the e-stim in the needles I would need to leave the needles in the foot and that it would be comfortable. She then consented to treatment and had a much better experience and had a 50% reduction in symptoms after 1 treatment. After about 2-3 weeks of TPDN and strengthening she was able to return to tumbling without pain in the foot.
Alternatively, dry needling is just one tool in our physical therapy toolbox to help patients achieve their goals. There are many ways to get results, sometimes dry needling can help speed up results but ultimately everyone has to be comfortable with the treatment choice for it to be successful!