Dry Needling vs. Acupuncture: Main Similarities & Differences


Sticking needles into your skin has become a popular way to rehabilitate from injuries and painful conditions. Techniques like acupuncture and dry needling are considered alternative treatments. Nevertheless, they have proved to be helpful over the years.

So, what is the difference between dry needling and acupuncture, and which technique has proven to be the best? Also, what are the Pros and Cons of Dry Needling? When it comes to acupuncture vs. dry needling, research and data collected over the years suggest that acupuncture is better and has yielded better results.

But, let’s not fool ourselves since that is only because research on dry needling therapy is small and is yet to show how beneficial it is for neck and muscle pain, nervous system, energy flow, etc.

What is Dry Needling?

The modern Dry Needling Technique is the process of inserting a couple of filiform needles into a trigger point or areas where knots are built.

The premise of this technique is that it helps to release the knots and relieve any spasm or muscle pain.

The name Dry Needling itself suggests that there are no liquids or fluids injected into your body.

The whole session lasts no more than 30 minutes(the time when needles are in the skin). 

Professionals who usually perform Dry Needling are sports injury therapists and physical therapists.

Other Dry Needling Techniques

The most common Dry Needling technique lasts somewhere between ten and thirty minutes. However, other methods have different session duration and points of insertion.

The in-and-out technique

The in-and-out technique, also called pistoning, involves inserting the needle directly into the trigger point.

After insertion, the dry needle is removed right away. The main difference between the pistoning technique and the standard one is the duration of the needle inserted into your skin.

The non-trigger points technique

The non-trigger points technique is different from the standard and the pistoning technique because its primary goal is to treat your central nervous system by inserting dry needles in areas around the pain points.

The philosophy behind this approach is that pain primarily results from a muscular issue or a greater nerve.

Benefits of Dry Needling

Dry needling has many benefits, but not all of them were proven by studies.

Because Dry Needling is a relatively new practice, further investigation and research are needed to prove its effectiveness and benefits.

However, some studies show significant improvements when it comes to:

  • RSD (Repetitive Stress Disorder) – RSD is the gradual buildup of damage done to the nerves and muscles from activities(mainly repetitive), muscle fatigue, and awkward motions.
  • Hip Pain – This includes stiffness of the pelvic area, impaired hip mobility, and tenderness and swelling.
  • Sciatica – Lower back pain spreads to the hips, glutes, and legs. 
  • Fibromyalgia – This includes pain all over the body, fatigue, tiredness, mental distress, and sleeping problems.

Dry Needling Side Effects

Dry Needling with E-Stim

An inexperienced or unlicensed person should never perform dry Needling treatment since it can cause severe injuries like infection, many diseases, and bloodborne illnesses.

There are some side effects when it comes to Dry Needling, and those are:

  • Temporary increase in pain: You might feel pain up to 48 hours after the dry needling session. Stretching and gentle activity might help to relieve the pain.
  • Bruising or bleeding: Insertion sites are where the bruising or bleeding occurs. People with blood thinners or blood vessel problems are more likely to experience this side effect. However, those situations are rare and only affect about 10% of patients.
  • Fainting: Fainting is more likely to affect healthy, athletic men, older people, weak individuals, middle-aged women with BP under 120/70, and those who are either dehydrated or hungry.
  • Fatigue and tiredness: On some rare occasions, people experience fatigue and tiredness
  • Skin reactions: After the session, you may notice small red spots on your skin, but they are likely to go away after a few minutes or hours.
  • Pneumothorax: Although rare, pneumothorax, or a collapsed lung, occurs when inexperienced or uncertified individuals perform Dry Needling sessions.

What is Acupuncture?

The actual practice of acupuncture is rooted in traditional Chinese medicine. Mainly considered an alternative treatment, acupuncture is widely used to treat different medical conditions for thousands of years.

The philosophy behind acupuncture is that the body is healed when chi(flow of energy) is released. Therefore, only certified and experienced practitioners should perform acupuncture sessions.

The method involves inserting needles at specific points to stimulate nerves and release endorphins, widely known as natural painkillers.

Acupuncture is excellent for relieving pain and tension in muscles. During the whole session, you are lying on a padded table. The phases of acupuncture are as follows:

Needle insertion

When the needles are inserted, sometimes there isn’t any discomfort at all. The pain comes when the needle reaches the proper depth.

Around five to twenty needles must be inserted at specific points on your body. 

Needle manipulation

The next phase involves needle manipulation, where the acupuncturist moves needles for therapeutic purposes.

Acupuncture practitioners sometimes use mild electrical pulses for easier manipulation.

Needle removal

The last phase of acupuncture includes needle removal. Depending on the therapist, needles might be left for about ten to twenty minutes.

People report there isn’t any discomfort during needle removal.

Benefits of Acupuncture

Compared to the dry needling technique, acupuncture has been more researched; therefore, more studies back up its benefits and therapeutic properties.

The main point of acupuncture is to restore your energy flow and state of balance. The large corpus of studies suggests that acupuncture is beneficial when it comes to:

  • Neck Pain: The cause of neck pain is often poor posture, resulting from today’s forward stance caused by the technological revolution, including mobile phones and the internet.
  • Stiffness: Strains and osteoarthritis play a significant role in stiffness. Increasing inactivity is a worrying factor as well.
  • Headaches: Migraines result from different factors, manifesting as pulsing feelings on the sides of the head.
  • Osteoarthritis: Characterized by painful and swollen joints due to cartilage breakdown.
  • Lower back pain: The leading cause is inactivity, tightened flexors, and weak glutes and core, but injuries and strains play a significant role as well.

Acupuncture Side Effects

Dry Needling with E-Stim controlled by the therapist

You should only choose to have acupuncture only if the practitioner is certified and experienced. This way, you will avoid adverse side effects.

However, if the previous step was unsuccessful, here are some side effects that may occur:

  • Pain: usually where the needles puncture the skin
  • Bleeding or bruising: bleeding and bruising may occur in places where needles are used to puncture the skin.
  • Drowsiness: after the session ends, you might experience slight sleepiness.
  • Feeling sick: temperature, vomiting, and headache are some indicators.
  • Feeling dizzy or faint: dizziness may occur after an intense acupuncture session.
  • Worsening of pre-existing symptoms: although very rare, pre-existing symptoms might worsen after the session ends.

Dry Needling vs. Acupuncture Similarities

Here is the list of similarities between acupuncture and dry needling:

  • Dry needling vs. acupuncture needles:  Both dry needling and acupuncture use thin, stainless steel filiform needles.
  • Insertion:  Both practices have the same process of inserting needles into the skin.
  • Trigger point dry needling vs. acupuncture:  Both methods claim to treat pain by inserting the needle in specific spots, but acupuncture has more solid evidence and studies to prove its benefits.

Dry Needling vs. Acupuncture Differences

Here is the list of differences between acupuncture and dry needling:

  • Medical basis: Dry needling is intended to release muscle tension by activating trigger point pain, and acupuncture is based on endorphin stimulation achieved by interacting with nerve endings. Also, dry needling is newer and mainly founded on scientifically evaluated evidence, while acupuncture has its origins in mystical tradition. Contradictory to itself, acupuncture, which evolved from mystical tradition, has more evidence to support its benefits and effectiveness when compared to new and scientifically founded dry needling.
  • Regulatory regime: Acupuncture is widely accepted by the U.S medical industry. That is why it has developed a governing body that has implemented a licensure process. When it comes to dry needling, the quality may vary because practitioners don’t require certification. This might be due to its slow development and recent creation.
  • Pain management: Dry needling is limited to treating muscle pain and cramping, while acupuncture has been used to treat different kinds of pain like muscle aches, migraines, knee pain, and labor-related pain.
  • Insurance coverage: Major carriers like Medicare will not cover dry needling treatments, while some private carriers might decide to cover acupuncture sessions.

Dry Needling vs. Acupuncture: Which Is Better?

a man laying with dry needling inline to his spinal cord

There is no precise determination if acupuncture is better than dry needling. Because dry needling is a relatively new pain treatment modality, there is not as much research and studies to support its effectiveness compared to acupuncture.

Even though acupuncture has a larger corpus of studies to support its effectiveness on different kinds of pain, including muscle aches, migraines, knee pain, and labor-related pain, dry needling is better for exclusively treating muscle pain.


So, what’s the verdict? Is dry needling better than acupuncture?

In some cases, yes. Dry needling is often more effective for addressing muscular pain and tension. However, acupuncture may be a better choice for chronic conditions or pain that has been present for a long time. Both therapies have their benefits and drawbacks, so it’s essential to consult a professional before deciding.

If you’re curious whether dry needling can help you address your specific pain relief needs, give us a call! We would be happy to discuss your individual situation and see if this treatment could help improve your quality of life.

Dr. JJ Thomas, DPT, MPT, CMTPT

JJ Thomas is the owner and founder of Primal Physical Therapy, located in Bryn Mawr, PA. She is an instructor for Evidence in Motion, and lectures and speaks nationally on the topics of Dry Needling, Functional Movement Analysis, and Functional Anatomy. She has been published in IJSPT for her contribution to a commentary on dry needling and consults as a content expert for organizations such as the APTA and FSBPT. In this role, she played a large part in the addition of a CPT code for dry needling through the AMA and was on the task force that helped identify competency standards for dry needling education nationally. JJ works with US Field Hockey teams, and individuals from US Lacrosse, US Polo, USA Track and Field, NFL, NBA, PLL, MLB, and more.
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