← What's That Rash?
What's That Rash?
Difference between dry needling and acupuncture?
00:22:34
If you've seen a physiotherapist, you might’ve undergone needling with the promise it will reduce your pain. Did you receive dry needling or acupuncture? How can you tell the difference between the two? Norman and Tegan poke through the evidence to find out how effective these techniques can be. References: Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points Dry Needling versus Acupuncture: The Ongoing Debate Acupuncture: Past, Present, and Future Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain—An Umbrella Review Methodological challenges in design and conduct of randomised controlled trials in acupuncture Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain: A Systematic Review and Network Meta-Analysis Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systema...
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A
ABC Listen podcasts, radio, news, music and more. Christopher and Pixie Skase flaunted their wealth.
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27 white limousines and the champagne flowed. It couldn't be bigger than Pixie's blonde.
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Hair spending other people's money. And when they were found out, Pixie paid the price.
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This sort of gilded cage that she was a prisoner in.
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I'm Mark Humphries. To binge the full series now, search for ABC Rewind and look for or skace Fall of a Tycoon on the ABC Listen app or wherever you get your podcasts.
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B
Have you ever partaken in acupuncture, Dr. Norman Swan?
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C
As it so happens, just recently I have for the first time ever.
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B
Oh, so recent. Oh, you must have known that these questions were going to be coming up.
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C
I must have known this. So I was at this rural doctors conference and a doctor came up to me because she'd seen me limping. We're not going to talk about my knee this week, but seen me limping. I'm trying very hard not to limp, but anyway took pity on me and she said, well, I do acupuncture and I'm getting great results. Would you like me to try it on you? And I obviously looked a bit askance at that and she said, but I've got this new thing which is they're like little dot things with tiny little needles in them. And you put them on your acupuncture point and you just leave them in. So it's a tiniest little needle. It just sort of breaks the skin. Doesn't even cause bleeding.
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B
I'm thinking about stepping on like a bindi and it doesn't have to be very big for something to hurt a lot and be pretty annoying.
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C
Anyway, I put them in and almost instantly my knee pain got worse.
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B
Because you suck needles in your knee.
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C
Anyway, I took them off the other day and I couldn't find the needles. I assume it's still on my skin. I don't know.
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B
Oh, my gosh.
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C
So that's a long story to tell you about my probably inadequate. You wouldn't judge acupuncture or dry needling based on my experience, but that's been my experience. You asked and I've told you.
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B
I love to think that whenever we're talking about your anecdotes, the N In N equals 1. So stands for Norman.
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C
Yeah. What about you?
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B
I'll tell you my dry needling story in a minute. Cause I reckon we need to get into it because this is.
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C
What's that rash, which is the show where we answer the health questions that everyone is asking.
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B
This week. The question comes from Jo and from Tim and from Marina and from Frank, and they're all asking variations on a theme, which is basically about dry needling and. Or acupuncture. Lots of questions. And I think the very first thing we need to clear up is what is the difference between acupuncture and dry needling?
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C
Well, some would argue there's no difference. But acupuncture, if you're doing traditional acupuncture, you would do, for example, pulse diagnosis and traditional Chinese diagnosis, and it wouldn't just be for pain, it would be for other conditions as well. And you have meridians, according to the theory that run through your. And these are independent of tracts of nerves or arteries or what have you, these meridians, which have a balance of male and female, yin and yang. And you needle points along those meridians, according to the diagnosis, to rebalance the body. And that's the essence of acupuncture.
- [03:19]
B
This is traditional Chinese medicine. We'll talk about the history in a little bit. But it's got a very long tradition.
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C
It has. And then the question is, how deep do the needles go, whether they're moved and whether they cause a bit of pain themselves. And there have been adaptations of acupuncture over time where they use lasers to simulate the effect of acupuncture. And dry needling is needling aimed at what are called myofascial trigger points. So some people who have pain, particularly chronic pain, will have trigger points, sometimes near to where the pain is and sometimes distant. When the doctor examines you, they can find a point where you jump and it's really sore.
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B
You have outed yourself before. Norman, as someone who hates massage, but I do love a massage, and I've said that before as well, And I've definitely had that experience where, especially at the base of my neck, the masseuse pushed sort of at the base of my skull, sorry, at a point, and the entire side, like, to the center point of my head, suddenly in, like, enormous amount of pain. And then when he let go, it stopped hurting again. Like, it is startling how effective some of these trigger points are.
- [04:36]
C
That's right. And they are often associated with a kind of knot in the muscle, which can be felt and, as you say, pressing on it can actually create pain itself. But it's also associated with curious phenomena that you get when you've got chronic pain. The pain's been on a long time. You can get hypersensitivity, which is called allodynia or allodynia, where touch or heat or cold can cause a painful sensation and then you've got those trigger points. But coming back to dry needling. Dry needling is usually about finding those trigger points when you've got pain and needling those trigger points to relieve them. So the technique most commonly used would be quite deep. It would be through the skin into near the muscle itself. In other words, you're irritating that point and doing what you experience with massage. And so myofascial trigger points are a real thing. Nobody has fully explained them. And the question is, does treating them make a difference? And that's where dry needling comes in. Or indeed massage therapy.
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B
Yeah. And the other thing that's kind of interesting is because acupuncture and dry needling look really similar if you're like, oh, you're sticking needles into someone's body, but their tradition that they've come out of are more different than I think I expected. I think I thought that dry needling was like the home brand version of acupuncture. But having looked at a traditional acupuncture, like I said before, it's really ancient. I think it started in China, as most people probably know, about 3,000 years ago. It was documented like more than 2,000 years ago. And it was actually described in European medicine in the 1600s. Someone called Ten Rhine, who worked for the East India Company and saw it happening in Japan. And it's then obviously filtered into the Western consciousness over the last couple of.
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C
Hundred years and of course happens figure in the history here. Yes, he was a very famous doctor. This guy was Sir William Osler.
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B
So did you study Osler? I obviously didn't study medicine. I don't know this name. But you sound like you do.
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C
Yeah, no. So he was very famous to describe lots of things. And there are nodes or nodules named after him. So these are nodules that appear on the hands and the fingers. They're supposed to be a skin manifestation if you've got an infection in your heart.
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B
I will say he wasn't infallible in medicine. He tried to treat lower back pain using acupuncture, but he used hat pins to do this. You've referenced them just before. I have a visceral reaction to this because my grandma in her little sewing cabinet used to have a little box of hat pins that had belonged to her mother. And not only were they. I mean, they were beautiful. They had like pearls and stuff.
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C
They're long.
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B
They're long, they're Thick. And of course, because they were old, these particular ones were rusted. And the idea of Oslo sticking that pin anywhere near my body, let alone my lower back, makes my stomach turn. Anyway, he actually injured someone. There was a wealthy patient, had severe lower back pain. It was aggregated even further after the treatment. So he was criticised quite sharply. Sharply for that. I'm sorry. The pun was coming out of my mouth before I realized it. And the comment about using hat pins was deleted from subsequent editions of his textbook that he wrote about various medical things. What actually interested me was that the provenance of dry needling is actually kind of different to acupuncture. Because I always, always a bit curious about the term dry needling, but it looks like it might have sprung up from a tradition where you might have been injecting into a muscle, say, an anesthetic.
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C
Yeah. So called wet needling.
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B
Wet needling, effectively. And then in trying to sort of figure out how effective the anesthetic was, realized that the act of poking the muscle kind of was doing something whether or not there was anesthetic, saline or nothing in the needle.
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C
Correct. Now, let's just disentangle the complexity here, because some acupuncturists would say that dry needling is very similar to acupuncture in terms of the acupoints. So there's a tradition called ashi, and you have ashi acupoints, which will go back a long time, so where the acupuncturist will actually traditionally look for those trigger points and will need all those trigger points rather than necessarily the traditional meridian channels. So acupuncturists would say it's very similar. And then the other part of the complexity is that when they do random, randomized controlled trials of acupuncture and they do sham acupuncture. Sham acupuncture is actually dry needling. So in other words, they put needles into the body but not into the traditional meridian points. And what these trials, by and large, show that when there's this kind of random needling compared to acupuncture, acupuncture is a little bit better, but they both work. So there's something about needling which actually works in terms of pain relief. Not necessarily hugely, but in some people, really, quite significantly.
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B
We should talk about clinical trials a little bit here. One, the story you just told just shows how hard it is to do a good sham treatment, because, like you say, you stick a needle in something, it's working to an extent. How do you pretend to stick a needle in someone without actually doing it. And there was a really fantastic talk on Occam's Razor, a currently dormant ABC podcast and radio show, where one of the speakers talked about using the techniques used by magicians and illusionists to basically do a placebo for acupuncture and dry needling.
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C
Yeah. So they had the same device, which was the needle in a sleeve, and they distracted the person when they were doing the acupuncture or the device, which actually didn't go through the skin, but it looked exactly the same to see whether they got the result.
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B
And they used, like, misdirection techniques. They used all sorts of.
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C
Oh, look over there.
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B
Yeah. Basically. Yeah. Using smoke and mirrors. Not unlike. Yeah, illusionists to basically help people think that they were getting the treatment but not actually give it to them.
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C
So there's not a lot of evidence on acupuncture as a treatment for medical conditions, but the best evidence is probably in relation to pain, which is the questions that we've been asking.
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B
And then there's especially muscle pain. The questions today are really about physiotherapy settings.
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C
That's right. Before we get to it, there's been a lot of theories. So here's the theory why they used to think that acupuncture and things like that worked, which is the gated or gait control theory of pain. And so you've got these pain fibers that transmit information from, say, your skin or your muscle to your spinal column, and then that information goes up to your brain. So you perceive pain like a nerve? Yeah, different kinds of nerves, different fibers within the nerve sheath, taking pain information up to the spinal cord, then the spinal cord transmits it to the brain. And the idea, the theory was, and it's developed over time, was that this is like a gate, and you have got fibers that can come in and inhibit the pain information so it doesn't get through the gate. And the idea here is that maybe something like acupuncture closes the gate to pain, pain information going to the brain, and that's how it works. It turns out the gate control theory is almost certainly wrong, or certainly only a very small part of the story. But there is an element of. Does acupuncture work if you're not creating a little bit of discomfort with the acupuncture? What's interesting, though, is that superficial dry needling doesn't actually get down to the myofascial trigger point, but when you look at the evidence, it's not great one way or the other, but it doesn't look as though superficial needling is much different from deep needling of trigger points.
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B
Maybe this is the time for me to tell you my dry needling experience. So I was seeing a physiotherapist who I had this persistent knots in my shoulders, and he was like, you know, massage, massage. He's like, have you considered dry needling? And I'm like, no, not really. I'm not really very interested. And he managed to talk me around. Anyway, it is. If you haven't had the dry needling experience, Norman, it is quite a strange one. The needle going in itself doesn't really hurt that much, but the whole muscle clenches up like. It's almost like electrical impulses to make your muscle turn on. Have you ever had one of those?
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C
I haven't, but I can imagine it.
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B
Works in a similar way that the needle went in and then my whole muscle was like. Anyway, so I had it done once or twice. One time I went along and I was really just so burnt out and stressed out and put the needle in, my whole muscle clenched up. And it actually gave me such a fright lying face down on this massage table that I started crying. And the poor physiotherapist just sort of like, quietly removed the needle, put a towel over me, and just like, left the room. I'm so embarrassed. But so basically to your point before, yes, it can hurt a little bit, and maybe that is the point, but on that particular day, it was more than I could take.
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C
Yeah, well, these are not necessarily unknown things. So let's just look at the whole treatment of myofascial trigger points. It looks as though there's no difference between the massage and stretching and pulling of a myofascial trigger point and the needling process. So you could argue, well, the needling process is maybe quicker and neater if it's going to work. The effect size is not necessarily huge, but it does look as though it can work, given that for some reason you get these trigger points when you're experiencing a lot of pain, particularly a lot of pain for an extended period of time, you know. And if it works, that relieves you from taking a medication that might affect the way your brain works, for example, like pregabalin.
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B
So, like I said, the questions that we're getting seem to be from like, a physiotherapy point of view. And it looks like a lot of the guidelines around either acupuncture or dry needling kind of incorporated into a broader program.
- [14:38]
C
Yes. And it all depends on what the Situation is with your pain, is there something active going on where you're feeling the pain itself? Is there a disease process going on that needs to be treated? If you've torn your muscle, if you've got a musculoskeletal injury and that's the cause of your pain, then you've got to manage that. And treating the trigger points might make it a little bit easier, but it's not going to cure it. It's just going to help the process and might make the treatment more tolerable. You know, if you're having massage therapy, if you're having muscle strengthening therapy, if you've not got a trigger point firing off all the time, that might make it easier to strengthen your muscles and get some exercise.
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B
So, coming back to the question from our various correspondents, there's not no evidence that either dry needling or acupuncture can be effective.
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C
Double neg, you mean? So there is evidence that they can work.
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B
Yes, yeah, exactly.
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C
And it's quite likely that a lot of acupuncture does work in a very similar way to dry needling in very similar spots, and therefore you're getting the same story. The question here is how much discomfort should the treatment create in order to sort out the painful stimulus?
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B
Okay, so it's interesting that you say that, Norman, because we literally got an email just the other day about our lymphatic draining episode of what's that rash, which we did a while ago now, basically where you disclosed that you don't like getting massages because they hurt so much. And this was from a massage therapist who said, why would you pay for someone to hurt you for an hour? Exactly. Like quoting you, Norman. But. But this person says there's a growing shared belief that creating pain does little to reduce pain, especially chronic pain with massage. And that massage doesn't have to hurt to work. Which kind of plays into what we're hearing with the fact that it's kind of impossible to do sham acupuncture trial, because it seems that even light touch seems to do something at least.
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C
Yeah. And I haven't seen much evidence that you've got to cause pain on the trigger point when you're treating it through massage. But you probably are causing pain simply because you're pushing reasonably hard on it to stretch it and pull it. But whether pain itself is the mechanism of treatment is the issue here. And here's somebody saying that with massage you can get results without necessarily causing pain. So you can walk on my back anytime.
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B
So to come back To Jo, Tim, Marina and Frank, all really asking about where the evidence lies when it comes to either dry needling and or acupuncture. What's the bottom line for them?
- [17:19]
C
There is some evidence that if you dry, needle or massage myofascial trigger points, you do get some relief. Not huge necessarily, but you do get some relief. And some techniques in acupuncture will actually do the same thing. They'll needle your trigger points. But then there's so many variations in the needling is done. The question is just is laser going to be as effective as deeper needling or superficial needling? We just simply don't know the answer to those questions. And that's one of the reasons the research is so widely variable in terms of the results. It's so widely variable in terms of the techniques, but the reality is you're not going to do yourself any harm.
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B
I don't think I expected this conversation to land so favourably. Maybe that's just disbelief on my behalf. It's good to know that there's good evidence here.
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C
So you just thought I was going to say bullshit, Bullshit, bullshit.
- [18:08]
B
Pretty much. No, I did, I did.
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C
I've been transformed by these little dots on my knee and I'd love to find where those needles went.
- [18:17]
B
Maybe they'll just pop out when you least expect it at some time.
- [18:20]
C
That's right.
- [18:21]
B
Well, thank you so much Joe, Tim, Marina and Frank for sending us that question. If you've got a question you want to ask us, maybe Norman will and you and the evidence will surprise me yet again. All you have to do is email thatrashbc.net au and don't forget we put.
- [18:36]
C
Refere the sources that we use on our show notes. So if you want to read more about it, go to our references.
- [18:42]
B
Yeah, come nerd out with us even more. Well, Norman, there's a couple of things in the mailbag this week relating to lead. Would you like to hear them?
- [18:51]
C
I would, since this goes back to our story on lead and protein powders.
- [18:54]
B
Yeah. So basically the upshot of that was that there was levels of lead in various protein powders that was tested. Were they dangerous for you? What does lead do to you? Again, you can listen to the episode if you want the answers to those questions. And Harry says that you mentioned normal. There's no Australian guideline for daily dietary exposure to lead, but Harry points out there is a guideline for lead in drinking water. The drinking water guideline for lead is a health based value of 0.005 milligrams per litre. And Harry points out that the lead measured in protein powder. I will say the very highest one that was measured was 7.7 micrograms per serve, so 0.0077 milligrams, saying one serve would exceed the Australian drinking water guideline recommended intake. It's not really comparing apples with apples, but it is interesting to know how close those numbers are.
- [19:49]
C
And we've also got a note from Brent.
- [19:51]
B
I might need your help with this one, Norman, because there's a British accent that needs to be invoked to get this story to come across and I didn't trust myself to be able to do it. Brent says it was very informative, the lead poisoning episode. It reminds me of my dad who years ago watched a documentary that highlight poisoning in Devon which came from the lead lined apple presses in the making of cider soda soda. Apparently the side effects include flaccid paralysis of the limbs and so the condition was locally called the danglers. Although this is a horrible symptom for sufferers, my dad decided to turn it into a fun game and would chase us kids around the house, whipping his floppy arms around him while shouting out in a broad west country accent, oi.
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C
I've got the danglers.
- [20:36]
B
Brent suggests this as an educational game you might want to consider with your kids.
- [20:40]
C
And to brush up on your west country accent, you should listen to the archers on radio, BBC Radio 4.
- [20:46]
B
This is sort of a bit of a sad ending to Brent's email. Unfortunately, he writes, my dad never played this game with my cousin and he was recently admitted to hospital for acute lead poisoning from inhaling fumes as he stripped the paint from the doors of a Victorian house he's renovating.
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C
Oh no.
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B
Brent signs off. Maybe the Danglars game could have prevented this.
- [21:06]
C
Yeah, still lead in our environment. Got to watch out.
- [21:08]
B
Well, thank you for your emails that rashbc.netu send us your feedback, send us your questions, send us your slightly dark humor related lead poisoning stories. We love it all.
- [21:19]
C
See you next week.
- [21:20]
B
See you then.