Why Dry Needling is NOT Acupuncture

Several states (California comes to mind) have been denied the use of trigger point dry needling (TDN) by trained Physical Therapists.  Some have blamed acupuncturists for lobbying to not allow PTs to utilize needling in their scope of practice.  While this is may not be the main reason California is not allowing TDN by PTs, surely its a part of the reason.  I wanted to briefly address why TDN is not acupuncture in this post. Additionally, 90% of my patients ask "is this the same as acupuncture"?  This post will go into the differences of these two modalities as well.
Possible arguments that acupuncturists have against TDN by PTs:
1.  You're not skilled enough!
I tend to agree! For example, in Virginia you only need 54 hours of training to practice.  That's just training, not certification or any type of actual competency testing to assess your actual skill level. Granted, some (most) people may be more then ready at 54 hours.  But some may not.  Sure, you can needle the "easy" muscles, but what about the more challenging muscles that may be more problematic or more challenging body types.  We don't want people missing the levator scapula because the Upper trap is easier. Or we don't want people just stopping at the first twitch response not understanding the benefits of leaving the needle in to get the maximum neurophysiological benefit.
nice gloves! enjoy your hepatitis! 
Further, can those with the minimum training adequately explain the pain science and rationale behind the TDN procedure?  Several hours is spent on this at myopain seminars (and I'm sure the others) but it takes repetition and testing to approve your overall understanding of the current body of (growing) evidence. For me, I was just ready to grip it and rip it at the first course and it wasn't until later that I truly appreciated and understood the mechanisms behind what I was doing.  Maybe these courses can start to have competency evaluations on the science and the safety  prior to the course, similar to how McKenzie/ MDT requires some online courses and examination prior to their actual class.  

54 hours is not a lot if you compare that to Califonia's 3,000 hours of theoretical and clinical training to sit for the exam. Granted, we have even more theory, practice, anatomy, etc in our doctoral program, but not specifically related to needling!  I'm not trying to throw out a new minimum number needed to practice TDN on patients.  However, I am saying we need to have some sort of minimal competency assessment to ensure safety and understanding, and thus longevity of TDN to be within our scope of practice.

I am not trained or anywhere experienced enough to be an acupuncturist as you can see above! Therefore, TDN by a PT is not acupuncture!  Maybe an acupuncturist can TDN but a PT can't perform acupuncture, but that shouldn't stop us from performing TDN.  A personal trainer can stretch a hamstring or kinesiotape someone or perform a corrective exercise, that doesn't make them PTs nor do I want them to stop doing these activities with their patients!  Several professions have overlap, especially in the medical field, and they work well together. If anything TDN by PTs will likely increase the utilization of acupuncture by acupuncturist!  That's a win-win!

2. Puncturing the skin for therapeutic gain is acupuncture
Now I tend to disagree.  For one your going into skin where we go into the muscle (generally).  We go deeper. (Insert that's what she said joke here)  We each have specific points, meridian vs trigger points, that are completely separate from each other.  Acupuncturists love to talk about a study that shows 71% correlation between meridian points and trigger points.  However this has already been refuted, demonstrating a mere 18% correlation. Which is really no (inverse) correlation at all.

Further, a shi points have a better correlation but they are everywhere, especially on the multifidi, neck, and gluts.    Regardless of this, it has two completely different purposes!  Look at the a shi points below, do you see glut minimus or do you see gallbladder 30? What's their purpose? What is ours? 

Lets not skip over the best argument that we have therefore. We have two different purposes for our treatment! Our main goal is to get a reset as thus to improve movement and any pain related to that movement. Movement. That's our goal.
Both techniques can release endorphins, cortisol, and change collagen/tissue remodeling.  However we want to deactivate TrPs, via diminishing the "noise" with the neuromuscular junction deficit and restore normal depolarization ability and normal length-tension, and for additional benefit get some pain control via central modulation. This doe not impinge on the goals and rationale for acupuncturists!  Again, we have some overlap in reduction of pain. Wonderful. More reason we can work together!

TDN is growing more popular. Not just because its new and "sexy". But because of the results. I'm getting patient and MD referrals not because they just have heard of TDN.  They have heard of the dramatic success it has had on their father, daughter, friend, and patients!  Success that has led to better movement, and thus function. That's something any medical professional can get behind.