When seeking pain management, injury recovery, and sports medicine options, patients often encounter two options for muscle release: acupuncture and dry needling. Dry needling, also known as Trigger Point Therapy, is a part of every acupuncturist’s training and most acupuncturists incorporate dry needling into their treatment strategies.  Understanding the differences can help you make an informed decision about your healthcare.

References are provided at the end of this article

Training and Expertise: A Significant Gap

The most striking difference lies in practitioner training.  Acupuncturists, Physical therapists, and Chiropractors are all medical specialists.  If I needed a hip replacement, I wouldn’t go to a dermatologist. I would go to the medical provider that has the most training and specialization.

Licensed acupuncturists undergo extensive education, completing 3,000-4,000 hours of clinical and didactic training over three to six years. This comprehensive education covers anatomy, physiology, Traditional Chinese Medicine theory, point location, needle techniques, herbal pharmacology, and extensive supervised clinical practice.

In contrast, dry needling certification typically requires only 24-100 hours of training—often completed over a weekend or short course. This dramatic difference in preparation raises important questions. Physical therapists and chiropractors who offer dry needling are certainly skilled professionals within their respective fields, but their needle training represents a fraction of what acupuncturists receive.

Holistic vs. Targeted Approach

Acupuncture represents a complete medical system developed over thousands of years. And backed by 70 years of modern research (See my paper in the Oregon Medical Board Report, TEDx talk, and other articles) Licensed acupuncturists evaluate patients holistically, considering symptoms within the context of overall health patterns, lifestyle factors, and constitutional characteristics. Treatment strategies address root causes while managing symptoms, often incorporating multiple therapeutic modalities including trigger point release, cupping, gua sha, massage, and herbal prescriptions.

Dry needling, while effective for certain conditions, focuses on trigger point release and localized muscle tension. It essentially represents one technique from the broader acupuncture toolkit, applied without the comprehensive diagnostic framework that guides a fully trained acupuncturist.

Safety Considerations

Research indicates that dry needling carries higher risks of adverse events, including pneumothorax (collapsed lung), nerve damage, and significant pain during treatment. The more aggressive needle manipulation characteristic of dry needling, combined with limited training hours, contributes to increased injury rates.

Acupuncture, when performed by licensed practitioners, demonstrates an excellent safety profile. The gentler approach, combined with extensive anatomical knowledge and clinical experience, results in fewer complications and greater patient comfort.

Many patients report falling asleep during an acupuncture treatment.

Mechanisms of Action

Acupuncturists understand multiple mechanisms through which needling affects the body: neurological pathways, endorphin release, anti-inflammatory responses, and circulatory improvements. This knowledge allows for more precise point selection and treatment customization.

While dry needling practitioners may understand basic trigger point physiology, they lack the comprehensive understanding of how different points and techniques affect various body systems.

The Complete Picture

Interestingly, many acupuncturists incorporate dry needling techniques within their practice, but from a more sophisticated perspective. They understand when aggressive needling is appropriate versus when gentler approaches are more effective, always considering the patient’s overall condition and constitution.

For patients seeking needle therapy, choosing a licensed acupuncturist ensures access to the full spectrum of needle techniques, comprehensive training, and holistic care—all delivered with the highest safety standards.

About the Author

Learn more about Dr. John Rybak, DAc here.

References

Training and Education Requirements

1. American Academy of Medical Acupuncture (AAMA). AAMA Policy on Dry Needling. NCCAOM. October 9, 2018. Available at: https://www.nccaom.org/about-us/press/press-releases/aama-policy-on-dry-needling/
2. Dry Needling Institute. Dry Needling Certification® for PTs, ATs and DCs. Available at: https://spinalmanipulation.org/dates-and-locations/dn-1-dry-needling/
3. Integrative Dry Needling. Scope of Practice. June 10, 2025. Available at: https://integrativedryneedling.com/scope-of-practice/
4. National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Dry Needling Position Statement. Available at: https://www.nccaom.org/wp-content/uploads/pdf/NCCAOM%20Dry%20Needling%20Position%20Statement.pdf
5. New York State Education Department. NYS Acupuncture: License Requirements. Available at: https://www.op.nysed.gov/professions/acupuncture/license-requirements

Safety and Adverse Events

1. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events associated with therapeutic dry needling. PMC. 2020. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7015026/
2. Dunning J, Butts R, Mourad F, et al. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017. DOI: 10.2519/jospt.2017.7096
3. Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. International Journal of Physical Therapy and Rehabilitation. 2019. Available at: https://www.graphyonline.com/archives/IJPTR/2019/IJPTR-157/
4. Medical News Today. What is dry needling and what are its benefits and risks? August 1, 2025. Available at: https://www.medicalnewstoday.com/articles/dry-needling

Comparative Analysis and Professional Standards

1. American Alliance for Professional Acupuncture Safety (AAPAS). Evidence and expert opinions: Dry needling versus acupuncture (II): The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. PubMed. 2016. PMID: 28265852
2. Cleveland Clinic. What Is Dry Needling? September 7, 2023. Available at: https://my.clevelandclinic.org/health/treatments/16542-dry-needling
3. Cleveland Clinic Health. What’s the Difference Between Dry Needling and Acupuncture? February 13, 2024. Available at: https://health.clevelandclinic.org/dry-needling-vs-acupuncture
4. East Meets West Healthcare. Risks of Dry Needling Acupuncture. Available at: http://www.eastmeetswesthealthcare.com/dry-needling
5. International Academy of Orthopedic Medicine-US (IAOMA). What is Dry Needling? Available at: http://iaoma.org/dn-resource-what-is-dry-needling/

Clinical Effectiveness and Mechanisms

1. Llurda-Almuzara L, Labata-Lezaun N, González-Rueda V, et al. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain—An Umbrella Review. Journal of Clinical Medicine. 2023;12(3):1205. DOI: 10.3390/jcm12031205
2. Morningside Acupuncture NYC. Dry Needling vs Acupuncture. February 18, 2025. Available at: https://www.morningsideacupuncturenyc.com/blog/dry-needling-vs-acupuncture
3. Raleigh Acupuncture Inc. Dry Needling Versus Acupuncture – A World of Difference. March 23, 2023. Available at: https://raleighacupunctureinc.com/dry-needling-versus-acupuncture/
4. Silva Guerrero JL, Chaves P, Pedersini P, Costantino C. Efficacy of Dry Needling and Acupuncture in the Treatment of Neck Pain. PMC. 2021. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8314077/