Dry Needling vs. Acupuncture
April 23, 2025/Dr. JJ Thomas, DPT, MPT, CMTPT
Inserting needles into the skin and underlying muscle tissue has become a popular way to accelerate recovery from injuries and painful conditions. This growing interest has sparked many discussions around dry Nneedling vs. acupuncture, as the two techniques often get confused. The term dry needling is often used by many practitioners, including Physical Therapists, Chiropractors, Medical Doctors, and acupuncturists. So if you’re wondering if dry needling is right for you, it can be difficult to know where to go.
Understanding the different types of dry needling and the different types of clinicians performing dry needling can help you choose the right place for you.
Dry Needling vs. Acupuncture
Dry Needling is a term used for a treatment that uses a needle without a liquid (or injectable). Most often, the needle used in this process is a very thin, filament needle.
This general definition of the term dry needling sometimes makes it confusing for the general population to understand what a treatment with dry needling might look like for them.
And unfortunately, there isn’t an easy answer.
Here’s the best guidance we can give you:
When the clinician performing the DN is a musculoskeletal expert, they will likely be doing a treatment to address the muscles, tendons, and nerves to help you move better.
Much of the research around Dry Needling in the field of Physical Therapy deals with Trigger Points and how they can limit a muscle’s ability to function. Dry Needling has been shown to reset the muscles on a structural, biochemical, and electrical level, which helps you not only move better but also reduce pain, feel better, and recover faster.
For more information, please also see my article: Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary
So, when a physical therapist or Chiropractor (who specializes in the MSK system as it relates to movement and pain) is performing dry needling, the process is directly related to the evaluation of how your body moves and what muscles we need to treat in order to help you move better and reduce pain.
If the practitioner is an acupuncturist, their evaluation will encompass evaluative skills that often relate to Traditional Chinese Medicine, energy fields, and meridians. The evaluative process, and therefore the treatment strategy, does not usually involve the mechanical evaluation of how you move. Now, keep in mind, there are some acupuncturists who have additional training in the MSK system, but their field has a broader scope than most MSK specialists, which has its pros and cons as they relate to your potential MSK injury.
Dry Needling Techniques You Might See in Your Physical
Therapy Appointment
As with many other manual techniques, there are different techniques that might be utilized in a typical dry needling session.
In general, most Dry Needling sessions will last somewhere between ten and thirty minutes, and in the PT world, they are almost always combined with other therapies, including massage, joint mobilizations, modalities like laser therapy, and exercises.
There are different types of techniques a therapist might use in a dry needling session, and often the technique chosen will align with the therapist’s goals for your session.
Here is a review of the types of techniques you might see and why:
The In-and-Out Technique
The in-and-out technique, also called pistoning, involves inserting the needle directly into the trigger point and manipulating the needle to create a Local Twitch Response, which has been shown to reset the muscle and allow it to function more normally.
After the desired response, the dry needle is removed, disposed of properly, and a new sterile needle is used for the next treatment area.
The pros to this technique are that the therapist can quickly and accurately test their theory on how your specific movements and patterns are being affected by that muscle or muscle groups. Treating in this way helps you get to the bottom of your injury faster, as we are super sleuthing out the most problematic causes.
The con to this technique is that for some people, the twitch responses can be uncomfortable. While most people don’t feel the needle insertion, the twitch responses can be pretty strong and because of this, some people prefer the In Situ method of dry needling.
Dry Needling with or without Electrical Stimulation
The primary goal of this treatment is to treat your peripheral and central nervous system by inserting and leaving the filament needles in the desired treatment area. Therapists will let the needles sit (in situ) either with or without electrical stimulation. This type of dry needling can be superior to the in-and-out technique for encouraging muscle recruitment, venous return (recovery), and encouraging restored nerve health to an injured nerve, such as in a cervical, lumbar, or spinal disc injury.
The pros to this technique are that it is often considered more comfortable for the patients, and it is sometimes superior to the in-and-out technique in restoring nerve health.
The main con to this technique is that needles are usually left in situ anywhere from 5-25 minutes, which limits our ability to use a quick test-retest method in each suspected area of involvement. This can sometimes make the root cause of the injury more difficult and/or take more time than if we are using a quick reset method followed by movement testing.