If I tell somebody “I think you may be a good candidate for Dry Needling, often their eyes open wide accompanied with a painful facial expression. The word “needling” doesn’t seem to trigger the best of responses even though “acupuncture” seems to have a more benign effect.

That’s a bit strange because by definition they’re the same thing:
Acu = Needle
Puncture = The act of piercing through 
As a Physiotherapist and Dry needling therapist, I’ve come to understand it’s mostly about understanding what’s going on during a dry needling treatment and what the differences/similarities are with acupuncture.
1. What is dry needling?
Dry needling is a so-called intramuscular- treatment performed by a specially trained physical therapist. This treatment method is often used for muscular complaints that have existed for a long time and is part of a total treatment. Examples can include chronic headaches, low back pain, RSI, neck problems, tennis elbow and other long-standing muscle problems . The physiotherapist uses thin acupuncture needles, which can help to quickly and easily fix “knots” in muscles.
2. Is it similar to acupuncture?
“There are similarities between acupuncture and dry needling.  For example, the same needles are used and the needle placement technique matches. However, there are also obvious differences.
The biggest difference is the approach. Chinese traditional Acupuncture is mainly used from an energetic concept. The idea is that the body has a wide map of “meridians”, which function as energy channels between different body charts. Blockages in these energy pathways can lead to problems and acupuncture needles are inserted to unblock the problematic areas.

A map of the meridians used in Traditional Chinese Medicine

Dry needling works from a physiological and bio-mechanical concept. There are many muscles that work together as a team through the body. Since all these muscles are connected, they strongly influence each-other. Sometimes some of the muscles in the team can hold “triggerpoints”, which are commonly known as “knots”. These points can cause pain, stiffness and dysfunction in the muscle and the joint it works for. But it can also affect the entire line it belongs to. With dry needling, the aim is to insert a thin acupuncture needle in the triggerpoint to release it from the muscle.

The Myofascial “arm line” muscle connection (From the book “Anatomy Trains”)

Another difference is that classical acupuncture often uses multiple needles, which remain in the body for some time. Dry needling uses one or a low amount of needles and they usually are in and out in a matter of seconds. 
3. When is dry needling applied?
“For long-term muscular complaints, dry needling is effective, especially if myofascial (muscle tissue and fascia = connective tissue) trigger points are present. These trigger points can be explained as a painful hardening or muscle node. Often these trigger points cause not only pressure pain , But also pain in other parts of the body.
The physical therapist is looking for these places because they can be the main cause of your complaints. In addition to pain, a triggerpoint can also provide movement limitation, stiffness and reduced activity of the particular muscle. Sometimes even reactions like sweating, dizziness, headache, blurred vision, tingling or cold hands can occur from an active Triggerpoint.

Low back muscles and their referred pain patterns

Most patients with muscle problems can be treated with DN, but in some cases dry needling is less suitable. Pregnancy is a reason not to treat, just as fear of needles. Acute injury due to an accident, for example a muscle tear, is also excluded from treatment.
4. How does it feel?
“In order to release trigger points, the physiotherapist will cause them to “twitch”, which will force the muscle to relax. The insertion of the needle will not or hardly be felt. The treatment of the muscle is often accompanied by a Sudden short tightening of the muscle. This “cramping” can be a bit painful but is usually short-lived,  and a positive effect of relief follows immediately after. The muscle may be more flexible, the mobility in the joint improves and pain decreases.
5. What is the effect of a treatment?
“After treatment, the treated muscles usually feel quite tired and heavy.” Strong muscle soreness” is a common phenomenon, which is quite normal and often disappears within a day. Sometimes, some general fatigue occurs after treatment. Regularly, patients experience a deep sleep on the night after treatment.
During a first treatment , the therapist usually only treats a small number of points. This way he/she can see how you react to the treatment before the intensity is built up.
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