Understanding of Myofascial Trigger Points (2): Acupuncture vs Dry Needling

Special Article - Acupuncture and Rehabilitation

Phys Med Rehabil Int. 2018; 5(3): 1146.

Understanding of Myofascial Trigger Points (2): Acupuncture vs Dry Needling

Huang QM1,2*, Xu AL1, Ji LJ1 and Pang B1

1School of Kinesiology, Shanghai University of Sport, Shanghai, China

2Department of rehabilitation, Hudong Hospital, Shanghai, China

*Corresponding author: Huang QM, School of Kinesiology, Shanghai University of Sport, 188 Henreng Road, Yangpu Area, Shanghai, China

Received: March 28, 2018; Accepted: May 04, 2018; Published: May 11, 2018


The use of acupuncture and dry needling has been widely debated, and the main point of contention is whether dry needling has been derived from acupuncture. This paper comprehensively discusses the two aspects of basic theory, diagnosis and treatment of traditional acupuncture, meridian, acupoints, and myofascial trigger points (MTrPs). Except the difference between two theories, many aspects are related in terms of clinical practice and basic laboratory studies. Nevertheless, two aspects are highly similar in terms of treatment action, applicable disease, and physiological experiments. Therefore, MTrP theory is considered a basis for modern acupuncture, which is different from traditional acupuncture theory. MTrP is also easily accepted and learned by individuals with a background in modern medicine and those with knowledge in traditional acupuncture. Hence, MTrPs may be the precise acupoints in traditional Chinese medicine under modern scientific research, and meridian involves the synthesis of referred pain, nerves, vessels, and fascia mechanics. The scientific basis of Chinese and Western medicines should be coherent, although the origin of these two theories varies because of the distinctiveness of the identity between ancient and modern knowledge. The final goals of the two theories are the same, and their results are highly similar. Therefore, one theory should not belong to the other one. Meanwhile, as human behavior or thinking is essential for acupuncture development, a person often attempts either to experience nostalgia based on ancient knowledge or to develop new appropriate theory along with modern experiment technology

Keywords: Myofascial Trigger Points; Acuponits; Acupuncture; Dry Needling; Meridian; Referred Pain; Local Twitch Response


TCM: Traditional Chinese Medicine; TCA: Traditional Chinese Acupuncture; MTrP: Myofascial Trigger Point; DN: Dry Needling; WN: Wet Needling

The Difference between Traditional Acupuncture and Dry Needling

Acupuncture is based on traditional Chinese medicine (TCM) theory and Yellow Emperor’s Inner Classic, which is one of the main textbooks [1] with records of over 3000 years of clinical experience. A total of 361 acupoints distributed in 12 meridians with dialectical diagnosis have been described, and needling and heat treatments have focused on unclear structures or any structures to address health problems, dysfunctions, and disorders. Therefore, a unique traditional Chinese acupuncture (TCA) and moxibustion have been formed in China [2]. By contrast, dry needling (DN) derived from wet needling (WN) is based on modern medicine and myofascial trigger point (MTrP) theory. In DN, symptoms, signs, and palpation are diagnosed, and physical examination is performed. However, needle and heat treatments have focused on all skeletal muscles to alleviate health conditions, dysfunctions, and disorders in humans. Hence, DN belongs to modern clinical medicine and physiotherapy [3-5]. However, we have to define acupoints and meridians and to locate their precise positions in the body. Actual results have yet to be obtained because they are too abstract without real anatomical, physiological, and pathological bases. Needling acupoints should achieve Qi, such as feeling of soreness, swelling, and numbness with pain [6]. As such, these acupoints are not easily understood by beginners or ordinary individuals who have earned education in modern medicine. In clinical treatment, most patients have benefitted from traditional acupuncture at beginning, but such effects have subsequently become invalid. When experiences in acupuncture practices have accumulated for acupoint positioning without the use of traditional textbooks as references, acupuncture skills of most doctors with a background in traditional acupuncture have been improved. This accumulated skill is unrelated to textbooks of TCA.

MTrPs are pathological structures that undergo morphological changes in muscle fibers with spontaneous electromyographic discharges [7-9]. Needling MTrPs should cause some alterations, such as a local twitch response (local muscle jump), a puncture referred pain, or a strong feeling of soreness, swelling, and numbness [10- 12]. Therefore, this procedure can be easily understood by beginners with a medical background, especially human anatomy, physiology, and pathology. The effect of needling treatment is stable and quick because of the precise positioning of MTrPs. When their experiences have accumulated, the effects will be enhanced and long lasting.

Two systems have different theoretical sources, and diagnostic methods and point localizations vary. In TCA, the general positioning of acupoints consists of three methods: “self-body surface”, “self-bone degree” and “self-finger inch”, simplified for positioning acupoints in strict arrangement on 12 meridian lines. By contrast, other acupoints outside the 12 meridians have their independent and specific body surface positions, so each point has a unique location in the human body [2,6]. Some doctors suggest “to speculate points,” although others promote “rather lose its point, do not lose it in meridian” [1,6]. Therefore, the positioning of acupoints should be accurately determined for an effective treatment. However, all of these acupoint positioning methods cannot accurately locate points because the definition and location of an acupoint are unknown, except that one can give up traditional theory and earn more clinical experience. It is said that Yi Jin Jing Classics can help precisely locate acupoints [10], but a vague description in this Classics lacks experimental data has been presented. Therefore, it always has a debate with meridian theory.

Positioning MTrPs generally needs clinical symptoms, physical signs, and dysfunctions as a diagnostic basis to determine affected muscles, and MTrPs can be accurately palpated as a painful taut band through a finger [5,11-13]. Palpation should be employed to accurately identify the location of MTrPs because their location varies from person to person [11-13]. Therefore, the anatomical and physiological characteristics of each muscle and the pathological properties of MTrPs have been described. The localization of MTrPs should satisfy three conditions [11-13]: 1) a palpable taut band with obvious pressing pain (Figure 1 left); 2) referred pain (Figure 1 middle); and 3) local twitch responses (local muscle jumps, or longdistance muscle jumps (Figure 1 right).