At first glance, the confusion is completely understandable. A patient hears that DeMaio Family Chiropractic & Physical Therapy offers dry needling and asks, “So… acupuncture?” No. Then comes the obvious follow-up: “But you’re putting a needle into me.” Correct. “So… acupuncture.” Still no.
It sounds like a comedy routine, but it is actually a fair question. Both procedures use extremely thin, solid needles that pass through the skin, and to someone watching from across the room they can look remarkably similar. The distinction is not simply the object in the practitioner’s hand. It is why that needle is being used, how the treatment area was selected, what tissue is being targeted, and what the practitioner is trying to accomplish.
Maryland regulations make that distinction quite deliberately. Dry needling is recognized as a musculoskeletal and neuromuscular intervention rather than another name for acupuncture. The two practices can overlap anatomically, and sometimes even use very similar needles, but they come from different clinical frameworks.
Which leads to the question patients usually ask next…
Why Is It Called “Dry” Needling?
Nothing about the word “dry” refers to your skin, the room, or whether somebody forgot the alcohol wipe.
The term distinguishes dry needling from an injection. A conventional injection uses a hollow needle to deliver medication, anesthetic, saline, corticosteroid, or another substance into the body. Dry needling uses a very fine solid filament needle. Nothing is injected; the needle itself provides the mechanical stimulus to the tissue.
The practitioner first evaluates the patient’s complaint and looks for muscles or related soft tissues that appear to be contributing to pain, restricted movement, guarding, or altered function. Depending on what is found, the needle may be directed into an irritable area within a muscle, often described as a trigger point, or another relevant soft-tissue structure.
That clinical connection is important. Dry needling is not supposed to amount to finding a sore spot and deciding that a needle seems like an interesting thing to do with it. There should be a reason the tissue is being treated and a relationship between that tissue and the problem being addressed.
Then What Makes Acupuncture Different?
Acupuncture has its own history, education, licensing requirements, diagnostic traditions, and approaches to treatment. Depending on the practitioner and the form of acupuncture being practiced, needle placement may be based on traditional acupuncture points, contemporary anatomical concepts, or a combination of both.
Dry needling developed within musculoskeletal care and is generally centered on findings from an examination: a muscle that is unusually sensitive, an area that reproduces familiar pain, restricted movement, protective tension, or another neuromuscular finding that appears relevant to the patient’s complaint.
That does not mean the two practices never occupy the same real estate. An acupuncture point and a location selected for dry needling can sometimes be very close—or even anatomically similar. Healthcare is full of that kind of overlap. Chiropractors and physical therapists can both work with lower-back pain without becoming the same profession, just as massage therapists and physical therapists can both work with muscle tension without performing the same treatment.
The needle itself does not settle the argument any more than a stethoscope tells you which profession is using it.
A needle is a tool. What gives the treatment meaning is why it is being used, where it is being placed, what the practitioner is trying to affect, and how that decision relates to the patient’s examination.
“Okay… But What Does It Feel Like?”
This is usually where the philosophical discussion about terminology ends and the patient’s attention returns to the obvious issue: somebody is proposing to put a needle into a muscle.
Fair enough.
The needles are extremely thin, and some insertions may produce very little sensation. When the needle reaches a sensitive or irritable portion of a muscle, however, the experience can be different. A patient may notice pressure, an ache, a brief cramp-like feeling, or a sensation that seems strangely familiar because it resembles the discomfort that brought them into the office in the first place.
Sometimes a muscle responds with a quick involuntary contraction known as a local twitch response. It can be surprising enough that patients occasionally abandon medical terminology altogether and ask something closer to, “What the hell was that?”
The answer is usually much less dramatic than the reaction. The muscle contracted briefly in response to the stimulus. A twitch can occur during dry needling, but producing as many of them as possible is not the objective, and a dramatic response does not automatically mean the treatment was more successful.
Some soreness afterward is also possible, much like the temporary tenderness someone may feel following deeper soft-tissue work or unfamiliar exercise. How much a person feels varies considerably, which is another reason dry needling should be discussed in the context of the individual patient rather than presented as a standardized experience everyone will have.
Why Would You Put a Needle Into a Muscle Anyway?
Muscles do considerably more than shorten and move bones. They help stabilize joints, respond to injury, compensate for weakness elsewhere, and sometimes remain guarded long after the original reason for guarding has passed.
A muscle can become overloaded, unusually sensitive, tight, poorly coordinated, or painful when pressed. In some cases, an irritable area can also reproduce discomfort somewhere else, which helps explain why a patient may point to pain around the shoulder blade while the clinician spends time examining the neck and shoulder.
Dry needling may be considered when the examination suggests that this muscular component is meaningful. The intent is not simply to find the sorest possible point and prove to the patient that it hurts. The larger objective is usually to improve the way the area moves and functions, often so the patient can progress more comfortably into stretching, strengthening, rehabilitation, or other treatment.
This is also where dry needling makes considerably more sense as part of a broader clinical approach than as a stand-alone attraction on a treatment menu.
One Tool Among Several at DeMaio
Suppose someone comes to DeMaio Family Chiropractic & Physical Therapy with persistent neck pain. The examination might reveal restricted cervical motion, irritated joints, muscular guarding, reduced endurance through the shoulders, weakness, or several of those things at once.
Needling one irritated muscle may be useful, but it obviously does not address every possible contributor.
For one patient, dry needling and exercise may fit together well. Another may benefit more from manual therapy and progressive strengthening. Chiropractic care may be directed toward restricted joint mechanics while physical therapy addresses mobility, endurance, or movement control. Massage therapy may make more sense when broader muscular tension is prominent, and some patients may have no reason to receive dry needling at all.
That last point is worth emphasizing because having a treatment available is not the same thing as believing everyone needs it. A clinic benefits from having several treatment options only when those options are chosen because they make sense for the patient sitting in front of us.
Maryland Does Not Treat Dry Needling as a Casual Add-On
From the outside, the procedure can look deceptively simple. The needle is tiny, the treatment area may be small, and the actual insertion can happen very quickly.
The training behind it is another matter.
Maryland has specific requirements governing dry needling by licensed professionals who are permitted to perform it. For physical therapists, the state requires additional education and hands-on practical training beyond the basic professional degree before dry needling may be incorporated into practice. Chiropractors who perform dry needling also operate under specific Maryland requirements involving eligibility, training, competency, informed consent, and documentation.
So no, the professional pathway is not: buy needles, find YouTube video, locate sore muscle, become adventurous.
Dry needling involves anatomy, patient selection, precautions, sterile technique, knowledge of structures beneath the treatment area, and the ability to recognize when the procedure is inappropriate. That matters considerably when a needle may be placed near nerves, blood vessels, the rib cage, or other structures that deserve a little more respect than a weekend seminar can provide.
“But Acupuncture Can Treat Muscle Pain Too, Right?”
Yes, and there is no reason to pretend otherwise.
Acupuncturists frequently treat patients with musculoskeletal complaints. Some acupuncture techniques are directed toward painful or tight muscles, and some points used in acupuncture may sit remarkably close to places a dry needling practitioner might select based on anatomy and examination findings.
That overlap occasionally turns discussions about the two treatments into a territorial argument that does very little for the patient.
A more useful question is wonderfully simple: Why are you putting the needle there?
The practitioner should be able to explain the reasoning. If the answer is that a particular muscle reproduces the patient’s familiar symptoms, appears to be limiting motion, or fits into a broader pattern found during the examination, that tells the patient far more than arguing over who first discovered the geographical coordinates of that spot on the body.
When the “Knot” Keeps Coming Back
Dry needling also raises another question we encounter frequently in musculoskeletal care. A patient has had the same “knot” worked on repeatedly. Massage helps for a while. Stretching helps a little. Someone presses on it and finds exactly the painful spot. Then three days later it is back.
At some point, continuing to attack the knot may be less useful than asking why that particular muscle keeps becoming irritated.
Perhaps it is compensating for restricted movement somewhere nearby. Maybe the muscle lacks endurance and is being asked to stabilize an area for hours at work. There may be weakness elsewhere, poor movement mechanics, an old injury, or a joint that is not moving particularly well. Sometimes several of these are happening together.
Dry needling may help reduce one part of that muscular problem, but the more interesting clinical question is what happens afterward. If the patient moves better temporarily, can we use that opportunity to restore motion, strengthen the area, improve control, or address whatever keeps asking the muscle to return to the same protective pattern?
That is where a treatment becomes part of a plan instead of merely an event.
Same Needle… Different Conversation
So, back to our original patient.
“You offer dry needling?”
Yes.
“So it’s acupuncture?”
No.
“But there is definitely a needle involved?”
Oh, there is definitely a needle involved.
Than there’s the stare down where the patient is contemplating whether they’re gonna repeat the cycle by saying, “So it’s accupuncture?” but they end up reevaluating their urge.
That’s when I explain that acupuncture and dry needling can share a similar-looking instrument and occasionally even similar anatomical locations, but the treatment is shaped by the reasoning behind it. In dry needling, that reasoning begins with a musculoskeletal examination and a decision that a particular muscle or related tissue may be contributing to the patient’s pain or movement problem.
At DeMaio Family Chiropractic & Physical Therapy, dry needling is one of several treatment options available to patients in our Bowie and Gambrills offices. Whether it belongs in someone’s care depends on what we find, what the patient is trying to get back to doing, and whether needling that tissue is likely to contribute something useful to the overall plan.
The needle may be the first thing everyone notices… Fortunately, it is not the most important part of the conversation.
With care,
Dr. John DeMaio, D.C., CNS
A Chiropractor in Bowie & Gambrills, Maryland
For appointments, call or text my office at:
Gambrills – (410) 721-2222
Bowie – (301) 262-4545
