Although not invented by her, Dr Travell did more to popularize the term than any other figure in US history. More on her role later!

The first published use of the term ‘dry needling’ was in 1947, in an article in The Lancet by John D. Paulett, MRCS. In describing the treatment of 25 cases of low back pain by injection into tender points, Paulett presented the finding that ‘dry needling’ was as effective as injections of anesthetic (procaine) and saline solution.

Paulett might have been aware that a few years prior to this, on the other side of the pond, a 1941 paper in the Annals of Internal Medicine by Ernest A. Brav, MD and Henry Sigmund, MD had presented the same “surprising” finding, but without using the term ‘dry needling.’

Notably, their paper begins with the statement that:

“The origin of the local and regional injection treatment of low back pain and sciatica dates back to the earliest descriptions of acupuncture.”

It is easy to see how standard acupuncture needling, which has a documented history spanning back over millennia, came to be referred to as ‘dry needling’ by practitioners of Western medicine. Injection therapy was widespread at the time this term was coined, and the use of a hypodermic needling without the injection of any liquid is, quite logically, ‘dry.’

It is interesting to speculate about whether, had the geopolitical tables been turned, injection therapy would have come to be known as ‘wet acupuncture’ by practitioners of Chinese medicine!

Myofascial Trigger Points (MTrP), a type of ashi point, are tender spots in the muscles that are either right in an area of pain, or at some distance from the pain in a related area of the body.
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When treating pain, it is important to differentiate between different types of ashi points to treat them effectively. A large healthy muscle with one or two tender spots will respond well to direct needling (ie “dry needling”). However, if the entire muscle is short and tight, or if there are multiple areas of pain that are not limited to individual muscles, then I will start with an acupuncture technique that can reduce tension and pain throughout a broad area.

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For example, if an athlete develops acute shoulder pain in the days following an intense workout, it might be possible to identify one or two MTrPs in the deltoid muscle on the affected side. Direct needling of these points will bring immediate relief to the affected muscle fibers.

As a counter-example, if someone has persistent shoulder and neck tension from working at a computer, and wakes up one morning unable to turn their head to one side, it is likely that multiple muscle groups are in spasm. In this case, dry needling would be inappropriate, and I would start with a distal approach that releases the entire neck and shoulder, including the trapezius, levator scapulae, deep cervical paraspinal muscles, etc.

Dry needling is an acupuncture technique used to release and lengthen muscle fascia and relieve pain.

It is also known as trigger point needling, orthopedic acupuncture, ashi needling, etc, and is an integral part of the practice of acupuncture.

Here's an example of needling based on myofascial pain referral patterns from 1624:

彼云肋下一点，按着则痛连胸腹，及细为揣摸，则正在章门穴也。
--《景岳全书》1624
"When I pressed a point slightly below the rib the patient stated that pain radiated to the chest and abdomen. I carefully felt for the point, and it indeed was exactly at Zhangmen (LV-13)."
--The Complete Works of Zhang Jingyue, 1624

One of the key characteristics of a myofascial trigger point (MTrP) is that it radiates pain to another area, as in the above example from 400 years ago. In that classic example, a patient came in complaining of pain in the abdomen and chest, and the practitioner found that pressing a tender point on the side of the ribs elicited the same pain.

He further identified this point as 章门 (zhangmen, LV-13, at the abdominal oblique muscle attachments), and the text goes on to describe the case's successful resolution.

In a common example from my practice, if a patient comes in with a headache behind one eye and in the temple, I will start by palpating the side of the neck and upper shoulder. If I can identify a tender area in the trapezius muscle (GB 21) that elicits the same pain when pressed, then we have found the source of the headache!
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