Defining the exact history of what is called in Quebec physiotherapy puncture with dry needles (PPAS) or the use of needles under the dermis (UASD) is a politically delicate task. It must be said that the practice of the dry needle (English: dry needling) can be similar to acupuncture in several aspects. Physiotherapeutic puncture with dry needles differs from what is called traditional acupuncture in that it does not in any case use the concepts of traditional Chinese medicine (meridians, energy circulation, etc.). It is based exclusively on contemporary scientific concepts, including, among others, neurology, immunology, molecular biology, physiology and anatomy. Seen this way, any puncture without injection according to scientific medical rationale to improve the signs and symptoms of a given pathology should in my opinion be considered dry needle practice. Historically, just as much of today’s medicine consists of herbal remedies that have been used for several hundred years in traditional medicines around the world, PPAS has developed in part through observation and the study of traditional Asian acupuncture methods.
It is important to note that the etymology of the word acupuncture is defined as -acu- for needle and -puncture- for puncture. From this point of view, any action of using a needle to puncture would be acupuncture, physiotherapeutic puncture with dry needles (PPAS) or the use of needles under the dermis (UASD) or “dry needling”. ”Would therefore be etymologically“ acu ”-“ puncture ”. It then becomes confusing to use this term since some use it to refer to traditional Asian acupuncture methods and while others use it in reference to contemporary acupuncture methods which use more scientific foundations, including dry needle techniques. In Quebec, PPAS is not considered acupuncture, it is also a good way to differentiate yourself from acupuncture concepts based on traditional Chinese medicine. I would also like to point out that in Quebec these methods are practiced by physiotherapists who have a university level of education in health science, acupuncture is a college-level technique that spends a lot of time studying the concepts of medicine. traditional Chinese and very little in the study of current medicine.
To increase the confusion, there are different definitions and different ways of framing legislation in different provinces and countries. For example, in some places physiotherapists or doctors can practice acupuncture in general and all “dry needling” techniques, other policies restrict professionals to only use “dry needling” techniques and do not can practice traditional Chinese acupuncture techniques which are reserved for acupuncturists. We must also consider the different ways of naming the techniques, physiotherapy puncture with dry needles (PPAS) or the use of needles under the dermis (UASD) in Quebec is generally the equivalent of “dry needling” or Intra-Muscular Manual Therapy (IMT) in the United States.
It is in the 17th century that we find traces of the interest in the use of needles in medicine, when a German doctor, Willem Ten Rhijne, reports his observations of traditional acupuncture. At this time, the medical community paid little attention to the phenomenon since during dissection of a corpse, anatomists could not find any trace of the meridians, these lines where energy should flow according to traditional Chinese medicine. It seems that at the beginning of the 19th century, certain medical books in France, Italy and England began to recommend the use of acupuncture. In 1821 and 1828, an English physician, JM Churchill published two books in which he described acupuncture treatment techniques for what is called rheumatalgia (literally joint pain). The development of “Western” acupuncture will be at a slower pace for the rest of the 19th century, potentially linked to the lack of scientific explanation of the functioning mechanisms. In 1912, in the 8th edition of his textbook entitled: “The Principles and Practice of Medicine”, an English physician from the University of Oxford wrote: “… For lumbago, acupuncture is in acute cases the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilized will do) are thrust into the lumbar muscles at the seat of the pain and withdrawn after five to ten minutes … ”. Clearly, we recognize in this extract a use of acupuncture that departs from traditional Chinese medicine. potentially related to the lack of scientific explanation of the operating mechanisms. In 1912, in the 8th edition of his textbook entitled: “The Principles and Practice of Medicine”, an English physician from the University of Oxford wrote: “… For lumbago, acupuncture is in acute cases the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilized will do) are thrust into the lumbar muscles at the seat of the pain and withdrawn after five to ten minutes … ”. Clearly, we recognize in this extract a use of acupuncture that departs from traditional Chinese medicine. potentially related to the lack of scientific explanation of the operating mechanisms. In 1912, in the 8th edition of his textbook entitled: “The Principles and Practice of Medicine”, an English doctor from the University of Oxford wrote: “… For lumbago, acupuncture is in acute cases the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilized will do) are thrust into the lumbar muscles at the seat of the pain and withdrawn after five to ten minutes … ”. Clearly, we recognize in this extract a use of acupuncture that departs from traditional Chinese medicine. acupuncture is in acute cases the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilized will do) are thrust into the lumbar muscles at the seat of the pain and withdrawn after five to ten minutes … ”. Clearly, we recognize in this extract a use of acupuncture that departs from traditional Chinese medicine. acupuncture is in acute cases the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet needles, sterilized will do) are thrust into the lumbar muscles at the seat of the pain and withdrawn after five to ten minutes … ”. Clearly, we recognize in this extract a use of acupuncture that departs from traditional Chinese medicine.
It is in the 1930s and 1940s that we can evoke the first scientific studies that drastically differ from traditional acupuncture. At this time, English doctors began to publish research on muscle pain. By injecting irritants into the muscles of healthy subjects, they compared the pain caused to patients with similar symptoms. They found that by injecting pain relievers into these places, they could suppress their patients’ symptoms.
Developments continued further in the United States in the 1940s with American doctor Janet Travell. This one dedicated his career to the pains of muscular origins. It was in the following years and with the publication of its two volumes that the world began to take more interest in the use of dry needles. The first techniques described techniques with injections of analgesic substances. But the accumulation of scientific evidence shows that, for the pains caused by points of excessive muscular tension, the therapeutic effect is due to the puncture, created by the needle in the muscle, which “undoes” the tension and not by the agent injected. Several recent studies show that for this type of problem, it is therefore sufficient to puncture the points of tension, without making any injection, to decrease symptoms. From these scientific approaches was defined the English term “Trigger Point Dry Needling”, which can be translated as “Dry needle for trigger point”. The terms “dry” or “dry” are used to define needle techniques without injections as opposed to techniques with injections (“wet needling”).
Along with the scientific medical developments described above, other research teams have recently focused on understanding the phenomena of the use of needles. In these studies, some speak of “dry needling”, others of “acupuncture” or more specifically of “traditional acupuncture” or “modern western acupuncture”. To give just a few examples, some studies seek to compare the effect of traditional acupuncture to “dry needling”, others study the effect of punctures on the brain by the use of functional magnetic resonance, others seek to describe the mechanisms of local actions at the molecular level. In short,
Physiotherapeutic puncture with dry needles (PPAS) or the use of needles under the dermis (UASD) or “dry needling” is recognized and practiced throughout the world by several health professionals, for example doctors, physiotherapists and chiropractors. It is still a young medical practice which shows a growing interest in both scientific research and clinical practice.
In Quebec, it was in 2002 that the Quebec government officially allowed the practice of UASD / PPAS and made it an act reserved for physiotherapists. It was only nine years later, in 2011, that the first official permits to practice PPAS were issued by the Professional Order of Physiotherapy of Quebec. In 2015, the Professional Order of Physiotherapy of Quebec suggests changing the terminology used, the use of needles under the dermis (UASD) becomes physiotherapeutic puncture with dry needles (PPAS).