Physiotherapists in New Zealand are increasingly learning and practicing Western acupuncture. Western acupuncture as a new and different tool is enhancing and yet challenging physiotherapists practice. This study explores the meaning behind Western acupuncture practice to further understand the implications of its development and possible future direction.Hermeneutic methodology was used because it facilitates the exploration between that which is familiar and that which is unfamiliar. Seven New Zealand physiotherapists qualified to practise Western acupuncture were interviewed about their practice experiences. The data in relation to the phenomenon of inquiry was analysed thematically.The findings revealed a complex array of tensions within physiotherapy because of the differences Western acupuncture brings to physiotherapists' practice. Western acupuncture is a new and useful tool in the physiotherapists 'toolbox'. It is congruent with other physiotherapy practices in that it shares the same scientific neurophysiological foundation. However, the association of Western acupuncture with traditional Chinese acupuncture causes it to be viewed as a complementary medical practice and thus, not completely legitimate as a part of physiotherapy. These tensions are further confounded because the technical rationalist paradigm, upon which physiotherapy is based, values evidence-based practices. The best evidence is perceived to be that gained from the randomised controlled trial. I argue that the randomised controlled trial is poorly suited to the evaluation of complex practices such as Western acupuncture. Such insights also challenge physiotherapy, as a whole, because the available 'evidence' does not acknowledge the complexities of practice involving individual practitioners, their colleagues, the profession, other healthcare professions, patients and the public.The tensions encountered in physiotherapy and Western acupuncture practice have led to a number of recommendations in education, practice, research and legislation. Overall, they suggest a need to develop a more inclusive model of practice development. Western acupuncture is a potentially valuable tool. In order to maximise use of this tool physiotherapy practice understandings need to be extended. This in turn, will assist development of the profession as a whole.