What is Dry Needling?

What is dry needling, is it safe and effective, and how does dry needling differ from acupuncture? Find out here!

Physical therapists have long used a multitude of techniques in order to address pain and dysfunction associated with myofascial trigger points. One technique in particular has recently received overwhelming attention: dry needling. Despite its efficacy and low risk, questions about the treatment remain: What is dry needling? How is dry needling different from acupuncture? Is dry needling safe? What conditions does dry needling treat? Is it effective? How long does it take to work? Is this technique within the scope of practice of physical therapists? We aim to address all of these questions here.

What is dry needling?

The American Physical Therapy Association (APTA) defines dry needling as “a skilled intervention where a thin filiform needle is used for pain management of neuromusculoskeletal origin and for movement impairments.” A thin filiform needle is used to stimulate underlying myofascial trigger points, connective tissues, and muscles after penetrating the skin. It manages pain that originates from muscles, fascia, and connective tissues. Dry needling reduces the persistent peripheral nociceptive input, thereby decreasing or restoring impairments in body structures and function. As a result, it leads to an improvement in activity and participation.

How is dry needling different from acupuncture?

At first, it may sound like dry needling is a form of acupuncture. The needles used in dry needling are single-use, thin filiform needles, similar to those used for acupuncture. The gauge and length of the needles may vary. But, dry needling is not the same as acupuncture, even though similar needles are used. Acupuncturists insert needles along meridian lines to release endorphins while dry needling is aimed at releasing specific myofascial trigger points (contracted knots within a muscle that occur when it is stressed or strained).

What conditions does dry needling treat?

Dry needling has been proven to help with major musculoskeletal pain conditions (low back pain, cervicogenic headaches, arthritis, sprains/strains, tendinitis, overuse injuries, etc.). The dry needles are inserted into trigger points that evoke a localized twitch response. This, in turn, helps decrease muscle contractions, improve flexibility, and ultimately, decrease pain. Although the majority of studies demonstrate effectiveness treating musculoskeletal pain, the evidence supports the use of dry needling on neurological presentation as well. Additional effects of dry needling include:

• Improves range of motion
• Improves functional independence
• Boosts physical, social, and mental well-being
• Improves quality of life
• Reduces the use of highly addictive pain medications
• Normalize or improves gait pattern

Thus, dry needling can be a treatment of choice to manage pain in patients with either acute or chronic pain issues.

How does dry needling work?

A physical therapist often uses dry needling in conjunction with other therapeutic modalities like therapeutic exercises, manual therapy, strengthening exercises, home exercise program, or electrical modalities. The research is conflicting as to whether or not dry needling alone is effective at treating pain or the benefits are achieved when combined with other modalities. Also, research is still lacking the fundamental answer to exactly how dry needling reduces the pain. The basic premise is that the twitch response from needle insertion induces “inflammatory mediators or other immune-related chemicals” that help alleviate muscle contractions and pain.

How long does it take for dry needling to work?

The treatment duration depends on the location and cause of the pain. Some patients have noticed improvement in pain symptoms in as little as 24 to 48 hours. With initial treatments, results typically last several days. With each additional treatment, the goal is to increase the window of relief meaning a longer relief period between sessions.

Is dry needling safe and effective?

Comparing the benefits to the minimal side effects, dry needling is a safe practice to improve quality of life (and, specifically, decrease the use of addictive pain medications) for those with acute or chronic pain conditions. However, dry needling is not ideal for every patient. There are a few precautions that physical therapists should be aware of:

1. Patients who are already anxious or fearful of needles are usually not good candidates for this treatment.
2. Patients who are taking blood-thinning medications should avoid dry needling. The needles may cause bruising, slight pain, or minimal bleeding.
3. Pregnant women should avoid the treatment.
4. Drowsiness, tiredness, or dizziness occurs after treatment in a small number of patients (<3%).
5. Existing pain may get worse after initial treatment, but then significantly improve.
6. Since dry needling is a newer PT approach, a few billing problems and insurance denials are outstanding. Both the APTA and FABPT have recognized this problem and are working with legislatures to resolve the issues.

Who should perform dry needling?

Dry needling should only be performed by an experienced and qualified physical therapist who has received the proper training on the technique. Even though PTs are well informed about muscle anatomy and trigger points in school, it is important to have proper qualifying education on dry needling. A detailed education regarding this approach is necessary. The American Medical Association stated in 2016 that the group “adopted a policy that physical therapists practicing dry needling should—at a minimum—have standards such as training certification and continuing education.” If you are a physical therapist and are interested in dry needling education, see our continuing education course titled, An Introduction to Trigger Point Dry Needling.

Is dry needling within the scope of practice of physical therapists?

There is an ongoing debate regarding whether or not dry needling is within a PT’s scope of practice. Every state has its own rules and regulations regarding this treatment. See our next blog where we discuss the scope of PT practice with dry needling and the APTA’s stance on it. References:

1. Int J Sports Phys Ther. 2015 Jun; 10(3): 402–418.
2. http://www.apta.org/StateIssues/DryNeedling/
3. http://www.apta.org/PTinMotion/2015/5/DryNeedling/
4. http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Dry_Needling/AnalysisCom pdf#search=%22dry%20needling%22