Dry needling is a therapeutic technique employed by physical therapists and other trained healthcare professionals for the management of musculoskeletal pain and movement impairments. It is typically integrated into a comprehensive pain management strategy, which may encompass exercises, stretches, massages, and other methodologies. In this procedure, practitioners insert fine, sharp needles beneath the skin to address underlying myofascial trigger points.

In the term “myofascial,” “myo” pertains to “muscle,” while “fascia” refers to the thin, white connective tissue enveloping muscles.

Trigger points denote tense, tender knots that develop within muscles, and they can be exquisitely sensitive and painful when touched. These points sometimes coincide with the source of pain, but they can also lead to referred pain, which affects remote areas of the body.

Dry needling involves the insertion of needles to alleviate trigger points. This intervention contributes to the reduction of tightness, enhancement of blood circulation, and mitigation of local and referred pain within muscles and tissues. The needles employed in this technique do not contain any medication, hence the term “dry.” This distinguishes it from trigger point injections, which involve the administration of medication and are conducted by physicians.

Alternative names for dry needling include trigger point dry needling and intramuscular stimulation.

How Does Dry Needling Function?

When a muscle becomes overused, it undergoes an energy deficit, leading to inadequate blood supply. This shortage of oxygen and nutrients prevents the muscle fibers from returning to their typical resting state.

Consequently, the tissue surrounding trigger points becomes more acidic, heightening sensitivity in nerves and resulting in soreness and pain.

The introduction of a needle into a trigger point encourages the return of a healthy blood supply, flushing out the region and relieving tension. Additionally, the prick sensation can activate nerve fibers that prompt the brain to release endorphins, the body’s natural pain-relieving chemicals.

Once a therapist identifies a trigger point, they insert a needle directly into it through the skin. Gentle manipulation of the needle may induce a local twitch response, a swift muscle spasm that signifies a positive reaction.

For some individuals, immediate improvements in pain and mobility are observable after a dry needling session, while others may require multiple sessions to experience similar effects.

Is Dry Needling Painful?

Trigger points are inherently sensitive to touch, so some discomfort may arise as the therapist locates them before needling.

Sensations of discomfort might also occur during needling. The needle is so fine that some may not feel its insertion, whereas others might experience a momentary prick. Once the needle reaches the trigger point, it can induce pain and trigger a twitch response. Subsequent to the procedure, mild tightness or soreness near the insertion site can manifest, though it is crucial to maintain movement and engage in stretching exercises.

What Are the Effects of Dry Needling?

Dry needling holds potential for alleviating pain and augmenting range of motion. Conditions that may benefit from dry needling encompass:

Joint ailments. Spinal disk problems. Tendinitis. Headaches, including migraines and tension-type headaches. Disorders affecting the jaw and mouth, such as temporomandibular joint (TMJ) issues. Whiplash-related discomfort. Repetitive motion disorders, like carpal tunnel syndrome. Spinal issues. Pelvic pain. Nocturnal muscle cramps. Phantom limb pain. Postherpetic neuralgia, a complication arising from shingles.

Who Should Avoid Dry Needling?

Certain demographic groups are advised against undergoing dry needling. Children under the age of 12 are not typically recommended for this procedure due to potential discomfort. In such cases, both the child and the guardian must provide consent, and less invasive alternatives should be explored initially. Additionally, individuals who should consult their physician before pursuing dry needling include those who:

  • Are pregnant.
  • Might have difficulty comprehending the treatment.
  • Suffer from severe needle-related fear (trypanophobia).
  • Possess compromised immune systems. Have recently undergone surgery.
  • Are taking blood-thinning medications.

What Occurs During a Dry Needling Session?

Initially, the provider will sterilize the treatment area and prepare the needle. The needles used are always single-use, sterile, and disposable. Employing one hand or their fingers, the provider will palpate the region to locate the trigger point. Utilizing the other hand, they will position the needle, encased in a plastic guide tube, over the area. This guide tube aids precise needle placement while the provider uses one hand.

Gently tapping the needle into the top layer of skin (epidermis), the guide tube is then discarded. The specific technique employed may vary and includes:

Superficial Technique: The needle is inserted 5 to 10 millimeters into the subcutaneous tissue (the layer beneath the skin) above the trigger point. Deep Technique: The needle penetrates beyond the subcutaneous tissue, reaching deep into the muscle to access the trigger point. The needle may remain in place for a brief two seconds or extend up to 20 minutes, depending on the technique employed. The pistoning technique, involving rapid up-and-down needle movements through the tissue, may also be employed. Check out these courses to learn more about this style of technique here.

Initially, one to two needles may be used during the initial treatment. Subsequent sessions could involve additional needles, as deemed appropriate based on your response. For instance, a back treatment may necessitate up to 10 to 15 needles along the spine.

During the procedure, sensations of muscle soreness or twitching are normal responses, indicating the muscles’ reaction to the treatment.

What Follows a Dry Needling Procedure?

Upon completion of the dry needling session, the provider will remove the needle and inspect your skin for any reactions. The used needle will be discarded in a designated sharps container.

You will be instructed to rise slowly, and if dizziness occurs, you will be advised to sit and rest before departing the facility.

After treatment, adequate hydration is important. While some muscle soreness may arise post-treatment, maintaining movement is essential. This discomfort is normal and typically subsides within 24 to 36 hours. Potential bruising near the treatment site, which may persist for about a week, is also possible.

Risks and Benefits What Are the Advantages of Dry Needling?

Integrated into an overall treatment regimen, dry needling boasts numerous advantages. It is cost-effective and generally considered safe, posing a low risk of complications when administered by a trained practitioner.

Research indicates that dry needling effectively releases trigger points, potentially mitigating muscle pain, stiffness, and enhancing flexibility and range of motion.

What Are the Potential Adverse Effects of Dry Needling?

The most common adverse effect of dry needling is temporary soreness during and after the procedure.

Other potential side effects are generally minor and encompass:

  • Stiffness.
    Bruising in or around the insertion site.
  • Fainting.
  • Fatigue.
  • While the risk of infection exists, it is imperative to confirm that the provider has received proper training.

Severe side effects are extremely rare. However, if bleeding occurs at the insertion site, applying firm pressure and contacting your provider or physician is crucial. If shortness of breath emerges, immediate contact with a provider, physician, or emergency services is recommended. In rare instances, dry needling in the thoracic region may lead to a collapsed lung (pneumothorax), necessitating a chest X-ray and further medical attention.

Additional Insights Dry Needling vs. Acupuncture — How Do They Differ?

Dry needling and acupuncture share a commonality in that both involve the insertion of needles through the skin. However, distinctions arise beyond this point.

Dry needling is executed by diverse healthcare professionals with varied training backgrounds. Acupuncture, on the other hand, is conducted exclusively by licensed acupuncturists and is rooted in Eastern medicine. Dry needling is grounded in Western medicine, focusing on pain pattern evaluation, postural analysis, dysfunctional movement patterns, and orthopedic assessment.

While acupuncture addresses musculoskeletal pain, its scope extends to other bodily systems. Dry needling is primarily aimed at muscle tissue, aiming to alleviate pain, deactivate trigger points, and enhance movement. It is frequently integrated into broader physical therapy protocols that incorporate various therapeutic approaches.

Is Dry Needling Accessible Nationwide?

Dry needling as a physical therapy practice is approved in 37 states and Washington, D.C. Regulatory laws pertaining to healthcare providers in certain states prohibit the practice of dry needling.

The administration of dry needling may fall under the purview of licensed physical therapists, athletic trainers, chiropractors, or medical doctors, provided they have received appropriate training, depending on the state’s regulations.