Why your physical therapist might recommend dry needling - and whether it actually works
- Dry needling is typically performed by a physical therapist to relieve pain and improve mobility.
- Needles are stuck into muscular knots, which triggers contraction followed by muscle relaxation.
- This increases blood circulation to the area and may change how your body responds to pain.
For people dealing with acute or chronic pain, medication is far from the only relief. Dry needling is a relatively painless, effective technique designed to treat muscular discomfort.
Here's what you need to know about how dry needling is performed, its benefits, and its risks.
What is dry needling?
Dry needling is a physical therapy technique designed to ease pain. It involves sticking needles into specific trigger points, says Bianca Beldini, DPT, MSOM, dual licensed Doctor of Physical Therapy and Licensed Acupuncturist at Sundala Wellness.
The practitioner inserts the needle into painful knots, which are areas of "muscle fibers that are shortened, thickened and hardened," says Beldini.
Dry needling may help with a range of musculoskeletal issues caused by overuse, injury, or trauma, such as:
- Shoulder pain
- Back pain
- Migraines
- Tendinitis
When you poke a needle into these knots, it causes your muscles to suddenly contract and then relax. This twitch changes the biochemical makeup of that point which may relieve pain.
Dry needling also works by increasing blood circulation to the area and stimulating nerve responses which can change how someone responds to pain, says Leng Tang-Ritchie DAOM, LAc, licensed acupuncturist and Director of Clinical Services at Pacific College of Health and Science.
The dry needling procedure
Beldini says the procedure steps are as follows:
- The practitioner locates a "knot" or area of tight tissue where the needle will be inserted.
- The practitioner inserts a needle into this trigger point. The number of needles needed depends on the size of the area being treated. For a larger area, like the lower back, 10 to 12 needles might be used, for example.
- You'll feel the muscle fibers respond with an involuntary twitch response as the fibers soften and relax.
- The whole procedure will typically last about 20 to 30 minutes.
The needles used will vary in gauge and length, based on what muscle is being treated. For example, shorter needles can be used for shallow muscles, but longer and larger needles are necessary for deeper muscles, says Beldini.
When needles are involved, it's common to worry about pain. However, Beldini says
that when dry needling is performed correctly, it shouldn't cause pain.
As for recovery, Tang-Ritchie says some people may feel soreness for 24-48 hours after a dry needling session. To optimize results during this time, Tang-Ritchie recommends:
- Staying hydrated
- Stretching
- Putting a warm heating pad on the affected area
Dry needling should be performed by a physical therapist or acupuncturist trained in the procedure. And while acupuncture and dry needling go by different names, they're fairly similar.
What is the difference between dry needling and acupuncture?
"'Dry needling' is a more recent term that was constructed by the physical therapy community, however the technique of dry needling has been done by acupuncturists for thousands of years," says Beldini.
One of the main differences is the vast library of research supporting acupuncture compared to the limited research on dry needling.
Acupuncture is typically done with more of a holistic approach with a focus on balancing "Qi," or energy within the body.
Whereas, dry needling addresses the specific body part that's in pain and is more focused on physical discomfort.
The benefits of dry needling
Research on the benefits of dry needling is limited, however preliminary small human studies indicates promising results for the following:
- Pain reduction: Pain relief is the primary purpose of dry needling. A small 2017 study found that three sessions of dry needling reduced discomfort for participants with chronic pain (in particular, myofascial pain syndrome).
- Improved circulation: A 2014 clinical review found that dry needling may improve blood flow to the area, which results in improved circulation. The review also suggests that this could be a reason why the procedure helps reduce pain, since low blood flow was linked to greater pain intensity.
- Improved mobility: Relief from tension and pain can lead to improved mobility. A small 2017 study involved patients who had knee replacement surgery and continued to suffer from pain and reduced mobility after physical therapy. But after four weeks of combining both physical therapy with dry needling, the participants saw significant improvements in range of motion, as well as pain relief.
However, more high-quality, larger-scale research needs to be done to further understand the benefits as well as long-term effects of dry needling, according to a 2017 systematic analysis.
The risks of dry needling
Dry needling comes with risks. One of the problems is that it's semi unregulated.
According to the American Physical Therapist Association, physical therapists are explicitly allowed to practice dry needling in 36 states and DC and prohibited from practicing it in six states. Eight states remain silent on the topic without laws in place.
There's controversy surrounding how much training physical therapists have to go through in order to be certified in dry needling, compared to how much training acupuncturists receive. In some states, acupuncturists need over 3,000 hours of training, whereas a dry needling certification can be earned after just 54 hours of training, says Tang-Ritchie.
If the dry needling procedure is done by a practitioner with little training, Beldini says the risks include:
- Soft tissue damage
- Organ puncture
- Increase in pain and swelling in the affected tissue
Insider's takeaway
There is evidence supporting the efficacy of dry needling as a treatment for pain, although more research is needed to draw more solid conclusions. Additionally, you shouldn't expect dry needling to be a cure-all for your pain.
Dry needling often goes hand in hand with other treatments for the best results. "Physical therapists often combine it with other conventional physical therapy interventions just like acupuncturists often combine it with other appropriate modalities," says Tang-Ritchie.
If you're considering dry needling, look into your state's regulations and think about your personal comfort level, which may determine if you should go to an acupuncturist or physical therapist.