Your Questions Answered: Dry Needling 101
Written by:
Dr. Eric Brown, PT, DPT, OCS, Cert. DN
Owner & Physical Therapist of Movement Restoration Physical Therapy (Sioux Falls, SD)
APTA Board-Certified Orthopedic Specialist, Dry Needling Certified
"What is dry needling?"
You’ve likely heard or experienced what feels like a “knot” in a muscle. They are often tender and pressing on them can cause pain to spread to other parts of your body. This is called referred pain. For example, the upper trapezius (see below) can refer to the shoulder, neck, and base of the head potentially leading to headaches. These trigger points or persistent trouble spots can be located in many regions of the body - not only in the upper trap, but also in the neck, shoulder, lower back, hip, knee, hamstrings, and foot.
Credit: JOSPT Patient Perspective
"What is the history of dry needling?"
There are many manual therapy interventions administered by healthcare professionals; however, dry needling has been around since the 1940s out of the work of Dr. Janet Travell and Dr. David Simon (above) on the treatment of myofascial ("muscle/fascia") pain. Only more recently has it gained its footing as a popular intervention in the musculoskeletal treatment world by physical therapists, physicians, and other healthcare practitioners.
"How does it work?"
Dry needling involves the insertion of a very thin needle into the targeted muscle trigger point to reduce pain, muscle tone, and tissue stiffness. Targets for treatment are typically identified by pressing on a hyperirritable spot and confirmed by actively contracting the muscle. That being said, expert insertion of these thin needles can directly impact these taut bands of muscle tissue, called trigger points (TrPs), underneath the skin by causing an initial “twitch” response leading to a subsequent release in muscle tension. Although a twitch is not always necessary, successful treatment generally reduces pain, muscles feel more relaxed, and a noticeable gain in mobility. Only licensed healthcare professionals certified in dry needling are allowed to perform this procedure to ensure your safety.
Ball A, Perreault T, Fernández-de-las-Peñas C, Agnone M, Spennato J. Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response. Diagnostics. 2022; 12(2):321. https://doi.org/10.3390/diagnostics12020321
"Who does dry needling?"
Typically physical therapists; however, other healthcare professionals treating the musculoskeletal system may administer dry needling as well (osteopathic physicians, physician assistants, nurse practitioners). Requirements for performing dry needling vary by each state's practice act but typically require additional continuing education or a certain number of hours of coursework. After submitting the appropriate documentation on education and certification, a state licensing board will authorize a healthcare professional to administer services.
"How is it different than acupuncture?"
Although the same thin filiform needles are used and are drug-free alternatives to address pain, their targets vary. While acupuncture follows an Eastern ideology of energy flow and meridians, dry needling uses a musculoskeletal approach by targeting specific muscles, specifically trigger points. Additionally, acupuncture needles are left in for longer while dry needling sessions are generally shorter in duration.
"What conditions does it treat?"
It can be used to treat conditions relating to:
Headaches & Migraines
Persistent / Chronic Pain
Temporomandibular Joint (TMJ) Dysfunction
Spinal Radiculopathies
Neck and Lower Back Pain
Sciatica
Strains and Sprains
Tennis & Golfer's Elbow
Tendinopathies of the Shoulder, Hip, and Knee
Bursitis around the Shoulder, Hip, and Knee
Plantar Fasciitis
Sports Injuries
Motor Vehicle Accidents
"Who is eligible to receive treatment?"
Easy! All consenting adults and adolescents who struggle with new or persistent muscle trigger points. Because accurate feedback from the patient is essential for a safe and effective treatment, it is not typically recommended for children and infants or those on blood thinners. Additionally, those who carry blood born infectious diseases are not candidates for treatment. "Well, Is it a miracle treatment?"
While effects can be profound, treatment effects are temporary and should be reinforced by trained movement patterns. You need to give your body a new program or blueprint for how to move after treatment to get the most benefit. I’ve personally experienced patients, for example, finally being able to fully rotate their heads or being able to touch their toes after years of being unable to do so.
That being said, it is my personal belief that it can provide the initial momentum to achieve better range or comfortable movement and that it should not be done as a sole treatment. Because treatment effects are temporary, one should follow up by giving the body a blueprint for how to move again through mobility or strengthening during this window of improvement. That provides the desired lasting effects.
"How can I receive dry needling treatment?"
After an evaluation by a licensed healthcare professional, they will likely discuss how dry needling will fit into your plan of care. I would not recommend solely receiving dry needling without supplemental treatment which may include other manual therapy interventions and home exercise programming.
"What are the side effects?"
Sometimes some localized bruising, but there should be no lasting soreness.
"Does insurance cover it?"
In most cases - no. After signing a consent form, you may receive an ABN, an advanced beneficiary notice, that services provided may or may not be covered by your insurance. Generally, it is on a cash-pay basis with an amount per session or per visit. How much it costs varies between health care practitioners. However, at my clinic, the cost per session ranges from $20.00-$30.00.
"I'm interested in learning more about dry needling, how can I get started?"
Feel free to reach out to me at 605-501-6685 or e-mail me at eric@mvmtrestoration.com for more information. If we decide together that dry needling is right for you, we will schedule a time and date to meet for evaluation and treatment.
Dr. Eric Brown, PT, DPT, OCS, Cert. DN
Owner & Physical Therapist of Movement Restoration Physical Therapy (Sioux Falls, SD), APTA Board-Certified Orthopedic Specialist, Dry Needling Certified