Dry Needling
What Is Dry Needling?
Dry needling is a therapeutic procedure used to relieve muscular pain and improve joint range of motion (ROM). It can cause side effects, such as soreness, bleeding, bruising, and fatigue. The procedure involves the insertion of a needle into myofascial trigger points—which are small muscle knots that can be highly sensitive and painful to the touch.1
A minimally invasive treatment with a low risk of complication, research suggests that dry needling may be effective in relieving acute and chronic pain when used along with other treatments including stretching, massage, ultrasound, electrical nerve stimulation, and heat therapy.2
Also Known As
-
Intramuscular stimulation
-
Trigger point dry needling
-
Myofascial dry needling
-
Purpose of Procedure
Dry needling is an outpatient procedure that involves the insertion of fine, short stainless steel needles (25-gauge or thinner) into the skin and muscle at trigger points. This elicits a muscle twitch response in the muscle, which helps relieve the symptoms.
Typically performed by an orthopedic doctor, chiropractor, or physical therapist during an office visit, dry needling may be used to treat:
-
Jaw and mouth problems, such as temporomandibular joint disorders (TMD)
-
Joint problems
-
Muscle weakness
-
Myofascial pain
-
Post-herpetic neuralgia (pain left behind by shingles)
-
Reduced range of motion
-
Spinal problems
Trigger points are associated with excess acetylcholine, which is a neurotransmitter that normally stimulates muscle contraction (movement). A trigger point is characterized by a taut band within the muscle. This band can develop as a natural protective measure in response to injury, repetitive motion, or sustained postures. These bands can become knots if left unresolved.4
Pain from trigger points is believed to be caused by reduced blood flow, leading to hypoxia (lack of oxygen) within the trigger point. Trigger points cause spontaneous local or referred pain, muscle weakness, stiffness, and restricted range of motion.5
Dry needling was developed in the 1980s and was modeled after the Traditional Chinese Medicine (TCM) technique of acupuncture. There are several variations of dry needling, all of which have the same purpose.
Dry Needling
-
Needles are placed into or near trigger points
-
Used to relieve pain and to help correct imbalances in muscle movement as well as joint ROM, which may or may not be accompanied by pain
Acupuncture
-
Needles are placed on meridians (energy pathways that enable qi to flow through the body)
-
Used to help treat a myriad of health conditions. The needles are meant to stimulate the central nervous system to release beneficial chemicals to assist with healing and function
How It Works
Unlike hollow needles that deliver medications (sometimes known as "wet" needles), this treatment uses solid filiform needles that don't contain anything (a.k.a. "dry"). The needles are placed directly into or near muscle knots. Often the trigger point is near the location of your pain, although sometimes pain is referred elsewhere in the body. For example, a trigger point in your neck may cause pain in your shoulder.
There are several theories about how dry needling works to relieve trigger points.
-
It may be due to the stimulation of a local twitch response, an involuntary reflex contraction of muscle fibers in a taut band. This triggers a chemical response that has an analgesic (pain-relieving) effect.3
-
Another potential mechanism of action of dry needling is muscle regeneration. Insertion of the needle causes small lesions that stimulate tissue repair and regeneration in the days immediately following treatment.3
A 2017 systematic review of 15 studies published in the Journal of Complementary Therapies in Medicine found dry needling offers short-term benefits of reduced pain, increased ROM, and better quality of life in patients with myofascial pain.
While the research is promising, the study authors note more quality studies are needed before dry needling can be definitively recommended.
Risks and Contraindications
You should not have dry needling if you have an infection until after the infection completely resolves. Pregnant women, people who are unable to understand the purpose of dry needling, and people who are very afraid of needles should not undergo dry needling.
If you are currently taking blood thinners or have any of the following conditions, tell your healthcare provider before trying dry needling to see if it's OK for you:3
-
Compromised immune system
-
Vascular disease
Side effects associated with dry needling include:
-
Soreness during or after the procedure
-
Bleeding where the needles were inserted
-
Fatigue
Most of these side effects are minor and do not cause significant injury or distress to patients who undergo dry needling.
There is also a risk of infection if non-sterile needles are used. The risks of dry needling are significantly decreased by working with a licensed and trained healthcare professional who uses consistent techniques and sterile equipment.
A rare but dangerous side effect of dry needling is organ damage resulting from a needle that punctures a major organ. This may include a pneumothorax (punctured lung) if needles are inserted in the chest
Before the Procedure
Prior to administering dry needling, your practitioner will review your medical history and do a physical examination to determine if you are a suitable candidate. If they think you will benefit from dry needling, they will explain the process in detail and ensure you are receptive to the treatment.8
The procedure may be done at the first office visit or you may have to make another appointment for the treatment. Be sure to ask any questions you have and let the practitioner know if you need time to decide if dry needling is right for you.
Timing
Dry needling typically takes 10 to 15 minutes. If you are receiving other treatments at the same time, such as physical therapy or massage, your appointment can last 30 to 60 minutes or longer.
What to Wear
Dress comfortably as you would for a physical therapy session, preferably in clothes that provide access to the treatment area. For example, if you are receiving dry needling on your knee, you will need to wear pants that can be rolled up above the knee or dress in layers.
If that is not possible, you may need to partially undress or change into a patient gown.
Cost and Health Insurance
Dry needling is not always covered by insurance, as it is considered an experimental treatment. Plans that cover acupuncture and other complementary and alternative therapies are more likely to cover dry needling, but it is a good idea to check first.
Some therapists provide dry needling on a cash-pay basis only.
During the Procedure
At the time of your appointment, you will check in with the receptionist and sign consent forms for treatment.
Pre-Procedure
A medical assistant will bring you to the treatment area, take your vitals, review your medical history, and prepare you for treatment.
You will be asked to adjust your clothes to allow access to the areas of your body being worked on, then instructed how to get into the right position for your treatment.
Throughout the Procedure
Your provider will start by sterilizing the area to be treated and preparing the needles.
Some therapists or healthcare providers will walk you through what they are doing as they are doing it, while others will describe the procedure beforehand. You are encouraged to ask questions at any time to better understand the process.
The technique your provider uses can vary. Common dry needling techniques include:9
-
Superficial dry needling: The needle is inserted into the skin above a trigger point just 5 millimeters (mm) to 10 mm deep for 30 seconds. Insertion may be repeated a few minutes later.
-
Pistoning technique (a.k.a. sparrow pecking, in-and-out technique): This method involves a quick insertion and removal of needles into trigger points. The needle pricks the trigger point but is not left inserted for any duration.
-
Non-trigger point dry needling: Instead of inserting needles directly into trigger points, this technique places needles in the muscle tissue surrounding the knot.
During the procedure, you may experience muscle soreness, muscle twitching, or an ache. These sensations are regarded as a good sign that your muscles are responding to treatment. However, the treatment should not be painful. Tell your provider if you experience any discomfort or feel faint.
Post-Procedure
Once the needles have been removed, your practitioner will inspect the skin to check for any bleeding or skin reactions.
If you are laying down during the procedure, you will likely be instructed to get up slowly. If you experience dizziness or other symptoms, you may be asked to sit and rest for a short while before leaving.
After the Procedure
Following a dry-needling session, it is important to keep hydrated and drink extra water. If you experience muscle soreness in the hours after a treatment session, your provider may recommend rest, heat or ice therapy, a warm bath with Epsom salts, or other at-home therapies.
Muscle soreness may be worse the morning after your treatment but should resolve in a few days. Bruising may last up to a week. Let your healthcare provider know if you experience any side effects.11
If you experience severe side effects, such as shortness of breath or major bleeding, contact emergency services immediately. While rare, this could be a sign of an infection or organ damage due to puncture.
Interpreting Results
To determine whether dry needling is an effective treatment for you, your healthcare provider or therapist will palpate your trigger points and ask you about your level of pain, movement, and stiffness following your session.
In some cases, your response to dry needling will be evident during the treatment, although some people may need to have a few sessions before muscle knots release and pain is reduced.
Follow-Up
Most people require at least two or three dry needling sessions to reach the full effects of treatment, though some may need up to six office visits. Dry needling can be done once or twice a week, depending on your condition. Your healthcare provider will let you know when you need to make a follow-up appointment.
If you experience adverse side effects or do not wish to continue receiving dry needling, your practitioner can discontinue therapy and recommend different procedures or treatments to assist in managing your symptoms.
Discontinuation of this treatment will not cause adverse effects.