What Is Dry Needling?

Dry needling being performed on a woman's back

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Developed in the 1980s by British physician Dr. Peter Baldry, FRCP, dry needling involves inserting a needle into myofascial trigger points—small muscle knots that are highly sensitive and painful to the touch. This therapeutic procedure is used to relieve pain, improve joint range of motion, and address neuromuscular conditions, such as nerve issues that cause muscular pain and weakness. 

A minimally invasive treatment with a low risk of complication, research shows dry needling is possibly effective in relieving acute and chronic pain when used along with other treatments including stretching, massage, ultrasound, electrical nerve stimulation, and heat therapy. 

Also Known As

  • Intramuscular stimulation
  • Trigger point dry needling
  • Myofascial dry needling

Purpose of Procedure

Dry needling is an outpatient procedure that involves inserting fine, short stainless steel needles (25-gauge or thinner) into skin and muscle at trigger points. This helps release knots and relieve pain and muscle spasms.

Typically performed by an orthopedic doctor, chiropractor, or physical therapist during an office visit, dry needling may be used to treat:

Trigger points are believed to be caused by an excess of the neurotransmitter acetylcholine, leading to a taut band forming within the muscle. A natural protective measure in response to injury, repetitive motion, or sustained postures, these bands can become knots if left unresolved.

Pain from trigger points is believed to be caused by decreased blood flow leading to hypoxia (lack of oxygen) within the trigger point. When active, trigger points cause spontaneous local or referred pain, muscle weakness, and restricted range of motion. Latent trigger points do not cause pain unless they are stimulated but can lead to stiffness and reduced range of motion.

Dry needling 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

  • Only used to relieve 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

How It Works

Unlike hollow needles that deliver medications (sometimes known as "wet" needles), this treatment uses filiform needles which are solid (a.k.a. "dry"). The needles are placed directly into or nearby muscle knots. Often this 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 result in pain in your shoulder.

Precisely how dry needling works to relieve trigger points is unclear. 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. 

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. 

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 range of motion, 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

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 other the following conditions, tell your doctor before trying dry needling to see if it's OK for you:

Side effects associated with dry needling include:

  • Soreness during or after the procedure
  • Bleeding where the needles were inserted
  • Fainting
  • Fatigue
  • Skin bruising

Most of these side effects are minor and do not cause significant injury or distress to patients who undergo dry needling.

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.

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.

How to Find a Dry Needling Practitioner

Used in both traditional orthopedic physical therapy settings and alternative medicine practices, there are no specific credentials or special training required to practice dry needling. You can find a provider in your area by searching the following directories: 

Before the Procedure

Prior to administering dry needling, your practitioner will review your medical history and perform a physical examination to evaluate your trigger points 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.

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 may 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, the appointment can last 30 to 60 minutes.

Location

Dry needling may occur in a doctor’s office, a therapy clinic, or an outpatient rehabilitation center. It is often performed in a secluded area, such as a separate exam or therapy room, or a curtained-off area of a larger room.

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.

What to Bring

Bring your health insurance card, if your plan offers related coverage, and any new patient paperwork if you were asked to fill out such forms. Also, be sure to bring a form of payment.

During the Procedure

At the time of your appointment, you will check in with the receptionist and asked to fill out paperwork 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 body parts being worked on, then instructed how to sit or lay down on the treatment.

Throughout the Procedure

The provider will start by sterilizing the area to be treated and preparing the needles.

Some therapists or doctors will walk you through what they are doing as they are doing it, while others will just 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:

  • Superficial dry needling: The most common technique used is the initial method developed by Dr. Baldry. The needle is inserted into the skin above a trigger point just 5 millimeters (mm) to 10 mm deep for 30 seconds. The practitioner then feels the trigger point to determine if stimulation with the needle was sufficient to release the knot. If not, this is repeated. 
  • 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. This is based on the philosophy that a specific area of pain is due to a greater nerve or muscular issue.

During the procedure, you may experience muscle soreness, muscle twitching, or an ache. These sensations are regarded as a good sign and mean your muscles are responding to the needle insertion. 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 where they were inserted to ensure there are no bleeding or skin reactions.

If you are laying down during the procedure, you will likely be instructed to get up slowly and watch for lightheadedness upon standing. If you experience any, 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.

Side effects of muscle soreness may be worse the morning after treatment but should resolve in a few days. Bruising may last up to a week. Let your doctor know if you experience any side effects.

If you experience more severe and rare side effects such as shortness of breath or major bleeding, contact emergency services immediately. While rare, this could indicate the presence of an infection or organ damage due to puncture.

Interpreting Results

To determine whether dry needling is an effective treatment for you, your doctor 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 at your doctor's discretion. Your doctor 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 without issue and recommend different procedures or treatments to assist in managing your symptoms.

A Word From Verywell

It is important to relay any questions or concerns you have about trying any new therapy to your healthcare provider so they can assist in providing you the information you need to feel confident and assured in your health decisions.

Dry needling is intended to relieve pain and improve your quality of life, so be sure that you begin treatment knowing what it can and cannot do. And as always, consult your doctor before receiving any procedure or treatment to ensure your safety and well-being.

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Article Sources
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