Dry Needling
Dry needling might be the most polarizing treatment approach in the world of physical therapy. Patients either love it or hate it, and its use can be a topic of debate among clinicians. It is also quite poorly understood, both by patients and therapists. I believe that people should understand the treatments they receive, and I believe that therapists should have a clear rationale for the treatments they offer; therefore, I’d like to answer some of the most common questions about dry needling as objectively as possible before concluding with my opinion based on my read of the literature and my clinical experience.
What is it?
Dry needling is a treatment that involves inserting thin needles into the body and is often used to reduce pain and muscle tension. Unlike acupuncture, which is based on traditional Chinese medicine, dry needling is based on Western medicine and is primarily used to treat musculoskeletal conditions.
How does it work?
There are many systems for dry needling; each one has its own way of explaining its effects. The most common explanation is that dry needling works by releasing trigger points (TPs), which are thought to be tight bands of muscle. The theory suggests that these tight bands are caused by chemical and neurological changes brought about by acute or chronic inflammation in the area, and that dry needling does the following:
It promotes healing by triggering he body’s inflammatory response and increasing blood flow to the area.
It reduces pain by modulating both local and central nervous system activity.
It is important to note that this is simply an theory for why and how dry needling might work. The exact mechanisms are not yet fully understood.
is it evidence-based?
At the present time, the evidence for, and against, dry needling are largely contextual. For example, dry needling has been shown to reduce spasticity caused by stroke, improve neck range of motion, and to help with pain management. However, one study found that its pain reducing effects were not statistically significant, and another study found that there is insufficient evidence* that dry needling is effective in the long term. Clearly, there is some evidence on either side of the argument.
Perhaps the most practically useful study is this systematic review and meta analysis, which found that dry needling can be helpful when used in conjunction with other forms of therapy.
I’m not aware of any high quality studies that make stronger claims for or against of dry needling, but if there are any, please do let me know and I will gladly update this page!
*Please note that the lack of evidence should not be an argument against the use of dry needling as it simply highlights the need for more research.
Is it safe?
Dry needling is very safe when performed by a trained professional. This study found a small chance of minor reactions, such as bruising and temporary soreness, and a very small chance (0.1%) of major reactions, including fainting or prolonged soreness. None of the reported incidents were fatal or permanent.
My thoughts
I was very skeptical of dry needling when I was in university and during my first few years of work as a physio. I’ve always felt that it was important to have an evidence-based practice, and neither the mechanisms nor the clinical efficacy of dry needling had really been convincingly proven in the literature. Because of this, I felt that I didn’t understand it well enough to justify using it, and I wasn’t interested in offering it as a treatment (especially since there are other, more evidence-based treatment options available).
There are also some very valid points made by therapists against the use of dry needling that I found quite convincing. The first was that dry needling is simply not as effective as exercise, lifestyle modification, and patient education in managing pain or improving objective rehab measures like strength and range of motion. Also, it is argued that, like other passive therapies, dry needling may contribute to patients feeling dependent on their therapists, which is not in their best interest. Finally, it is argued that since its mechanisms are not entirely understood, dry needling should not be considered an evidence-based form of treatment.
I agree that dry needling is not the most powerful tool we have as physical therapists for managing pain or for regaining physical function in the long term. I’ve also seen many patients become dependent on it, just as many patients become dependent on joint manipulations and soft tissue techniques for temporary relief, and I don’t want to promote this kind of paradigm. I also think it’s important that we have rational justifications for the treatments we use, and the research doesn’t really present a very strong theoretical or practical case for dry needling at the present time.
With all that being said, I don’t think that we should avoid considering dry needling as a potential treatment option. I’m not saying that dry needling should ever be a primary treatment approach (I still think that exercise and education should be the main focus of any physiotherapy program), but I am saying that it might be worth trying in the right context, with a clear understanding of what we are trying to accomplish by using it.
As I mentioned earlier, we do have evidence to suggest that dry needling can be helpful when used in conjunction with other therapies in people with persistent pain. Of course, we do need RCTs that can zoom in on the specific effects of a treatment, but clinically I’m more interested in understanding how a type of therapy fits into a larger treatment plan. In my experience, dry needling has helped some patients by reducing the amount of tightness and pain that they experience, which allows them to more consistently and comfortably perform their home exercises. This effect varies greatly from person-to-person; some people experience almost immediate and long-lasting pain relief, while others feel very little to no benefit. It’s hard to predict who will respond well and who won’t, and I think that it’s ok to accept a little bit of uncertainty in your practice.
How I explain this to my cLients
Any patient who undergoes dry needling should be able to give their informed consent prior to treatment. When I am considering using this form of therapy, my preamble usually goes something like this:
I ask whether they have heard of dry needling, or if they’ve tried it in the past.
I explain the basics: it involves using needles to help relax tight muscles, similar to trigger point massage.
I explain why I think the patient is a good candidate for dry needling.
I explain the risks: it is normal to expect some soreness or a bit of bruising; it is possible, though very unlikely, to experience a more serious reaction such as a pneumothorax (when treating around the ribs), infection, or fainting.
I go through the contraindications and precautions, such as a phobia of needles, an autoimmune condition, suppressed immune system, etc.
I ask if they have any questions, and if they are comfortable with proceeding with the treatment.
If—and only if—the client seems comfortable with everything we’ve discussed, we try it. I usually save it for the end of the treatment to make sure we prioritize more essential therapies like exercise and education.
Please note that this is meant to be a primer on dry needling, and is not meant to replace personalized health advice from your health professional, nor is it meant to act as instruction for therapists who have not completed a certification to perform dry needling. With all that being said, I hope this helped you better understand dry needling.