Dry Needling: I’ve heard of it, but what is it?

Many of us have heard the term “dry needling” or have experience with it in a physical therapy clinic, but we may not understand what it is or how it helps. A really nice review of dry needling called “Dry Needling: A Clinical Commentary“ was recently published in a recent issue of the International Journal of Sports Physical Therapy. Here are the key points from the article for those of you who have been curious about this popular treatment choice.

The American Physical Therapy Association defines dry needling as the following: “a skilled intervention that uses a thin filiform needle to pen­etrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the manage­ment of neuromusculoskeletal pain and movement impair­ments.” Let’s break that down into something more understandable.

• Thin filiform needle – Very thin, bendy needle. Unlike an IV needle, this needle is bendable.

• Myofascial trigger points – Tight band of muscle that is painful. This pain is sometimes felt in areas other than the direct location of the tightened muscle tissue.

• Connective tissue – imagine a huge spider webbing of tissue that binds skin, muscle, tendon, bone, and ligaments. It’s everywhere and can get bound up and tight

• Neuromusculoskeletal pain – A technical term for pain that involves muscles and nerves

What do you mean by “dry”?

The term dry needling is because the pain relief is from the needle insertion alone into the muscle. There is no injection of fluid.

How far in does the needle go?

There are two options here. The choice depends on patient comfort as well as recommendation by your physical therapist.

1. Superficial dry needling – The needle is inserted into the muscle only to the bottom layer of the skin.

2. Deep dry needling – The needle is inserted into the muscle to penetrate the trigger point.

Then what happens?

Again we have two options here. The choice depends on patient comfort as well as recommendation by your physical therapist.

1. The needle can be left alone, typically ~5min but can be up to 20min; however, more is not necessarily better.

2. The needle is pistoned in and out to trigger a “twitch response” during which the muscle may grab the needle. Once there is no longer a resultant muscle twitch, the needle is removed

Reference: McAphee D, Bagwell M, Falsone S. Dry Needling: A Clinical Commentary. Int J Sports Phys Ther. 2022 Jun 1;17(4):551-555. doi: 10.26603/001c.35693. PMID: 35693854; PMCID: PMC9159711.

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