Usage of Dry Needling by Physical Therapists

Years ago, I was in the process of applying to grad school for physical therapy. To do so, I needed to have shadowing hours with licensed physical therapists. Shadowing meant following these physical therapists during their workday and seeing how they interact and treat their patients. My first setting was inpatient at a hospital in Las Vegas and then I shadowed an outpatient physical therapist who owned his own clinic. The latter physical therapist was certified in dry needling, and I got to see him treat patients with it. Up until that point in time, I had never heard of dry needling before. It was fascinating watching the physical therapist use dry needling to treat his patients' pain. It didn't make sense to me at the time, but I couldn't deny the results. It worked!

Though I knew I was years away from becoming a physical therapist, I knew I wanted to be certified in dry needling, too. I wanted to learn this technique in order to better serve my future patients.

For some reason, I thought I'd be trained in dry needling during the course of completing my doctorate degree, just like I was trained in a bunch of other different techniques and skills. Nope, that was not the case! We learned about it, and got to see it demonstrated on people in class, but nothing hands-on. Dry needling was considered beyond entry level, so it was something I'd have to train in after grad school.

What is dry needling?

Dry needling is a skilled technique that physical therapists can perform once they are certified. It uses a "thin filiform needle to penetrate the skin and underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments." This allows patients to recover faster and improves their ability to perform their activities.

How does dry needling work?

There are a few theories on how dry needling works. One theory is that needling a muscle creates an inflammatory reaction. This reaction "is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation." This helps a muscle to recover and heal. Another similar theory is that needling dissipates "inflammatory mediators" within musculoskeletal tissue.

The exact mechanics behind why dry needling works is not clear, but there is more research coming out, particularly about trigger points. Trigger points are "the tight points within muscular tissue that produce and refer pain." While it is possible to reach trigger points through manual techniques using one's hands or cupping or IASTM, using dry needling reaches a deeper depth. Which makes sense as the needle penetrates the skin and down into the depth of the muscle.

The difference between dry needling and acupuncture

While both techniques used needles, dry needling and acupuncture are NOT the same. Both techniques differ in regard to their "historical, philosophical, indicative, and practical context." Like I tell my patients, I do not care about their chakras or meridians (acupuncture terms), only the tight bands within their muscles. Nor would we dry needle anyone's ears, as that tissue is made of cartilage and not muscles.

Dry needling is provided by physical therapists while acupuncture is done by practitioners of Acupuncture and Oriental Medicine. Acupuncture follows meridians and pathways while dry needling targets myofascial trigger points.

How physical therapists may use dry needling

Dry needling is rarely used alone and is combined with other interventions used by other physical therapists. This may be myofascial mobilization, therapeutic exercises and activities, stretches, or neuro re-education interventions.

As a pelvic physical therapist, I tend to use dry needling to help my patients with downtraining, along with other interventions such as, but not limited to, breath work, stretching, and behavioral changes. Dry needling tends to have an almost immediate result that helps to facilitate a buy-in with my patients.

With other physical therapists, they may be using dry needling to decrease a patient's pain or improve range of motion in a muscle. All of this as a means to help a patient rehab faster and accomplish their goals.

What states allow physical therapists to perform dry needling

As of 2024, there are 39 states and DC that permit physical therapists to perform dry needling. This number jumped up from 37 in 2022. Thankfully, Nevada is one of those states, so I am able to perform dry needling on my patients. Four states currently prohibit this treatment (California, Hawaii, New York, and Oregon) while seven states have not stated either way (Connecticut, Massachusetts, Michigan, Minnesota, Missouri, Oklahoma, and Pennsylvania).

A History of Dry Needling (2014)

I enjoy telling my patients the history of dry needling because its origins are far different than the origins of acupuncture. In 1941, a paper from Brav and Sigmord claimed that pain could be relieved by simple needling without the injection of any substance. They had set up a clinical trial to determine the efficacy of an anesthetic injection. Patients were split into three groups: one percent novacaine, normal saline solution, and a needle inserted with no substance injected.

The group that had the best outcome was the group that had novocaine injected into them. However, the group with no substance injected (not named as dry needling within the paper but is to be understood that this was dry needling) "came in a close second" which surprised the researchers.

It wasn't until 1947 that the term "dry needling" was mentioned in a paper.

Dry needling "emerged from the use of injections of anesthetic to treat painful musculoskeletal conditions." Myofascial trigger points, the tender points in muscles, is "defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band." These trigger points are able to "cause referred pain, pain that mimicked visceral conditions and autonomic phenomena."

Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review (2020)

The studies within the review ranged from systematic reviews, randomized control trials, and cohort studies. Overall, the results were favorable towards dry needling.

Different theories on why dry needling works as a treatment for tendinopathy, as well as what may cause tendinopathy, was brought up in this narrative review. Tendinopathy is a generic term used for conditions that are "characterized by a combination of pain, swelling (diffuse or localized), and impaired performance of tendons and surrounding structures, usually arising from overuse."

The term dry needling is used vs other terms is to "emphasize that the procedure does not involve the injection of any substance, and therefore, placing the needle into the tendon may be the primary reason that the tendon improves and not a specific substance."

All in all, much of the research out there indicates that dry needling does provide a benefit to patients.

I like to joke to my patients that my superpower is that needles don't hurt. They tickle me. I could be getting blood drawn for lab tests or donating blood or getting dry needling from my fellow physical therapists, and I'd be giggling the entire time. So whenever my patients ask me if it hurts, I preface by saying, "It doesn't for me. It tickles. But for you, it might." That tends to get a chuckle out of my patients. The nice thing about my superpower is that I don't mind performing dry needling on the muscles I am able to reach on my own. I might as well take advantage of it!

Speaking of relieving pain, it actually varies on how long before that takes effect. For some of my patients, they find relief and improved pain levels soon after the needle is withdrawn. For some, it's a few minutes later. For others, it's a few hours later. It could also be the next day. Anecdotal, but I find that the more trigger points I hit during dry needling, the sorer the muscle gets, and it can take awhile for the soreness to disappear. Even with the soreness, I have had patients tell me that there was soreness, but not the sharp pain they originally had in said muscle.

I am very fortunate that I am certified in Dry Needling, Level 1. It has been a huge boon to treating my patients for their pain relief, as I knew it would when I was trying to get into grad school. If you live in Southern Nevada, and are dealing with musculoskeletal pain, dry needling may help you. Contact us today to schedule an appointment for dry needling.

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References

American Physical Therapy Association (2024, July 2). State Laws and Regulations Governing Dry Needling Performed by PTs. Retrieved May 8, 2025, from https://www.apta.org/patient-care/interventions/dry-needling/laws-by-state

Legge, David. (2014). A History of Dry Needling. Journal of Musculoskeletal Pain. 22. 10.3109/10582452.2014.883041.

Ries, E. (2015, May 1). Dry Needling: Getting to the Point. Retrieved May 8, 2025, from https://www.apta.org/apta-magazine/2015/05/01/dry-needling-getting-to-the-point

Stoychev V, Finestone AS, Kalichman L. Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Curr Rev Musculoskelet Med. 2020;13(1):133-140. doi:10.1007/s12178-020-09608-0