Inserting needles into the skin and underlying muscle tissue has become a popular way to accelerate recovery from injuries and painful conditions. The term dry needling is often used by many practitioners, including Physical Therapists, Chiropractors, Medical Doctors, and acupuncturists. So if you’re wondering if dry needling is right for you, it can be difficult to know where to go.
Understanding the different types of dry needling and the different types of clinicians performing dry needling can help you choose the right place for you.
What is Dry Needling?
Dry Needling is a term used for a treatment that uses a needle without a liquid (or injectate). Most often, the needle used in this process is a very thin, filament needle.
This general definition of the term dry needling sometimes makes it confusing for the general population to understand what a treatment with dry needling might look like for them.
And unfortunately, there isn’t an easy answer.
Here’s the best guidance we can give you:
When the clinician performing the DN is a musculoskeletal expert, they will likely be doing a treatment to address the muscles, tendons, and nerves, to help you move better.
Much of the research around Dry Needling in the field of Physical Therapy deals with Trigger Points and how they can limit a muscle’s ability to function. Dry Needling has been shown to reset the muscles on a structural, biochemical, and electrical level, which helps you not only move better, but reduce pain, feel better, and recover faster.
For more information, please also see my article: Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary
So, when a physical therapist or Chiropractor (who specializes in the MSK system as it relates to movement and pain) is performing dry needling, the process is directly related to the evaluation of how your body moves and what muscles we need to treat in order to help you move better and reduce pain.
If the practitioner is an acupuncturist, their evaluation will encompass evaluative skills that often relate to Traditional Chinese Medicine, energy fields, and meridians. The evaluative process, and therefore the treatment strategy, does not usually involve the mechanical evaluation of how you move. Now, keep in mind, there are some acupuncturists who have additional training in the MSK system, but their field has a broader scope than most MSK specialists, which has its pros and cons as they relate to your potential MSK injury.
Dry Needling Techniques you might see in your Physical Therapy appointment:
As with many other manual techniques, there are different techniques that might be utilized in a typical dry needling session.
In general, most Dry Needling sessions will last somewhere between ten and thirty minutes, and in the PT world, they are almost always combined with other therapies including massage, joint mobilizations, modalities like laser therapy, and exercises.
There are different types of techniques a therapist might use in a dry needling session, and often the technique chosen will align with the therapists goals for your session.
Here is a review of the types of techniques you might see and why:
The in-and-out or technique
The in-and-out technique, also called pistoning, involves inserting the needle directly into the trigger point, and manipulating of the needle to create a Local Twitch Response, which has been shown to reset the muscle and allow it to function more normally.
After the desired response, the dry needle is removed, disposed of properly, and a new sterile needle will be used for the next treatment area.
The pros to this technique are that the therapist can get a quickly and accurately test their theory on how your specific movements and patterns are being affected by that muscle or muscle groups. Treating in this way helps you get to the bottom of your injury faster, as we are super sleuthing out the most problematic causes.
The con to this technique is that for some people the twitch responses can be uncomfortable. While most people don’t feel the needle insertion, the twitch responses can be pretty strong and because of this, some people prefer the In Situ method of dry needling.
In-Situ Dry Needling with or without Electrical Stimulation
The primary goal is with this treatment is to treat your peripheral and central nervous system by inserting and leaving the filament needles in the desired treatment area. Therapists will let the needles sit (in situ) either with or without electrical stimulation . This type of dry needling can be superior to the in and out technique for encouraging muscle recruitment, venous return (recovery), and to encourage restored nerve health to an injured nerve such as in a cervical, lumbar, or spinal disc injury.
The pros to this technique is that it is often considered more comfortable for the patients, and it is sometimes superior to the in and out technique in restoring the nerve health.
The main con to this technique is that needles are usually left in situ anywhere from 5-25 minutes, which limits our ability to use a quick test retest method to each suspected area of involvement. This can sometimes make the root cause of the injury more difficult and/or take more time than if we are using a quick reset method followed by movement testing.
Benefits of Dry Needling
Dry needling has been shown to
- Decrease pain (through pain pressure threshold ratings)
- Increase blood flow
- Increase range of motion
- Improve muscle activation or muscle firing
- Improve function
- Decrease use of opiates to manage pain
Here are some studies to that highlight the use of Dry Needling to treat:
- Low Back Pain (https://www.tandfonline.com/doi/abs/10.1080/10669817.2021.2011556 )
- Plantar Fasciitis (https://pubmed.ncbi.nlm.nih.gov/30379937/
- Hip arthritis https://pubmed.ncbi.nlm.nih.gov/31352178/
- Patellar Tendinopathy https://pubmed.ncbi.nlm.nih.gov/31606317/
Dry Needling Side Effects
The most common side effects include
- Bruising (treated areas may incur bruising and this is more common if the patient is on blood thinners).
- muscle soreness after needling can occur for up to 48 hours after the session in the muscles treated. This is due to the biochemical reset in the muscles and will often dissipate fairly quickly with movement like walking that encourages blood flow to accelerate the body’s natural healing process.
- Skin irritation, or minor red spots maybe noticeable in the areas treated. This dissipates very quickly after treatment.
Very, very rare occurrences of more serious side effects have been reported including
- Fainting, due to a vaso-vagal response, can occur in a very small number of patients.
- pneumothorax (puncturing of a lung) has a minimal chance of occurring, and this risk is greatly reduced when being treated under an appropriately trained clinician.
While these incidents are very, very low, it is still very important that you choose a provider who has been well trained in dry needling and the important anatomy, technique, and application of the technique.
An inexperienced or unlicensed person should never perform dry Needling.
What is Acupuncture?
The typical practice of acupuncture is rooted in traditional Chinese medicine. It is a broader medical approach to the treatment of pain and other conditions. The approach involves an integrated philosophy that addresses more than the musculoskeletal system and movement, but how the body is affected by Eastern Medicine’s meridians related to organ systems and energy fields.
Often times, the Acupuncturist may refer to the release of things like chi (flow of energy) in the process.
So, what is the difference between dry needling by a MSK Specialist (PT, CHIRO) and an acupuncturist, and which technique is right for you?
When asking yourself this question, there are a few things to consider, like:
- Do I think my symptoms are musculuskeletal in nature (an injury to the MSK system, involves the bones, muscles, nerves, or joints).
- Do I think there may be an underlying systemic component that I should see a doctor for first, or do I think my body has a systemic issue going on in addition to a MSK issue that might benefit from both approaches?
- What are the Pros and Cons of Dry Needling?
Due to the positive reports of successful patient outcomes with dry needling therapy , there has recently been a rapid increase in the research being done in the field of physical therapy.
Dry Needling vs. Acupuncture Similarities
Here is the list of similarities between acupuncture and dry needling:
- Dry needling vs. acupuncture needles: Both dry needling and acupuncture use thin, stainless steel filiform needles.
- Insertion: Both practices have the same process of inserting needles into the skin, however the depth of the insertion and target tissue will vary due to the different goals of the practitioner.
Dry Needling vs. Acupuncture Differences
The confusing thing about this question is that Acupuncture is a form of dry needling. The difference between an acupuncturist who is dry needling and a physical therapist who is dry needling comes down to this:
- Medical basis/educational background:
Dry needling by a Physical Therapist will focus on the treatment of a MSK condition as it relates to your pain, movement and function. While an acupuncturist may have some extra training in MSK conditions, their practice is more broad and therefore they may not have the same experience in addressing the MSK issue as a physical therapist. However, if there are other factors related to your pain, a physical therapist and an acupuncturist would work very well together to treat the entire system and simultaneously address any non-musculoskeletal components to the injury.
- Treatment approach:
A physical therapist specializes in MSK conditions and will include dry needling as a component of your treatment in addition to other treatments like joint mobilizations, neuromuscular reeducation, postural education, strength, mobility, and flexibility exercises. Typically an acupuncturist will not include the same components of a MSK specialist’s treatment style, but may offer other adjunctive therapies like recommending herbal supplements and/or dietary changes to facilitate healing.
Dry Needling vs. Acupuncture: Which Is Better?
This question really should be, “Which is Better for you?”
- For a MSK injury, a MSK specialist like a PT or Chiro may be a better option, as they are trained to give a multifaceted approach to the treatment of your MSK pain and movement condition. However, recognize that there are acupuncturists who spend extra time educating themselves in the MSK world, and so a well trained acupuncturist who specializes in sports medicine might be a good option to treat your MSK injury as well.
- For an injury that appears to have a non-MSK component, consulting your MD first would be best.
So, what’s the verdict? Is dry needling better than acupuncture?
The truth is, it is very important to take the time to research your provider’s experience in dry needling and the conditions they specialize in treating.
My opinion is that training, experience, and reputation matter. Finding a well respected clinician with lots of experience is key when choosing a dry needling provider. I always tell patients that choosing the person is important in any field.
For anyone who is having movement or mobility limitations related to their pain, the Physical Therapist is going to offer adjunctive treatments to bridge the gap between reducing pain and restoring function and movement.
However, a good Physical Therapist will work well with an experienced, trusted acupuncturist and vice versa to give potentially even faster results than with one clinician alone. That said, if you’re looking to explore dry needling in Philadelphia, PA, call us today to schedule a consultation.