In recent years, a rather unusual method has made its way into physical therapy settings. It’s somewhat different from acupuncture but still involves a therapist inserting tiny needles into the skin, which could certainly make you squirm for a moment.
This technique, known as dry needling, involves placing ultrafine needles into trigger points to alleviate tension. The American Medical Association recognized it as a legitimate therapeutic practice back in 2016. Since then, it has been widely adopted in sports medicine, with athletes like Travis Kelce and Caitlin Clark using it to aid recovery.
Proponents claim it can provide quick relief, often describing a sensation of pain melting away or a feeling of release at the site of needling. Others, however, view it as a temporary solution at best.
Though generally deemed safe, inserting needles does come with potential risks. For instance, T.J. Watt, a linebacker for the Pittsburgh Steelers, experienced a collapsed lung following a dry needling session, although he eventually recovered and continued the season.
So, what should one understand about dry needling? Is it a groundbreaking remedy for chronic pain or merely an overhyped trend?
What is dry needling?
Essentially, dry needling aims to create a minor injury in painful body areas to enhance blood circulation and relax tight muscles and other tissues. The needles themselves don’t deliver any substances; thus, they are referred to as “dry.” This treatment typically addresses injuries related to overuse or stress, especially muscle knots.
Practitioners may leave the needles in place, move them gently beneath the skin, or even apply electrical stimulation to further relax the targeted muscles. The sensation can be quite intriguing.
For example, Caroline Miller, a 64-year-old competitive swimmer from Maryland, recounted witnessing the muscles in her arm moving while being treated, but noted that the pain disappeared the next day.
While traditionally focusing on muscles, dry needling has recently extended to treat tendons, scar tissue, fascia, and even bone surfaces. Some findings suggest it might also help with headaches. Yet, it’s important to note that dry needling differs from acupuncture.
“Dry needling specifically targets musculoskeletal issues, such as trigger points,” explained Melissa Monroe, a Los Angeles acupuncturist. In contrast, acupuncture involves principles from traditional Chinese medicine, focusing on energy and pathways in the body.
Does it work?
The answer, like many things in physical therapy, is: It depends.
While long-term benefit evidence for dry needling is somewhat lacking, numerous studies indicate it’s generally more effective than a placebo and at least as good as traditional techniques like exercise and massage for short-term relief.
Many patients report almost immediate relief following treatment, along with improved strength and flexibility, as noted by Jan Dommerholt, a Maryland physical therapist who leads a certification program.
However, the exact mechanism behind how needling works remains unclear. Experts agree on the existence of muscle knots, but there’s no consensus on whether they cause myofascial pain or if needling is indeed the best approach for treating them.
“At best, dry needling is a short-term remedy that overlooks the underlying issues,” remarked Rhett Polka, a physical therapist from Loveland, Colorado. He argues it merely alleviates symptoms like tightness and spasms but doesn’t address deeper physiological problems.
“Other therapies like heat and gentle massage can also effectively loosen muscles,” noted Nelin Krull, a physical therapist based in Toronto.
Even supporters of dry needling caution that it’s not a catch-all solution. It should be administered by trained professionals and often in conjunction with other treatments, such as joint mobilization, soft tissue work, therapeutic exercise, or gait training.
Some research suggests that electro-stimulation may provide quicker pain relief, although again, typically only in the short term. When it comes to headaches, some randomized trials indicate needling can be beneficial but not necessarily more so than alternative therapies.
While Medicare covers dry needling for lower back pain, many insurance plans do not.
Is it safe?
Research indicates that when performed correctly, dry needling rarely causes significant complications, although the risk is not entirely absent. Minor side effects, such as bruising or temporary post-treatment pain, are relatively common according to a 2020 study.
More serious issues, like exacerbated symptoms or forgotten needles, are extremely rare, occurring in less than 0.1 percent of cases. Instances of collapsed lungs, like that of Mr. Watt, are even less common.
In recent years, the availability of certification programs has increased, making it important to find a qualified practitioner. However, state laws around certification requirements vary widely. For example, Maryland and New Jersey mandate 80 hours of education, while Virginia only requires proof of competency. Interestingly, seven states have no regulations at all.
Due to lobbying efforts from acupuncturists, states like California, New York, and Hawaii limit dry needling to licensed acupuncturists.
Ashley Katzenback, a physical therapist from Cape Cod, Massachusetts, suggested treating dry needling like any other specialized medical service: ask about the clinician’s certification, training, and experience.
Dry needling is not suitable for pregnant individuals or those with bleeding disorders, compromised immune systems, lymphedema, cancer, or active skin infections.
Ultimately, while dry needling is generally safe and can effectively ease muscle tension and discomfort in the short term, it may not be superior to other methods and may not get to the root causes of pain.
