Dry Needling

Dry needling releases tight, tender knots in muscle. A thin solid needle is inserted into the trigger point and moved until the muscle twitches, which is thought to relax the tight band and calm the nerve signals that keep it painful^[9]. The goal is less pain and freer movement so you can stretch and strengthen the muscle. It treats the muscle — not arthritis, disc problems or pinched nerves — so a proper diagnosis comes first.

Both use thin, solid needles, but they differ in theory and purpose. Acupuncture comes from traditional Chinese medicine, places needles at set acupuncture points, is performed by licensed acupuncturists and is used for many conditions^[10][9]. Dry needling is based on Western anatomy, targets trigger points found by touch, often aims for a muscle twitch, and is used mainly for muscle pain^[9]. Acupuncture research covers back, neck and knee pain^[10]; dry needling research focuses on short-term relief of muscle pain^[5]. Medicare treats dry needling as a form of acupuncture^[1].

Most people feel a quick prick as the needle goes in, then a deep ache, cramp or brief twitch when it reaches the knot — often a familiar version of their pain^[9]. These sensations last only seconds. In a large survey of treatments, pain during needling was reported in about 3% of sessions^[7]. Afterward, the muscle commonly feels sore, much like after a hard workout, for 24 to 36 hours^[9].

Feeling tired, light-headed, emotional or a little “off” for a few hours after dry needling can happen and usually passes quickly. In a prospective survey of 7,629 treatments, drowsiness, headache, nausea, fatigue and altered emotions were each reported after less than 1% of sessions^[7]. Muscle soreness is more common. Eating beforehand, drinking water and resting briefly afterward can help. Call us if you feel short of breath, have chest pain, or the symptoms do not settle.

Avoid hard workouts of the treated muscles and heavy lifting for the rest of the day, but do not stay completely still — gentle movement and stretching help the soreness settle, and drinking plenty of water is advised^[9]. Expect soreness to ease within a day or two. If a needle site bleeds, press on it firmly, and contact us if the bleeding continues^[9]. Call right away for fever, spreading redness, or shortness of breath.

It varies. Some people feel better after one session, while others need several^[9]. A common approach is a short series of sessions over a few weeks, combined with exercise, with your physician checking progress along the way. Research shows benefit mainly up to about 12 weeks^[5], so if you are not clearly better after a few sessions, it makes sense to stop and consider other treatments rather than continue indefinitely.

They can. Dry needling can release a trigger point, but if the things that created it — posture, repetitive strain, weak or overworked muscles, stress or poor sleep — stay the same, knots often return. Experts recommend a combined approach that includes exercise, ergonomic changes and treating contributing problems to keep myofascial pain from recurring^[8]. Evidence for long-term benefit from dry needling alone is lacking^[5], which is why it should be paired with a home program.

Dry needling is debated for three main reasons. First, the research consists mostly of small studies of very low to moderate quality that show short-term benefit, with little long-term data^[5]. Second, myofascial pain has no single agreed diagnostic test, so studies define trigger points differently^[8]. Third, who may perform dry needling, and with how much training, varies from state to state^[9]. None of this means it cannot help — it means expectations should be realistic.

Serious problems are rare. In a prospective survey of 7,629 treatments, no significant adverse events occurred; the most common minor effects were bruising (7.55%), bleeding (4.65%) and pain during or after treatment^[7]. The most important rare risk is a collapsed lung (pneumothorax) when needling over the chest wall or upper back^[9], so tell us right away about new shortness of breath or chest pain. Infection is uncommon with sterile, single-use needles^[10].

Dry needling is usually not recommended for children under 12, and people who are pregnant, have a weakened immune system, have had recent surgery or take blood thinners should discuss it with their physician first^[9]. It should not be done over infected or broken skin, and it will not help pain that comes mainly from a pinched nerve, an arthritic joint or a disc. If you have a strong fear of needles, a non-needle option such as shockwave therapy or physical therapy may suit you better.

Usually not, but tell us about them. Dry needling uses very thin needles, and interventional pain guidelines place similar superficial muscle procedures, such as trigger point injections, in the lowest bleeding-risk group^[4]. You may bruise more easily, and some deeper areas may be avoided. Never stop a blood thinner on your own — any change should be made only with the doctor who prescribed it. Otherwise, eat a light meal beforehand and wear loose clothing.

Often not, so dry needling is usually self-pay. Medicare’s national policy covers acupuncture, including dry needling, only for chronic low back pain that meets specific criteria — up to 12 visits in 90 days — and does not cover it for any other condition^[1]. Many commercial plans do not cover it. New York workers’ compensation guidelines include dry needling as a trigger point treatment for non-acute neck and back pain^[2]. Our staff can explain the cost and check your benefits before your visit.

Alternatives include a structured physical therapy and home exercise program, massage and other hands-on therapy, trigger point injections with a local anesthetic, acupuncture, and medicines such as anti-inflammatories or muscle relaxants^[8]. For tendon pain rather than muscle knots, shockwave therapy or PRP may be more suitable. If muscle pain persists despite treatment, your physician will look for an underlying joint, disc or nerve problem.