What is Dry Needling in Physical Therapy?

Dry needling is one of the many techniques used by physical therapists to treat muscle and connective tissue pain. The method uses a dry, solid needle that does not contain or harbor any type of external medication. The practice of dry needle therapy involves inserting the needle into the skin into muscle regions known as trigger points. The therapy is also sometimes referred to as trigger point dry needling or intramuscular manual therapy.

Trigger Points

Trigger points were discovered by neuroanatomists and scientific studies involving the musculoskeletal and nervous systems. A trigger point refers to a tight band or knot that forms somewhere within a muscle. These points are typically tender, may lead to muscle spasms and often cause pain that radiates to other areas.

Type of Needles Used

The stainless steel needles that therapists use for the procedure are known as thin filiform needles, which appear similar to the instruments used in acupuncture. During the procedure, the licensed therapist washes their hands, wear gloves and uses disposable sterile needles in accordance with Standard Precautions, the Guide to Infection Prevention in Outpatient Settings and OSHA standards. After completing the treatment, the needles are inserted into a sharps container.

Difference Between Acupuncture and Dry Needling

Acupuncture is a form of traditional Chinese medicine that serves to clear the energy pathways that practitioners believe flow throughout the body. The needles are inserted into specific areas known as meridians in order to open blockages and encourage the energy to flow freely. Needling physical therapy involves inserting one or more needles directly into the muscle knot, manipulating or applying a slight electrical current to each needle to stimulate relaxation of that trigger point. The needle disrupts the nerve impulses that cause a muscle to tense and transmit pain signals by causing a local response that stimulates the release of a number of protein and neurotransmitting compounds. These chemicals act to block the transmission of pain signals. This type of physical therapy has been shown to reduce muscle tension and pain while helping to restore range of motion.

Is the Process Painful?

Patients typically do not feel the needle during the insertion process. However, when inserted into the affected muscle area, the tissues commonly twitch in response. This action may cause a slight twinge of discomfort that feels like a momentary ache, cramp, or tingling sensation. After removing the needle, the therapist applies direct pressure to the site for up to 30 seconds.

When is Dry Needling Used?

During physical therapy, the practitioner commonly uses a number of techniques to minimize pain, promote healing and natural movement. Needle insertion is one of these methods. This type of therapy might be used for:

Benefits of Dry Needling Physical Therapy

Therapists and patients alike report that the procedure alleviates pain and restores normal movement more quickly. The number of treatments required to gain optimal benefits depends on the type of muscular problem. Some patients need only one session to experience dramatic results. Others may require two or more sessions.

Dry Needling Side Effects

The after effects of the procedure vary from one person to the next. Common effects include mild muscle soreness and bruising around the insertion site. The soreness generally lasts for 24 to 48 hours and is caused by the build-up of lactic acid. Patients should drink plenty of fluids, apply heat and move normally the following treatment. Bleeding is minimal to non-existent.

Who Performs Dry Needling?

Physical therapists learn the ability and skill to perform needling therapy during the course of their education process, during residency and clinical internships. The physical skill needed to perform the practice efficiently is learned and developed during specialized course training that can involve up to an additional year of study. Prior to allowing a physical therapist to perform the procedure, patients should ask the practitioner about their educational and experience background in dry needling physical therapy.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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