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How Therapists Use Dry Needling to Relieve Pain

degeyterDry needling (DN) is a skilled intervention used by specially trained physical therapists to manage multiple neuromuscular and/or musculoskeletal impairments. The therapist uses a thin, monofilament needle to puncture the skin and stimulate the underlying connective tissue in order to optimize function in the muscle and fascia. This helps to reduce pain and improve mobility.

This is achieved by inserting the needle into an active and/or latent trigger point with the intention of provoking a localized twitch response (LTR). A trigger point is a hyper-irritable spot in a taut band of muscle and/or fascia that refers pain to another area of the body and impedes optimal function. A LTR is an abnormal, involuntary muscle spasm that occurs in muscles that are no longer functioning optimally. It is desired to elicit this response, which helps to improve circulation and modulate the tone of the muscle.

DN is not acupuncture. DN does use the same needles as used in acupuncture, but the approach and treatment are very different. A physical therapist is trained with a Western medical approach to evaluate neuromuscular and musculoskeletal disorders. DN is used as a modality to treat muscle and/or fascia in order to improve function and decrease pain. Acupuncture is performed by a licensed acupuncturist who has undergone training in traditional Chinese medicine to evaluate tongue and pulse readings in order to determine the flow of energy along meridians of the body.

When receiving DN, the therapist will initially take time to thoroughly palpate and assess location of trigger points and restricted areas. Once these have been assessed, the therapist will communicate the locations that h/she intends to treat. The needle will be inserted with a quick tap through the skin and then guided deeper into the tissue. The initial tap usually feels similar to a pinprick and as the needle goes deeper into the tissue there may be a dull, achy sensation. If the initial insertion provokes the desired LTR, the patient may also feel a brief, intense muscle spasm. The therapist may choice to piston or may redirect the needle once inserted to provoke multiple LTRs. The number of needles used and how long the needles remain in the body depends on many factors such as: patient’s tolerance to treatment, number of pain sites, size of impaired region, number of palpable trigger points and pain presentation.

Following DN, the patient should expect muscle soreness and/or slight bruising, which typically resolves within 24-48 hours. The soreness generally feels similar to muscle soreness experienced after a hard workout. Some patients will also experience generalized fatigue for approximately 24 hours. It is important to drink plenty of water and to NOT increase any workouts or activity for 24 hours until the patient understands his/her personal response to the treatment. Continuing with any regularly performed exercise or activities is encouraged.

As with any invasive procedure, there are potential complications. Common complications include needle insertion pain, bruising, muscle soreness, bleeding and fatigue. Other rare complications can include: feeling faint or dizzy, headache, aggravation of symptoms, infection, pneumothorax, nausea/vomiting, neurological response, vasovagal response, and emotional response (anxiety, euphoria).

It is very important that the patient openly communicates any concerns with the therapist. If at any time or for any reason the patient wishes to stop the treatment, this should be communicated and therapist will immediately cease DN. It is important to be both physical and emotionally comfortable with this treatment, so please be honest and communicate any concerns. FBN

By Julie DeGeyter, PT, DPT

Julie DeGeyter is a physical therapist at Flagstaff Bone and Joint located at 77 West Forest Avenue (in the Physicians & Surgeons Offices attached to the north side of Flagstaff Medical Center). DeGeyter treats patients with a variety of impairments including orthopaedic injuries, vestibular disorders, chronic pain, pelvic floor dysfunction, and postoperative rehabilitation. Her primary focus is treatment with manual therapy and functional exercise to restore pain-free motion and improve a person’s quality of life. For additional information or to schedule an appointment visit www.flagstaffboneandjoint.com or call 928.773.2280.  

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38 Responses to How Therapists Use Dry Needling to Relieve Pain

  1. Rawls May 16, 2016 at 12:49 PM #

    Dry Needling is acupuncture! There is no difference. Needles are the same, and Acupuncture is also used to “treat muscle and/or fascia in order to improve function and decrease pain”. Additionally, Acupuncturists have 2000+ hours of training to perform this modality whereas PTs have minimal training of less than 50 hours before performing DN. There are no educational standards for PTs practicing DN, no board exams, Clean Needle Technique nor supervised practice. Acupucnturists must pass board exams, Clean Needle and have over 500 hours of supervised practice. Seek an acupuncturist for any needling of this kind!

  2. Tracy Hackett, AP, LAc, DAOM May 16, 2016 at 1:58 PM #

    If DN isn’t acupuncture, why then do you use acupuncture needles? The term dry needling comes from the use of an empty syringe to release the trigger point, but now instead PTs have co-opted acupuncture technique and instruments. DN is indeed acupuncture as it is currently practiced. I have a clinical doctorate degree in the subject and have studied in China where I learned the exact technique that you refer to here in this article as “dry needling”. Your weekend course is in no way the equivalent of my study. Punctured organs and damaged nerves happen when the provider does not have enough training, which happens frequently with PTs doing “dry needling” = practicing acupuncture without the training or license. Your definition of acupuncture is a convenient play of semantics to serve your ends which is a further manipulation of the public trust. PTs learn exercise sciences, not invasive techniques which require sticking needles into people. If it hurts or injures your patients, you’re likely doing the technique wrong.

  3. Olga Mar May 16, 2016 at 3:55 PM #

    ” Acupuncture is performed by a licensed acupuncturist who has undergone training in traditional Chinese medicine for a minimum of 3 years practicing for over 300 hours in a clinical supervised setting to ensure the safety and efficacy of inserting needles to stumulate and alleviate pain.

  4. Jason L. May 16, 2016 at 4:00 PM #

    DN is absolutely acupuncture, the difference being that a trained acupuncturist has close to or more than a thousand hours of practice and training along with differential theories/diagnosis and alternative methods of needling available whereas a physical therapist typically has less than 50 hours training and no knowledge of alternative needling treatment methods. The nick name Pain and Torture is not far off the mark when having an under qualified practitioner preform your treatment. Educate yourself and find a skilled practitioner.

  5. Kristin ten Broeck May 16, 2016 at 4:24 PM #

    Very thoughtful article and explanation. I would like to point out, as a licensed acupuncturist, that the discription used to describe what I might do as a licensed acupuncturist is very limited. We palpate the body in depth to find the appropriate points to needle, as practitioners of Chinese medicine have been doing for thousands of years. We have also sat in western anatomy and physiology classes (including in-depth western musculoskeletal anatomy), attended cadaver lab, and took classes in advanced palpation and needling techniques, to approach acupuncture from many different angles. So, while the diagnostic approach might differ somewhat, there is much overlap, and I would prefer that someone who doesn’t know my training not reduce what I do and stand complicit in using semantics to take what I devoted my life to study and add to it their scope of practice. I wish PTs would put in the hours that other professions put it to learn acupuncture safely and with skilled technique. PTs and their teachers did not invent the techniques you are using, so call it what it is. Dry needling = subset of acupuncture. Graston technique = gua sha.

  6. Eric Martin May 16, 2016 at 6:44 PM #

    Nonsense. Dry Needling is acupuncture performed by people with little or no training in acupuncture. This is a battle being played out around the country and so far, acupuncturists are winning the majority of these cases, as judges and legislators are agreeing that dry needling is acupuncture, and as such should only be performed by those trained and licensed as acupuncturist. Buyer beware.

  7. Dr. Raymond Burns May 16, 2016 at 6:54 PM #

    Dry needling is a cheap knock off of acupuncture. Interesting to experience, but I would rather my patients, friends and family experience the real thing. I don’t appreciate physical therapists considering themselves specialists doing a minute fraction of the training necessary (4 hour course) to needle patients correctly and safely. As a western medical physician, I would never refer to a physical therapist trained in this modality.

  8. Lucas B May 16, 2016 at 7:10 PM #

    Hate to burst your bubble, but modern acupuncture does all those things you state Dry Needling does. Only Licensed acupuncturists receive far more training. So, unlike dry needling, it doesn’t hurt nor does it bruise as frequently. If you spent years needling patients while training before performing this procedure like A liscensed acupuncturist (LAc) does you will find zero complications. Characterizing a pneumothorax (puncturing the lung), a simple complication is misleading. I would characterize it as malpractice. The complications you mention are not from the acupuncture needle, rather, a lack of skill.

    Call it what you will, but dry needling IS acupuncture performed by less skilled practitioners. Acupuncture may be pre-scientific in origin, but has evolved beyond simple diagnosis of tongue and pulse.

  9. Ashli May 16, 2016 at 7:12 PM #

    How many hours of needle training does a “dry needler” need before they can do this?

  10. John May 16, 2016 at 7:19 PM #

    PT’s shouldn’t be anywhere near an ACUPUNCTURE needle without proper training. 6 MONTHS TO A YEAR, NOT A FUCKING WEEKEND. I notice also they call it acupuncture when they collapse someone’s lung because they don’t have proper training in needling techniques.

  11. Ina schlenoff May 16, 2016 at 7:25 PM #

    What training does the therapist have to needle? Is she trained in needle technique? A weekend course does not make an appropriate practioners. Seek a licensed acupuncturist, who has over 3 years of training.

  12. jingriver May 16, 2016 at 7:26 PM #

    DN is acupuncture because it uses acupuncture needles. You need an acupuncture license to purchase and use acupuncture needles. Without the license you are breaking the law.

  13. Allison Blaisdell May 16, 2016 at 7:30 PM #

    Dry needling is not a “skilled intervention”. Dry needling courses are as little as 12 hours long and are not subject to any 3rd party testing or accreditation.

  14. Dennis Galvin May 16, 2016 at 7:30 PM #

    The use of acupuncture needles in treating motor and trigger points is one of many techniques an Acupuncturist will use to treat pain conditions.

  15. S. T. Greene May 16, 2016 at 7:41 PM #

    A few questions: what training do physical therapists receive? Licensed acupuncturists receive between 2500-3500 hours of training depending on the institution, which includes clinical work. Acupuncturists also do more than “adjust energy” in the body. Acupuncture has been recommended by national and international bodies for the treatment of pain. Acupuncturists receive specific training for the treatment of pain which includes the use of trigger points. Only an acupuncturist should use needles as described in the article since they are FDA controlled medical devices. If someone without a license uses them, they should be reported for improper use of medical devices. Be safe. Choose a highly trained acupuncturists instead of someone who took a weekend seminar.

  16. Gina Terinoni May 16, 2016 at 7:49 PM #

    DN is acupuncture. Get a dictionary and read the definition of acupuncture. That’s what you are doing. Licensed acupuncturists are trained in musculoskeletal medicine. Your information use incorrect on so many levels.

  17. Amy Mager May 16, 2016 at 8:07 PM #

    Dry Needling is acupuncture. Current opposition to the practice of Dry Needling/acupuncture by non-Medical Doctor, non-Acupuncturist practitioners should not be considered a ‘turf-war’, but rather a reflection of concern for objectively verified, minimal competency standards that protect the public from substandard and dangerous invasive medical procedures.

    In closing, I quote from Jan Dommerholt’s book, Trigger Point Dry Needling, p.61
    “It would be counterproductive and inaccurate to state that dry needling TrP and intramuscular therapy would not be within the scope of acupuncture, and that within the context of acupuncture, dry needling is a technique of acupuncture”

  18. Lucy Terrance May 16, 2016 at 8:16 PM #

    I’m curious where the writer got her training in dry needling. My understanding is that one weekend class is all that is required for PTs to insert needles. This is dangerous and negligent because dry needling is acupuncture. Compare that to four years of an acupuncturist’s training. Scary.

  19. M. Reed May 16, 2016 at 8:43 PM #

    Dry needling is an excellent intervention and produces excellent results when performed by a skilled practitioner. However, I feel the need to address some misinformation presented in this article. The article claims that acupuncture is intended to manipulate some Sort of metaphysical energy. This statement is false. The Chinese NEVER postulated the existence of energy meridians. The whole energy fantasy that became popular in the West is based on a twentieth century fabrication by a Frenchman named George Soulie de Morant. The Nei Jing and Nan Jing (classic texts on which much of Chinese medicine is based) talk about organs blood vessels and the like, but do not mention any sort of mystical energy (the character qi has a number of meanings including breath, gas and function. However, none of its meanings Remotely resembles energy). For further reading, I would recommend Donald Kendall’s ‘Dao of Chinese Medicine’. It is also worth noting that modern acupuncturists in the United States generally undergo four to six academic years of graduate level training, learn anatomy and physiology and are trained to perform orthopedic tests, in addition to examining pulse and tongue. That being said, Dr. Travell’s work on trigger points is meticulous and thorough, and randomized controlled trials have demonstrated dry needling to be more effective than TCM style acupuncture (another twentieth century creation) at treating pain when trigger points are present.

  20. Bainidh May 16, 2016 at 9:00 PM #

    There is nothing skilled or ‘special’ about performing an invasive treatment after one weekend of ‘training’. There is also very little honor in moderating an article so that opposing comments are censored or deleted. Honesty is a matter of public safety in this situation.

  21. Erin Thomas May 16, 2016 at 9:37 PM #

    The therapy this author is describing is exactly acupuncture. “Dry Needling” is acupuncture and should only be performed by a fully trained & licensed acupuncturist, not a physical therapist.

  22. Angela May 16, 2016 at 9:57 PM #

    Hello there, how long is the training to be able to insert needle in tge body?

  23. Larry Pannell L.Ac., DOM, MSOM May 16, 2016 at 9:58 PM #

    DN is a unethical version of acupuncture applied by the untrained in Traditional Chinese Medicine that are side stepping the law. Please do your research about this subject before posting an article on the subject. And please note the following from the National Board Certification Commission, NCCAOM, that oversees all licensing in the US. You must have there certification before applying for a state license. Also a quote from the state acupuncture association where I am LICENSED.
    Larry Anthony Pannell L.Ac., DOM, MSOM

    “Acupuncture, like Western Medicine is a complex subject. It cannot be mastered in a weekend course or in a month. All AAMA members, in addition to four years of medical school a non-physician must have in excess of 2,000 hours of clinical and didactic education and training before they can become certified to treat patients.

    To include dry needling into the scope of practice of physical therapists is unnecessarily to expose the public to serious and potentially hazardous risks. It is critical to understand that dry needling, in the hands of minimally educated practitioners can cause extreme harm.” – National Commission and Certification of Acupuncture and Oriental Medicine.

    “Across the country Physical Therapists, Chiropractors, Nurse Practitioners and other professionals are being certified to administer acupuncture under the pseudonym “Dry Needling” with as little as 27 hours of training.” – Idaho Acupuncture Association

  24. Lisa May 17, 2016 at 12:09 AM #

    Dry needling is acupuncture! Acupuncturist have been trained for 4 years verses being trained in a weekend course. Acupuncturist have been doing what dry needling does for thousands of years. You have just gave it a new name. It’s called marketing, dry needling is acupuncture. I would never trust someone who has had so little training. I have watched a video of a physical therapist performing “dry needling” and they did it so poorly they caused a pneumothorax! Acupuncturist have been trained so throughly to know the depths and Angel of insertion for each point and motor points of the muscles. They have trained with senior acupuncturist in a clinical setting for over 3 years + to be trained properly. What a risk to do dry needling with a physical therapist who has trained over the weekend. Why risk collapsing a lung when you can go to an acupuncturist who knows what they are doing. Stop stealing acupuncturists techniques! You have no idea what you are doing.

  25. Esther May 17, 2016 at 12:29 AM #

    How much training is needed for a therapist to practice dry needling? I know acupuncturist need like 3-4 years minimum.

  26. David Frederick May 17, 2016 at 2:38 AM #

    Is there more actual science to support this than there is acupuncture? Could you provide some sources?

  27. Jamil Shoot May 17, 2016 at 5:49 AM #

    Dry needling is the untrained use of acupuncture. Using acupuncture needles to pierce the skin no matter what you call it is acupuncture.

  28. Dr. Raymond Burns May 17, 2016 at 6:53 AM #

    Moderator of these is unethical and a complete moron. Reporting this newspaper.

  29. Isaac May 17, 2016 at 8:49 AM #

    Boo this author for deleting comments from acupuncturists who legitimately work with ACUPUNCTURE needles. There is no such thing as a ‘dry needling needle’ and just because you say that PT treatment principles are very different does not make that statement true. Orthopedic medicine has been within the scope of acupuncturists since the start of the practice thousands of years ago, and indeed TCM treatment principles remain strikingly similar to needling methods of trigger point release. How many hours of supervised training using ACUPUNCTURE needles did you receive Julie? Acupuncturists receive around 2000 hours supervised training (primarily using ACUPUNCTURE needles) on average between the classroom and the clinic. Have fun deleting this comment like all the others, either way the acupuncture community has been alerted to this farce of an educational health piece.

  30. Karen Vaughan May 17, 2016 at 9:53 AM #

    The training for dry needling is minimal and points affect non-musculo-skeletal issues as well. I wouldn’t allow anyone with a few hundred hours of training (MD, PT, DC) needle me when it takes a good 3-4 thousand hours to treat without causing harm. For instance points on the toe affect headaches and the stomach is affected by points on the leg. One of the best lower back pain points is on the hand. Licensed acupuncturists learn that and “dry needling” is well within our training and purvue.

  31. Molly May 17, 2016 at 2:39 PM #

    Not correct. This technique is acupuncture and all sciouncturists are trained in dry needling- the name is new, the principle is ancient. It is one piece of a large system of medicine used incorrectly when taught and practiced in isolation. If you choose to use acupuncture to treat your patients great, but first get the appropriate education. If you don’t want to attend 4 more years of school, then stick to your profession.

  32. A state licensed Acupuncturist May 17, 2016 at 5:22 PM #

    I wish you were better educated on what a license acupuncturist really does and how a true diagnosis is put together. “evaluate tongue and pulse readings in order to determine the flow of energy along meridians of the body.” Really now, there is so much involved with someone who practices Traditional Medicine. Acupuncturist study for four or more years of school with thousands of hours of clinical training before being able to sit for either a national or state exam. Many PT doing Dry needling take a long weekend course. You say that “evaluate tongue and pulse readings in order to determine the flow of energy along meridians of the body.” I assure you any acupuncturist can name the point and its function as well as a speak about a specific selection of points that go along with it to aid in healing or adjustment.

    For a true experience using acupuncture needles patients should be guided to a licensed acupuncturist in their area. Dry needling is dynamically inferior to a total acupuncture treatment deliver by a licensed acupuncturist.

  33. Debi May 18, 2016 at 3:00 AM #

    Dry needling = untrained acupuncture.. Missing the point of thousands of years of development and understanding of the human body

  34. Will Sheppy May 18, 2016 at 10:09 AM #

    Dry Needling is a form of Acupuncture. Most acupuncturist are taught, DN and have training in western neuromuscular and musculoskeletal disorders.

    Some Acupuncture even specialize in Orthopedic Acupuncture and will take Continuing Education Certifications that go above and beyond what PT are required.

    http://www.whitfieldreaves.com/education/seminars/

    https://www.sportsmedicineacupuncture.com/certification-program/course-descriptions/

    The Billing of DN to Insurance is often done as Acupuncture or Manual Therapy which is incorrect. In some states it is unclear if Malpractice insurance covers DN.

    PT are great! Combining Physical Therapy with a Certified Orthopedic Acupuncturist with will you the best results.

  35. Beverly Sorrells, AP May 18, 2016 at 11:09 AM #

    Dry needling IS acupuncture. In historic Chinese medical texts, trigger points are mentioned and they go by the name “Ashi” points. An acupuncturist inserts the same needles into these same points to achieve the same thing: to improve function and reduce pain. In addition, acupuncturists will frequently needle certain points along specific meridians to speed correction of the underlying root issue(s) of the pain to help achieve lasting results. Done correctly, the needling of Ashi (aka trigger points) should NOT cause bruising. Once treated, patients typically report feeling reduced pain, reduced tightness and increased range of motion – the majority noticing this as they get off the table before leaving the office.

  36. jimmy May 18, 2016 at 1:58 PM #

    this is total BS. DN IS ACUPUNCTURE. It has been used in the USA for many years. It appears that physical therapists are misinformed and feel like they have invented something that already exists.

  37. Abby Stewart June 10, 2019 at 6:36 AM #

    Awesome article, I really enjoyed this and it help put things in perspective for me.
    Always excellent, informative, sensible advice. Keep up the good work!

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