Dry Needling: Is it Worth the Pain?

Arriving at a physical therapy appointment to have a needle stuck deep into the body’s muscles only to leave hobbling and sorer than before doesn’t seem like an effective method for rehabilitation. However, the post-treatment benefits have made dry needling one of the many techniques individuals are using to treat and prevent injury from exercise.

What is Dry Needling?

While wet needling uses hollow needles to inject corticosteroids into muscle [7], dry needling (DN) consists of inserting a fine needle, similar to those used in acupuncture, deep into the muscle without injections. The needle is then twisted and moved around the area without being fully removed from the skin. The needling itself can be uncomfortable, feeling like a pinch, cramp, or deep prick, and can result in local soreness post-treatment. Physical therapists seek to insert the needle into a myofascial trigger point (MTrP) to relieve myofascial pain syndrome (MPS), the most common muscle pain disorder seen in clinical practice [1]. In exercise science, MTrPs are defined as “hyperirritable local point(s) located in taut bands of skeletal muscle or fascia which when compressed causes local tenderness and referred pain” [10]. Potentially caused by muscle overuse [2], this pain is commonly described as having a knot in a muscle and creates localized tenderness, pain to deep touch, and restricted movement [1].

The video above shows a physical therapist performing the dry needling technique on various muscles. Created by Dynamic Physical Therapy, Covington, LA (2013).

Dry needling is used as a rehabilitation technique to decrease the pain MTrPs can cause. The “fast-in and fast-out needle technique” applies high pressure stimulation to the MTrP, often causing a twitch response. These twitch responses are the result of a spinal reflex generated by the activation of nociceptors and mechanoreceptors. These receptors respond to the painful mechanical irritation and stretch the needle causes within the muscle [1]. When this occurs, a single motor unit fires and a visible, isolated contraction – the “twitch” – can be seen. These twitch responses can occur local to the needle or within muscles on the opposite side of the body. This phenomenon has led researchers to believe that the pain associated with MTrPs is due to central nervous system (CNS) changes [1]. 

How is Dry Needling Portrayed in Healthcare?

Healthcare providers, such as MedStar National Rehabilitation Network and ChristianaCare, have been advocates for dry needling. They mention DN is “an effective physical therapy modality…in the treatment of orthopedic injuries” [5] and that it can even be used for preventing pain and injury [4]. There have been many personal accounts of the wonders of dry needling in recovery from nagging injuries. AshleyJane Kneeland, who struggles with muscular pain due to lupus, fibromyalgia, and postural orthostatic tachycardia syndrome, cites DN treatment as relief for her painful spasms and headaches, as well as providing general relaxation [6]. But how effective is dry needling, really? Is there science to back up these claims?

What Does the Science Say?

Elizabeth A. Tough and co-authors performed a meta-analysis in 2009 of seven studies assessing the effectiveness of DN in managing MTrP pain. This study provides an update for the systematic review by Cummings and White, which found no evidence suggesting injections through wet needling generate a better response than dry needling [3]. One study found by Tough et al. suggests DN is more effective in treating MTrP pain than undergoing no treatment, two studies produced contradictory results when comparing DN in MTrPs to DN elsewhere, and four studies showed DN is more effective than other non-penetrating forms of treatment (placebo controls). However, when combining these studies for a sample size of n=134, no statistical significance was found between DN and placebo treatments. 

While the authors conclude the overall direction of past studies trend towards showing that DN is effective in treating MTrP and MPS [10], there is no significant evidence yet. The lack of statistical significance could be due to low consistency in study design for studies included in the meta-analysis, as each employed varying mechanisms for needle placement, depth, and treatment frequencies, along with there being an overall small sample size. Therefore, further studies are required to significantly conclude that DN is effective in MTrP rehabilitation.

Ortega-Cebrian et al. recognized the limitations in previous studies and thus sought to create a significant evaluation of the ability of DN to decrease pain and improve functional movements. The authors use a myometer (MyotonPro, [8]) and surface electromyography (sEMG) to assess the mechanical properties of muscle in subjects (n=20 M) with quadricep muscle tension and pain [9]. 

The MyotonPro allows researchers to quantify muscle tone and stiffness. While no standards exist for describing these parameters with respect to changes after rehabilitation techniques, researchers found the device to be reliable through inter-rater reliability (comparing values of the MyotonPro to another rater). Pain was assessed by subjects using the Visual Analogue Scale (VAS) and a goniometer was used to measure small range of motion (ROM) improvements. DN was performed by one of two experienced therapists until twitch responses ceased [9].

Authors report that DN resulted in statistically significant pain reduction and an increase in flexion ROM. However, the ROM was very small and could be within the range of measurement error of the goniometer. Also, the p-values reported in-text for these parameters do not match the corresponding table which presents a question of the reliability of author reporting. All sEMG parameters, except for decreased vastus lateralis activity, were not significantly changed by DN, as well as all MyotonPro parameters, besides a decrease in vastus medialis decrement (muscle elasticity) and resistance. In a power analysis performed after the study, authors report needing 198 subjects for statistically significant results – much higher than the 20 subjects used [9]. Therefore this study continues the uncertainty in the benefits of DN, but does present significant subject-reported pain reduction.

Is it Worth the Pain?

So is dry needling worth the pain? After being put to the test through experimental studies, there is no clear evidence that dry needling is more beneficial than alternative rehabilitation methods such as wet needling, placebo needling, or acupuncture [9]. However, while the mechanisms of changes in muscles with trigger points due to dry needling are unknown, subjects do report pain reduction. Dry needling should be taken on a case-by-case basis since current knowledge of widespread benefits is limited. Essentially, if dry needling treatment alleviates pain more than other rehabilitation methods and the pain of the procedure is bearable, why not give it a try?

 

Questions to Consider:

  • Would you be willing to try dry needling regardless of uncertainties in the literature?
  • Do you believe it is a problem that healthcare providers claim dry needling is effective despite a lack of conclusive evidence?
  • What should future studies do to ensure significant results?

 

References:

[1] Audette, J. F., Wang, F., & Smith, H. (2004). Bilateral Activation of Motor Unit Potentials with Unilateral Needle Stimulation of Active Myofascial Trigger Points. American Journal of Physical Medicine & Rehabilitation, 83(5), 368–374. doi: 10.1097/01.phm.0000118037.61143.7c. 

[2] Bron, C., & Dommerholt, J. D. (2012). Etiology of Myofascial Trigger Points. Current Pain and Headache Reports, 16(5), 439–444. doi: 10.1007/s11916-012-0289-4. 

[3] Cummings, T., & White, A. R. (2001). Needling therapies in the management of myofascial trigger point pain: A systematic review. Archives of Physical Medicine and Rehabilitation, 82(7), 986–992. doi: 10.1053/apmr.2001.24023. 

[4] Dry Needling®. (n.d.). Retrieved from https://christianacare.org/services/rehabilitation/physicaltherapy/dryneedling/

[5] Dry Needling. (n.d.). Retrieved from https://www.medstarnrh.org/our-services/specialty-services/services/dry-needling/

 [6] Dry Needling: The Most Painful Thing I’ve Ever Loved. (2015, March 25). Retrieved from https://www.everydayhealth.com/columns/my-health-story/dry-needling-most-painful-thing-ever-loved/

[7] Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252–265. doi: 10.1179/108331913×13844245102034. 

[8] Muscle Tone, Stiffness, Elasticity measurement device. (n.d.). Retrieved from 

 [9] Ortega-Cebrian, S., Luchini, N., & Whiteley, R. (2016). Dry needling: Effects on activation and passive mechanical properties of the quadriceps, pain and range during late stage rehabilitation of ACL reconstructed patients. Physical Therapy in Sport, 21, 57–62. doi: 10.1016/j.ptsp.2016.02.001. 

[10] Tough, E. A., White, A. R., Cummings, T. M., Richards, S. H., & Campbell, J. L. (2009). Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. European Journal of Pain, 13(1), 3–10. doi: 10.1016/j.ejpain.2008.02.006.

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11 thoughts on “Dry Needling: Is it Worth the Pain?

  1. Great read! I heard of dry needling before, but I never understood its purpose. You did a great job of providing enough information to describe its purpose and why so many results from studies are inconclusive. I don’t think I would try dry needling myself (not the biggest fan of needles to begin with), but maybe I could be convinced with some better evidence!

  2. I was unfamiliar with dry needling being a technique to encourage muscle recovery. Your post made it clear that people will go to great lengths to have a speedy recovery. Similar to cpfeifer, I personally would not resort to stabbing my self with needles to feel less sore. However, if I was Ashley Jane Kneeland, I may consider it. I feel like we as humans often search for the quick-fix without questioning it, and I feel dry needling may fit into that category. The inconsistency of results shown in your post also fuels my beliefs towards dry needling. Why can exercise and sports-related research be so indeterminate at times?

    • I agree that it’s frustrating that most exercise research is inconclusive. Dry needling can seem like a quick-fix or maybe just something else to try when other treatment options have been exhausted without success, which is why I chose to try it in treating my injuries.

  3. Overall, I felt this was an excellent post to understand what is dry needling and the limited conclusion about its effectiveness. The video was additionally helpful to summarize the method and use of dry needling, especially from a patient perspective. In addition to being hesitant to use dry needling with a lack of sufficient evidence backing its success, I would also be curious to know more about the consequences of dry needling. You mention there is no clear evidence that dry needling is more effective compared to other methods, like acupuncture, but I would be curious to know how its relative safety compares to these other methods. A prospective study performed in 2014 found approximately 19% mild adverse events following trigger point dry needling reports, with the most common being bruising, but no significant adverse events [1]. It could be interesting to know how the other methods compare in regards to safety and adverse events. Especially if there is a lack of significant evidence proving this method is effective, I would want to know the potentially harmful effects of it before undergoing treatment myself.
    As you mention from the meta-analysis and the article by Ortega-Cebrian et al, perhaps focusing in future studies on standardizing the methodology behind dry needling, such as targeting specific muscle groups or categorizing patient symptoms prior to the treatment, might be helpful in producing significant results should dry needling actually be effective.
    [1] Brady S, Mcevoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. doi:10.1179/2042618613Y.0000000044.

    • Thanks for reading! I appreciate the additional research you found on possible adverse effects of dry needling as the studies I found did not mention this. I agree that it is important to know the potential consequences of a procedure before undergoing treatment. Bruising being the most severe known adverse effect outweighs the potential benefits of tension release, for me at least.

  4. I have never had dry needling done so I cannot speak to a personal experience, but I am curious if it leaves any sort of bruising? I know you mentioned soreness/tenderness in the area that the needle punctured but I was curious if there were any other known effects. Some people use cupping as a way to alleviate muscle pain and soreness but this leaves large bruises on the treated area so if dry needling is just as effective in reducing pain it may be a better alternative!

    • Thanks for the comment! Anna’s comment mentioned a study that found bruising in about 1/5th of subjects with no severe adverse effects. I personally did not experience bruising after dry needling but did bruise after other treatments like cupping and Graston. I agree that less bruising is a major benefit of dry needling compared to cupping, etc. It would be interesting to find a study comparing dry needling to these other methods in terms of effectiveness and adverse effects like bruising.

  5. No way would I try dry needling. I looked into it and I found it kind of funny that dry needling came about after people started wondering if the needle itself, not what people were injecting into their muscles, was helping them feel better. It’s also funny that there isn’t any real conclusive evidence of this but people still swear by it. Maybe the earlier, less reliable studies did show it was better.

    PS that video was gross

  6. This was a very interesting post! I thought it was concerning that companies like Christiana Care are advocating for dry needling when researchers haven’t found any evidence that it is effective. I think that takes some of their credibility with their patients away. I personally would not try dry needling because it sounds painful and wouldn’t want to risk other issues with something that doesn’t have a lot of evidence to support that it works.

  7. This was a very interesting read! I find it very interesting that there are so many different forms of rehabilitation using needles that you mentioned (dry needling, wet needling, acupuncture) but there is no concrete evidence showing the effects it has on recovery. I for one do not fancy getting needles stabbed into me an wiggled around for recovery, it does not sound pleasant nor worth it especially if there is initially increased soreness. Like jrramp, I had wondered if dry needling resulted in any post treatment bruising. I agree it would be interesting to compare dry needling to other rehabilitation methods outside the needling realm.

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