What is Dry Needling?

Feb 5

A History and Explanation of Dry Needling (DN)

Early Origins (1940s–1950s)

Dry needling began in the 1940s and 1950s with medical research on muscle pain and trigger points. Dr. Janet Travell, a physician who later became White House physician to President John F. Kennedy, was a pioneer in identifying myofascial trigger points (knots) as a source of musculoskeletal pain. In her research, she worked with Acupuncturists to target “trigger points”. The idea of trigger points has changed with time and science, but we know we can palpate Motor Banding within muscle tissue, which is the target of dry needling today.

The concept / name of “dry” needling came about through studies that looked at the efficacy of anesthetic injections. Researchers soon discovered that inserting a needle without any medication had a similar effect on reducing pain.

Development of Modern Dry Needling (1970s–1990s)

Throughout the 1970s to 1990s, clinicians and researchers continued refining Dry Needling. Studies found that dry needling was beneficial to:

Reduce muscle tension
Decrease pain
Improve range of motion

During this period, dry needling began gaining traction among physical therapists and sports medicine practitioners, especially in Europe and Australia.

Widespread Clinical Use (2000s–Present)

Since the early 2000s, dry needling has become more widely practiced by PTs in the United States. Advancements in anatomy education, pain science, and research helped standardize training and improve safety and effectiveness. Safe, reproducible techniques were developed with ultrasound guided imaging to approach muscles.

An independent party reviewed the Doctorate of Physical Therapy curriculum and ruled that 85% of the necessary information to practice dry needling is acquired within the DPT degree. The remaining 15% is acquired through post-graduate course work. States vary in their requirements to practice dry needling (some being zero education… which is concerning!), but Washington shares the most intensive requirements within the United States. It was legalized within the scope of the Physical Therapy Practice Act 2 years ago, and Ben was amongst the first cohort of Dry Needling w/ E-Stim Certified providers via the Institute of Clinical Excellence in Washington. He’s been using the treatment extensively for a couple years now and is adept at placing needles and making it as manageable of a process as possible. Josh used dry needling in Montana as part of his practice, and he’ll have completed the necessary coursework to perform dry needling in Washington by April 2026.

Dry Needling with Electrical Stimulation

This is a relatively newer application that builds on earlier uses of electrotherapy, and it enhances treatment effects. Any amount of stim is better than none. E-Stim delivered through the tip of the needle is highly concentrated and more potent than through pads. It’s also very specific to the desired part of the muscle being treated and can be administered deeper than transdermal stim. The benefits of stim include:

Reduced post treatment soreness from ~2-3 days to ~12-24 hours.
Reduced need for needle manipulation making it less painful / more tolerable.
Increased recruitment of fast twitch and coordination muscle fibers.
Increased blood flow, decreased pain, and reduced inflammation through a passive muscle pump.
Rhythmical muscle contractions help to restore normal motor unit firing.
Stim interaction with nerves increases production of Brain Derived Neurotrophic Growth Factor (BDNP), a hormone responsible for nerve healing.

Is it safe?...Yes! But with any invasive procedure there are some possible complications to be aware of:

The worst possible complication is a Pneumothorax (lung collapse), and risk is less than .01% or <1/10,000. Quality training lessens risk. There are a handful of case studies detailing a lung collapse, and technique is usually questionable. There are ways to make it more safe / less likely. Patient positioning, holding onto the muscle to keep it away from the lung field, angle of needle orientation, the size of the needle, and the amount of needle manipulation all play into mitigating the risk as much as possible. If it were to occur, it is a chest X-ray to diagnose, and it typically resolves on its own in 10-14 days without further medical intervention. Odds are higher with the various injections that are also common practice with a very low risk.
A small bruise the size of a nickel or a pin prick bleed which clots quickly occurs about 10-15% of the time. This is the most common “complication”.
We can’t say infection risk is zero, but the bioload on a monofilament needle has been shown to be insufficient to cause an infection. It’d be very unlikely.
Anatomy knowledge is imperative to avoid blood vessels and nerves. Nerves have a protective sheath around them called the epineurial sheath that’ll cause numbness/tingling if it gets interacted with that’ll typically resolve within 10min. As long as the practitioner is cautious, nerve damage would be difficult to cause.
Professional liability insurance coverage premiums are not increasing due to physical therapists performing dry needling.
Every state except for Hawaii, California, and New York have legalized it for PT’s to perform.

How Dry Needling differs from Acupuncture

Based on Western medicine principles. The clinical rationale differs.
Focused on muscle, nerve, and connective tissue dysfunction
The technique is generally deeper as we’re targeting specific muscles driving pain and dysfunction, not meridian points. Acupuncturists claim it’s a subset of acupuncture, which is not wrong, but our application and the patient experience of dry needling is rarely the same.

I’ve treated several individuals who have worked with the different muscle specific acupuncturists in town and we’re often not treating the same muscles. I bring a perspective derived from years of musculoskeletal rehab to the treatment approach which is a different lens. Both approaches can be helpful, but out of a few thousand dry needling treatments I’ve had just a few people report the same technique or experience. The overlap doesn’t seem too significant.

The E-stim is generally more powerful / intense
The entire needle is lubricated to improve comfort with going deeper, compared to just the tip of the needle being lubricated and not the shaft.
DN is used as an adjunct to the overall plan of care, not the primary treatment.

The biggest difference in application is that we couple dry needling with exercise immediately after. It’s a powerful tool to lessen pain, reduce muscle guarding, and restore normal muscle recruitment. Loading tissue to drive adaptation and get stronger / more resilient after has a greater treatment effect than needling alone and is the most important part of any recovery. Increasing strength and capacity remains the main treatment goal.

Some Research:

There’s a lot of research showing its efficacy. In a recent study regarding patient-perceived benefits of dry needling (published in 2025), 82.1% of respondents stated they would recommend the treatment to a family member or friend.

Key findings from this research include:

Pain Relief: 73.8% of patients reported improved pain across various body regions.
Mobility: 70.6% of respondents experienced improved mobility.
Other Improvements: Patients also reported gains in gait (46.2%) and strength (38.5%).
Clinical Effectiveness (Neck Pain): A specific trial in Colorado noted that 82% of participants in a dry needling group achieved complete relief of chronic neck pain symptoms within three sessions, compared to only 23% in a control group.

In Conclusion:

With all medical interventions, there’s a range of efficacy, but the general consensus is that it’s helpful for the vast majority as a part of their recovery. Some experience dramatic changes in pain and function. It’s a powerful tool that can help us achieve your goals faster, but at the same time it’s not always essential or required to get better, it just might take longer. I’ve treated a fair amount of people who benefited from dry needling when they did not respond to all the other types of treatment, it was the key to helping them get past their pain. The hybrid approach of coupling dry needling with a good sports PT who understands a wide variety of ways to load the body, drive connective tissue adaptation, and produce a more resilient and robust human is the way.