Dry Needling for Physical Therapy

Posted by on October 24, 2014 in Treatment | 4 comments


What is dry needling?

Dry needling is an invasive procedure in which a solid filament needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle.

Is dry needling similar to acupuncture?

There are many similarities and differences between dry needling and acupuncture. Licensed physical therapists in a growing number of states can use dry needling under the scope of their practice. Dry needling also falls within the scope of acupuncture practice. However, most physical therapists that perform dry needling are not licensed acupuncturists and do not practice acupuncture. In contrast to most schools of acupuncture, dry needling is strictly based on Western medicine principles and research.

How does dry needling work?

The exact mechanisms of dry needling are not known. There are mechanical and biochemical effects. Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institutes of Health, we know that inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain.

It is essential to elicit so-called local twitch responses, which are spinal cord reflexes. Getting local twitch responses with dry needling is the first step in breaking the pain cycle.

What type of problems can be treated with dry needling?

Dry needling can be used for a variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms.

Such conditions include, but are not limited to TMD, neck, back and shoulder pain, arm pain (tennis elbow, carpal tunnel, golfer’s elbow), headache to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstrings strains, calf tightness/spasms). The treatment of muscles has the greatest effect on reducing pain mechanisms in the nervous system.

Is the procedure painful?

Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief (less than a second) painful response. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

Are the needles sterile?

Yes, we only use sterile disposable needles.

Can I do dry needling at home?



What side effects can I expect after the treatment?

Most patients report being sore after the procedure. The soreness is described as muscle soreness over the area treated and into the areas of referred symptoms. The soreness is usually less intense and different than the patient’s original pain. Typically, the soreness lasts between a few hours and two days.

What should I do after having the procedure done?

Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment. Recommendations may include applying heat or ice over the area, gentle stretches and modifications of activities.

How long does it take for the procedure to work?

Typically, it takes several visits for a positive reaction to take place. Again, we are trying to cause mechanical and biochemical changes without any pharmacological means. Therefore, we are looking for a cumulative response to achieve a certain threshold after which the pain cycle is disturbed. Some patients notice a reduction and change in their pain level and the area of their pain after 1 or 2 sessions.

Why is my doctor not familiar with dry needling?

In the US, dry needling is a relatively new method for treating myofascial pain and not everyone is already aware of this effective modality. Feel free to inform your doctor about this treatment option. It is upon all of us to educate others about new and innovative ways to treat pain.

Where does dry needling fit in the entire rehabilitation program?

Dry needling is an additional intervention we feel fortunate to be able to offer our patients suffering from pain. At Freedom, we are very excited to offer an extensive and eclectic background of treatment options to manage all our patients with their various diagnoses.

Once I am feeling better, how often do I need to come back to maintain my progress?

The musculoskeletal system is under constant pressure from gravity, stress, work etc. A regular exercise program combined with good posture can prevent many problems. If the pain comes back, “tune-ups” are recommended to treat and prevent serious injuries.

Where can I get more information about the procedure and people that are licensed to perform it?

Visit us at one of our locations in WI. For more information go to www.FreedomPT.com.

“In this age of specialization, few clinicians are broad enough to see the whole patient and his/her problem”
Janet G. Travell, MD (1901 – 1997)


Mike Karegeannes (25 Posts)

Michael Karegeannes, PT, MHSc, LAT, MTC,CFC, CCTT, CMTPT is the owner of Freedom Physical Therapy Services in WI and is one of the few physical therapists in the United States recognized as a Certified Cervical and Temporomandibular Therapist with the AAOP and PTBCTT.


  1. kate9956@hotmail.com'

    dry needling of the masseter muscle is what worked for me after 17 months of suffering from tmjd, having jaw lock at 17mm. I can now open to 38mm with no pain.
    I did the 3 month bottom splint therapy, had mri and was 1 week from arthroscopic surgery.
    my physiotherapist was not concerned about my mri stating that my disk was out of place, your body makes a new one for you over time called a pseudodisk.
    he told me the most important thing to do is to keep teeth apart during the day, stretch constantly and wear a hard upper nightguard at night.
    after 2 sessions of dry needling I was pain free and opening wide, still, one month later no pain and opening wide.
    I highly recommend dry needling . If I only tried this from the start I would have saved a lot of money, time and pain. I hope this helps and I’m thinking about you all who are suffering from this terrible life robbing problem

    • Hi Kate, Thanks so much for your post. I am so happy to hear you had such a positive response. Dry needling can be a wonderful tool for a skilled physical therapist to use. I have had very similar, positive results when using it with my TMD clients, along with the great advice your PT gave you. I am wondering if you could elaborate a little more. I am curious as to what you think had caused your TMD problem? at 17mm of opening only, makes me curious if you suffered from Trismus vs. a disc problem? However given you had an MRI that probably confirmed the disc as part of the problem. Did you have any dental procedure that preceded your TMD problem. once again thanks so much for taking the time to post your feedback! You are continued proof that conservative, reversible TMD care really can work and help vs. more invasive procedures. I hope you continue to do well.

      • tedfurlette@gmail.com'

        dry needling has worked wonderfully for me in the past – for issues such as bursitis (knee). I have been struggling with TMD for a year w/o result. Tried mouth gards, eating nothing solid, messages, etc. I was thinking dry needling may help, goggled it, and found this article. I tried to call a physical therapy center to see if I could get in for dry needling, but they say I need a prescription. What kind of doctor would check my TMD and write a prescription for dry needling? I know my ENT would not do it, dentist would not. Do you know I should seek out? I need to find relief! Many thanks

        • Hello Ted, I appreciate your comments. Well it would be helpful to know a little bit more, for example in Wisconsin, PTs have direct access so we would be able to see you without a prescription. Some insurances will pay without a prescription, some might still require a script, but we also offer a cash plan at Freedom so clients can bypass insurance should they wish. As for a doctor to see, ideally it would be great if you could find a dentist with a TMD specialty. I am a member of the AAOP, if you go to this website http://www.aaop.org/ you can search for a dentist in your area if one exists. Also if I know what City and State you are in, I can help you find a dry needling PT in your area that hopefully has an expertise in TMD and the skill necessary to dry needle the facial muscles, etc. Please keep us posted on your progress! Thanks, Mike

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