Dry Needling

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is dry needling?

Dry needling is a procedure that treats pain. Practitioners use very fine needles inserted in target locations on the body. These are called trigger points. The procedure name includes the word “dry” to separate it from other kinds of treatments that use needles to inject fluids. There are no fluids or injections with dry needling.

Other names for dry needling include trigger point dry needling and myofascial trigger point dry needling. “Myofascial” refers to muscle pain that goes beyond the usual pain people may feel when they have worked out too hard or they have injured themselves. It is a chronic condition but is usually limited to certain locations rather than throughout the body.

Trigger points are spots where muscle has knotted or contracted. The tight spot is sensitive to the slightest pressure and when touched, pain can radiate down the muscle. The most common areas where dry needling is performed are the shoulders and neck, as well as the hips, back and heels.

How is dry needling different from acupuncture?

Acupuncture and dry needling are similar in that they both use very fine, filament needles and they do not use any form of injection. But this is where the similarity stops.

Acupuncture is a form of traditional Chinese medicine and has been performed for centuries. Acupuncturists insert the needles into various acupuncture points in the body to help relieve physical and mental ailments. Practitioners believe these acupuncture points help promote better energy flow, called Qi. The needles can be inserted in different places over the body that do not seem related to the actual problem. For example, a client who has facial pain may have needles inserted not only around the face, but in the legs and arms.

Acupuncture is also not limited to treating pain. Acupuncturists also treat conditions such as:

Dry needling was developed in the West in the 1940s and became more mainstream in the 1980s. It focuses on treating pain directly at the affected muscle tissue. Unlike acupuncture, which can be a stand-alone treatment, dry needling is usually performed in conjunction with other treatments like physical therapy or chiropractic.

Some providers combine acupuncture with dry needling for patients who have myofascial pain combined with other issues that could benefit from acupuncture.

What are the benefits of dry needling?

People who experience myofascial pain that has not been relieved with traditional treatments, such as medications and physical therapy, may benefit from dry needling.

Dry needling is considered a minimally invasive treatment. This means that, while the provider does insert needles, they do not go in very far and they do not stay in the muscle for long periods. People who get relief from dry needling may cut back or eliminate their pain medicine over time.

Dry needling can also improve the chances of success from other therapies. For example, the procedure could help people feel less muscle stiffness and pain during their physical therapy or massage sessions, increasing their odds of positive results from the therapy.

How much does dry needling cost?

Before booking an appointment for dry needling, people should contact their insurance company to see if the treatment is covered and, if so, what the company needs to process the claim. The insurance company may also have a list of approved, or in-network practitioners. The price for dry needling sessions varies according to practitioner. Some charge about $40 to $60 per session, others as low as $15 per session.

Usually, people receiving dry needling attend between 3 to 6 sessions. More sessions may be necessary, depending on the pain and responses to the therapy.

The practitioner may offer a value pack of multiple sessions, which can be helpful in the absence of insurance coverage. They may also charge a reduced rate for clients without medical insurance or dry needling coverage.

Who performs dry needling?

Healthcare providers who may offer dry needling include physical therapists, acupuncturists, chiropractors, and physicians with training in the procedure. However, state regulations determine the types of practitioners who may perform dry needling. For example, in California, only acupuncturists and physicians may perform dry needling.

When choosing a dry needling provider, make sure they are qualified. Ask where they received their dry needling training and certification, and how much experience they have.

How is dry needling performed?

Dry needling is performed in the provider’s office or clinic. The patient lies in a position that allows the provider to access the trigger points. Once the appropriate trigger points are located, the provider cleans the skin to reduce the risk of infection, holds or pinches off the area, then inserts very fine sterile microfilament needles into the trigger point. This causes the muscle to contract (pull tight), and then relax.

The depth of the needle placement varies, depending on the type of pain the provider is treating. Some needles are short and placed only a few millimeters (mm; 25 mm equals 1 inch) beyond the skin, while others are longer and enter 25 to 125 mm into the muscle and fascia. For some people, the needle may remain only for a few seconds, but for others, it could be as long as 10 or 15 minutes. The provider may also move the needle up and down a few times.

Some people say they do not feel the needles as they enter the skin, while others feel a pinch or a cramping feeling.

The needles are only used once and then disposed of for sanitary purposes.

What to expect the day of your dry needling

There are no special preparations before a dry needling session, although it is always a good idea to speak with the provider first to know for sure. It helps to wear loose clothing. People who take anticoagulants (blood thinners) should speak with the prescribing doctor before undergoing dry needling. The dry needling provider should also know if a client is taking this type of medication.

The provider will explain the procedure and how long it will take. It is important to stay still while the needle is inserted, taking the opportunity to relax at the same time.

Soreness in the muscles around the dry needling areas is common afterwards, but it is much like the muscle soreness experienced after exercise. This will go away. Applying a warm compress will help relax the muscle.

What are the risks and potential complications of dry needling?

Dry needling is a fairly safe procedure, but there are some people who should not undergo dry needling. These include:

  • People with a needle phobia

  • People who are unable to understand the treatment and may move or become agitated

  • Pregnant women, as more research on the safety of dry needling is suggested, even when avoiding historical "forbidden" acupuncture points believed to stimulate miscarriage or early labor.

People taking blood thinners or who have recently had surgery should discuss the procedure with their doctor before undergoing dry needling.

Risks and side effects of dry needling

Although there may be some side effects after a dry needling session, complications are rare. Side effects may include:

  • Sore muscles, which may be immediate or a few hours after the session. A warm compress for 20 minutes several times a day can help soothe the area. 

  • Bruising

  • Bleeding

  • Fatigue

  • Fainting

  • Nausea

  • Temporary increase in the pain symptoms that the needling is meant to treat

The very rare complication associated with dry needling occurs if the needle is inserted far enough to puncture an organ, such as a lung.

What can I expect after dry needling?

Some people feel sore after a dry needling session. People who have some discomfort after a dry needling session may feel better if they:

  • Soak in a warm bath with Epsom salts

  • Apply heat over the area, or alternate heat with ice (wrapped in a towel so it does not touch the skin directly)

  • Lightly stretch the affected muscles 

  • Take over-the-counter anti-inflammatory medications

  • Increase their fluid intake for a day or two following the session

When should I call my doctor?

People with concerning side effects should contact their provider as soon as possible. These would include:

  • Bruising that worsens instead of going away

  • Bleeding that does not stop after firm pressure for a few minutes

  • Increase in pain

  • Signs of an infection, such as increased pain in the needled area, redness, pus, or fever
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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