Dry Needling: Another Tool in a Physical Therapist’s Toolbox

Dry needling can be an effective compliment to physical therapy intervention.

• By School of Health Professions
• September 8, 2021

 

While the term “dry needling” may sound like a bizarre interrogation tool, it is actually a highly effective physical therapy technique for patients with many common musculoskeletal conditions. With dry needling, a thin monofilament needle is used to penetrate the skin and treat underlying muscular trigger points for the management of neuromusculoskeletal pain and movement impairments.

 

We spoke with Gary Kearns, PT, ScD, assistant professor in the Doctor of Physical Therapy program in the School of Health Professions, about how dry needling works for patients, the training that goes into learning the technique, and some common misconceptions. 

 

“When I went through physical therapy school, dry needling wasn’t discussed,” Kearns says. “Historically the U.S. is slow to adopt things that are new to the physical therapy world.” 

 

While other countries have had some form of dry needling for decades, Kearns says that it has become popular in the United States in the last five to 10 years. 

 

“I’d been practicing seven to eight years when I caught wind of dry needling as part PT,” Kearns continues, “And I thought people were absolutely crazy. I didn’t think it made sense in the scope of physical therapy.” 

 

But a personal experience would soon convert Kearns’s doubt into trusting this form of treatment. 

 

“My wife was constantly asking me to work on her neck, but massage wasn’t alleviating her pain,” he explains. “A colleague did dry needling on her neck and she got a lot of relief from it, so I decided I should check it out.” 

 

How Dry Needling Compliments Physical Therapy

 

Kearns stresses that dry needling should be used as complementary treatment with a patient’s physical therapy course of action instead of a stand-alone intervention. 

 

“A soapbox frustration of mine is that younger generation physical therapists often overly focus on learning techniques, instead of learning to identify who is most appropriate for the technique” Kearns says. 

 

According to Kearns, the key to the success of dry needling is in identifying the patients for whom it will be the most beneficial. 

 

He believes physical therapists should try to get their patients better first without the needle, which will in turn improve their skills at identifying those who do need the needle. The more chronic the patient’s pain, the more powerful an impact dry needling will have. 

 

“Certain muscles are too deep for us to touch with our fingers,” he explains. “Needles add a level of specificity you can’t get with other soft tissue techniques.” 

 

“Certain muscles are too deep for us to touch with our fingers,” he explains. “Needles add a level of specificity you can’t get with other soft tissue techniques.” 

 

Misconceptions About Dry Needling

 

Most people hear about dry needling and think, “This sounds a lot like acupuncture.” Kearns explains that there are a lot of similarities between the two practices but it boils down to semantics and philosophy.

 

“There’s a lot of overlap,” he says, “but the Western medical physicians that identified trigger points and began treating them successfully with dry needling can be viewed as independent, secondary validation of what acupuncture has been doing for centuries.”

 

A common concern is that dry needling is painful. Kearns says that this depends on the severity of the patient’s current pain and suggests that therapists should always try getting a patient’s pain down before beginning dry needling. 

 

“Manipulation of the needle once in the muscle can be a bit uncomfortable,” he says. 

 

As the needle is twisted or moved up and down, the physical therapist is looking for a local twitch response, similar to a doctor checking your reflexes. Kearns says that people with a twitch response tend to have longer lasting pain relief. 

 

As the needle is twisted or moved up and down, the physical therapist is looking for a local twitch response, similar to a doctor checking your reflexes. Kearns says that people with a twitch response tend to have longer lasting pain relief. 

 

Another misconception is that dry needling can cause nerve damage. Kearns explains that the biggest risk is a small amount of soreness and bruising. 

 

“Physical therapists need to know their anatomy and know where nerves course so they can be avoided,” he says. 

 

Some say that dry needling is better than massage, but Kearns is quick to say this is only true on a case by case basis. 

 

“One former patient who had been in the military liked dry needling because “it’s like the sniper of soft tissue”,” Kearns says. 

 

“You can be very specific, very detailed and get to just the spot you want to relieve pain.” Sometimes, patients can have an area of muscle or skin that doesn’t move well, so using your hands to improve soft-tissue mobility is more effective. But, often, a physical therapist will be using both massage and dry needling as treatment.

 

How Do I Learn the Technique of Dry Needling?

 

Dry needling requires formal training and licensing, often accomplished through weekend and continuing education courses. Kearns says that most courses are two- to three-day weekend classes and that you can receive the training in a weekend and have it integrated into your practice very quickly. The requirements to perform dry needling vary from state to state.  The practice act in Texas is very open and only requires that you receive formal training.

 

He emphasizes to patients and physical therapy students the need for a thorough assessment to determine if dry needling is the right approach. It can be great for the right person, but existing conditions need to be vetted before applying this therapy.