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  • Writer's pictureNashville PT

Dry Needling in Physical Therapy: The "Poke" That Packs a Powerful Punch

If you've ever experienced muscle knots, trigger points, or stubborn muscular pain, you know how frustrating it can be. It can limit your range of motion, hinder your performance, and even affect your overall quality of life. But fear not, because physical therapy has a secret weapon in its arsenal: dry needling. No, it's not as scary as it sounds! In fact, it's a highly effective technique that can bring you relief and help you get back to your active, pain-free lifestyle. So, let's dive into the needling and explore what it's all about.

What is Dry Needling?

Dry needling is a technique used by physical therapists to target and release muscle trigger points. Unlike traditional acupuncture, which follows the principles of traditional Chinese medicine, dry needling is based on Western anatomical and neurophysiological concepts. The therapist inserts thin needles directly into tight muscles, fascia, or connective tissues, aiming to alleviate pain, reduce muscle tension, and restore proper muscle function. It is called "dry needling" because there is no medication or other substance being injected into the area.

How Does Dry Needling Work?

When a muscle is in a shortened or contracted state, it can develop trigger points—tight knots of muscle fibers that are hypersensitive and can refer pain to other areas of the body. By inserting a needle into these trigger points, physical therapists can create a localized twitch response, which is a brief contraction followed by relaxation of the muscle. This response helps release tension, improve blood flow, and promote the healing process.

What Is a Localized Twitch Response?

In dry needling, a twitch response refers to a characteristic muscular response that occurs when a needle is inserted into a trigger point or taut band of muscle fibers. It is often described as a brief contraction followed by a rapid relaxation of the muscle.

When a needle is inserted into a trigger point, it stimulates the nerve endings within the muscle. This stimulation can elicit a local twitch response, which is an involuntary muscular contraction. The twitch response is a sign that the needle has reached the targeted area and has effectively stimulated the dysfunctional muscle fibers.

The twitch response is believed to be a crucial part of the therapeutic process in dry needling. It helps to release muscle tension, promote blood flow, and reset the neuromuscular system. By eliciting the twitch response, physical therapists can effectively release trigger points, reduce pain, and restore proper muscle function.

It's important to note that the twitch response may vary in intensity and sensation from person to person. Some individuals may experience a slight twitch or subtle muscle movement, while others may feel a stronger, more pronounced twitch. The presence or absence of a twitch response does not necessarily determine the effectiveness of dry needling, as the treatment can still provide benefits even without a noticeable twitch.

Physical therapists who perform dry needling are trained to identify and elicit the twitch response in a safe and controlled manner. They use their expertise to accurately locate and target trigger points, ensuring optimal therapeutic outcomes for their patients.

What About Hooking the Needles Up to an E-stim Unit?

When dry needles are connected to an electrical stimulation unit, it can be referred to as Electro-Dry Needling. This technique combines the principles of traditional dry needling with the use of electrical stimulation to enhance the therapeutic effects of the treatment.

Here's how it works:

1. Insertion of Dry Needles: First, the dry needles are inserted into trigger points, just like in traditional dry needling. These points are selected based on the individual's condition and treatment goals.

2. Connection to Electrical Stimulation Unit: Once the needles are in place, they are connected to an electrical stimulation unit. This unit delivers low-level electrical currents through the needles.

3. Electrical Stimulation Parameters: The physical therapist or healthcare professional adjusts the parameters of the electrical stimulation unit, such as frequency, intensity, and duration, based on the individual's needs and response.

4. Stimulation of Needles: The electrical stimulation unit delivers electrical impulses through the needles, creating a mild tingling or pulsating sensation at the treatment site. The electrical current can be continuous or intermittent, depending on the treatment plan.

5. Therapeutic Effects: The combination of dry needling and electrical stimulation can have several potential effects:

- Increased Blood Flow: Electrical stimulation can help increase blood circulation in the treated area, promoting the delivery of oxygen and nutrients and removing waste products.

- Enhanced Muscle Relaxation: The electrical currents can stimulate muscle fibers and induce muscle relaxation, helping to reduce muscle tension and spasms.

- Pain Modulation: Electrical stimulation may interfere with pain signals and promote the release of endorphins, the body's natural pain-relieving chemicals. This can help alleviate pain and promote a sense of well-being.

- Neurological Effects: The electrical impulses can influence the nervous system and stimulate nerve fibers, potentially impacting motor control, sensory perception, and other neurological functions.

It's important to note that Electro-Dry Needling should be performed by trained healthcare professionals such as physical therapists who have expertise in both dry needling techniques and electrical stimulation. They will consider the individual's condition, medical history, and treatment goals to determine the appropriate parameters and ensure safety during the procedure.

(As with any medical intervention, there may be contraindications or precautions for certain individuals. It's essential to consult with a qualified healthcare professional to determine if Electro-Dry Needling is suitable for your specific needs and to receive proper guidance throughout the treatment process.)

The Benefits of Dry Needling:

1. Pain Relief: Dry needling can provide significant pain relief by reducing muscle tension and releasing trigger points. Research has shown that it can be particularly effective in relieving chronic musculoskeletal pain, including neck pain, back pain, and shoulder pain.

2. Improved Range of Motion and Flexibility: By targeting and releasing tight muscles, dry needling can improve your range of motion and flexibility. This can be especially beneficial for athletes or individuals recovering from injuries, allowing them to regain their optimal movement patterns.

3. Enhanced Muscle Recovery: Dry needling can accelerate muscle recovery by promoting blood flow and stimulating the healing process. It can be an excellent complement to other physical therapy techniques, such as therapeutic exercises and manual therapy, for a holistic approach to rehabilitation.

4. Complementary to Other Treatments: Dry needling can be used in conjunction with other physical therapy treatments to enhance their effectiveness. It can be combined with exercise therapy, manual therapy, and stretching techniques to provide a comprehensive treatment plan tailored to your specific needs.

It is important to note that while dry needling can be an effective treatment, it is typically used as part of a comprehensive physical therapy program. Prescriptive exercise, along with other modalities and interventions, is crucial for long-term changes and sustainable improvements. Exercise helps strengthen and stabilize the affected area, improves muscle imbalances, and enhances overall functional capacity.

Incorporating dry needling as an adjunct to other physical therapy treatments can provide immediate relief and facilitate the effectiveness of exercise-based interventions. The combination of these therapies allows for a comprehensive approach to address both the immediate symptoms and the underlying causes of musculoskeletal conditions.

As with any treatment, the specific application of dry needling and exercise will vary based on the individual's condition, goals, and response to therapy. Working with a skilled physical therapist who can develop an individualized treatment plan is essential to ensure safe and effective use of dry needling in conjunction with other physical therapy interventions.

Research on Dry Needling:

While the research on dry needling is still evolving, several studies have explored its effectiveness in various conditions. Here are some key findings:

1. A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy concluded that dry needling can provide short-term pain relief and improve function in individuals with musculoskeletal conditions, such as neck pain, lower back pain, and knee osteoarthritis.

2. A study published in the Journal of Bodywork and Movement Therapies found that dry needling significantly reduced pain and improved functional outcomes in patients with myofascial pain syndrome.

3. Research published in the Journal of Manual & Manipulative Therapy demonstrated that dry needling can be effective in reducing pain and improving function in individuals with chronic plantar fasciitis.

It's important to note that individual responses to dry needling may vary, and more research is needed to fully understand its mechanisms and long-term effects. However, the existing evidence suggests its potential as a valuable treatment option in physical therapy.

Is Dry Needling Right for You?

Dry needling is a safe and well-tolerated procedure when performed by a trained and

licensed physical therapist. However, it may not be suitable for everyone. It's crucial to consult with your physical therapist to determine if dry needling is appropriate for your specific condition and goals.

Dry needling is a powerful tool in the hands of skilled physical therapists. With its ability to target trigger points, release muscle tension, and promote healing, it can bring you significant pain relief, improved function, and a faster recovery. While more research is needed, the existing evidence supports its use in various musculoskeletal conditions. So, if you're struggling with muscle knots or chronic pain, consider exploring the benefits of dry needling with your trusted physical therapist.

(Remember, this article is for informational purposes only and should not replace professional medical advice or treatment. Consult with a qualified healthcare provider for personalized guidance based on your specific needs and condition.)

If you think dry needling might be right for you, schedule your evaluation today with any of our physical therapists HERE.


- Dommerholt, J., & Fernández-de-las-Peñas, C. (2017). Trigger point dry needling: an evidence and clinical-based approach (2nd ed.). Churchill Livingstone.

- Kietrys, D. M., Palombaro, K. M., Azzaretto, E., & Hubler, R. (2013). Does the literature provide evidence that dry needling is effective in reducing pain and disability in patients with myofascial pain syndrome? Journal of Orthopaedic & Sports Physical Therapy, 43(9), 635–642.

- Notarnicola, A., & Maccagnano, G. (2015). Dry needling as a treatment of myofascial pain syndrome in athletes: a case series. Journal of Bodywork and Movement Therapies, 19(4), 800–805.

- Reneker, J. C., & Farrell, J. M. (2018). The efficacy of trigger point dry needling for plantar heel pain: a randomized controlled trial. Journal of Manual & Manipulative Therapy, 26(1), 30–37.

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