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Treating pain: Dry needling lives up to its name

graphic of dry needles with text
Dry needling uses needles similar to those used in acupuncture, but differs greatly in where they are applied.

When it comes to pain, you want as many options as possible to get you on the road to relief.

Now, an option with a weird name may be just the thing to help you manage pain – dry needling.

Marshfield Clinic physical therapists have added dry needling to their treatments for acute or chronic pain.

It’s like a tool that’s part of our physical therapy toolbox,” said Heather Nelson, a physical therapist who has been trained in the technique. “It’s an alternative to doing trigger point release massage or deep tissue massage.”

And unlike pain medication injections, it doesn’t involve injecting medicine or other liquids into the body. Hence the name, dry needling.

Nelson said introducing a needle into a trigger point or tight spot in a muscle causes an involuntary twitch reflex. In the process, it fatigues that section of muscle, which makes tighter spots relax and pain subside. Another way to look at it is to consider a muscle being stuck in the “on” position; the needling twitch triggers a “re-set” to allow the muscle to relax and work normally.

Dry needling works from the inside out

“It’s a more direct way to get muscles to loosen up, like we’re doing it from the inside out. We find it lasts longer than massage therapy in certain situations,” Nelson said. Dry needling has the same needles as acupuncture but uses a completely different philosophy.

In general, dry needling treats trigger points based on a provider feeling them by hand, along with muscle pain patterns, as opposed to pre-determined points in the body that is typical with acupuncture. Rooted in ancient Chinese philosophy, acupuncture needling insertion is more specific to certain pathways within the body to re-balance energy flow. Physical therapists, by contrast, determine dry needling treatment areas based on palpable muscle tightness and trigger points that may cause radiating pain.

Who can benefit?

Dry needling can be an effective adjunct for treating cases of tennis elbow, sciatica, calf tightness, headaches and neck and low back pain. It’s not a cure-all, however.

Among other precautions, this technique is not appropriate for certain kinds of pain locations, people with needle phobia or women in their first trimester of pregnancy. Your physical therapist will discuss this with you prior to treatment.

“People who have heard about the technique will say they just want to be needled, but it doesn’t work that way,” she said. “We might do this to help decrease tension in a muscle, but we want to figure out why the tension is there in the first place to prevent it from coming back.”

Uncomfortable but tolerable

Worried about needles? Nelson said when the needle is inserted and hits a trigger point, it’s uncomfortable but tolerable, similar to a cramp. Discomfort mostly disappears when the needle is withdrawn after 30 seconds. Dry needling is typically performed once a week for a particular muscle group and may be used for one to four visits.

Physical therapists at Marshfield Clinic are trained in dry-needling technique. They are not licensed acupuncturists and do not practice acupuncture.

20 responses to “Treating pain: Dry needling lives up to its name”

  1. Mackenzie

    Will it help reduce heel pain from plantar fasciitis?

    1. Jacob Zipperer

      Hi Mackenzie,

      Thanks for reading Shine365. We appreciate you reaching out. If you'd like to learn more about plantar fascitis and how a dry needling procedure can help, check out this Shine365 blog post: https://shine365.marshfieldclinic.org/bone-joint/plantar-fasciitis/

      Thanks and hope this helps,
      Jake

  2. Lyn Heiting

    Kristen
    I've had the dry needling done. I've had the steroid shots in the spine. I don't want to have surgery down the road! The needling has been the best for results overall. The steroid shots have been good but again the body is receiving a chemical intake and an individual can only receive so many per yr. The needling is basically not covered by insurance when I checked overall and my particular insurance, Security Health did not. Yes, there is some discomfort in the process but compared to the pain from the medical problem it is worth the trade difference. The needling has relieved the pain that I could function again to stay available to function physically and stay mentally balanced. When anyone has pain..it becomes a mental and personality balance also. Why majority of insurances are not covering the needling it is confusing. Way cheaper than the cost of the steroid shots and less invasive to the body. Can the medical advisories help and get this explained to the insurance companies.

  3. Lora

    How many needles does the PT put in your back during one visit? Why would a person have a "flight or fight" response during this procedure ? Also what can be done to avoid this response during this procedure?

    1. Kirsten Shakal

      Hi, Lora. I shared your questions with Heather, a physical therapist trained in dry needling. She said:

      The number of needles depends on the patient’s symptoms and tolerance to the procedure — if they have a large area or multiple areas of restrictions within a muscle, we may use dry needling on two areas or six areas, for example. The needles are typically not left in the muscle so you would not have multiple needles in place at one time.

      I am not sure what you mean by "flight or fight" in this instance; perhaps you are referring to anxiety like symptoms (increased heart rate and breathing, hyperarousal symptoms, etc.)? If a patient gets anxious, it is helpful to concentrate on deep breathing or relaxation techniques during the procedure. Needling is quite short — maybe 30 seconds or less — and can be stopped at any requested moment. We try to educate patients as much as possible for what symptoms to expect, normal procedure sensations and also talk them through the symptoms and referred pain that may occur during the needling procedure, which should help to reassure them.

      I hope Heather's comments answered your questions. Thanks for reading. -Kirstie

  4. Wanda

    Is there anyone in the Park Falls Center that can do this?

    1. Kirsten Shakal

      Hi, Wanda. Our Marshfield Clinic Park Falls Center does not have physical therapy services. This chart identifies our PT locations and which provide dry needling: https://marshfieldclinic.org/specialties/physical-therapy/physical-therapy-services-chart Please let me know if you have further questions. -Kirstie

  5. Loree Rezaie

    How does this treatment work for headaches if the cause is unknown and has been chronic for 10 months?

    1. Kirsten Shakal

      Hi, Loree. We cannot provide individualized medical advice on this forum so suggest you share your specific headache concerns and history with a physical therapist to determine if dry needling can help your case. Find a physical therapist: https://marshfieldclinic.org/Doctors/Search?k=occupational%20OR%20physical%20therapy

      Heather Nelson, physical therapist, was able to provide some general insight into headaches and dry needling: Dry needling can be done to help with myofascial or “tension” headaches, or head pain radiating from the muscles surrounding the neck. Chronicity is not an issue for whether dry needling can be helpful – what is causing the pain is more of the indicator whether dry needling could be a helpful treatment. When the cause of the headaches is unknown, dry needling is something that could be TRIED, but if none of the headache pain is related to muscles then it likely wouldn’t be helpful.

      Thank you,
      Kirstie

  6. Jack Russell

    Is dry needling covered by insurance or self pay? Can it be done as a stand alone procedure thru a PT self referral if the cause is known ? To get dry needling do most people have to jump thru the time consuming and costly hoops of having a doctors visit, get diagnostic tests like a mri and finally getting a PT to evaluate and treat order?

    1. Kirsten Shakal

      Jack – Some insurances cover dry needling. An evaluation still needs to be done, and insurance will be billed for non-needling codes, so we don’t consider it a “stand alone procedure.” Due to direct access being legal in the state of Wisconsin, many people have the opportunity to self-refer to physical therapy and don’t require a doctor’s visit or other testing. You will want to check with your insurance company to see if they require a doctor’s order to pay for physical therapy.

      If you have any further fee questions on dry needling, Marshfield Clinic fee estimators can help: https://www.marshfieldclinic.org/patient-resources/billing/fee-estimates Your insurance company may also be able to assist you with these questions. -Kirstie

    2. Ginna

      My insurance wouldn't cover it and I always have to jump through each and every hoop until the proper procedure is obtained which usually turns a patient OFF, making them less likely to go to the doctor again unless they're dying.

  7. Jackie

    Will insurance cover this procedure?

    1. Kirsten Shakal

      Hi, Jackie. Great question. We advise you check with your insurance company to see if dry needling is covered.

      If the fee is not covered by insurance, people can (and have) elected to self-pay for the dry needling portion of their physical therapy treatment.

      Marshfield Clinic fee estimators can provide you with an estimated cost of this care: https://www.marshfieldclinic.org/patient-resources/billing/fee-estimates

      Thanks for reading. -Kirstie

  8. Marian Ritland

    How is this different from acupuncture?

    1. Kirsten Shakal

      This is a common question, Marian. As the story says, dry needling treats trigger points based on a provider feeling them by hand, whereas acupuncture uses pre-determined points on the body. Acupuncture needling insertion is more specific to certain pathways within the body to re-balance energy flow. Physical therapists, by contrast, determine dry needling treatment areas based on palpable muscle tightness and trigger points that may cause radiating pain. -Kirstie

  9. Doreen McGill

    Will this work for Achilles tendinitis?

    1. Kirsten Shakal

      Hi, Doreen. Physical therapist Heather Nelson was able to provide us answers on your question:

      Dry needling can be used as part of a treatment plan for Achilles tendonitis. Here's the physiology behind it: Dry needling itself will not decrease inflammation of the Achilles tendon, but dry needling as a technique can decrease calf tightness; this can help decrease strain on the Achilles tendon, therefore helping to decrease the tendonitis and pain.

      However, discussing dry needling with your doctor or physical therapist is a good idea to determine together whether this treatment is right for you. If you do not have a physical therapist, you can find one here: https://www.marshfieldclinic.org/Doctors/Search?k=occupational%20OR%20physical%20therapy

      Thanks for reading! I hope this information helps. -Kirstie

  10. SUSAN TINDELL

    Dry needling was a miracle for my muscle pain! Thank you April for your great care and expertise which allowed me to heal and get back to living +

    1. Kirsten Shakal

      This is wonderful to hear, Susan. Thanks for the feedback. I will share with April. -Kirstie

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