Dry needling: In a sense, the name says it all. Practitioners put dry needles—without medications or other additives—into their patients’ skin, targeting “trigger points” that are said to relieve pain and tension. If that sounds a whole lot like acupuncture, you’re not entirely wrong. Although both techniques use needles, acupuncture is based on traditional Chinese medicine (TCM), while dry needling is based in Western medicine. Dry needling is also closely related to myofascial release massage. We decided to look into the science behind the practice of dry needling. If you’re thinking about trying a dry needle treatment, here’s what you need to know.
Dry Needling vs. Acupuncture: Is there really any difference?
On paper, dry needling and acupuncture look similar: An acupuncturist or physical therapist sticks needles in your body, removes them, and you (hopefully) walk away feeling better. “Dry needling needles are the same as acupuncture needles,” says personal trainer Lauren Lobert, doctor of physical therapy and owner of APEX Physical Therapy. “They are very, very thin and flexible needles of different lengths, depending on the area [of the] needling and patient’s size.” Lobert has been dry needling for about 18 months. For the most part, she says that her patients report positive experiences. “I have heard a lot of different responses,” she says. “Most people say the majority of the needles don’t feel like anything! But, just like with a massage, if you are hitting areas that are tighter or more tender, then it will be more sore. Sometimes it is described as a pressure or feeling of fullness. Sometimes it just hurts. But, it’s typically just for a second and then it goes away.” The basic idea behind dry needling is that the human body has a number of “trigger points,” spots with sensitive, knotted tissues that cause pain. By needling those areas, practitioners believe that they can relieve the myofascia—the dense tissue that covers the muscles—providing quick pain relief. “Chinese medicine is both an art and science and there are over 361 points on the body, and rarely is there any side effect [with acupuncture] except a small bruise,” claims board-certified acupuncturist Elizabeth Trattner. “Needling techniques are different all over the body, especially the trunk, as needling the chest can cause a collapsed lung. This is never done in TCM, and it is the first thing we learn in our four-year journey to become a licensed doctor of TCM.” That sounded pretty dramatic to us, so we researched it. According to a piece published in Acupuncture in Medicine, “pneumothorax complications” are rare but can occur in both dry needling and acupuncture. In any case, Trattner says that the national acupuncture community is “outraged” by the current dry needling trend. “We have an obligation to educate the public that dry needling and acupuncture are two different things,” Trattner says. “One is legal, one is not. One is safe, the other, not.” Dry needling is legal in many states, though, according to the American Physical Therapy Association, although the organization notes that the legality of the practice “continues to be a question posed to state regulatory boards, legislatures, and agencies.” Trattner does raise an interesting point, however: Given that any type of therapy carries potential risks, are there enough benefits to justify dry needling treatments?
The Scientific Evidence for Dry Needling
There’s some evidence that both dry needling and acupuncture can provide benefits for certain chronic pain conditions according to the National Center for Complementary and Integrative Health. With that said, there’s not necessarily evidence that either technique works better than a placebo. One systematic review from 2001 found that “when treating myofascial trigger point pain with trigger point injection, the nature of the injected substance makes no difference to the outcome, and … wet needling is not therapeutically superior to dry needling.” That sounds like a big win for dry needling practitioners. However, the same review “did not find any rigorous evidence that needling therapies have an effect beyond placebo in myofascial trigger point pain.” There’s plenty of anecdotal evidence for dry needling—a quick Google search turns up hundreds of positive stories—but not much scientific evidence apart from a few limited studies. That could change over time, but some clinical physicians are skeptical. “The only patients I’d recommend dry needling to are those susceptible to the placebo effect, because the idea that it does anything important is, as best I can tell from the literature, [untrue],” says Stuart Spitalnic, MD, clinical assistant professor of emergency medicine at Brown University. We asked him whether he could think of any situation in which he’d recommend dry needling, even as a placebo. “I would never recommend dry needling, nor [anything else on] a growing list of nonsense therapy that people continue to do—acupuncture, chiropractic, homeopathy, most herbals. Maybe chiropractic for low back pain only, though I believe you would be better off with a good massage,” he tells HealthyWay in an email. “Now, when faced with a patient that is already participating in one of these therapies and believes they are receiving benefits from them, so long as it is not clearly dangerous, it is likely best for a clinician to either say nothing or be muted in their objections, unless specifically asked to pass judgement on a therapy. Then it would be wrong to lie.” Spitalnic notes that the people who offer dry needling therapy often have good intentions. “To be fair, most practitioners are not dishonest; they are true believers, well armed with anecdotes of those who have been helped by either the placebo effect or coincident with the start of therapy,” he writes. “[That’s] similar to the parent who believes their child’s cold was cured by antibiotics because, by the time they got around to seeing the doctor and getting the prescription, the kid was on the verge of improvement anyway.” In his position, Spitalnic frequently analyzes scientific studies, and his position is clear: Without credible research, there’s no reason to start sticking yourself (or anyone else) with needles. “I have reviewed many implausible therapies and, without fail, when they are backed at all, they are backed by incredibly biased, fatally flawed, and/or typically non-reproducible research. And, whenever tested rigorously, their effects vanish.” We asked Lobert to weigh in on those concerns. “I totally understand the skepticism of many people in regards to both dry needling and acupuncture,” she says. “It’s very common that people are skeptical about this treatment! …The bottom line is that dry needling, when performed by a trained professional, is extremely safe and well received by patients. If it is placebo that causes them to feel better, I’m okay with that. With soaring rates of opioid-related deaths and other side effects [of opiate use], I believe that trying alternative methods in order to decrease pain and regain function can be hugely beneficial.” To be clear, Lobert does not believe that the results are all due to placebo. Her position is that pain management is a complex issue, and she believes that trigger-point therapies like dry point needling offer an excellent alternative to pharmaceutical treatments.
What are the risks of dry needling?
If you still want to try dry needling to experience the purported benefits for yourself, ensure that you are visiting a properly trained practitioner. Check to make sure that dry needling is legal in your state, and don’t expect your insurance to cover the practice (Blue Cross Blue Shield, for instance, typically considers dry needling to be “experimental” or “investigational,” and therefore exempt from coverage). Be aware of the limited risks of this type of procedure. “There are safety considerations, such as if someone is on high doses of blood thinners, but that doesn’t mean you can’t do it,” says Lobert. “Immediately after surgery, it is not recommended. However, once the incisions are healed and doing well, [dry needling] is fine. If you have an active infection, you don’t want to be dry needling. And if you have an intense fear of needles, dry needling will probably not be a pleasant experience for you.” While still extremely skeptical of dry needling therapies, Spitalnic says that they probably don’t pose much of a risk to patients. “I’m sure the overall risks are low, though infection and inadvertent injury to a subcutaneous structure are possible,” Spitalnic says. If you’ve got a significant chronic pain condition, you might want to see a physician before engaging in either dry needling or acupuncture. Otherwise, you’re probably good to go. Just make sure to temper your expectations.