Dry Needling Treatment – How it Works

Dry Needling Treatment Explained
by Logan Swisher SPT

How is Dry Needling treatment applied?

Dry needling treatment has become an increasingly popular treatment technique performed by certified health care providers. It refers to the insertion of a very thin needle into muscles, ligaments, tendons, subcutaneous fascia, and/or scar tissue for the management of numerous musculoskeletal pain syndromes.

Trigger points

There are several advantages to the technique documented in the literature which include an immediate reduction in local and /or widespread pain, restoration of range of motion and normalization of chemical imbalances with active myofascial trigger points. A trigger point is a hyperirritable spot often referred to “a knot” in the muscle or fascia which can cause pinpoint pain in the or refer to another area in the body. Trigger points can further be divided into active and latent trigger points. Active trigger points commonly have spontaneous local and referred pain while latent trigger points do not cause spontaneous pain unless they are stimulated by pressure.

How are trigger points formed?

The exact mechanism of trigger point formation is not well understood but it is thought that it starts as the development of tight muscle fibers or taut bands which may or may not be painful. This is possibly due to chemical reaction dysfunction at the cellular level of muscle fibers. Trigger points are thought to develop following low-load repetitive tasks, sustained postures or rapid loading and unloading of muscles. Initially taut band formation is a normal physiologic, protective and stabilizing mechanism associated with damage or potential muscle damage. Active trigger points produce constant pain signals to the brain which can alter movement patterns and lead to disuse. Trigger points have also been seen to cause decreased blood flow and oxygen to the affect muscle which further decreases the muscles ability to function properly.

Differences between dry needling treatment and manual trigger point release

The main difference between dry needling and manual trigger point release is the specificity dry needling provides. Dry needling latent trigger points can lead to their inactivation and prevent the formation of active trigger points as well as reduce the pain signals they produce. It is rarely a stand-alone treatment and is generally considered another instrument assisted manual therapy technique. Dry needling can be very useful in facilitating a rapid reduction of pain and return to function.

How it is applied at Physical Therapy First

Here at PTFirst we will perform a comprehensive exam and work with you to decide if dry needling is a good option for you. We pride ourselves on taking a multimodal approach to reducing pain and improving function so you can return to the activities that are important to you.

Does Dry Needling really work?

A Dry Needling Study
by Logan Swisher SPT


Myofascial pain syndrome is caused by myofascial trigger points or highly localized and irritable spots in muscle. Recently dry needling has been used as an instrument assisted technique to address myofascial trigger points. Research in the effectiveness of dry needling has been limited by the difficulty of providing a true control or sham treatment. This study took advantage of a planned total knee replacement to allow for needling vs no needling while a patient was under anesthesia to allow for a true randomized clinical trial. Trigger points are common in lower extremity muscles in patients with hip and/or knee osteoarthritis. Most patients experience the greatest amount of pain in the first month following a total knee replacement.


40 total participants

-20 participants in the true dry needling group

-20 participants in the sham dry needling group


This study was a double-blind, placebo-controlled, randomized clinical trial. Several hours prior to their total knee replacement surgery, patients were examined by experienced physical therapist for the presence of trigger points. The participants placed into the dry needling group received dry needling for 20 insertions of the intended site while under anesthesia. The participants in the sham dry needling* group did not receive any treatment for their trigger points. Patients gave a baseline and follow up measurements at 1, 3- and 6-months following surgery using the visual analog scale (VAS), need for postoperative analgesics, and the western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC).


There was a significant improvement in VAS values with the dry needling* group in the first month as compared to the sham dry needling* group. It was also found that the use of analgesic medications was significantly lower in the dry needling* group.

Dry Needling – Clinical Application:

This study demonstrated dry needling* of trigger points in the lower limbs allowed patients to reach the same degree of pain reduction in 1-month as the subjects with the placebo intervention achieved in 6-months.  The use of dry needling* also significantly reduced the need for post surgical analgesic medications which is always a postoperative goal. While this study was limited to surgical patients, ti was a well-designed study which suggests dry needling* would be beneficial for many patients with muscle pain. Here at PTFirst we can incorporate the use of dry needling, other manual techniques and modalities to reduce muscle pain associated with surgery, injury, and/or overuse.

Dry Needling Article:

Mayoral, O., Salvat, I., Martín, M. T., Martín, S., Santiago, J., Cotarelo, J., & Rodríguez, C. (2013). Efficacy of myofascial trigger point dry needling* in the prevention of pain after total knee arthroplasty: A randomized, double-blinded, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine : ECAM, 2013, 694941-8. doi:10.1155/2013/694941

Plantar Fasciitis a Clinical Study

by Logan Swisher, SPT


Plantar fasciitis is the inflammation of the plantar fascia and a very common cause of heel pain. The plantar fascia is a thick band of tissue that runs from the heel bone to the toes and supports the arch of the foot. The pain is usually most noticeable when first standing up and walking or after walking, running, or standing for long periods; and may decrease after light activity. Plantar fasciitis can be a very frustrating diagnosis due to the fact that most people have to be on their feet at sometime during the day which further exacerbates their symptoms.


66 total participants

-32 in dry needling group

-34 in the steroid injection group


This study was a single-blind, randomized clinical trial. The participants placed into the dry needling group received dry needling for 30 seconds of the intended site. The participants in the steroid injection group received an injection at the intended site and the needle was immediately withdrawn. Patients gave a baseline measurement using the visual analog scale (VAS) and were followed up with at 3 weeks, 6 weeks, 3 months, 6 months and 1 year.


Baseline visual analog scale (VAS) scores to rate pain were taken in both groups before treatment. When scores were retested at 3 weeks, the dry needling and the steroid group both improved, although the steroid group demonstrated greater pain relief. This trend continued until the 3 month follow-up where the steroid began to demonstrate a gradual increase in pain. The dry needling group continued to demonstrate a gradual decrease in the VAS score at every follow-up. In conclusion, the steroid group got more effective short term relief while the dry needling group more significantly lowered their VAS score overall and were able to maintain their decrease over a 1 year follow up.

Clinical Application – Plantar Fasciitis:

This study demonstrated that steroid injections can make a rapid improvement in plantar fasciitis pain peaking at 3 weeks while dry needling showed a gradual decrease in pain that lasted up to the 1 year follow up. Here at PTFirst, we will work with you and your doctor to find the optimal treatment combination to reduce your pain. If dry needling does not interest you as viable treatment option we have many other treatments which include manual therapy, stretching, exercise, ultrasound and taping among others.

Article treatment of plantar fasciitis:

Rastegar, S., Baradaran Mahdavi, S., Hoseinzadeh, B., & Badiei, S. (2018). Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: A single-blind randomized clinical trial. International Orthopaedics, 42(1), 109.