Here's everything you need to know about the semi-controversial practice.

By Julia Malacoff
September 26, 2018
Photo: AGLPhotography /

When I had a weird "popping" feeling in my right hip flexors for months, my trainer suggested I try out dry needling. I'd never heard of the practice before, but after a little internet research, I was intrigued. The basic premise: By sticking needles into specific points in a muscle and triggering a spasm, dry needling therapy can provide relief in hard-to-release muscles. (BTW, here's what to do when your hip flexors are sore AF.)

And it worked. After just two treatments, in my iliacus (which runs from the hip to the inner thigh) and pectineus (which is located in the inner thigh), I was feeling back and better than ever-and ready to tackle my workouts.

If you've got tight muscles that just won't chill, here's what you need to know before you try dry needling.

What is dry needling?

People often wonder what the difference between acupuncture and dry needling is. Both acupuncture and dry needling use extremely thin, hollow needles, which are inserted into specific parts of the body, but "the similarity between acupuncture and dry needling begins and ends with the tool that is being used," explains Ashley Speights O'Neill, D.P.T., a physical therapist at PhysioDC who uses dry needling in her practice. (Related: I Tried Cosmetic Acupuncture to See What This Natural Anti-Aging Procedure Was All About)

"Acupuncture is based on Eastern medical diagnosis, requiring training in traditional Chinese medicine," adds O'Neill. "Acupuncturists have extensive evaluation tools that guide the practitioner to insert needles into points that lie along meridians of the body to effect chi flows. The overall goal of acupuncture treatment is to restore normal flow of the chi, or life force."

On the other hand, dry needling is firmly rooted in Western medicine and is based on anatomy. "It requires a full orthopedic evaluation," says O'Neill. Information from that evaluation is how insertion points are determined.

So what happens when they put the needle in? Well, the needles are inserted into certain trigger points in the muscle. "The micro-lesion created breaks up shortened tissues, normalizes the inflammatory response, and mediates your pain," explains Lauren Lobert, D.P.T., C.S.C.S., owner of APEX Physical Therapy. "The environment created enhances your body's ability to heal, thus reducing pain." Nifty, right?!

Why dry needling?

Dry needling is actually great for athletes, O'Neill says, but it can help with all kinds of muscular pain and injuries. "Some injuries that tend to do quite well with dry needling include chronic upper trapezius strains, runner's knee and ITB syndrome, shoulder impingement, generalized low back pain, shin splints, and other muscle strains and spasms," she notes. (Related: Does Myotherapy for Pain Relief Really Work?)

It's also important to add, she says, that dry needling isn't a cure-all, but it can really help in combination with corrective/prescriptive exercises from a physical therapist.

There are some people who should not try dry needling, like those who are in their first trimester of pregnancy, have a history of lymph node removal with lymphedema, have uncontrolled anticoagulant usage (i.e., you're taking anti-clotting medication), have an infection, or have an active tumor, according to O'Neill.

Does it hurt?!

One of the biggest questions people ask about dry needling is how much it hurts.

In my experience, it hurts depending on how tight the muscle being needled is. When I tried it, I didn't feel the needles going in, but when they were gently tapped to trigger a spasm, I definitely felt it. Rather than a sharp pain, it felt almost like a shock wave or cramp going through the whole muscle. While that probably doesn't sound pleasant, I was super relieved to be able to feel a release in the muscles that I'd been unsuccessfully trying to stretch and foam roll for months. The initial pain only lasted for about 30 seconds and was followed by a dull, achy pain that lasted for the rest of the day, similar to what you'd feel if you pulled a muscle.

That being said, each person may experience it slightly differently. "A lot of people report feeling 'pressure' or 'full' in the area. Some report more painful areas, but that is generally the area that 'needs it,' similar to when a massage therapist gets a knot," says Lobert. Luckily, "the majority of people have told me that it is less painful than they thought it would be," she adds.

Why is it sorta controversial?

Not all physical therapists are trained in dry needling. "It's not in the education of entry-level physical therapists, so continuing education is necessary to perform it safely and effectively," says Lobert. That's actually not the reason it's controversial, though. (Related: 6 Natural Pain Relief Remedies Every Active Girl Should Know About)

The American Physical Therapy Association recognizes dry needling as a treatment that physical therapists can perform. However, the practice of physical therapy is governed at the state level. Most states do not say one way or another if it is "legal" for a physical therapist to do dry needling, and it is up to the discretion of the individual PT to decide if they want to take on that risk, explains Lobert. However, certain states have statutes that prevent interventions that penetrate the skin, making dry needling a no-go for PTs who practice there.

FYI, the states where physical therapists are *not* allowed to practice dry needling are California, Florida (rules are in process to change this, however), Hawaii, New Jersey, New York, Oregon, and Washington. That doesn't mean you can't get dry needling in those states, but you'll likely need to look for an acupuncturist who also does dry needling trigger point therapy. (Related: How One Woman Used Alternative Medicine to Overcome Her Opioid Dependency)

What should you know before trying it?

You'll probably need to do it more than once. "There is no specific guideline or research on the frequency of dry needling needed to be effective," says Lobert. "I generally start with once a week and go from there, depending on how it is tolerated. It can be done daily in some cases."

The risks are low, but worth knowing about. "When dry needling, it is important to avoid areas over the lungs or other organs that you can damage by going too deep," says Lobert. "You also want to avoid large nerves as this can be very sensitive, or large arteries that may excessively bleed." If you are visiting a trained practitioner, the risk of this happening will be extremely low. In terms of run-of-the-mill side effects, there's nothing too bad involved. "Small areas of bruising can form where the needles were inserted," notes Lobert. "Some people feel tired or energized after, or even an emotional release."

You will likely be sore afterward. "Dry needling does leave patients feeling sore for 24 to 48 hours and I advise patients to use heat after treatment if they are feeling particularly sore," says O'Neill.

You might want to try to squeeze in your workout beforehand. Or consider taking a rest day. It's not that you can't work out after dry needling. But if you're super sore, it might not be a great idea. At the very least, O'Neill recommends sticking with corrective exercises from your PT right afterward, or doing a workout your body is used to. In other words, it's not a good idea to try your first CrossFit class right after doing dry needling.