How Physical Therapists Use Dry Needling to Ease Back Pain

Dry needling is an emerging treatment for myofascial trigger points—those tender, twitchy “knots” in your back or neck that cause muscle pain. Physical therapists are among are clinicians who typically perform this treatment. But with a small body of evidence and questions among some state licensing boards, dry needling isn’t widely available in the United States. However, that may change as more patients demand safe, effective, non-drug therapies to manage pain.
Dry needling being performed on the neck and upper back.Physical therapists are among clinicians who perform dry needling to treat back or neck muscle pain. Photo Credit:

First, how may dry needling ease your back pain?

With dry needling, a physical therapist injects thin filiform needles (just like the ones used in acupuncture) into a painful trigger point. Gently moving the needles stimulates blood flow to the trigger point, which may help relax tight muscles. Researchers also think the technique blocks pain signals, but they’re not exactly sure how dry needling eases pain.

While they don’t know how it works, researchers know that it does work. Many patients experience relief immediately after a session that may last anywhere from hours or weeks. For the most benefit, researchers recommend integrating dry needling into a larger treatment plan that includes other back pain therapies (eg, gentle exercise or spinal injections).

Do Physical Therapists perform dry needling? It depends where you live.

While the American Physical Therapy Association (APTA) recognizes dry needling as part of a physical therapist’s scope of practice, the decision about whether a physical therapist can practice dry needling ultimately lies with state regulatory boards.

According to the APTA, states that license physical therapists to practice dry needling are:1
Dry needling statesStates that license physical therapists to practice dry needling per the American Physical Therapy Association.
Many states that include dry needling into the physical therapy scope of practice mandate that physical therapists must complete additional education and training in dry needing before performing the therapy on a patient. Those competency standards and guidelines vary by state.

In 5 states—Hawaii, Idaho, Kansas, New York, and South Dakota—dry needling is not included in the state board’s physical therapy scope of practice. In Hawaii, for example, physical therapists cannot perform any therapy that penetrates the skin.1

For the rest of the states, the availability of dry needling is more nebulous. When a state neither forbids nor confirms dry needling in its physical therapy scope of practice, it’s considered a “silent” status.2

Can’t I just see an Acupuncturist for dry needling?

Acupuncture and dry needling often get lumped together because they both use thin needles as part of their therapy, but they are different. Whereas acupuncture is based on tenets of ancient Chinese medicine, dry needling’s foundation is in Western medicine.

According to an APTA research paper about dry needling: “The practice of acupuncture by acupuncturists and the performance of dry needling by physical therapists differ in terms of historical, philosophical, indicative, and practical context. The performance of modern dry needling by physical therapists is based on western neuroanatomy (body’s nervous system) and modern scientific study of the musculoskeletal and nervous systems. Physical therapists that perform dry needling do not use traditional acupuncture theories or acupuncture terminology.”1

Despite their shared use of needles to release pain, acupuncture and dry needling are governed by different regulatory bodies.

“The fact that needles are being used in the practice of dry needling does not mean that a state acupuncture board would automatically have jurisdiction over such practice,” noted the APTA research paper.

How to Find a Physical Therapist Who Performs Dry Needling

Dry needling is not available everywhere—and some states prohibit physical therapists from practicing it. However, more states are including it in a physical therapist’s scope of practice, so access to this treatment is set to rise.

Some organizations, including Institute of Advanced Musculoskeletal Treatments, include a list of therapists who have completed advanced training in dry needling. The APTA also has a Find A PT tool, which connects you to APTA members who may provide (are licensed) dry needling services. If you have a physical therapist you’ve worked with in the past, ask whether they practice dry needling or have a colleague who does.

Your Physical Therapist Can Help Ease Your Trigger Point Pain

Physical therapists have an arsenal of tools to help ease trigger point pain—and dry needling is just one of them. Like many physical therapy modalities, dry needling may be a safe way to ease your spinal muscle pain. However, it’s not a magic bullet. Your physical therapist will likely pair dry needling with other treatments—such as massage or heat therapy—and teach you ways to take care of yourself at home to give you the best chance of banishing your painful trigger points for good.

Updated on: 05/07/19
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What You Need to Know About Dry Needling for Low Back Pain
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What You Need to Know About Dry Needling for Low Back Pain

Dry needling is an emerging treatment for trigger points; tender and stiff knots of bundled muscles in your low back or neck. Dry needling for low back pain is often combined with physical therapy.
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