1. Dry Needling
Sarah Guarino
Ithaca College
2/12/15

2. What is Dry Needling?
Skilled intervention used by PTs that uses a thin, solid
filiform needle (without medication) to penetrate the
skin and stimulate underlying myofascial trigger points,
muscular, and connective
tissue for the management
of neuro-musculoskeletal
pain and movement
impairments.

3. Dry Needling

4. Terminology
• Dry needling, trigger point manual therapy,
trigger point dry needling, intramuscular manual
therapy.
• Trigger Point: a taut
band of skeletal muscle
located within a larger
muscle group.
-Usually tender to the touch and can refer pain.

5. Uses of Dry Needling
• Research Supports:
–Pain control.
–Reduces muscle tension.
–Normalizes biochemical and electrical
dysfunction of motor endplates.
–Facilitates an accelerated return to active
rehabilitation.

6. Common Impairments
• Acute/chronic tendonitis
– Overuse injuries
• Scarring & post-surgical pain
• Carpal tunnel
• Sciatic pain
• TMJ
• Myofascial pain
• Headaches & whiplash
• LBP
• Motor recruitment
• Neuromuscular firing problems
• Decrease spasm/ increase mm. extensibility

7. Goals of Dry Needling
• To release/inactivate the trigger point and
relieve pain.

8. Adverse Events
• Practiced for over 20 years by PTs.
• Most common side effects include post-needling
soreness and minor hematomas.
• FSBPT’s ELDD has 0 entries of harm caused by DN
performed by PTs.
• Europe: 2 reports of pneumothoraces, 1
autonomic response, no other serious side
effects.
• DN is under-utilized with no real danger/side
effects involved in its practice by PTs.

9. APTA
• Recognizes dry needling as being part of the Physical
Therapist professional scope of practice.
2012= 27 states

10. • As of April 2014 states that include dry needling
in PT scope of practice include but are not limited
to Alabama, Arizona, Georgia, Kentucky,
Maryland, Massachusetts, New Hampshire,
North/South Carolina, Texas, Wisconsin.
– 9 State boards (Idaho, Kansas, New York, South
Dakota, Hawaii) have stated it is not within PT scope
of practice.
• Others :“not-prohibited”, “no position”, “unresolved”
• Countries that currently practice dry needling
include Australia, Belgium, Canada, Chile,
Denmark, Ireland, The Netherlands, New
Zealand, Norway, South Africa, Spain and the
United Kingdom.

11. Dry Needling in NJ
As of October 23, 2012:
• “The NJ State Board of Physical Therapy
Examiners statutes and regulations do not
prohibit the use of dry needling techniques or
trigger point release by a physical therapist
provided the physical therapist is trained and
competent in the technique. Dry needling is not
solely under the practice of acupuncture.”
• “The NJ Acupuncture Examining Board considers
dry needling by a NJ PT to be the unlicensed
practice of acupuncture.”

12. Dry Needling VS.
-Based on Western
neuroanatomy
and the scientific study of the
musculoskeletal and nervous
system.
-Not curative.
Acupuncture
-Based on ancient Chinese
medicine.
-Uses Meridians/Channels,
energetic physiology and energy
flow patterns.
-Can treat smoking termination,
fertility, depression, allergies
and other non-
musculoskeletal conditions.
-Promotion, maintenance
and restoration of health and
the prevention of
disease.
-3 yr. graduate program.

13. Billing/Reimbursement
• Medicare part A:
– Dry needling not covered.
• Medicare part B:
– Medically necessary services: Services or supplies that
are needed to diagnose or treat your medical
condition and that meet accepted standards of
medical practice.
– Preventive services: Health care to prevent illness (ex:
flu) or detect it at an early stage, when treatment is
most likely to work best.

14. Cost to PT and patient
• For patients:
– $75-$100 per initial evaluation.
– $30-$60 per average treatment.
– Based on time.
• For PTs:
– #1 Brand: Lhasa Oms Inc.
• DBC Spring Acupuncture Needles ~$35-$50.
– Box of 1000 disposable needles.
– Various length/thickness.
– Additional Features:
• Wires for E-Stim through needle ~$20/ pair.

15. Opportunities
• Not being taught in most entry level PT
programs with the exception of Georgia State
University, Mercer University, University of St.
Augustine for Health Sciences and the Army
PT program at Baylor.

16. THERAPY CONCEPTS COURSE
• Level 1: 3 day course $950
– Theory and physiology of myofascial trigger points,
history of dry needling, anatomy review and referral
patterns.
• Cervical & lumbar spine, hip, LE, shoulder and forearm.
– 20 participants/course, min. 2 years experience.
• Level 2: 3 day course $950
– Lecture, testing, demo & hands on lab sessions.
• Ant. Neck, head/face, thoracic spine, rib cage, hand, foot and
other musculature.
http://www.therapyconceptsinc.com/#!/physical-therapy-continuing-education

17. GLOBAL EDUCATION FOR MANUAL THERAPISTS
• Level 1: 3 days (27.5 contact hrs.) $950
– Evaluation/ application of dry needling of
neuromyofascial trigger points for basic musculature.
– Lecture, testing, demo, hands on lab sessions.
• Level 2: 2 days $550
– Research based, specific Dx.
• Level 3: 2 days $550
http://www.gemtinfo.com.au
Various Seminars: ~55 hrs. of online/ home study + 3
day theoretical and practical examinations. ~$1295
http://dryneedlingcourse.com/schedule-and-registration

18. Case Study 1
“Efficacy of myofascial trigger point dry needling in
the prevention of pain after TKA.”
• Randomized, double-blind, placebo controlled.
• Population: >65 yr. old (mean age: 72)
– Acute care
• Subjects: 40 participants (29 F, 11 M)
• Involved knee: 60% R, 40% L
• 70% general anesthesia, 30% spinal anesthesia

19. Treatment Groups
• Group 1: After anesthesia and before surgery.
Myofascial trigger points located in TFL, hip
add., H/S, quads, gastrocnemius, popliteal.
– Both active and latent trigger points marked.
– 20 insertions in each trigger point with consistent
patient/ joint positions.
– Patients were unable to see their LE during Tx.
• Group 2: Sham, no treatment given for
myofascial trigger points.

20. • Purpose: Is dry needling of myofascial trigger
point effective in the prevention of pain post-
TKA?
• Conclusion: Group 1 experienced reduced pain in
1st month post-op compared to group 2, when
pain is typically at its highest.
– Group 1 reached the same degree of pain reduction in
month 1 as group 2 reached by month 6.
– Significantly reduced need for post-op analgesia for
group 1.
– No difference in WOMAC, knee ROM or knee strength
at any time post-op.

21. Case Study 2
“Management of shoulder injuries using dry needling in
elite volleyball players.”
• Case report/ case study
• Population: 18-64 yr. old (mean age: 25, SD 2)
– Outpatient care
– 4 women on Great Britain national volleyball squad with
complaints of anterior/anterolateral shoulder pain
• Subjects: 4- all female
– Right arm dominant
• Pain in shoulder ranging from 4/10 to 8/10 prior to tx,
shoulder ROM limited in all cases in ABD and IR due to
pain.

22. Treatment Group
• Group 1: Dry needling to myofascial trigger points,
STM to shoulder, Cryo post-training, exercises and
stretching prn.
– 1 session of dry needling, 5-12 needles used and left inserted
for 10 minutes.
• Purpose: To describe the ST benefits of dry needling
on shoulder problems in 4 elite athletes, with
replicable measures of functional pain scores on
court and objective measurements of AROM.

23. Results:
• Pain decreased to 3/10 or less
-3 with outcome, 1 without
• Full pain-free ROM post-Tx into shoulder ABD
-3 with outcome, 1 without
• Full pain-free ROM post-Tx into shoulder IR @ 90
ABD
-2 with outcome, 2 without
• Conclusion: Supports use of trigger point dry
needling in elite female athletes with ST pain relief
and improved AROM in the management of acute
shoulder injuries, during an intense competitive
period.

24. Resources
• Adrian, Leslie. "FSBPT Dry Needling Resource Paper." Intramuscular
Manual Therapy 4 (2013): 1-16. Pub-Med. Web. 28 Jan. 2015.
• Mayoral, Orlando, Isabel Salvat, María Teresa Martín, Stella Martín,
Jesús Santiago, José Cotarelo, and Constantino Rodríguez. "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 2013 (2013): 1-8. Pub-Med. Web. 1 Feb.
2015.
• Osborne, N. J., and I. T. Gatt. "Management of Shoulder Injuries
Using Dry Needling in Elite Volleyball Players." Acupuncture in
Medicine 28.1 (2010): 42-45. Pub-Med. Web. 1 Feb. 2015.
• "Physical Therapists & The Performance of Dry Needling." An
Educational Resource Paper (2012): n. pag. APTA. Web. 28 Jan.
2015.