Have you heard of dry needling? It’s a procedure that’s growing in popularity due to its ability to reduce pain in some patients. If you’re wondering if you should add dry needling to your existing skill set, you’re not alone. Find out more about dry needling and decide if it's a good fit for your patients!
Get the answers to your questions:
The Basics of Dry Needling
What is dry needling?
How is dry needling different from acupuncture?
What types of pain is dry needling used for?
What are the benefits of dry needling?
Practicing and Receiving Dry Needling Treatments
What professionals practice dry needling?
Who can receive dry needling treatments?
What are the side effects and risks of dry needling?
More Information for Professionals on Dry Needling
Are there certifications for dry needling?
Can dry needling be used with other modalities/treatments?
How is dry needling billed? Is it covered by insurance?
Where can I get supplies for dry needling?
The Basics of Dry Needling
Dry needling is an intervention that stimulates myofascial trigger point release to relieve neuromuscular pain and movement impairments.[1] The treatment is done by inserting thin filiform needles to penetrate the skin.
The needles may be placed deeply or superficially and will remain in place for a few seconds or minutes, depending on the type of pain being treated.[2] The needles do not inject any medication - they are only used to stimulate the muscle tissue.
In some ways, dry needling and acupuncture are similar. Both use sterile needles that are inserted into the skin to stimulate points in the body. But from there the practices diverge into very different approaches.
Acupuncture is based on Traditional Chinese Medical (TMC) concepts. Qi (pronounced ‘chee’) is a life force that is believed to flow throughout the body in meridian channels. When the energy is out of balance or blocked, TMC believes it can lead to illness or pain that can be treated with acupuncture. Depending on the practitioner it may be used to treat many medical ailments beyond pain, including depression, fatigue, insomnia, and high blood pressure. The main measure of success is the patient’s reporting of symptom relief, though some practitioners measure other factors.[10]
Dry needling is based on Western Medicine principles of anatomy. Myofascial trigger points (sensitive points in the body) are stimulated using dry needles to treat muscle dysfunctions. Dry needling is only used to treat neuromusculoskeletal ailments, not weight management, depression, or any other conditions that aren’t related to the neuromusculoskeletal system. Success is measured by tracking a variety of metrics including balance, coordination, range of motion, and strength.[10]
Dry needling is often used as part of a treatment plan for any condition where myofascial trigger points are present.[1] Some examples of conditions where dry needling can be used include:
- Tendonitis
- Joint dysfunction
- Disk pathology
- Tension-type headaches
- Migraines
- Carpal tunnel syndrome
- Phantom pain
- Nocturnal cramps
- Radiculopathies
- Jaw and mouth problems (like TMD)
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- Craniomandibular dysfunction
- Whiplash associated disorders
- Spinal dysfunction
- Computer-related disorders
- Pelvic pain and other urologic syndromes
- Complex regional pain syndrome
- Post-herpetic neuralgia (pain left by shingles)
- And other more uncommon diagnoses
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The main benefit of dry needling is its ability to be another effective tool for helping your patients manage and relieve their pain. Many practitioners consider dry needling to be safe, easy to learn, and often effective with minimal discomfort for the patient.[3]
According to an article from PT in Motion, many physical therapists who practice dry needling have seen its benefits for their patients.[3]
One patient, Karen, had myofascial pain disorder and small fiber sensory neuropathy, which left her in chronic pain. Dry needling and movement-based therapy led to an 80% gain in her gait fluidity and helped relieve her pain.
Another PT’s patient presented with myofascial pain so intense he could barely walk two blocks from his hotel to the clinic. Dry needling combined with therapeutic exercise and conditioning resulted in the man being pain-free and able to play sports and play with his children.
While dry needling isn’t a “magic bullet”, it can help relieve pain for some patients.
Whether a professional can practice dry needling depends on their state’s practice act and whether it allows dry needling as part of the medical professionals’ plan of care. Most states require additional training or certification which varies by state jurisdiction.
These professionals include:
- Physical Therapists
- According to American Physical Therapy Association (APTA), as of April 2019, 34 states and Washington, D.C. have affirmed that dry needling is within the PT scope of practice. Others have not yet made a statement. However, five states (CA, FL, HI, NJ, NY, OR, and WA) have decided dry needling is not within the PT’s scope of practice.[1]
- Occupational Therapists
- In 2017, the American Occupational Therapy Association’s (AOTA) Commission of Practice (COP) stated that they don’t have sufficient evidence that dry needling is currently a part of OT practice. They indicate that OT practice is regulated at the state level, so practitioners should review their individual state’s legislature to determine if they can practice dry needling. They recognize that the practice is evolving and may revisit the topic in the future.[4]
- Athletic Trainers
- The National Athletic Trainers’ Association (NATA) says there is no professional-wide standard for AT’s dry needling competence. They indicate that prior to performing dry needling, athletic trainers should ensure their state legislature allows dry needling as part of athletic training care and make sure they have fulfilled any educational/training requirements.[5]
- Chiropractors
- As of November 2019, an article on the American Chiropractic Association (ACA) blog asserts that the majority of states approve of dry needling by chiropractors. Most of these states require additional training or certification. However, this varies by state, so you should check your individual state’s legislature.[6] [5]
Dry needling is appropriate for nearly all patients with trigger point pain conditions.
However, for certain people dry needling should not be used or precautions should be taken, including [1,2 ]:
- People with a needle aversion/phobia
- Children younger than 12
- Women who are pregnant
- People who cannot understand the treatment or are not willing or able to give consent to the procedure
- People with local skin lesions, local or systemic infections, or local lymphedema are generally considered contraindicated
- People who are allergic to certain metals may need specific needles to be used
- People on blood thinners, those have recently had surgery, and patients with other concerns should consult their doctor before considering dry needling
Minor side effects include:
- Bruising
- Soreness during or after treatment
- Fatigue
- Fainting
- Bleeding at the site where the needle was inserted
One very rare risk when performing dry needling is the puncturing of a major organ, such as a pneumothorax (collapsed lung).[7]
A few different companies offer courses and training for dry needling certification.
For both beginner and advanced dry needling courses consider:
The APTA states that dry needling “is rarely a stand-alone procedure and should be part of a broader physical therapy approach”.[1] Jan Dommerholt, PT, DPT, DAAPM agrees that dry needling should be done in conjunction with mobilization, manipulation, stretching, exercise, posture correction, and other interventions.[3]
In 2014, there was no CPT code for dry needling. The APTA recommended that practitioners check the payer’s coverage policy and see if dry needling is covered and if the code to use is specified. They state that dry needling does not fall under billing code 97140 (manual therapy) and if no specific code for the service exists it should be reported using the appropriate
unlisted physical medicine/rehabilitation service or procedure code 97799.[8]
In 2019, the ACA and the APTA worked collaboratively to create CPT codes for dry needling which were referred to the AMA CPT Editorial Panel. The new codes are listed in the CPT 2020.[9]
- CPT® Code 20560 Needle insertion(s) without injection(s), 1-2 muscles, describes the work of dry needling to 1 or 2 muscles *
- CPT ® Code 20561 3 or more muscles, describes the work of dry needling to 3 or more muscles*
*Muscle(s) treated must be identified in the patient's health record for both of these services.
Coverage for needle insertion without injection will be determined by individual carrier/payer in 2020. Dry needling is not covered by all insurance providers.
Be sure to check the current CPT® Codes and your patient's insurance coverage before billing for dry needling.
Performance Health offers needles and supplies for dry needling.
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