Watt is up with dry needling? It’s very unfortunate that anyone could get a pneumothorax from any procedure, let alone dry needling. Unfortunately, very little is known about Mr. Watt’s injury, and most people are hearing the words “dry needling” for the very first time. Everyone wants to know about it and how something like that could happen. Yes, I am very perplexed that this occurred and am wondering the same things as many of you, so I felt it would be a good opportunity to explain dry needling in a nutshell, since this is what I do and have thousands of hours of experience in. Prayers for Mr. Watt. Please let me be clear, no treatment out there comes without some risk. In any case, the clinician delivering treatment must weigh the risk vs reward of the treatment they are administering and always use good, sound clinical judgement when deciding on intervention. When it comes to dry needling, there are very low risks relative to many other interventions, but it is not something that is totally risk-free. We will go over what the numbers say shortly.
Many news media outlets reported on dry needling and interviewed acupuncturists regarding the treatment. Unanimously, they all stated that they should be the only clinicians qualified to insert needles into a patient, and that dry needling was a form of acupuncture called “ashi”. Let’s get to it.
Dry needling is a procedure where a qualified medical professional inserts a thin monofilament needle (acupuncture needle) into muscle tissue that is “pathological”. This muscle tissue would be identified via palpation and targeted as a trigger point. A trigger point is tissue that is, in a sense, stuck in a shortened, banded position. It is poorly oxygenated tissue, and it cannot fully relax and could be in a miniature spasm. Trigger points can cause pain, decreased range of motion, lack of mobility, and prevent muscle tissue from operating to its full capability. This can cause weakness of the muscle since it’s not operating to fully contract and relax like it needs to. By the use of the needle striking these motor fibers to reset firing processes and relax the tissue, we can resolve pain, inflammation, range of motion deficits, and improve strength. When the needle strikes the muscle, receptors in the tendon attachments are activated to signal to the muscle to relax from its shortened position and re-establish optimal muscle tonicity and length. The second part of the treatment is a chemical change that occurs in the muscle. Muscle that is not getting good oxygenated blood flow typically builds up with lactic acid, and muscle that is constantly in a state of firing (spasm) will use oxygenated blood flow and have lactic acid as its end product. Dry needling promotes oxygenated blood flow to the muscle, allowing the reduction of the lactic acid buildup in the area. That release of lactic acid from the muscle tissue will cause the most common side effect of dry needling, which is delayed onset muscle soreness in the area.
Dry needling is used to treat a wide variety of musculoskeletal and neuromuscular conditions such as sciatica, lumbar and cervical pain and compression, migraines, plantar fasciitis, tennis elbow, shoulder impingement, TMJ, etc. Pain relief is usually seen quickly, within 24 hours of treatment. We have even seen pre-test and post-test strength gains before and after dry needling change directly after treatment.
The risks to treatment are as follows. Risks include muscle soreness and brief discomfort in the area treated, and minor bruising on occasion. Statistically, the rate of pneumothorax with dry needling is <0.01%. That’s super rare. If the clinician is trained in safe technique over the lung fields, this really should never happen because the needle is never angled directly at the thorax. The rate of infection is <0.009% (2 in 22,000). Clinicians should be wearing gloves and cleaning off skin with alcohol prior to treatment. The rate of nerve-related symptoms reported to dry needling treatment (numbness/tingling) is extremely rare and often temporary, but occurs in less than 4 in 100,000 treatments.
While it is important to know the risks and benefits of dry needling, it is also important to know that your clinician performing the technique is certified and thoroughly trained. All of our therapists are certified through the most rigorous dry needling certification courses and have continued education throughout the course of their career. Our clinic has over 30+ years of combined dry needling experience, and we have logged over 44,000 sessions. Safety and effectiveness of treatment must go hand in hand, with safety being the top priority.
Lastly, physical therapists cannot perform acupuncture. We cannot do what an acupuncturist does, and we are not certified to perform acupuncture. Yes, we use the same tool (monofilament needle), but the methodology of its use and what we target are completely different. Physical therapists have more training in anatomy and identifying trigger points than most health care professionals, and are capable of knowing if muscle tissue needs to be addressed with this tool or not, and are capable of treating musculoskeletal and neuromuscular conditions with this tool (with the proper training on how to use this tool). We do not use meridian points to insert the needles; we are palpating for trigger points and also using our knowledge of referral patterns, myotomes (motor innervation from the spine), and dermatomes (sensory innervation from the spine) to determine appropriate needle placement.
When it comes to dry needling, this technique, used properly and safely, is extremely effective. In my opinion, I have seen the benefits highly outweigh the risks, which is why I use it clinically daily.
I hope you all have enjoyed our articles this year, and we look forward to continuing them in 2026. May God bless you and your loved ones for a year full of blessings, good health, and good times.
-Dr. Emilio Galis
