Dry Needling in Physical Therapy 2.0: Three Key Ways Dry Needling Has Evolved

Dry Needling is not new – even in physical therapy practices. Heck – we could take you back to 1941 when Brav and Sigmond realized pain could be relieved by needling without injectate and then walk you through the Janet Travell era before exploring the dozens of more recent schools alongside their different philosophical approaches.  However, we can probably all agree that just that single run-on sentence was sufficiently boring to consider a different direction for this blog post.

Instead of talking about the history of dry needling, let’s talk about the present day… Specifically three exciting spaces where our knowledge has evolved resulting in patients receiving less soreness, greater pain relief, and improved functional capacity at record breaking levels.

Three New Takes on a Seasoned Too – Dry Needling in Physical Therapy:

  1. The central nervous system is involved. Involved probably isn’t the right word here, “driving the bus” is likely far more accurate.  With the days of trigger point models behind us, where chemical milieu and resultant tissue irritability dominated conversations about efficacy, we now know the excitement of a rich interneuron pool and the cortex activation that follows is where the magic truly happens.  Considering we are decades into the concepts of “cortical smudging” in the chronic pain space, perhaps we should have suspected earlier that the rush of afferentation to the somatosensory cortex via the novel input of needling would result in profound changes.  Well we know now, and how it widens our understanding of dry needling’s utility couldn’t be overstated if we tried.
  2. E-stim is the way to go. Ask anyone who has been the unfortunate recipient of high volume pistoning and you’ll know why.  Fortunately, the repetitive microtrauma of rapidly driving the needle in and out of soft tissue has been replaced with intentional use of e-stim, where needles can remain in one place and the stim settings manipulated to achieve your goal of activation, recovery, and pain relief. Trust us, your patients will be particularly appreciative of this paradigm shift
  3. Dry Needling is incredibly safe. This isn’t exactly new knowledge, but the quantity and quality of data we have to prove it certainly is.  A 2020 paper by Boyce et al investigated data on 20,464 dry needling sessions and there were ZERO pneumothoraces and an overall severe adverse event rate of <0.01%!  A quick comparison to commonly used pain relieving medications such as NSAIDs (adverse event rate 1.4%) and Opioid medication (adverse event rate 7.8%) reveals a tremendously lopsided risk-benefit ratio in favor of dry needling.

The three examples above are just a select few of many to showcase where our understanding of how physical therapists can effectively utilize dry needling is evolving.

Want to learn more about how to implement dry needling in your physical therapy practice?

Want to dive deeper, master the psychomotor skill of dry needling, and learn how to integrate clinical reasoning along with post-needling exercise to maximize improvement with your patients?  The Institute of Clinical Excellence now offers comprehensive upper quarter and lower quarter dry needling certifications. Developed and instructed by Dr. Paul Killoren, founder of iDryNeedle and dry needling educator since 2014, these courses blend the fitness forward model championed by ICE with dry needling in a way no other course series could.

When registering through our institute, every course is offered in both two and three day formats. This allows us to accommodate requirements of different Practice Acts across the nation. Dozens of dates and locations are offered each year across the country, don’t miss your chance to be a part of it all!


Boyce D, Wempe H, Campbell C, Fuehne S, Zylstra E, Smith G, Wingard C, Jones R. ADVERSE EVENTS ASSOCIATED WITH THERAPEUTIC DRY NEEDLING. Int J Sports Phys Ther. 2020 Feb;15(1):103-113. PMID: 32089962; PMCID: PMC7015026.