The Popularity of Dry Needling in Physiotherapy: Pros & Cons

Brook Cheng

November 8, 2025

Since 1990s, dry needling has been introduced into musculoskeletal community with striking feedbacks on its impact. According to Edo Zylstra, the creator of KinetaCore in Michigan, which trains 50-80% of the PTs getting accredited in dry needling across the country: “[among] methods like e-stim, hot packs, ...correctional workout, and lasers …Dry needling permits physiotherapists to be the most reliable in returning clients...”

For many musculoskeletal clinicians, they feel application of DN greatly increased their confidence in their practice. Steve Curtis, a licensed PT for three decades who also became an acupuncturist 18 years ago, says “It’s a great technique. The dry needling is just a tool that blows the doors off any other (muscular-skeletal pain) technique that’s out there.” (Stainton, Lilo H, 2018).

According to Cleveland Clinic, “Dry needling is a safe, minimally painful and often very effective technique for people with certain musculoskeletal conditions. Many people have found the treatment to be a game-changer in improving their quality of life”.

How Effective DN Is for Musculoskeletal Conditions?

One feature of DN is that it does not always provide consistent outcomes. Its clinical effectiveness was very heterogeneous.

In 2017, a systematic review on the effectiveness of TrP DN for musculoskeletal conditions by physical therapists published on the Journal of Orthopedic Sports Physical Therapy (Eric Gattie et al, 2017) which included 13 trials with 723 participants. The review concluded:

Compared to no treatment or sham dry needling at 6 to 12 months,

1. For pain relief, very low-quality to moderate-quality evidence suggests DN is more effective for a short-term.

2. For function, low-quality evidence suggests DN is more effective for a short-term.

3. For long-term benefit, no evidence exists for a conclusion.

In 2020, a systematic review including 28 trials on the efficacy of DN for neck pain was published in the Journal of Clinical Medicine (Marcos J.N.S. et al, 2020), which reached the similar conclusion:

• Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with TrPs at the short-term.

• No significant effects on pressure pain sensitivity or cervical range of motion were observed.

Specifically for neck and upper trap pain, a 2015 trial involving 52 patients investigated the efficacy of dry needling on an active MtrP on upper traps for the patients who have neck or shoulder girdle pain (> 3 months) ( Lynn H. Gerber, et al, 2015).

The outcome of this trial is that DN reduced VAS pain score by 74.3% (from 3.5 to 0.9) after 9 sessions of treatment performed in 3 weeks. But DN did not produce significant improvement for BPI and PPT.

Since this trail did not set up a control group for comparison, we are not sure how much effect was truly produced by DN itself and how much was from patient's natural healing.

Assuming patients' natural healing produced 17% pain reduction from the base line (17% is a reasonable number based on literature), it follows that DN in this case produced 57.3% pain reduction after 9 sessions of treatments for neck and upper trap conditions (which includes the levator scapulae muscle). This is a wonderful outcome.

But with DN, can we do even better in obtaining a more reliable efficacy with less torture to our patients? Yes, we can. Actually, we can transform DN into a magic wand. Here you only need to know the “secrets” how.

The “Secrets” to Obtaining Magic Effectiveness & Reliability

In MSK field, dry needling is performed by inserting the needle on so-called trigger points which are located on or close to the impaired body part to be treated. But the “Secrets” to obtaining magic effectiveness & reliability are:

1. Forget your beloved TrP (No one is sure about its existence nor its clinical meaning. Even the hardcore advocators of TrP admit it is no more a hypothesis).

2. Forget the impaired muscle or body region where the pain is located.

3. Insert your needles at a location far away from the pain. To treat pain at A, forget A, pain at B, forget B, pain at C, forget C ...don't rub salt to the wound.

Is TrP Necessary? Debate continues about whether the MTrP is necessary for MPS diagnosis and whether it needs to be the target of treatment (Lynn H. Gerber, et al, 2015). The pathogenesis of the MTrP is elusive and current explanations about its relationship to MPS remain incomplete.

In modern medicine particularly in musculoskeletal field, we have a lot of “uncertainty” but no “confidence”. All we can do is just “shot in the dark then pray”. If we perform dry needling in a different way as state above, not only will we become more confident in winning patients' trust, we can change the game, we can change the status-quo world of MSK medicine.

References

Aitor M.P. et al, Post-needling soreness after myofascial trigger point dry needling: Current status and future research, J Bodyw Mov Ther., 2018 Oct;22(4):941-946

AshleyJane Kneeland, Dry Needling: The Most Painful Thing I’ve Ever Loved, 2015, everydayhealth.com

Eric Gattie et al The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133–149

Lewit K: The needle effect in the relief of myofascial pain. Pain 6: 83–90, 1979.

Lynn H. Gerber, et al, Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects with Chronic Myofascial Pain. PM R. 2015 Jul; 7(7): 711–718.

Marcos Jose Navarro Santana et al, Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis, November 2020, Journal of Clinical Medicine 9(10):3300

Manuel Rodríguez-Huguet et al, Dry Needling in Physical Therapy Treatment of Chronic Neck Pain: Systematic Review. J. Clin. Med. 2022, 11, 2370

Stainton, Lilo H, Physical Therapists Win Latest Battle in Turf War... New Jersy Spotlight News 2018.