Dry Needling

Dry needling at MedRehab Group

Dry needling is a technique some of our physiotherapists use inside a physiotherapy session to release a tight, painful band of muscle that has not let go with hands-on treatment or exercise. A fine sterile needle is placed into the knot, the muscle twitches and relaxes, and the area that has been guarding for weeks often eases within a session or two. It is not a separate service you book, it is not acupuncture, and it is not for everyone. Your physiotherapist will suggest it when it fits, and only after assessing you.

Dry needling is offered by physiotherapists who have completed additional training and are listed on the College of Physiotherapists of Ontario’s roster for acupuncture and dry needling. Not every physiotherapist at every clinic is rostered, so if you specifically want it, say so when you book and we will place you with someone who is.

Dry needling or acupuncture: what is the difference?

The needles look the same, which is where the confusion starts. The two are different treatments with different reasoning behind them.

Acupuncture comes from traditional Chinese medicine and places needles at points along mapped channels, often well away from where you feel pain, to influence the body more broadly. At MedRehab Group it is provided by registered acupuncturists. Dry needling comes from Western musculoskeletal medicine and places the needle directly into a trigger point, the taut, tender band inside a muscle that refers pain elsewhere. It usually involves fewer needles, kept in for less time, and it is one tool within a physiotherapy plan rather than a treatment on its own.

If your problem is a specific muscle that will not release, dry needling is the more direct answer. If you are looking for a broader approach to pain, stress or a condition that is not a single tight muscle, acupuncture is the better fit, and both are available across the group.

How it works

A trigger point is a small patch of muscle fibres that have contracted and stayed contracted. It is tender to press, it can refer pain to somewhere nearby (a trigger point in the upper shoulder muscle is a common source of headaches), and it keeps the muscle short and weak. Massage and stretching reach it from the outside; a needle reaches it directly.

When the needle enters the trigger point, the muscle often gives a brief involuntary twitch, called a local twitch response. That twitch is the sign the right spot has been found, and it is usually followed by the band softening and the referred pain easing. The current understanding is that the needle disrupts the contracted fibres, improves local blood flow, and changes how the nerves in the area are signalling. It is not injecting anything, which is where the word dry comes from.

Conditions it is used for

Dry needling is most useful for pain that comes from muscle rather than from a joint or a nerve, particularly when that muscle has been tight for a long time. The research is strongest for trigger points in the neck and shoulder: reviews find low to moderate quality evidence that it reduces pain and improves function in the short term compared with sham treatment, placebo or no treatment, and that it works better as part of a plan than on its own. At our clinics it is used for:

• Neck and upper shoulder tension, including the tightness that comes with desk work and phone use
• Headaches that start in the neck or the muscles at the base of the skull
• Low back pain where the muscles alongside the spine or in the buttock are the main source
• Hip and buttock pain from the deep rotator muscles, which can mimic sciatica
• Calf, hamstring and quadriceps tightness in runners and athletes
• Tennis elbow and golfer’s elbow where the forearm muscles are involved
• Jaw pain from clenching, where the chewing muscles hold trigger points
• Muscle guarding after an injury or a car accident that will not settle with hands-on treatment

What it does, and what it does not

Dry needling is good at one thing: releasing a muscle that is stuck in contraction and easing the pain that comes from it. It is quick, and the relief can be immediate. It does not fix the reason the muscle tightened in the first place, which is nearly always a matter of load, posture, weakness or an underlying joint or nerve problem. That is why it is never the whole plan at MedRehab Group. Your physiotherapist uses it to open a window, then fills that window with the strengthening and movement work that stops the muscle tightening again.

It is not pain free, and we will not tell you it is. Most people feel a brief cramping or deep ache as the muscle twitches, and the treated area is commonly sore for a day or two afterwards, like the day after a hard workout. It is also not the right treatment for every pain. If your problem is a joint that is not moving, a nerve that is compressed, an inflamed tendon or an unexplained pain, needling a muscle near it will do little, and your physiotherapist will say so.

Some people should not have it: anyone with a bleeding disorder or on blood-thinning medication, anyone with a needle phobia, an infection or skin problem over the area, a compromised immune system, or in the first trimester of pregnancy. Needling over the chest, upper back and shoulder carries a small but real risk of puncturing the lung, which is why those areas are needled only by physiotherapists trained in the safe angles and depths, and why you are asked to report any breathlessness or chest pain afterwards immediately.

What a session is like

Dry needling happens within a physiotherapy appointment, not as a separate booking. Your physiotherapist assesses you first, explains what they have found and why needling would help, and asks for your consent, which you can withdraw at any point. They clean the skin and use a new sterile single-use needle, much thinner than the needles used for injections. The needle is placed into the trigger point, may be moved gently in and out to provoke the twitch, and is then removed; sometimes several points are treated in one session. Each needle is in for seconds to a few minutes. Afterwards you may be given a stretch or a movement to do straight away, while the muscle is loose.

Most people need between one and four sessions of needling within their physiotherapy plan, spaced a few days to a week apart. If a muscle needs needling every week for months, something else is driving it and the plan needs to change.

Who provides it

Only registered physiotherapists who have completed recognised post-graduate training in acupuncture and dry needling and are listed on the College of Physiotherapists of Ontario’s public roster for it. The College sets the training, safety and consent requirements in its Controlled Acts Standard, and you can confirm any physiotherapist’s roster status on the College’s public register. Dry needling is never done by an assistant or by anyone who has not assessed you first.

Cost, insurance and direct billing

Because dry needling is part of a physiotherapy session, it is covered the way physiotherapy is. Most extended health plans through work cover it under their physiotherapy benefit, and we bill most major insurers directly so you pay only what your plan does not cover. It is not covered by OHIP. After a car accident it can be part of the treatment plan submitted to your auto insurer; under WSIB it can be included in a program of care. Physiotherapy is exempt from HST. Ask the clinic whether your plan treats needling as an add-on, because a few do.

Where can I book dry needling?

At any clinic where a rostered physiotherapist practises. Rosters change, so rather than publish a list that goes out of date, we ask you to do one thing: book a physiotherapy assessment at your nearest clinic and say you want dry needling. Reception confirms which physiotherapist at which clinic can provide it and places you with them. Choose a clinic from the list on the physiotherapy page or use the clinic finder. Availability at a given clinic must be confirmed at booking.

Questions we are asked most

Related services

Dry needling is one tool within physiotherapy. For the same muscle tension treated from the outside, massage therapy is the alternative many people prefer, and for a broader approach to pain, acupuncture is provided by registered acupuncturists at seven of our clinics.