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Updated: Aug 29, 2023

Dry Needling can be a powerful tool used by Physical Therapists, Chiropractors, and Doctors to assist with musculoskeletal painful conditions. It is the use of a thin, filaform needle to penetrate the skin to stimulate underlying myofascial trigger points, muscular and connectives tissues for the purpose of movement impairment and pain management for neuro-musculoskeletal issues.

Each filaform needle is individually packaged. The skin is cleaned with alcohol and the clinician is gloved. The tube surrounding each needle is pressed upon the skin and inserted with a strong finger tap into the skin and inserted in the tissue below. Check out my post to see it live! How Deep do the Needles Go?

dry needling
Dry Needling

  • The depth of penetration in based upon the tissue the clinician is trying to effect. For example, the gluteus minimus sits deep to the gluteus medius so the needle would be inserted deeper. The size and thickness of the needle would be dependent upon the area being treated. There are different sizes and thickness for different size people and areas!

Why is it called Dry Needling?

  • There is no medication involved with it! These needles are not hollow, are much smaller, and do not have a sharpened cutting tip. Multiple dry needling needles can fit into a blood draw needle. There is NO Injection of medication or removal of liquids from the body hence the name!

What are the benefits of Dry Needling?

  • Increases blood flow and oxygenation to the area

  • Brings inflammatory markers to the affected are to help the body repair tissue

  • Reduces muscle tension, active trigger points, and pain which can increase range of motion and improve muscle function

How many needles are used?

  • This is dependent upon the area being treated. As little as one needle could be used or as many as twenty depending upon size.

Dry Needling is not appropriate for everyone! Here are the reasons we would NOT do dry needling!

  • Needle phobia

  • Cognitive Impairment not to understand the procedure

  • Local or Systemic Infections

  • Localized Edema

  • Vascular Disease

  • Compromised Immune System

  • First Trimester of Pregnancy

    • can be used in later stages of pregnancy pending the area

  • Bleeding disorders

Here are some of the Indications that Dry Needling May be Helpful:

  • Acute Muscle Spasms

  • Headaches, TMJ Pain

  • Tendonitis, Tendonosis

  • Muscle Strains

  • Chronic Pain

  • C-sections scars

  • Enhanced Recovery

How does dry needling differ from acupuncture?

  • Acupuncture is based in Chinese medicine where the needles are placed along the meridian lines of the body. The meridian lines represent different organs in the body. The idea is restore the flow of energy throughout the body.

  • Dry Needling is intended to release taut bands of muscle throughout the body otherwise known as trigger points in order to restore function.

How does Dry Needling fit into treatment?

  • Dry Needling is typically used in conjunction with other soft tissue modalities, joint mobilizations, and exercise. Dry needling used by itself does not usually solve the problem, but when combined with other treatment modalities it can be a key player with getting muscle tension resolved.

Is it painful?

  • There can be some discomfort with needle insertion. While the needles are inserted it is possible to feel muscle twitching, aching, or no additional sensation. Post treatment soreness in common.

What are the risks?

  • Small risk of infection, bruising, and nerve damage

  • Risk of lung puncture

What Muscle Areas can be treated with Dry Needling?

  • Arms, Shoulders, hand

  • Neck, Mid Back, low back

  • Legs, Hips, Pelvis, feet

  • Abdominal wall, Jaw

Dry Needling Techniques:

  • Stagnant Needle

  • Spinning

  • Pistoning

  • E-stim

Check out my post to view what these techniques look like live! Hopefully this information paints a better picture of the how and why dry needling can be an integral part of a care plan! If you have any further questions, please don’t hesitate to ask!


Butts R, Dunning J, Perreault T, Mourad F, Grubb M (2016) Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. Int J Phys Med Rehabil 4: 327. doi:10.4172/2329-9096.100032

Dommerholt, J. (2023). Dry Needling Systematic Reviews and Meta-Analyses. Myopain Seminars.

Dpmr-Admin. (2018, October 25). Difference Between Dry Needling and Acupuncture | Denver Physical Med. Denver Physical Medicine & Rehab.

McAphee, D., Bagwell, M. S., & Falsone, S. (2022). Dry Needling: A Clinical Commentary. International Journal of Sports Physical Therapy, 17(4).

Nuhmani, S., Khan, M. H., Ahsan, M., Abualait, T., & Muaidi, Q. I. (2023). Dry needling in the management of tendinopathy: A systematic review of randomized control trials. Journal of Bodywork and Movement Therapies, 33, 128–135.

Pai, M. Y. B., Toma, J. T., Kaziyama, H. H. S., Listik, C., Galhardoni, R., Yeng, L. T., Teixeira, M. J., & De Andrade, D. C. (2021). Dry needling has lasting analgesic effect in shoulder pain: a double-blind, sham-controlled trial. Pain Reports, 6(2), e939.

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pelvic inlet, pelvic outlet, hips
Pelvic Motion

The hips and pelvis are powerful structures that play a large role in almost all movements we do as human beings. We walk, sit, stand, breath all using our pelvis and hips. The structures of our pelvis should move against each other. Now this movement is larger through the femur and acetabulum (or hip joint) and more minimal within the pelvis (sacrum and ilum bones). View the link to my social media post explaining a little bit more how the pelvis should move as we walk

When we are lacking these movements problems or issues in our bodies can ensue! Things like low back pain, sacroiliac joint pain (SI Joint), pubagia (pubic symphysis pain), hip pain, sciatica, altered walking patterns, painful exercise, pelvic pain, dysfunction in pelvic floor. It leads to an imbalance in the forces going through the pelvis that can lead to pain. It can even affect how we put force through our feet! Have you ever seen someone “waddle” back and forth when ambulating? Essentially shifting weight from one foot to the other by leaning their trunk over one foot then the other? This displays a lack of relative motion in the pelvis and hip region leading to the need to lean the trunk to shift the center of body weight over each foot to propel forward in space when walking.

The movement of hip shifting was a concept first presented to me from the Postural Restoration Institute. The idea behind the movement of hip shifting is to open up the Pelvic Outlet (the bottom opening of the see picture above) and increase hip internal rotation. These motions or having access to this movement is necessary to effectively put force into the ground from our pelvis through our feet. It is used with push-off during gait, to push out from the mid range of a squat (to get through the sticking point), to propel forward while running, and to push out of a cut on the soccer field. This position is also necessary in the last stages of a vaginal delivery when trying to push baby out the pelvic outlet.

As the pelvic outlet is able to open up, the sacrum (structure in the back of the pelvis) tips open forward and the innominate bones squeeze together on the top to allow the bottom to open. This motion allows the femur bones to turn inward more to close off the front of the hip joint. This position allows the back of the pelvic floor to relax to move through the sticking point in a squat, allows easier defecation, and easier for baby to come out. It puts the gluteus maximus in a lengthened position to allow for energy storage to then push into and extend the hip for maximum propulsion.

hip internal rotation, pelvic outlet opening, sacral nutation
Pelvic Internal Rotation/Exhalation

Below are some exercises that are options to assist with increasing your ability to work on hip shifting. Please note that there are many variations of hip shifting and these are just a few! Some of these variations were introduced to me by fitness trainer Katie St. Clair whom is one of the most insightful exercise creators I have had the pleasure of learning from!

If you struggle with any of these variations, my greatest suggestion is to begin with the sidelying adductor pullback then work towards the 90/90 hip shift with feet on the wall, and from hands and knees (not shown) variation prior to the split squat and then finally the hinging wall supported hip shift. The wall supported variation is by far the hardest and works on the very end of internal rotation from a hip extended position and with the most weight and pressure on the pelvis making it most difficult.

The subtle shifts in body position can make a difference to the success of this movement. Trouble shooting strategies include making sure your lumbar spine is in more a “neutral position”. What I mean by this is not “over tucking” our buttocks area under by contracting the glute muscles and not allowing them to relax. It is also challenging to have success if the lumbar spine is in an extended or arched position. Make sure that you feel supported by your abdominal wall in the front. You should feel the muscles on the inside of your thighs working quite through the initial squeeze and then imagine pulling the femur head backwards in the socket. With this movement on the side you are pulling backwards and may feel your hamstrings as well. There can be resistance felt on the outside of the hip not quite allow this movement to happen. You may also feel the anterior glute medius on the outside of the hip. It may give the sensation of groin cramping on the involved side when done correctly. You should NOT feel the muscles in the front of your hips working. If that is the case, then the knee is being pulled upwards towards your head instead of backwards.

I encourage movement exploration with these for most people struggle more on one side than the other but should be able to perform on both sides. This movement could be the key to gaining lost internal rotation contributing to that unrelenting back pain or sciatica!

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Breathing has been a “buzz word” for a while in the fitness and yoga industry. The question is always why? Most people say to themselves I can breathe because I’m living! Well the truth is that most of us struggle to breath optimally for our bodies. Let’s discuss the differences between nasal breathing and mouth breathing.

When inhaling through our nose, the air is filtered, cleaned, and warmed. Warming the air prior to entering the lungs moistens it which allows for easier absorption. During inhalation a negative pressure is created in the upper thorax by the descension of the diaphragm and expansion of the rib cage. This shape change is essential for optimal breathing. Inhaling through the nose adds at least 50% more resistance to air flow. It helps maintain normal elasticity of the lungs, thus assuring optimal conditions for providing oxygen and good heart function. It also increases carbon dioxide levels and tolerance to it. Nitric Oxide is a vasodilator gas produced in the nasopharynx. It is boosted six times in the amount when breathing through nasal passages. It helps us absorb 18% more oxygen compared to mouth breathing. Nitric Oxide is also helpful for immune health and general body homeostasis. Nasal Breathing during exercise lowers heart rate and breath rate. When performed during exercise, the person will perceive as less exertion during exercise. Nasal breathing allows for a shorter recovery times and increases endurances. Also interesting that it reduces the galvanic skin stress response.

Did you know that nasal cycles exist where throughout the day there is a dominance of one nostril over the other. This can change every 30 minutes to four hours. There can be structural influences that may influence the ability for nasal lateralization such as a deviated septum, nasal valve prolapse, or history of facial trauma. Nasal cycles can influence the rhythm and balance of our central and autonomic nervous system. Right nasal breathing is tied into the sympathetic nervous system which is responsible for our fight or flight responses. Inherently, right nasal breathing speeds up circulation, increases body temperature, cortisol levels, blood pressure, and heart rate. It also feeds more blood into the left hemisphere to the prefrontal cortex which is associated with logical decisions, language, and computing. Left nasal breathing is associated with the parasympathetic nervous system otherwise known as the rest and digest. It lowers body temperature, blood pressure, and reduces anxiety. Left nasal breathing shifts blood circulation to the right prefrontal cortex responsible for creative though, emotions, and formation of mental abstractions. So when in need for some relaxation, Left nostril breathing may be the ticket! As human beings we breathe 22-24 thousand times per day. During this time our bones are moving to make this happen! Our rib cage expands and contracts and our pelvis inlet and outlet shifting position as we breathing. Finally, nasal breathing actually moves our cranial bones! Yes! This may seem strange or unbelievable. Our breathing system is a pump that allows for fluid shifting throughout our bodies. Our guts move up and down as we breathe. This is able to be seen on MRI. While cranial expansion and compression happens, it helps move through the cerebral spinal fluid and arterial flow through the cranium. An extreme example of this fluid shift is when we are upside down for a long period of time and there is a rush of blood to our head. There are many other structures that assist with this fluid flow through our system as well including the thoracic diaphragm and the pelvic floor to name a few. Development of our breathing system starts at a very young age. It is one of the first things we do as we exit the womb. We practice and develop our breathing system as we grow in utero as well as nursing as a young child. Nasal breathing can improve oral tongue posture and facial development. There is a vacuum affect when the tongue sits on the roof of the mouth to increase suction. It increases oxygen transport by 10-20% by increases back pressure during exhalation which forces more oxygen into the bronchi and bronchioles allowing more to be pushed into alveoli increasing oxygen diffusion into the blood stream. Optimizing tongue position with nasal breathing can assist with this cranio-facial development in young children and improve dental bite alignment and decrease airway constriction. Issues with these things can can lead to problems later on in life such as temporomandibular joint dysfunction and sleep apnea. Myofunctional therapy is one type of therapy that can assist with development of these skills. If all of these reasons don’t convince you to pay a little more attention to nasal breathing, I’m not sure what will. Are you looking for more resources on this topic? Three books that have really helped me understand more about breathing include: Breath by James Nestor; The Oxygen Advantage by Patrick McKeown; and Jaws by Sandra Kahn and Paul Ehrlich. Additionally, some of my education from the Postural Restoration Institute and Integrative Rehab Training has been key to my understanding of its importance!

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