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How Does Dry Needling Work? What can I expect?

Let's start with the basics:

"The overwhelming majority of Americans are living with chronic sympathetic nervous system hyperactivity. If the autonomic nervous system is dysregulated into sympathetic hyperactivity for more than a few days, all of our internal functions begin to degrade. Blood pressure elevates, heart rate increases, PVC’s or arrhythmias may begin, nerve conduction velocity goes down, oxygen saturation decreases, liver filtration slows down, anxiety increases, pain increases, muscles shorten, tissue hypoxia gets worse, and a lot of other not-so-great stuff happens. When the sympathetic autonomic nervous system goes up, the parasympathetic autonomic nervous system gets reciprocally inhibited, leading to generalized widespread panic and dysfunction of our neuromusculoskeletal systems."

Exercise, nutrition, and sleep all help to regulate your nervous system which in turn keeps your stress system working at it's best. This is what helps your system fight off infections, chronic diseases and can help increase your HEALTHSPAN and your LIFESPAN.

In essence, while lifespan provides a numeric value to one's life duration, healthspan delves deeper into the quality of those years from a health and functionality standpoint. As physical therapists, our goal is not just to add years to life but also life to those years, enhancing healthspan by promoting optimal physical health, mobility, and function.

The problem is, that many people don't have the time or lifestyle in place to prioritize the health basics into their daily routines, and/or they are just so overwhelmed with stressors that their system needs an extra boost to be able to get back to its happy place, or what we call "homeostasis".

This is where things like dry needling can be super helpful in re-routing your system back to its baseline both by itself, and even more powerful when you add in your healthy lifestyle.

To simply the currently known science, Dry Needling is most beneficial working on both the muscular trigger points in your body, BUT more importantly the nervous system as a whole which will allow your body to help heal itself. For example, you have tight shoulders, we can needle the shoulder muscles and tissues and that would automatically help to stimulate the system to reset itself to a better tension baseline. But if we combine that localized needling of the area PLUS needling the areas of the body that regulate your ENTIRE nervous system more towards parasympathetic activity (rest, digest, heal) and away from fight or flight (muscle guarding, pain, tension). That combination is going to help reset your WHOLE NERVOUS SYSTEM ENVIRONMENT, helping your localized painful or tight tissues, while also creating an environment for the effects to stick around longer.

That is why the secret sauce is in the combination of where we needle to get the maximum benefit at the local and global system levels.


Do you have any questions about whether Dry Needling could be right for you? Book a free 15 minute phone consult with Dr. Zazu DPT [here]

Where can we dry needle?

Good news is that we can needle pretty much anywhere in the body safely using the appropriate techniques. There are certain areas like around the lung fields, organs and major vessels that we avoid for safety reasons. For similar reasons and because it is also not as beneficial for the target tissue, "pistoning" the needle is not ideal. Pistoning is where the provider repeatedly jabs the needle in and out of the muscle to elicit a "twitch" response. Firstly, it is very uncomfortable for the client and completely unnecessary to get the desired effect. Secondly, it could actually be dangerous depending on where you are needling, say the upper trap muscles where most of hold some tension because there is a part of the lung that lives up there.

Dry needling can be really helpful in bringing bloodflow to areas that are generally thought to have minimal blood flow (therefore healing capacity) to them such as meniscal tissue and scar tissue! This is great news so we can treat these areas in a more conservative way prior to resorting to more aggressive surgeries or even injections with medications that may have undesirable side effects.

I have also seen it be helpful for people with chronic tension headaches, migraines, even vestibular issues! Along with our more common orthopedic injuries like spine, shoulder, hip and knee issues.


Clients with PELVIC FLOOR ISSUES generally have great success with the needling and in combination with a specific protocol called PTNS, in which we place the needle in specific areas along the foot and lower leg to directly stimulate the nerves that impact your pelvic floor function. I will write another blog diving into this topic that can be so helpful for so many people struggling with chronic pelvic floor issues where traditional PT has failed them. But in short...

Pelvic floor dry needling is appropriate for many diagnoses we may see that involve the pelvic floor. These include pelvic pain, urinary incontinence, constipation, pudendal neuralgia, coccydynia, and even diastasis rectus abdominus.

And no, I’m not going “right up in there” with the needle. I actually take an outside to in approach. With a patient lying on their side, I will find their “sit bone” and place the needle directly inside of this. This is an easy place to access many of the pelvic floor muscles without going right up through the perineum.

I will also often use dry needling for other muscles that have a very close relationship to the pelvic floor. These include the lower back, TL junction (the part of your spine in your mid-back), glutes/hips, abdomen, and inner thigh muscles. Because all of these muscle groups work so closely with the pelvic floor, if we see dysfunction in one, we will often see dysfunction in the other. It is very important to assess and treat dysfunction in these muscles whenever we are treating the pelvic floor.

What can I expect? Will it hurt?

With dry needling, a very thin, solid monofilament needle is inserted directly into the muscle belly. The muscle I choose to insert the needle into will depend on which muscle function I am trying to target and improve.

I am not going to tell you that it is discomfort-free. However, I have lots of patients who don't even feel the needles. For those that do, I would not call it “painful.” There can be a little bit of discomfort once the needle is inserted into the muscle belly. To me, it feels like a deep muscle ache, others describe it as a muscle “grab”. The good thing is that is short lived. (Yes, I have had dry needling to myself and even to my own pelvic floor! I know exactly how it feels!) Once this deep ache resolves, the patient will typically feel nothing! I even have some patients that prefer dry needling to traditional manual therapy because they found the dry needling more comfortable!

The other exciting part of this all is that I can use a small hand-held device to apply electric stimulation directly into the muscle! Why is this helpful? Well, when we apply electric stimulation into the dysfunctional muscle, we see a “reset” of the muscle and surrounding nerve structures. This “reset” can help a tight muscle relax, or help a weak muscle “wake up” in order to make strengthening exercises more effective! Current research is supporting the application of electrical stimulation along with dry needling and finding this to be more effective than dry needling alone in some areas of the body. The electrical stim does not hurt. Rather, you will feel a deep “thump” in the muscles. The nice thing about this treatment is that the intensity of the electrical stimulation is totally driven by you, the patient! I only turn up the intensity to a level that is comfortable.

Have you tried everything to feel better and are looking for something new? Dry needling may be for you!


Questions? Shoot me an email at or click on my contact page to write me a note!

To Your Health,
Dr. Zazu DPT

Here is a great (very long) article by the Owner of the Intricate Art Spine and Dry Needling Solutions Seminars, an expert in Dry Needling, who works with physicians, sports teams, and big name folks from around the world. He provides a plethora of research, and adds his own quirky personality to his articles!


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