Dry Needling: A Powerful Tool for Pain Relief, Strength, and Recovery

If you're an athlete, CrossFitter, or someone who pushes their body to the limit, you know how important muscle recovery, strength, and injury prevention are to maintaining peak performance. If you're struggling with muscle pain, stiffness, or slow recovery from workouts, dry needling might be the solution you've been looking for! If you have tried physical therapy but have not had any dry needling, you may need to consider adding this into your treatment or finding a provider who can provide this treatment. Read on to learn more about this unique intervention!

What is Dry Needling?

Dry needling is defined as a “skilled technique performed by a physical therapist using filiform needles to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability” (Caramango et al., 2015). Furthermore, dry needling with electrical stimulation (E-stim) is a cutting-edge technique used by physical therapists to relieve pain, improve muscle function, and speed up recovery—helping you train harder and move better. 

We often get asked the question: how is dry needling different from acupuncture? Acupuncture, is based on traditional Chinese medicine, dry needling, is grounded in modern Western evidence-based medicine and focuses more on local tissue targets to restore function in the client. 

Acupuncture is used in treatment of anxiety, depression, digestion, fertility, sleep, and musculoskeletal dysfunction. Most of these things besides musculoskeletal dysfunction are not within the scope of physical therapy treatment. Both dry needling and acupuncture often use the same monofilament needles. The dry needles used at Summit Physio & Performance are specifically designed for physical therapy use and have additional lubrication to help improve insertional discomfort and are the optimal thickness and lengths depending on the tissue target.

How Dry Needling Works: A Simple Breakdown

Dry needling is more than just inserting a thin needle into a muscle—it’s a powerful tool that influences your nervous system, pain response, and muscle function. By understanding how dry needling works, we can see why it’s so effective for pain relief, strength and mobility enhancements, and recovery. Let’s break down the process into steps. 

Step 1: The Needle Sends a Signal to the Spinal Cord and Brain

• The dry needle stimulates nerves inside the muscle (muscle spindle), which then send signals up to the spinal cord and brain called an afferent response.

• These signals travel through the dorsal root ganglion (DRG)—a relay center for sensory information, and then the interneuron pool is stimulated which we can think of as a “gatekeeper” of controlling pain signals. 

Step 2: Resetting Pain Patterns and Brain Changes

When an injury happens, your brain maps the affected area that is injured. Within an hour of injury, the brain’s representation of that area can become blurred and disorganized—a process called "homuncular smudging."

For example:

• If you sprain your ankle, your brain originally maps the pain just at the ankle.

• Over time, the pain may spread to the lower leg, even though the injury hasn’t moved.

• If left untreated, this miscommunication can cause long-term pain and compensation patterns.

This is why some people continue to feel pain long after an injury has healed. Dry needling helps retrain the brain and nervous system to sharpen these maps and restore accurate sensation.

If this system is overactive, it can create chronic pain patterns where your brain interprets normal sensations (like light touch) as painful. Dry needling helps reset this system, reducing pain sensitivity.

Step 3: The Brain Sends a Motor Response Back to the Muscle

After the brain processes the needling input, it sends efferent motor signals back down through the ventral horn of the spinal cord—which controls muscle movement and activation.

• This activates both large, power-producing muscle fibers (Alpha motor neurons) and smaller, fine-tuning muscle fibers (Gamma motor neurons).

• The result? We basically have a reset on a motor unit creating a blended response that improves:
  ✅ Muscle activation and coordination
  ✅ Flexibility and mobility
  ✅ Strength and stability

Summary: Restoring Normal Muscle Function

If your muscles aren’t working efficiently, your movement patterns can become unorganized and imbalanced, leading to tightness, weakness, or instability. Dry needling resets the motor system, leading to:
✔ Better muscle tone (not too tight, not too loose)
✔ Improved blood flow and oxygen delivery - there is vasodilation effect that occurs in the area treated immediately after dry needling
✔ Reduction of pain-causing chemicals in the muscle and improved muscle function

There are several ways dry needling can be applied: 

• Static dry needling - needle is placed in the tissue statically without movement 

• Twisting/spinning and tugging - twisting or pinning of the needle 

• Pistoning - moving the needle in and out to elicit a local twitch response 

• In-dwelling E-stim - adding electrical stimulation through alligator clips attached to an e-stim unit, which can have additional cortical benefits and often clients experience less treatment soreness

Tissues we commonly target: 

• Muscle (most common) - most commonly needled area - main tissue target for our dry needling, needles targeted toward a muscle spindle to eclectic a twitch response. When we treat muscles we most often incorporate a E-stim for a greater treatment effect. 

• Tendon - dry needling combined with eccentric exercise improves pain and functional outcomes for tendinopathies (ie: Achilles tendinopathy, patellar tendinopathy)

• Static needles - Dry needles placed into tendons and left in, with our without twisting

• Fenestration - Moving the needle in and out of the tendon, promoting mechanical microtrauma to promote collagen re-synthesis, or through restarting the body’s natural inflammatory response to assist with tissue healing

• In-dwelling E-stim - Needles placed in the tendon and connected to E-Stim stimulates cellular repair processes, improved blood flow, and improvement in cortical response 

Achilles Tendon Dry Needling

• Nerve

• Techniques: 

• Perineural dry needling - Dry needling with e-stim to target muscles along peripheral nerve path 

• Peripheral nerve stim (PNS) - Dry needling with e-stim to directly stipulate a peripheral nerve 

• Targeting the epineural sheath (outside of the nerve not directly puncturing the nerve) to elicit a motor response with a goal to achieve the following response: 

• Nerve healing/regeneration 

• Reduce pain from nerve related conditions including radiculopathy (pinched nerve/sciatica), post-surgical pain, post amputation, oncological pain, neuropathic pain, anterior knee pain, one-sided muscle weakness

• Improved muscle function

• Improved flexibility

• Pelvic pain function/incontinence

• How it works:

• Release of brain-derived neurotrophic factor (BDNF) and Calcitonin Gene-Related Peptide (CGRP) to improve the health of the nerve and muscle function 

• BDNF: Think of this as "fertilizer" for your brain and nerves. It helps nerve cells (neurons) grow, mature, and stay alive. It also acts as a protector for your brain, especially in tough conditions, and speeds up the repair process if your nerves get damaged.

• CGRP: This is like a natural "plumber" for your body’s circulation. It helps open up blood vessels (vasodilation), which improves blood flow. This is important for healing and delivering nutrients to muscles and tissues. It also plays a role in reducing pain and inflammation. 

• Scar - Dry needling for scars help with tissue remodeling, can reduce scar hyperproliferation (abnormal scar tissue development), develop new blood vessels and cell proliferation, and can suppress local inflammation 

Dry needling a scar for a client who had a labral repair

Types of Scar needling:

• Static dry needling - Needles surrounding the scar

• Grasping - Twisting and tugging on subcutaneous/fascial tissue around scar can stimulate C-fiber input which is often associated with chronic pain

• Shoveling - Mechanically disrupt scar tissue and adhesions with mini in-out strokes with special needles 

• Bone - Periosteal pecking to help the healing of bone and to stimulate healing and blood flow toward the injured area 

Benefits of Dry Needling with Electrical Stimulation 

Adding electrical stimulation (e-stim) to dry needling can enhance this effect, making the brain-muscle connection even sharper and more responsive. At Summit Physio & Performance, we use only the best technology out there, the ES-160 Electro-Therapy unit which adds electrostimulation to the needle. We then choose a specific setting on this device to target your needs of either pain relief/mobility benefits, neuromuscular and strength benefits, or muscle recovery benefits. We also can perform dry needling without the use of electrical stimulation (e-stim), but the use of dry needling plus e-stim is typically more effective and better tolerated than dry needling alone. We can specifically target muscles, tendons, nerves, bones, scars, and subcutaneous tissue. Overall, dry needling is an effective way to target tight muscles, improve strength, and speed up the healing process. We often integrate dry needling into treatment plans tailored for our clients.

There are numerous benefits of why we choose to add in E-stim! Here’s a few: 

• Confirmation we are in the correct muscle target and needle location through the motor output response of the muscle 

• Mitigation of post-treatment soreness

• Creation of a muscle pump in order to improve blood flow and aid with venous return for our lymphatic system

• Neuromuscular changes  to improve muscle recruitment and output

• Tissue changes

• Neural regeneration for damaged nerves

• Increased cortical (brain) activation through somatosensory reorganization, cortical sharpening, and remapping of the cortex 

3 main types of Dry Needling with E-Stim: 

1. Pain Relief

Dry needling is highly effective at reducing muscle pain, tension, and stiffness. By targeting specific areas relevant to each patient’s unique presentation, it helps:

• Reduce chronic pain from conditions like tendonitis, muscle strains, and myofascial pain syndrome.

• Improve range of motion by releasing tight muscles.

• Stimulate the release of endorphins, the body's natural painkillers.

For athletes and active individuals, this means less discomfort and better movement efficiency during workouts and daily activities.

Dry needling for pain relief is typically achieved through the use of alternating current for 10-15 minutes. You will typically feel the current beat faster and then slow. Typically after this modality we want to reinforce the areas we treated after pain is reduced - this often opens up a window of opportunity for loading and improving mobility with less pain and makes the treatment move effective. 

2. Strength and Muscle Activation

Did you know that tight or overactive muscles can actually negatively impact your performance? When a muscle is constantly in a state of tension, it can't properly activate or generate force.

Neuromuscular dry needling helps: 

• Improve muscle tone and tension

• Improve the muscle contraction and contraction thickness and cross-sectional area (Hypsertophy)  

• Improve neuromuscular communication, helping muscles fire more efficiently and have better recruitment with less pain inhibition

• Improves strength output 

• Restore proper movement patterns to optimize strength and coordination and muscle performance 

This makes dry needling a great tool for clients who are looking to enhance their performance, restore strength, and prevent future injuries. Dry needling for neuromuscular benefits is typically achieved through the use of alternating high to low frequency. The high frequency portion is typically a 2-3 second burst that fully contracts the muscle, called tetany. We typically perform between 10-40 bursts and follow this treatment with strength and hypertrophy training principles as this treatment primes the muscles to improve their strength and capacity. This treatment often helps combat atrophy and improves joint activation. 

Normally our body’s muscle contraction recruits muscle fibers small to large and type 1 muscle fibers before type 2 muscle fibers with synchronous recruitment - recruiting from small to large motor axons. With e-stim, we see the opposite happen, large to small recruitment as larger motor neurons have less electric resistance. We see a preference for recruiting type 2 muscle fibers before type 1 muscle fibers which can help better combat atrophy and muscle inhibition.  

3. Faster Recovery and Reduced Swelling

After intense training, your muscles go through stress and micro-tears that need time to heal. With acute injury, we also see local swelling in or nearby the injured area which can impact function and pain.  

Dry needling can help improve recovery and reduce inflammation by: 

• Increasing blood circulation to bring oxygen and nutrients to the affected muscles.

• Reducing inflammation by promoting natural healing responses.

• Reducing post-workout soreness and stiffness by flushing out metabolic waste that contributes to soreness and stiffness through improving venous return through rhythmic contractions. 

• Promoting faster healing from muscle strains, ligament sprains, and joint pain.

This makes dry needling an excellent option for post-workout recovery, injury rehabilitation, and swelling reduction. Dry needling for recovery and swelling benefits is typically achieved through the use of low frequency applied for a long duration of time, typically > 15 minutes. We typically also choose tissue targets such as the medial gastroc, adductor magnus, quads, glute max, or vastus medialis in the lower body and the pec, biceps, deltoid and upper trap in the upper body in addition to the task/specific injured muscle. Dry needling for recovery can help you recover faster from intense workouts, races, or events; recovery faster from injury, and help reduce pain and swelling at a faster rate. 

Is Dry Needling Right for You?

Dry needling is safe and effective for a variety of conditions, including:

• Athletic injuries (such as strains, sprains, and overuse injuries)

• Acute and Chronic pain (like lower back pain, neck pain, or headaches)

• Tendon and joint pain

• Post-surgical rehabilitation

• Performance enhancement

• Muscle tightness and stiffness

At Summit Physio & Performance, our expert therapists assess each individual to determine if dry needling is the right fit for their treatment plan. Whether you're dealing with pain, weakness, or slow recovery, this technique can be a game-changer in your rehabilitation and performance journey.

Experience the Benefits of Dry Needling at Summit Physio & Performance

If you’re looking for a safe, effective, and evidence-based approach to pain relief, strength, and recovery, dry needling might be the solution for you. Our team at Summit Physio & Performance is trained in advanced dry needling techniques with and without e-stim to help you move, feel, and perform at your best. 

📍 Book your appointment today and take the next step toward a pain-free, stronger, and more resilient body!

-Dr. Tessa Kothe, PT, DPT, Cert. DN

References: 

Caramagno, J., Adrian, L., Mueller, L., & Purl, J. (2015). Analysis of competencies for dry needling by physical therapists. Hum. Resources Res. Organ, 33, 5-7.

Paul Killoren, (2023, March) ICE Dry Needling: Lower Body [Course presentation]. Institute of Clinical Excellence.

Paul Killoren, (2024, December) ICE Dry Needling: Advanced [Course presentation]. Institute of Clinical Excellence.