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DR. SUBHANJAN DAS, PT 
Subhanjan_82@yahoo.com 
+91 8967549104 
Dry Needling Instructor 
MPT (Musculoskeletal & Sports) 
Assoc. Prof., BIMLS, Burdwan
Also in the series 
 http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling 
 http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling 
 http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling 
 http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling 
 http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling 
 http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-needling 
 http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture 
 http://www.slideshare.net/SubhanjanDas/9-electroacupuncture 
 http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling
What comes to our mind first when 
we think of Dry Needling
What comes to our mind first when 
we think of Dry Needling 
Acupuncture
What comes to our mind first when 
we think of Dry Needling 
CHINESE
What comes to our mind first when 
we think of Dry Needling 
Placebo
What comes to our mind first when 
we think of Dry Needling 
UNSCIENTIFIC?
What comes to our mind first when 
we think of Dry Needling 
And still, we feel a little curious!
Is it acupuncture? 
“ From a physical therapy perspective, TrP-DN has no 
similarities with traditional acupuncture other than 
the tool.”- Jan Dommerholt1
Is it Chinese? 
Early proponents of dry needling include Klellgren 
(British), Chan Gunn (Canadian) and other people of 
western world.
Is it unscientific? 
 A no. of independent research validates Dry Needling. 
 2 systematic reviews3,4 have validated dry needling 
including a Cochrane review (highly prestigious!)
Is it placebo? 
Various studies in animal and human models have found 
specific physiological changes related with dry 
needling. Some placebo effects may be present but 
there is a sea of evidence showing objective 
measurable changes which rules out ‘placebo only’ 
theories.
What is dry needling? 
 Dry needling is a procedure where filiform needles are 
tapped through the skin to the target tissue to bring 
about a therapeutic effect. 
 No medicine is delivered, thus it is called ‘dry’, 
compared to injections, which are ‘wet’. 
 Other names/variations are IMS, TrP DN etc.
Needles 
 Needles can be as short as12.5 mm or as long as 100 
mm. the choice of needle is based on the target 
tissue and specific techniques used. 
 Disposable filiform acupuncture needle with 
guide tube is used. (filiform= solid) 
 Guide tube minimizes pain
Disposable sterile needles packed
Needles with guide tubes
Needles sans guide tube
How is it performed?  With careful precision the structure to be needled is 
chosen. Then sterilized disposable needles are pierced 
through the skin into the target tissue. 
 Choice of needle is dependent upon depth of target 
tissue. 
 A clean field technique is used. As there is minimal or 
no bleeding, sterile field is not needed. 
 The needles are kept inserted for a span of 30 seconds 
to few minutes and then withdrawn and disposed 
properly.
How is it performed? 
 A sharps bin is 
mandatory for needle 
disposal. 
Alternate to sharps bin
Specific techniques 
 Deep Dry Needling: When needle is pierced deep into 
the muscle/target tissue. Local Twitch Response is 
elicited. 
 Superficial Dry Needling: Started by Peter Baldry, 
where only the skin overlying the target tissue is 
pierced. 
 Periosteal pecking 
 Needle manipulation 
 Intramuscular electrical stimulation (PENS)
PENS
Response to needling  Dry needling, much like MWM, when indicated, 
produces immediate effect. 
 Different people respond to needling differently and 
are thus classified as strong, average and weak 
responders. A strong responder will need minimal 
needle stimulation to achieve needling effect; 
overstimulation can worsen patient’s pain2.
To sum up 
 With proper judgment and precision dry needling is a 
powerful tool for the physiotherapist. 
 It is a quick, cost efficient treatment which when 
indicated produces immediate result. 
 The risks are real. Need for training and safety 
precautions can not be over emphasized.
References 
1. Dommerholt et. al, Trigger point dry needling. 
2. Baldry P. Acupuncture treatment of fibromyalgia and 
myofascial pain. Fibromyalgia syndrome. Elsevier, 
2010:149 
3. Cummings TM, White AR. Needling therapies in the 
management of myofascial trigger point pain: a 
systematic review. Arch Phys Med 
Rehabil2001; 82: 986–92. 
4. Furlan AD, van TulderMW, et al. Acupuncture and 
dry-needling for low back pain. Cochrane Database 
Syst Rev 2005;(1):CD001351
References 
5. Travel and Simon’s Myofascial pain and dysfunction 
the trigger point manual 
6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo 
microanalytical technique for measuring the local 
biochemical milieu of human skeletal muscle. J Appl 
Physiol 2005;99:1980-1987. 
7. Lundeberg T, Stener-Victorin E. Is there a 
physiological basis for the use of acupuncture in pain? 
Int Congress Series 2002;1238:3-10.
References 
8. Baldry PE. Acupuncture, Trigger Points and 
Musculoskeletal Pain. Edinburgh, UK: Churchill 
Livingstone, 2005. 
 9. Langevin HM, Bouffard NA, Badger GJ, Churchill 
DL, Howe AK. Subcutaneous tissue fibroblast 
cytoskeletal remodeling induced by acupuncture: 
Evidence for a mechanotransduction-based 
mechanism. J Cell Physiol 2006;207:767-774

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Introduction to dry needling

  • 1. DR. SUBHANJAN DAS, PT Subhanjan_82@yahoo.com +91 8967549104 Dry Needling Instructor MPT (Musculoskeletal & Sports) Assoc. Prof., BIMLS, Burdwan
  • 2. Also in the series  http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling  http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling  http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling  http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling  http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling  http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-needling  http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture  http://www.slideshare.net/SubhanjanDas/9-electroacupuncture  http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling
  • 3. What comes to our mind first when we think of Dry Needling
  • 4. What comes to our mind first when we think of Dry Needling Acupuncture
  • 5. What comes to our mind first when we think of Dry Needling CHINESE
  • 6. What comes to our mind first when we think of Dry Needling Placebo
  • 7. What comes to our mind first when we think of Dry Needling UNSCIENTIFIC?
  • 8. What comes to our mind first when we think of Dry Needling And still, we feel a little curious!
  • 9. Is it acupuncture? “ From a physical therapy perspective, TrP-DN has no similarities with traditional acupuncture other than the tool.”- Jan Dommerholt1
  • 10. Is it Chinese? Early proponents of dry needling include Klellgren (British), Chan Gunn (Canadian) and other people of western world.
  • 11. Is it unscientific?  A no. of independent research validates Dry Needling.  2 systematic reviews3,4 have validated dry needling including a Cochrane review (highly prestigious!)
  • 12. Is it placebo? Various studies in animal and human models have found specific physiological changes related with dry needling. Some placebo effects may be present but there is a sea of evidence showing objective measurable changes which rules out ‘placebo only’ theories.
  • 13. What is dry needling?  Dry needling is a procedure where filiform needles are tapped through the skin to the target tissue to bring about a therapeutic effect.  No medicine is delivered, thus it is called ‘dry’, compared to injections, which are ‘wet’.  Other names/variations are IMS, TrP DN etc.
  • 14. Needles  Needles can be as short as12.5 mm or as long as 100 mm. the choice of needle is based on the target tissue and specific techniques used.  Disposable filiform acupuncture needle with guide tube is used. (filiform= solid)  Guide tube minimizes pain
  • 18. How is it performed?  With careful precision the structure to be needled is chosen. Then sterilized disposable needles are pierced through the skin into the target tissue.  Choice of needle is dependent upon depth of target tissue.  A clean field technique is used. As there is minimal or no bleeding, sterile field is not needed.  The needles are kept inserted for a span of 30 seconds to few minutes and then withdrawn and disposed properly.
  • 19. How is it performed?  A sharps bin is mandatory for needle disposal. Alternate to sharps bin
  • 20. Specific techniques  Deep Dry Needling: When needle is pierced deep into the muscle/target tissue. Local Twitch Response is elicited.  Superficial Dry Needling: Started by Peter Baldry, where only the skin overlying the target tissue is pierced.  Periosteal pecking  Needle manipulation  Intramuscular electrical stimulation (PENS)
  • 21. PENS
  • 22. Response to needling  Dry needling, much like MWM, when indicated, produces immediate effect.  Different people respond to needling differently and are thus classified as strong, average and weak responders. A strong responder will need minimal needle stimulation to achieve needling effect; overstimulation can worsen patient’s pain2.
  • 23.
  • 24. To sum up  With proper judgment and precision dry needling is a powerful tool for the physiotherapist.  It is a quick, cost efficient treatment which when indicated produces immediate result.  The risks are real. Need for training and safety precautions can not be over emphasized.
  • 25.
  • 26. References 1. Dommerholt et. al, Trigger point dry needling. 2. Baldry P. Acupuncture treatment of fibromyalgia and myofascial pain. Fibromyalgia syndrome. Elsevier, 2010:149 3. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil2001; 82: 986–92. 4. Furlan AD, van TulderMW, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005;(1):CD001351
  • 27. References 5. Travel and Simon’s Myofascial pain and dysfunction the trigger point manual 6. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005;99:1980-1987. 7. Lundeberg T, Stener-Victorin E. Is there a physiological basis for the use of acupuncture in pain? Int Congress Series 2002;1238:3-10.
  • 28. References 8. Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh, UK: Churchill Livingstone, 2005.  9. Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: Evidence for a mechanotransduction-based mechanism. J Cell Physiol 2006;207:767-774