Dry Needling Pros and Cons
(That You Need to Know)

In this post, I’m going to introduce the pros and cons of dry needling that you need to know before signing up for treatment.

I’ve helped thousands of people relieve physical pain both with and without dry needling since 2015 alone.

First, let’s go over what dry needling is.

If you’re not familiar with the term, dry needling, also known as dry needling physical therapy, is a powerful, effective pain relief treatment option for both acute injury and chronic pain. It uses tiny needles, similar to acupuncture needles, to go into muscle and other soft tissue to create an immediate change to the tissue tension, local blood flow, or ability to activate.

It can provide quick pain relief without medication.

Dry needling is extremely safe when performed by an expert and it has long-lasting results, especially in combination with other therapeutic strategies.

What dry needling does:

  • Relieves tension and trigger points in muscles caused by stress and posture.
  • Accelerates recovery from sports injuries.
  • Pinpoints and corrects the source of radiating and nerve-related pain.
  • Improves mechanics of the spine, addressing acute or chronic neck and back pain.
  • Activates deep stabilizing muscles to feel more control over movement and performance.

It can be performed on a wide range of people; However, patients who are pregnant, immunocompromised, or have uncontrolled blood clotting issues are not candidates for dry needling.

Manual therapy, cupping, and other therapeutic strategies are ideal treatment options for these clients.

Dry needling is currently more popular in sport physical therapy or athletic physical therapy (which we also perform here at Chain Effect), but it is making its way into traditional pain relief clinics (more on this later).

With that, let’s dive right in.

Chain Effect dry needling expert inserting needle into lower back with gloves.


Pain Relief:

New muscle pain that pops up after a bad night of sleep can be a nuisance, but can also be relieved in as little as one dry needling appointment.

We have many clients who will only come in once or twice a year when a small injury occurs for one or two dry needling physical therapy treatment sessions.

Chronic pain generally requires a longer plan of care, but needling is often a jumpstart tool used on the road to lasting pain relief.

Fast and Effective:

While there are many different styles of manual therapy, there is no other technique that I have found capable of producing as powerful a result as quickly as dry needling.

A single muscle can be treated in as little as 10 seconds when targeted properly.

Since muscles are interconnected, we are typically going after a pattern of dysfunction, meaning we usually treat a handful of interconnected muscles in one session.

But still, we can typically finish needling all areas of concern in 5-15 minutes.

The rest of your appointment at Chain Effect is spent identifying and treating the underlying issue with hands-on manual therapy and functional corrective exercises.

We want you to spend time with your family, not in a medical practice.


Dry needling physical therapy is extremely safe when performed by a skilled physical therapist

Physical therapists are licensed experts in anatomy, physiology, and the interplay between the two. 

However, physical therapists must do intensive advanced coursework after working in the field for at least 1 year (North Carolina Physical Therapy Board recommendation) before they are allowed to perform dry needling on patients. 

Back in 2014 when I became a Certified Dry Needling Practitioner it was about an 8 month process including 3 separate in-person courses and 200 volunteer sessions before I ever treated my first patient. 

When discussing dry needling pros and cons, we must clarify that even with the most skilled provider, every invasive treatment has some risk.

The biggest risk with dry needling is a pneumothorax or a punctured lung. Dry needling around the lungs or anywhere around the ribs and spine should be handled with extra care and requires even more advanced training. 

While extremely rare and preventable, if a pneumothorax were to occur, most go untreated and resolve with observation.

However, if you are experiencing shortness of breath or unexplained rapid heart rate following a dry needling session, you should seek medical attention and alert your physical therapist. 

Other risks of dry needling include bruising, malaise, soreness, and in some cases a vasovagal response or lightheadedness.

This lightheadedness typically resolves in 10-20 minutes. 

No Referral Required in NC:

Luckily, North Carolinians have total, unrestricted access to physical therapists and do not need a doctor’s referral.

This privilege also comes with responsibility. Once again, we stress the importance of going to a dry needling expert. At Chain Effect, we hire practitioners with advanced training and years of practice under their belt.

Do your research when choosing your healthcare providers.

Ask questions.

You can book same-day dry needling appointments online with a Chain Effect dry needling expert here.

Long Lasting:

Dry needling physical therapy is a powerful service that is most effective when combined with other hands-on techniques and exercises.

At Chain Effect, our physical therapy studio in Raleigh, NC, we always reinforce soft tissue work with other manual interventions, biofeedback, and behavior modification suggestions.

When appropriate, this is followed by a trip back to our functional fitness studio to perform corrective exercises with weights designed to fix the root problem.

Chemical Free:

There is no foreign substance being injected into your body with dry needling – unlike Botox and steroid injections, which can cost hundreds or thousands.

While injections have their place in healthcare, they are often administered without other muscle-programming techniques that are critical to achieving long-lasting results.

Injections can offer pain relief for days to months, but if you haven’t corrected the movement dysfunction that caused the pain, it’s likely to come back the same or worse.

For those who have just received a steroid injection, now can be the perfect time to make the most of a 60-minute physical therapy appointment.

Can Be Excitatory:

While much of the time we use dry needling to quiet down overactive and sensitive muscles, we can also use it to “wake up” muscles that might currently have a tough time activating.

This is particularly useful in some of our deeper stabilizing muscles.

For instance, in our spine we have muscles called multifidi.

These are a series of muscles connecting each vertebra in our back to the vertebrae above and below.

When our pelvis is in the correct position and our core is engaged, these muscles act as a group to stabilize the spine.

Here is the problem: In folks with acute or chronic low back pain, often the lumbar multifidi are not given the proper conditions to fire.

In these situations, we can insert needles into these muscles and then wake them up with electric stimulation.

Once “woken up,” even just once, these muscles are much more likely to fire on their own.

Used in conjunction with corrective exercise, we can greatly impact the feeling of control and stability that is associated with a happy back and pain-free movement. (You can read more about this in our eBook.)

We provide Functional Dry Needling, which is a soft tissue technique that is extremely effective and can speed recovery time for acute injuries



This is self-explanatory.

If you don’t like needles, you may not like the idea of dry needling.

It’s true, the needles we use are tiny: 5 of our needles could fit inside the hole of a traditional hypodermic needle (the kind that draws your blood).

But they are still needles nonetheless.

For patients who are very afraid of needles, there are different manual therapy options that aim to achieve similar results. We’ll cover these in future blog posts.


There is no reason to sugarcoat it, dry needling can be painful and uncomfortable.

It’s not for everybody.

That said, most of the time the discomfort from dry needling is more associated with the “twitch response” than it is the actual needle.

The “twitch response” is a brief, involuntary contraction of a muscle that occurs when a needle releases a trigger point.

To learn more about the twitch response and how dry needling works, download our Dry Needling eBook here.

While this is one of the goals of the treatment, it is typically a different sensation than most people are used to.

For this reason, Chain Effect therapists use different hands-on techniques to both reduce pain during the procedure and to relieve soreness following the treatment.

Tiredness or Malaise:

Because dry needling is so powerful, sometimes the experience can leave patients feeling a little “out of it” or tired following the session.

This is more common in shorter, 30-minute appointments.

In 60-minute appointments, patients are naturally re-energized through the physical therapy exercises we do following needling.

For patients who leave right after needling, a 10-15 minute walk after the session is usually enough to restore energy levels.

Raising Popularity and Mainstream Acceptance:

Why is this a dry needling con?

Well, as with all disciplines and treatments requiring skill, there are always a range from the great experts, to well-meaning practitioners, and then the… bless-their-hearts… others.

I hate to say it but physical therapists are no different.

With the rise in popularity of dry needling comes many providers who are interested in adding the technique to their toolbox.

While it is safe to assume all of these physical therapists will be trained to deliver the treatment safely, dry needling is, like most advanced skills, an art that requires practice.

Insurance Coverage Hasn’t Caught On Yet

Due to insurance reimbursement rates, most physical therapists aren’t afforded the time necessary in their treatment sessions to diagnose the problem, perform dry needling and other soft tissue techniques, reinforce the necessary changes, and reload the patient with corrective exercise and functional movement patterns all in one session.

However, this is what it takes to truly have an effective treatment.

Most in-network physical therapy clinics end up charging extra for dry needling, a fee on top of the patient’s copay.

At Chain Effect, we don’t believe in “nickel and dime-ing” our clients, therefore there is no extra charge for dry needling in physical therapy sessions.

This is one of the main reasons why our physical therapists are not in network with insurance. We charge a flat fee for our time, and that includes whatever best serves the patient.

Our Physical Therapists at Chain Effect in Raleigh, NC are always 1 on 1 with their patients, for the full appointment duration.

Most appointments are 60 minutes.

While there are situations when our patients may only require a 30 minute session, this is typically a patient further along in their treatment plan.


Now that you’ve known the pros and cons, you can discuss with your physical therapist/dry needling expert if it’s a good treatment option for your specific pain.

If you’re interested in learning more, download our Dry Needling eBook or contact us.

Dry needling needles inserted into lower back.
Dry needling uses tiny filiform needles to penetrate dysfunctional muscles.


Dr. Taylor Pope owner of Chain Effect and one of the Doctors of Physical Therapy at Chain Effect

Written by Taylor Pope, DPT, Chain Effect Co-Owner.

Taylor Pope has over a decade in the field and has helped thousands of clients relieve pain with dry needling, manual therapy, and movement. At Chain Effect, he now hand-selects dry needling experts to provide Raleigh with safe and effective pain relief services and transformations.