Cross-Sectional StudyTreatment: Dry NeedlingClinical RelevanceDOI
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Patient-friendly summary

If you read nothing else

This study looks at how often physical therapists in Spain use dry needling and the problems they run into, like soreness and bent needles.

Bottom line

Promising based on this evidence, but worth discussing with your provider.

Moderate evidence

Not everyone agrees

The safety of dry needling is still being debated among experts.

Ask your provider

  • What is your experience with dry needling?
  • What are the potential benefits and risks?
  • How do I know if dry needling is right for me?

Call your doctor if

  • Severe pain after treatment
  • Fever or redness at the needle site
  • Increased pain that doesn't get better

General warning signs for this condition, not side effects of the studied treatment. If any apply to you, contact a clinician promptly.

Try this week

  • Ask your physical therapist about their experience with dry needling.
  • Discuss with your provider the potential benefits and risks of dry needling.
Full research — for clinicians and curious readers

Study Summary

Background

Dry needling (DN) is a common technique used by physical therapists to treat myofascial trigger points and musculoskeletal pain. Despite its effectiveness, safety remains a topic of debate among clinicians and researchers. Adverse events (AEs) range from mild (post-needling soreness, bruising) to severe (pneumothorax, nerve injury). There's limited comprehensive research on the current state of DN practice and the incidence of complications.

This study aimed to provide an overview of current DN practices in Spain, focusing on frequency of use, training levels, and adverse event rates.

What They Did

Researchers conducted an online cross-sectional survey of 422 licensed physical therapists working in Spain from January 2019 to April 2024. The survey collected demographic and professional data including hours of DN training, years of experience, percentage of patients treated with DN, weekly clinical hours, and use of ultrasound guidance. Participants rated the frequency of various adverse events using a 5-point scale (Never to Frequently). The survey covered pain-related events (post-needling soreness, symptom worsening), needle complications (bent, stuck, broken needles), and side effects (pneumothorax, bleeding, hematoma, nerve puncture, infections).

What They Found

Most participants had 21-60 hours of DN training (38.6%), less than 2 years of experience (36%), and used DN on 20-39% of their patients (34.6%). Only 14.5% routinely used ultrasound guidance. Minor adverse events were extremely common: 95.5% of therapists reported causing post-needling soreness, and 85.3% reported bruising. Bent needles were the most common needle complication (69%).

Major adverse events were less common but still significant: pneumothorax was reported by 8.2% of therapists over their careers, nerve puncture by 53%, and fainting by 51.7%. Surprisingly, therapists with more training hours didn't consistently report fewer adverse events - some actually reported more, likely due to increased exposure from performing DN more frequently.

What This Means

This study reveals that while DN is widely used and generally safe, adverse events are more common than previously thought. The paradox of more experienced therapists reporting higher rates of some complications suggests that training volume alone doesn't guarantee safety. The low use of ultrasound guidance (14.5%) is concerning, especially since it can significantly improve safety by allowing visualization of anatomical structures. For patients, this means DN is a useful treatment but comes with risks that should be discussed beforehand.

For clinicians, it emphasizes the need for comprehensive safety training, proper patient monitoring, and consideration of ultrasound guidance, especially in high-risk areas like the thoracic region.

65/100
Evidence StrengthModerate
Study Quality
Sample Size
Replication
95.5%
Report Post-needling Soreness
8.2%
Experienced Pneumothorax
14.5%
Use Ultrasound Guidance
53%
Nerve Puncture Events
Enrolled

422

Randomized
n=422

All Participants

Survey of DN practices and adverse events

Results Comparison

Training Hours Distribution

%
0-20 hours20.4 %
21-60 hours38.6 %
61-100 hours16.1 %
>100 hours24.9 %

Key Findings

Post-needling soreness reported by 95.5% of therapistsHigh

Most common adverse event, occurring often (47.9%) or sometimes (31.3%)

Pneumothorax occurred in 8.2% of therapist careersHigh

Higher than previously reported rates of <0.1%, likely due to career-long reporting

More training didn't consistently reduce adverse eventsHigh

Therapists with >100 hours training reported increased bleeding and symptom worsening

Only 14.5% use ultrasound guidance routinelyMedium

Despite evidence that ultrasound improves safety and needle placement accuracy

Bent needles most common needle complicationMedium

Occurred in 69% of therapists, particularly with 20-60 hours training

Nerve puncture events reported by 53% of therapistsMedium

Though actual nerve injury extremely rare, accidental puncture common

Study Methodology
Study Design
Online cross-sectional survey using Google Forms
Sample Size
422
Duration
January 2019 to April 2024
Population
Licensed physical therapists in Spain
Outcome Measures
5-point Likert scale for adverse event frequency · Demographic and professional data · Training hours and experience

Strengths

  • Large sample size of 422 physiotherapists
  • Comprehensive assessment of multiple types of adverse events
  • National scope providing representative data from Spain
  • Used validated survey methodology with pilot testing

Limitations

  • Self-reported data may introduce recall bias
  • Cross-sectional design prevents assessment of causality
  • Career-long reporting vs. per-treatment rates limits comparability
  • Lack of detailed context surrounding adverse events

Key Takeaways for Patients

What This Means for You

  1. 01Dry needling is widely used by physical therapists and can be effective for muscle pain and trigger points
  2. 02Soreness after treatment is very common (happens to almost everyone) and usually mild and temporary
  3. 03Serious complications like collapsed lung are rare but can happen, especially in chest/back areas
  4. 04Ask your therapist about their training, experience, and whether they use ultrasound guidance
  5. 05Make sure your therapist explains potential risks and what to watch for after treatment

Read the Full Paper

Access the complete peer-reviewed study from Medicina

View Full Study

Related Research

●●●●● LandmarkSystematic Review

Deep Versus Superficial Dry Needling for Neck Pain: A Systematic Review of Randomised Clinical Trials

Alhakami et al.·Medicina·2025

This systematic review of 8 randomized trials found that both deep and superficial dry needling provide similar short-term pain relief and functional improvement in patients with neck pain and myofascial trigger points. No clinically meaningful differences were found between the two needling depths.

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●●●●● LandmarkCross-Sectional Study

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists

Brady et al.·Journal of Manual and Manipulative Therapy·2014

First comprehensive safety study of trigger point dry needling found mild adverse events in 19% of treatments but no serious complications. Common side effects included bleeding, bruising, and temporary pain.

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●●●●● LandmarkNarrative Review

Dry Needling in the Management of Musculoskeletal Pain

Kalichman, Leonid & Vulfsons, Simon·Journal of the American Board of Family Medicine·2010

Clinical review confirming dry needling as an effective, low-risk treatment for myofascial pain affecting up to 10% of adults. Deep needling shows superior long-term results compared to superficial techniques.

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●●●●○ StrongRandomized Controlled Trial

Comparative effects of static, classical, and sham dry needling on muscle properties and autonomic nervous system activity in cervical myofascial pain syndrome

Olaniszyn et al.·Complementary Therapies in Medicine·2026

Classical dynamic dry needling with pistoning and local twitch response elicitation produced greater short-term improvements in pressure pain threshold, muscle stiffness, tone, and perfusion compared to static needling or sham in upper trapezius myofascial pain. Static needling was largely indistinguishable from sham on most outcomes.

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