Notes from the Road | 004
Welcome back to Notes from the Road. I'm Travis Nichols with Nichols PT & Wellness, and as a Functional Dry Needling Specialist trained through Kinetacore and Evidence in Motion, I get two questions about dry needling more than any others: "Does it hurt?" and "How does it work?" Let's start at the beginning.
What Is Dry Needling?
Dry needling is a technique where a physical therapist inserts a very thin, solid needle into muscle or other soft tissue to help reduce pain and improve movement. It's called "dry" because nothing is injected. It's one tool in my toolbox, used alongside a thorough evaluation, movement work, and education, because the goal is to help you move better and stay better.
Question 1: Does Dry Needling Hurt?
For most people, it's not painful in the way they expect, but it isn't necessarily sensation-free either.
The needles are extremely thin, much thinner than those used for a shot or blood draw, and many people barely feel them go in. What you're more likely to notice is the response once the needle reaches a sensitive muscle: a deep ache or pressure, a brief muscle twitch, or a quick cramping feeling that fades fast.
That twitch can be surprising the first time, but it's typically short-lived. I'll explain what to expect, check in throughout, and adjust based on your feedback. You're always in control.
Afterward, it's common to feel soreness in the treated area for a day or two, much like after a good workout. That's normal. If something feels different, such as sharp pain or rapidly climbing intensity, use the stoplight framework from my last post and let me know.
Question 2: How Does Dry Needling Work?
Dry needling rests on well-established physiology, and the effects show up at three levels.
Local tissue. A needle placed in an overworked, irritable area of muscle produces a measurable local response, including that twitch. Research has found changes in the chemical environment and blood flow around these areas afterward, and the muscle tends to settle down and move more freely.
Nervous system. Pain is shaped by how your nervous system processes input, not just by what's happening in the tissue. Needling delivers a strong, specific signal that can engage the body's own pain-modulating pathways, which is why relief often reaches beyond the exact spot where the needle went.
Movement. Less pain and a calmer muscle give you a window of opportunity. That's when I pair needling with active movement so the change sticks.
Why "Functional" Dry Needling?
The goal isn't to needle where it hurts and hope for the best. Needling is guided by a full movement evaluation, so we're looking at what's driving your symptoms, not just where you feel them.
My Approach to Treatment
Dry needling isn't one-size-fits-all. There are several treatment philosophies within dry needling, and which one I use depends on what's going on with you that day.
For most clients, I pair the needle with electrical stimulation (e-stim), which gives us options needling alone doesn't. To calm pain, I use settings that help modulate pain signaling. To wake up a muscle that isn't firing well, I use settings that facilitate it. For swelling or sluggish fluid movement, I use settings aimed at improving fluid dynamics.
And I stay with you the entire time. I'm not setting you up and walking away. I closely watch how the tissue responds, including the pattern of muscle contractions the e-stim creates. Early on, those are often asynchronous, and my goal is to help them become synchronous, or rhythmic, which is often a sign the tissue is responding the way we want. That monitoring lets me adjust in real time instead of guessing.
Safety and Informed Consent
Your safety comes first, and it's built into how I practice. Based on my training, before any needles are used, I walk through any contraindications or precautions that may apply to you specifically. Every client is different, so that conversation is based on your health history, your current conditions, and your individual situation, not a generic checklist.
We also go through informed consent together. You'll read through a consent document, and I'll answer any questions you have about the technique, what to expect, the potential risks, and the alternatives. You sign off on it before any needles go in. If you're unsure at any point, we pause and talk it through. If dry needling isn't the right fit for you, we'll use other tools.
Is Dry Needling Right for You?
It isn't for everyone, and it isn't a first step for every problem. Your evaluation helps us decide whether it makes sense for you.
Curious whether dry needling could help with something that's been bothering you? Reach out! I come to you, whether that's your home, gym, or office. Visit nicholsptandwellness.com to schedule your evaluation.
Until next time, keep moving.