A Trail Runner’s Guide to Dry Needling

There’s a good chance you’ve heard of dry needling: Olympic medalist and world champ Emma Coburn, Olympian Colleen Quigley, pro Stephanie Garcia, and other high-caliber athletes, including climber Sasha DiGiulian, have shared their experiences about dry needling. And they’re not alone; it’s practiced around the world as a form of physical therapy.

Dry needling is a treatment technique that uses a thin, solid, thread-like needle to target specific areas of soft tissue. The aim? To stimulate myofascial trigger points (those irritable spots where you might feel pain or tightness in skeletal muscle fibers and adjacent fascia), muscle tissues, and connective tissue. Unlike a standard vaccine-delivering hypodermic needle, a “dry” needle is solid and doesn’t inject medication, or anything else under your skin. The needle pricks may be deep or superficial.

As both a runner and a coach (and a squeamish author), I and a handful of my athletes have tried it, with varying degrees of pain and relief across a range of body parts. Of course, every body is different—and complicated—and so too are injuries, experiences of pain, and discerning what exactly helps. But might dry needling work for you?

Let’s take a closer look at dry needling, whether it’s safe, and when, where, and with whom to try it.

Dry Needling as Physical Therapy

Dry needling was developed in the last century as a modality for treating musculoskeletal disorders. While more research is needed, as always, studies suggest it may help manage muscle pain. It’s not yet completely clear how or which scientific mechanisms make dry needling “work” when it comes to pain and recovery.

Delving more deeply into what dry needling is (and is not) feels contentious, in particular between lobbying groups of acupuncturists and physical therapists. This contention has lead to legislative and legal battles about who can do what with a dry needle and what is required (say, from the health board) before anyone gets poked.

Quite generally, acupuncture is a thousands-of-years-old practice originating in Chinese medicine. With years of education, training, and required certifications under their belts, licensed practitioners place very thin metallic needles into the skin to stimulate specific points on the body, often with a focus on Qi (“chi”), or the energy that flows around bodies. Sometimes treatment includes heat, electrical current, or manual therapy. Research suggests that acupuncture may help reduce chronic pain and headaches, among other ailments, including mental health.

Dry Needling for Runners

Ginna Ellis, a licensed acupuncturist and owner of Boulder Acusport in Boulder, Colorado, uses acupuncture needles to release trigger points for runners, among other techniques. A runner herself, she’s well aware of runner-specific issues, including those Coburn and other pros face. “We have a lot of trigger points,” she says.

Both acupuncturists and physical therapists use the same type of needles and, sometimes, similar techniques, despite acupuncture having a wider purview. State laws dictate how much training acupuncturists, physical therapists, and other practitioners need to wield dry needles, and those requirements vary from state to state. Some critics say more thorough training should be required of PTs.

Although other healthcare providers, including medical doctors, may use it, dry needling as an intervention for runners is increasingly performed by physical therapists.

Garrett Fischer, DPT, of Kauai Therapy and Wellness in Sandpoint, Idaho, is certified in dry needling and uses it to treat runners and a variety of neuromusculoskeletal conditions. He sees dry needling as part of a more comprehensive physical therapy care plan—not a standalone treatment.

“The research has taught us that dry needling has the ability to elicit biochemical, biomechanical, endocrinological, and neurovascular changes associated with reductions in pain and disability in our patients, meaning that dry needling can play a role in more than just trigger point therapy,” he says.

This may be helpful for conditions such as Achilles tendinopathy and plantar fasciitis. The addition of manual and electric stimulation may improve how tendons heal, improving “the structure, organization, and strength of collagen fibers,” says Fischer.

In this way, Fischer sees dry needling as part of treating the roots of a runner’s issues—whether pesky tendinopathy, shin splints, or low back pain—alongside biomechanical issues or strength and range of motion limitations.

Is Dry Needling Safe?

By most accounts, dry needling is safe when performed by a well-trained and licensed practitioner. There are a few horror stories, including a freeskier who suffered a collapsed lung potentially connected to dry needling. But one study in the International Journal of Sports Physical Therapy found that of 20,464 therapeutic dry needling sessions, 20 major adverse events (think: collapsed lung or pneumothorax, excessive bleeding, prolonged aggravation) were reported. (That’s less than 0.1 percent.) The same study found that 37 percent of reported treatments resulted in minor adverse effects, such as bleeding, bruising, and pain during the session.

Acupuncture has potential adverse effects, too, including infections and punctured organs.

Is Dry Needling Painful?

Anecdotally, this author can confirm discomfort associated with dry needling, especially on the top of the foot and inner lower leg, as well as the occasional twinge with acupuncture. The dry needling discomfort ranged from brief spasms and sharp, fleeting pain to slight muscle cramps and soreness, which resolved by 24 to 48 hours.

A small study of NCAA Division I athletes (mostly female) in the Sport Journal reported that 61 percent of participants found dry needling to be comfortable, and 52 percent agreed that it was effective for muscle pain management. Half would both try it again and recommend it to others.

In a dry needling session, expect a consultation, cleanliness, and the insertion of needles—some deeper than others. Treatments may include leaving the needles in the body for up to 30 minutes, potentially with manual (two to three needle rotations) or electrical stimulation (a continuous biphasic waveform set to a frequency of 2 Hz and pulse duration of 250 microseconds), says Fischer.

Other practitioners insert the needles momentarily and “tease” them, including twists and pulls.

Currently, six states prohibit physical therapists from performing dry needling: Hawaii, Washington, Oregon, California, New Jersey, and New York. But that number has decreased over the years; other state laws are silent on the issue.

To find a qualified, effective practitioner in your area, ask around. Running buddies, running community groups, and other potential trusted sources, such as a primary care doc, often have recommendations or referrals. From there, do your research.

Check for credentials. Look for certifications like “Cert. DN” or “FAAOMPT” (Fellowship with the American Academy of Orthopaedic Manual Physical Therapists) attached to physical therapists’ credentials. Look for acupuncture licenses. Ask the clinician whether (and how) they treat runners and running injuries, plus about training hours, continuing education, and any additional specialties, skills, or tools in their arsenal.

Of course, whoever’s needling should wear gloves and appropriate personal protective equipment. They should disinfect  your skin and only use sterile needles in a clean, safe setting. Plus, they should be able to keep track and properly dispose of all those needles so you don’t leave looking like a pincushion.