Physiotherapy treatment

Physiotherapy treatment: What are your biggest fears about dry needling?

Did your physician or physiotherapist recommend dry needling for your low back pain or neck pain? Your mind probably went, ‘say what now? Needles? No!’. But you couldn’t say it out loud for fear of being judged. So, here you are, on the internet, googling away; What is a dry needle and how big is it? Is it necessary? Does it hurt?

Let’s be real, nobody enjoys getting poked by a needle. It is said that about 1 in 4 people have strong negative emotions about needles. You shouldn’t find it surprising that you have frantically googled looking for information.

Whether you have experienced the benefits of Intramuscular Stimulation before or this is the first time you’ve been recommended it, we got you covered.

As physiotherapists who are skilled and also intentional about doing whatever it takes to guide your recovery, we want to respond to all your fears in a way that’s reassuring for you. What are your biggest fears about dry needling? Here we go.

Answer 1: I don’t know what dry needling is, it just sounds uncomfortable.

  • The word needle evokes that response in most of us, but it’s not as uncomfortable as it sounds. Allow us to explain; Dry needling is the umbrella term that refers to any type of treatment using a dry needle. It is an invasive, but highly effective procedure used by certified physiotherapists in a variety of musculoskeletal conditions.
  • It’s not always advised; it depends on your physiotherapists clinical reasoning and a thorough assessment of your low back pain or neck pain.
  • Dry needling usually splits up into Intramuscular stimulation (IMS) and Anatomical Acupuncture. It is based on Neuroanatomy, the musculoskeletal, and the neuromuscular system.

Answer 2: But the needle, tell me about it. how big is it? What if I bleed too much?

  • Bleeding is rare, but sometimes you may notice a small bruise around where the needle went in.  This will vary if you are on blood thinners.
  • Dry needles are fine filament needles, approximately 0.9mm in diameter. That’s about 16 times smaller than your average matchstick.

Answer 3: How much pain can I expect? 

  • The filament needle is thin, solid and flexible. The sensation you experience is different from the ‘needle pain’ you would usually anticipate. When the needle reaches a taut band of muscle, sometimes a twitch can be felt.  The twitch Is a response of the muscle and often an immediate reduction in pain and/or improvement in function is felt.
  • As your physiotherapists, we are committed to ensuring your experience is as comfortable as possible, pleasant and effective.

Answer 4: Somebody suggested acupuncture, I just cannot decide between the two.

  • This is completely fair as both procedures use the same type of needles. Allows us to explain the differences.
  • Intramuscular stimulation (IMS) is based on palpation and targeting tight trigger points and muscle knots in the body. Acupuncture is based on releasing energy patterns in the body based on energy meridians.
  • IMS usually only takes a couple minutes because we poke the needle, manipulate it, and take it out. Acupuncture takes longer, it usually requires the practitioner to use multiple needles and is required to leave the needles untouched on the body for 15-20 minutes.

Answer 5: Trigger points, how did I get those?

  • Repetitive stress or injuries that are not healed can result in trigger points. Repetitive stress can look like poor posture while carrying out day to day tasks. Injuries can be a result of a sudden movement or impact on particular parts of the musculoskeletal system. For example, adopting a slouched posture while working at your desk or a whiplash injury following a car accident can all result in trigger points.
  • The injured bit of the muscle, due to repetitive stress or microtrauma, can become tight or taut which the muscle group hyperirritable and painful.
  • These trigger points or nodules can be felt when we palpate your muscles to look for them. We know we have found the right spot when touching it causes radiating pain (pain that spreads along the nerve) or localized pain.

Answer 6: So, the trigger points are poked into?

  • Yes, pretty much. IMS or dry needling requires taking a thin single use dry needle to pierce the skin and hit trigger points. Its main cause is to reset the tissue and cause an inflammatory response so the trigger points heal properly. You may feel a spasm of the muscle when a trigger point is hit. You will feel sore during and after the session. It feels like a post workout soreness.
  • It is a powerful modality because it allows us to go much deeper to hit deep muscles and innervate the nervous system.

Answer 7: Well, are the needles clean?

  • All the needles we use are single use, sterile, and disposable.

Answer 8: How long will the poking go on for?

  • It usually takes 5-10 seconds to go in and out, for each trigger point. Depending on the severity, necessity and patient tolerance we will decide how many we will do per session.
  • That’s not all, IMS is always adjunct with exercises. You will receive physiotherapy for your low back pain and neck pain as indicated. You will be given an exercise prescription for strength and endurance training, posture correction and stabilization.

Answer 9: Can I walk in to any physiotherapy clinic to receive this treatment?

  • The Intramuscular stimulation (IMS) education is NOT part of the Master’s program of Physiotherapy. Additional courses must be taken to get the dry needling certification in which one typically needs 4 years of practice.
  • You will want to make sure your physiotherapist is certified to practice dry needling. Always remember you have a right to ask and confirm their certification.

At Revere, we are experienced physiotherapists with certifications to practice this highly effective technique. We have seen it work on hundreds of patients over the course of our career, most of whom started out just as apprehensive as you.

We are committed to ensuring you are comfortable and your healing is thorough. That’s why we offer IMS/Dry needling services at no extra cost. You will be billed at our regular physiotherapy rates.

We hope this helps make your decision easier. At Revere, you are in good hands!

If you live in East Vancouver, Book now and drop in to our clinic, we are open between 9 am and 6:30 pm, Monday through Saturday.

If you have any questions or concerns reach out at We offer complimentary phone consultations for you to decide if we’ll be a good fit. Give us a call at 604-566-5108.

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