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Athletic Trainers’ Use of Dry Needling in Practice

Dry needling has become a popular topic within Athletic Trainer (AT) state regulation resulting in efforts by states to address the issue of dry needling for ATs to use in practice. Brian Hortz, PhD, ATC is the Director of Research and Education at Structure and Function Education in Phoenix, Arizona and discusses the important things state regulators need to know about dry needling.

What is dry needling?

Dry needling refers to the insertion of thin monofilament needles, without the use of injectate. Dry needling is typically used to treat muscles, ligaments, tendons, subcutaneous fascia, scar tissue, peripheral nerve and neurovascular bundles for the management of a variety of musculoskeletal pain syndromes.1

How can it improve patient care?

Dry needling can improve patient care due to its three levels of effect, local, segmental and systemic. Locally, dry needling helps the body’s natural healing process by increasing blood flow, facilitating tissue healing, manipulating the local inflammatory process and encouraging the replacement of damaged tissues like nerve, collagen, fibroblast.2–5Segmentally, dry needling helps manage acute and chronic pain by influencing descending control mechanism’s at the spinal level needled.6–9 Systemically dry needling manages the inflammatory processes in the body through stimulation of the body autoimmune systems.8,10–13

Why are ATs interested in learning this skill?

Dry needling is commonly used by a wide variety of practitioners in an effort to help their patients. ATs can use dry needling for the management of many of injuries we treat regularly.Dry needling has been demonstrated to be effective for managing pain14,15, musculoskeletal injuries16–19, arthritis20–22, among other diagnoses. It is an effective and safe modality when used appropriately to treat patients. As such, ATs have been trained for dry needling in greater numbers as state boards have allowed the practice.

How are ATs qualified to learn and perform this skill?

Hortz et al. published an expert-opinion comparison of the competencies outlined in the “Analysis of Competencies for Dry Needling by Physical Therapists” and the” 2020 Standards for Accreditation of Professional Athletic Training Programs,” and the “Athletic Training Education Competencies – 5th Edition.” They concluded that “89% of the dry needling tasks were “provided through entry-level education” and 11% were not “provided through entry-level education” and were therefore deemed dry needling specific.23 Very similar to the education of physical therapists.24 Given this fact, dry needling courses and certifications are required to fill the 11% not already taught by entry-level education before an Athletic Trainer practices dry needling.


  1. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014;19(4):252-265. doi:10.1179/108331913X13844245102034
  2. Langevin HM. Acupuncture, connective tissue, and peripheral sensory modulation. Crit Rev Eukaryot Gene Expr. 2014;24(3):249-253.
  3. Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J Off Publ Fed Am Soc Exp Biol. 2001;15(12):2275-2282. doi:10.1096/fj.01-0015hyp
  4. Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L. The Influence of Dry Needling of the Trapezius Muscle on Muscle Blood Flow and Oxygenation. J Manipulative Physiol Ther. 2012;35(9):685-691. doi:10.1016/j.jmpt.2012.10.005
  5. Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic Effects of Dry Needling. Curr Pain Headache Rep. 2013;17(8):348. doi:10.1007/s11916-013-0348-5
  6. Griswold D, Gargano F, Learman KE. A randomized clinical trial comparing non-thrust manipulation with segmental and distal dry needling on pain, disability, and rate of recovery for patients with non-specific low back pain. J Man Manip Ther. Published online February 9, 2019:1-11. doi:10.1080/10669817.2019.1574389
  7. Srbely J, Dickey J, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010;42(5):463-468. doi:10.2340/16501977-0535
  8. Butts R, Dunning J. Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. Int J Phys Med Rehabil. 2016;04(02). doi:10.4172/2329-9096.1000327
  9. Butts R, Dunning J, Serafino C. Dry needling strategies for musculoskeletal conditions: Do the number of needles and needle retention time matter? A narrative literature review. J Bodyw Mov Ther. 2021;26:353-363. doi:10.1016/j.jbmt.2020.12.003
  10. Zijlstra FJ, van den Berg-de Lange I, Huygen FJPM, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003;12(2):59-69. doi:10.1080/0962935031000114943
  11. Park JY, Namgung U. Electroacupuncture therapy in inflammation regulation: current perspectives. J Inflamm Res. 2018;Volume 11:227-237. doi:10.2147/JIR.S141198
  12. Cho ZH, Hwang SC, Wong EK, et al. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand. 2006;113(6):370-377. doi:10.1111/j.1600-0404.2006.00600.x
  13. Cho ZH, Na CS, Wang EK, Lee SH, Hong IK. Functional Magnetic Resonance Imaging of the Brain in the Investigation of Acupuncture. In: Stux G, Hammerschlag R, eds. Clinical Acupuncture. Springer Berlin Heidelberg; 2001:83-95. doi:10.1007/978-3-642-56732-2_5
  14. Griswold D, Wilhelm M, Donaldson M, Learman K, Cleland J. The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis. J Man Manip Ther. 2019;27(3):128-140. doi:10.1080/10669817.2019.1589030
  15. Navarro-Santana MJ, Sanchez-Infante J, Fernández-de-las-Peñas C, Cleland JA, Martín-Casas P, Plaza-Manzano G. Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis. J Clin Med. 2020;9(10). doi:10.3390/jcm9103300
  16. Kalichman L, Vulfsons S. Dry Needling in the Management of Musculoskeletal Pain. J Am Board Fam Med. 2010;23(5):640-646. doi:10.3122/jabfm.2010.05.090296
  17. Lee JW, Lee JH, Kim SY. Use of Acupuncture for the Treatment of Sports-Related Injuries in Athletes: A Systematic Review of Case Reports. Int J Environ Res Public Health. 2020;17(21):8226. doi:10.3390/ijerph17218226
  18. Rahou-El-Bachiri Y, Navarro-Santana MJ, Gómez-Chiguano GF, et al. Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis. J Clin Med. 2020;9(7):2044. doi:10.3390/jcm9072044
  19. Fernández-De-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, et al. Is Dry Needling Effective When Combined with Other Therapies for Myofascial Trigger Points Associated with Neck Pain Symptoms? A Systematic Review and Meta-Analysis. Pain Res Manag. 2021;2021. doi:10.1155/2021/8836427
  20. Dunning J, Butts R, Young I, et al. Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multi-Center Randomized Clinical Trial. Clin J Pain. Published online May 2018:1. doi:10.1097/AJP.0000000000000634
  21. Ceballos-Laita L, Jiménez-del-Barrio S, Marín-Zurdo J, et al. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020;51:102443. doi:10.1016/j.ctim.2020.102443
  22. Sánchez-Romero EA, Pecos-Martín D, Calvo-Lobo C, Ochoa-Sáez V, Burgos-Caballero V, Fernández-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis. Published online 2018:8.
  23. Hortz, Brian V, Sue Falsone, and Duncan Tulimieri. “Current Athletic Training Educational Preparation for Dry Needling.” Journal of Sports Medicine and Allied Health Science 4, no. 3 (2019): 12.
  24. Joseph Caramagno, Leslie Adrian, Lorin Mueller, Justin Purl. Analysis of Competencies for Dry Needling by Physical Therapists Final Report.…
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