What Happens When Dry Needling Hits A Nerve?

Are you interested in dry needling but worried about injury to a nerve? First, let us start by saying you are not alone. Almost everyone thinks about the sharp “zap” feeling or if they will have nerve damage or experience numbness.

Just thinking about the needle hitting a nerve is scary enough, especially with chronic pain. Can dry needling cause nerve damage?

Maybe you have read things on social media or the internet about a serious injury or complication with dry needling, plus you’re afraid of needles to start with. Now you are wondering, are the risks worth the benefits? This is an entirely natural and valid assessment.

The good news is that, while nerve contact does occur in some dry needling treatment sessions, the complication rate is low, and complications with injury are infrequent. Most nerve contacts are brief and a non-event, with only minor and temporary feelings or sensations.

By learning and understanding what happens when dry needling hits a nerve, you can have a little more assurance and be aware of your choices for treatment.

How Dry Needling Works?

Dry needling for nerve pain involves the insertion of fine, sterile needles into muscle knots that we refer to as trigger points. Trigger points are hyperirritable areas within taut bands of muscle that result in pain and limited mobility. When muscles are overworked or injured, they can enter an energy crisis in which the muscle fibers do not receive enough blood flow.

The Science of Muscle Trigger Points

When muscles are deprived of proper oxygenation and nutrients, the tissue becomes more acidic. Muscle acidity increases the sensitivity of your nerves, resulting in soreness and needle pain. The affected muscle fibers then become tight knots (i.e., trigger points) that can refer pain to other parts of the body.

Trigger points contain high levels of inflammatory chemicals (substance P, cytokines, and pain mediators) that keep the muscle in a constant state of contraction and sensitivity.

How do the Needles Create Healing?

The use of needles is beneficial in alleviating muscle tension and inflammation through a couple of mechanisms. When the needles are inserted into trigger points, one of the mechanisms is causing muscle contractions, or twitches, to help reset the dysfunctional muscle pattern. A local twitch response is usually a good sign that the treatment is working.

Dry needling also triggers the release of your body’s natural pain relievers called endorphins. Additionally, the needle stimulation blocks the transmission of pain signals heading to your brain via the gate control theory of pain. A common side effect of the stimulated damage is an almost instantaneous relief of pain for many patients.

Improved Blood Flow and Healing

Another critical and well-recognized effect of dry needling is its ability to improve blood flow to the affected tissue. The improvement in blood flow reduces toxins in the area and improves oxygen delivery. Improved blood flow positively influences the cycle of muscle dysfunction and promotes healing.

When dry needling occurs in the affected area, the needle will also induce vasodilation. Vasodilation aids in healing by delivering healing chemicals to the damaged tissue. It is also beneficial in flushing out any metabolic waste products that can contribute to muscle pain and stiffness.

Different from Acupuncture

Dry needling differs from acupuncture and has a different approach and philosophy. It embraces and follows modern medicine principles that are based on musculoskeletal anatomy and neurophysiology. Physical therapists and medical doctors perform dry needling for the specific treatment of muscle/joint dysfunction.

While acupuncture centers on energy meridians, dry needling focuses on specific anatomical structures. The therapy is rooted in scientific evidence regarding the anatomy of trigger points and muscle dysfunction.

Needle Properties and Application

The needles are extremely thin – only 0.16 mm wide, and completely sterile. They are inserted directly into the problem areas in the muscle when dry needling, without injecting anything into the body. This is precisely why the terminology “dry needling” is employed – nothing goes into the body except the needle.

The needles stay in place for generally 10 seconds to 20 minutes, pending the therapist’s goals and the site of dry needling within your muscle. The therapist may instruct you to move your muscle, which may cause the needle to move slightly as well, in an attempt to generate the muscle twitch response that is the goal of the dry needling.

The muscle twitch response facilitates natural healing and improves pain through multiple biological mechanisms. You may feel immediate relief after dry needling, and the technique is most effective when combined with exercise and other physical rehabilitation techniques.

Common Conditions Treated With Dry Needling

Dry needling has the potential to treat a wide variety of health problems involving various systems in the body. Some examples are chronic back pain, chronic neck pain, shoulder pain that has not responded to traditional techniques, headaches, migraines, and general trigger points in your neck and scalp muscles.

1. Musculoskeletal Conditions

The most common conditions treated with dry needling include myofascial pain syndrome, which occurs in the fascia connective tissue surrounding the muscles. Another example is temporomandibular joint disorders (TMJ), which benefit from needling the underlying jaw muscles. Other joint problems, including the hip, knee, and ankle, benefit from trigger point release in the musculature surrounding these joints.

Similarly, spinal conditions seen by physical therapists, including herniated disks and chronic back problems, can improve significantly with dry needling. Dry needling can decrease muscle guarding and spasm around the injured vertebrae. Whiplash injuries from a car accident often resolve faster with dry needling in the treatment plan.

2. Sports and Athletic Injuries

Also, athletes (especially those in sports medicine) utilize dry needling for both sports injuries/rehab and performance enhancement. One common sport injury/dysfunction is tennis elbow, which resolves faster with dry needling of tight forearm muscles, leading to improved grip strength.

Running injuries such as IT band syndrome, calf strains, and pulls can also resolve more quickly with the application of dry needling for a specific muscle or muscle group. Plantar fasciitis (a common running condition) can be treated with dry needling of the calf and foot musculature. Dry needling can also improve muscle weakness by restoring proper muscle activation patterns.

3. Chronic Pain Conditions

It is also possible and likely that those with fibromyalgia may benefit from dry needling due to decreased widespread muscle tension and pain sensitivity. Chronic fatigue syndrome patients benefit from improved muscle function and decreased pain. Restless leg syndrome also improves when the trigger points of the leg musculature are released and relaxed.

4. Nerve-Related Conditions

Neuropathy and nerve-related issues, such as sciatica and carpal tunnel syndrome, are significantly improved with dry needling. Various doctors adopt the technique to treat neuropathy and pinched nerves by decreasing the muscular compression on compromised nerves. Dry needling can also be used following amputation to treat phantom pain.

Cases of post-shingles pain, otherwise known as post-herpetic neuralgia, seem to benefit when needling of the affected skin region is done carefully. Pain associated with other pelvic pain conditions, which entails nerve irritation, also benefits from the trigger-point release of troubled pelvic floor muscles.

Tendon-related and overuse injuries seem to respond to dry needling as well. Various studies have already demonstrated its effectiveness in treating tendinopathy. One of the essential mechanisms of benefit appears to be increased blood flow and a pronounced healing of the collagen tissue itself.

Tennis elbow, golfer’s elbow, and Achilles tendonitis are a few examples involving tendinopathy that respond favorably to dry needling; increased blood flow helps with tissue repair following a period of muscle overuse that promotes chronic inflammation.

The Benefits of Dry Needling

Dry needling appears to help treat repetitive motion disorders that occur from prolonged computer use and/or manual labor. In many cases of carpal tunnel syndrome, it is common to provide dry needling and observe symptom recovery once the trigger points in the forearm muscles are released.

One of the most notable benefits of dry needling is its ability to provide fast relief from muscle pain and tension. Most patients truly experience relief during their first and certainly second treatments. It is also common for patients to experience immediate improvement in symptoms.

1. Immediate Pain Relief

Multiple mechanisms of the treatment make for rapid pain reduction. When needles stimulate trigger points, they produce a “good” muscle twitch, which releases muscular tension. This immediate response helps to break the pain-spasm cycle that keeps your muscles in a tight state.

Concerning dry needling, there is also a pain control issue through the gate control theory. Needling stimulates several areas, which block the pain signals from reaching your brain. In doing so, it provides you with almost instantaneous relief that lasts for hours and even days after treatment.

2. Improved Blood Flow & Healing

The treatment is effective in acutely improving blood flow to the injured area. This will increase circulation to areas that are damaged, bringing fresh oxygen and nutrients to the damaged tissues. Improved blood flow offers the additional benefit of removing toxic waste products that contribute to nerve damage and inflammation.

Research has demonstrated that dry needling increases levels of oxygen saturation values around the treated area, which accentuates the body’s ability to heal itself. Enhanced circulation helps to relieve swelling and initiate tissue repair.

3. Improved Range of Motion

The treatment significantly improves your range of motion by releasing restrictions in the muscle. When your tight trigger points are released, you can move your joints more easily. The treatment also restores normal muscle length and flexibility, reversing the shortened state that caused the problem.

This improved ability in range of motion and flexibility takes place very quickly and is typically noticed after the treatment as a result of needling. Improving your range of motion can help lower your risk of future injuries.

4. Breaking Pain Cycles

Dry needling can deactivate pain cycles you may have been experiencing for years. If you have chronic pain, your nervous system may be more sensitive to pain over time. In these cases, minor issues or problems feel worse than they should.

Dry needling treatment can reset your nervous system pain response and decrease hypersensitivity that can develop with chronic pain or medical conditions. Your body can still receive pain signals appropriately, as it did in the past.

5. Natural Pain Relief

The treatment releases natural pain relief chemicals called endorphins throughout your body that can be more powerful than most medications. It tends to produce lasting pain relief without long-term side effects of dry needling through the endorphins released during the treatment.

It can also encourage the release of natural anti-inflammatory chemicals that reduce swelling and tissue irritation. This provides a healing environment that helps with the healing process.

6. Complementary Treatment Benefits

Dry needling works well with other treatments such as exercise, massage therapy, and physiotherapy. Combining treatment with exercise and stretching practices can provide additional benefits. Patients report fewer treatment sessions needed when more than one treatment is applied together.

Dry needling can make other treatments more successful by reducing muscle guarding. When muscles are more relaxed, manual therapy and exercise can be more effective. A combined approach often leads to the best long-term outcomes.

What Happens When Dry Needling Hits A Nerve?

When a needle comes into contact with a nerve, the sensation you feel is totally different from the sensation of muscle pain. You may feel a strong jolt or zap, often described as if you’ve touched a “live wire.”

In fact, that sensation does come in the form of a sharp jolt. However, the most common sensations people describe are those of tingling, wherein the tingling travels down the arm or leg along the path of the nerve. Here’s a brief idea of what happens when dry needling hits a nerve.

• Immediate Symptoms

The most common and immediate symptoms of hitting a nerve will be sharp, shooting pain that travels along a nerve tract. The pain may radiate to an area distant from the insertion location. The pain will be different than normal muscle soreness, as it will feel electric.
Some individuals may experience immediate numbness or tingling in the area involved. The area may feel different again immediately after contact with the needle and can feel like “pins and needles.” These are normal responses to stimulation and irritation; no two reactions are the same.

A burning feeling may be present, but, as mentioned, an electric feeling usually will be there. Specific individuals may involuntarily jerk or flinch when contact is made. And again, the affected area may feel hyperactive or hyper-reactive to touch immediately after contact is made.

• Temporary Effects

In rare cases, dry needling negligence can result in temporary numbness that persists longer than the needle’s removal. The area may feel weak for a period of time, and this could affect the ability to move normally. Typically, the numbness will go away in 24-48 hours, and the nerve will recover.

Muscle twitching and spasms may last several minutes after removing the needle. The area may remain tender and sore, similar to the soreness you may expect after an acupuncture session. Some patients report a feeling of “heaviness” or altered sensation, which resolves but may take longer than expected.

• Inflammation and Healing Response

Nerve contact may provoke a localized inflammatory response in the area around the affected nerve. This inflammatory response may cause swelling and redness in the local area and increase tenderness. They are a natural response in your body’s healing response, but often aggravate symptoms temporarily.

The inflammatory response usually peaks over the next 24-48 hours after getting the needle, before fading. You may notice increased sensitivity in the nerve’s distribution area and the surrounding areas. Ice is an excellent anti-inflammatory measure to decrease these sensations.

Potential Long-term Effects

While serious, dry needling side effects from nerve contact are infrequent with treatment done by a trained professional, they may include prolonged numbness in an area lasting longer than a few days. Some people may have weakness (without severe damage) that lingers longer than expected and affects normal daily activities.

Persistent tingling or altered sensation may occur in infrequent situations, especially when the nerve has already been compromised earlier. In rare cases, chronic nerve pain may develop after dry needling if the nerve is severely irritated by needle insertion.

• Serious Complications

In these sporadic instances, nerve damage could lead to neuropathy affecting sensation or movement in the distribution of the nerve. Patients may experience long-lasting numbness, weakness, or pain in the distribution of the nerve involved. Significant motor dysfunction may accompany damage to the motor nerve.

It is important to restate that permanent nerve damage is exceedingly rare with the procedure of dry needling being performed by a trained professional. The risk for permanent nerve damage can be significantly reduced through training, precise placement of the needle, and recognizing and reacting appropriately to feedback from the patient.

How Should You Minimize Risks During Dry Needling Treatment?

The most critical first step to minimizing any risks of dry needling is to see a trained professional. Physical therapists and licensed doctors undergo extensive training in anatomy, including detailed information about nerve pathways and areas of the body to avoid when performing needling.

• Practitioner Credentials

It is recommended that dry needling treatment be performed only by practitioners who have taken thorough training courses. For introductory needling courses, you can expect a minimum recommended total of 16 hours of training to cover basic needling techniques. Advanced or complex techniques, such as needling of the trunk and cervical region, would require more than basic training.

To ensure overall safety, it is strongly advised that you only receive treatment from therapists who are current in their certifications, continuing education requirements, professional affiliations (e.g., membership), and knowledge of the safety protocols involved.
Don’t be afraid to ask your practitioner about the training they have completed in relation to dry needling and how long they have been practicing. It is more important to be safe when looking for a practitioner rather than having to stop due to neurovascular system issues (e.g., pain or immobility of an arm and/or lower extremity).

Your therapist is responsible for performing dry needling within their scope of practice and treating only conditions they are adequately trained in. They should also maintain insurance coverage for dry needling procedures (professional liability insurance coverage).

• Communication during Treatment

Throughout your treatment, you should always inform your therapist of any sensations you are experiencing. If you feel anything odd, such as electric shock, sharp shooting pain, or tingling, let your therapist know right away. Please do not try to “tough it out” and ignore weird feelings, as it puts you at greater risk.

Your therapist should also inform you about what feelings and sensations are normal during the treatment. Along the way, they should also be giving you status updates. If you cannot convey your feelings or convey them regularly due to some form of anxiety or other reasons, dry needling may not be right for you.

Also, use clear descriptive words to explain your sensations instead of the generic “it hurts.” For example, you could say “it feels like an electric shock” or “it is a sharp shooting pain.” This will allow your therapist to understand more precisely what you are experiencing.

• Assessment of Medical History

Your therapist should conduct a thorough assessment of your medical history before the initiation of treatment. Your therapist will want to know about prior nerve injuries, surgeries, and neurological conditions, which could contribute to your risk. The therapist should also conduct a discussion focused on your medical history that would contribute to a safer approach to treatment.

You should tell your therapist about all medications you are taking, particularly blood thinners, as they are very relevant. Some medical conditions, such as diabetes or immune system conditions, may lead to delayed healing. You should also inform your therapist of any previous needle reactions or fainting events.

Your therapist also needs to be made aware of implanted devices, such as a pacemaker or metal hardware of some sort. Also, the presence of prior infection or current inflammation should be given additional follow-up consideration.

• Safety Protocols

Practitioners in good standing will have strict safety protocols according to their professional organization. Every patient will receive needles that are sterile and single-use, without exception. Part of every procedure will include properly cleaning and disinfecting the area of treatment before initiating treatment.

• Infection Control

All needles must also be in an unexpired packaging condition for the date of treatment. Practitioners need to handle needles by the shaft and never touch the needle tip. If the needle is contaminated, it must be removed from the procedure immediately.

Hand hygiene is essential- therapists must wash and disinfect their hands and nails before and immediately following treatment. Many practitioners also wear gloves for additional protection. The area of the body being treated must also be disinfected and completely dry before the insertion of the needle.

Used needles need to be immediately placed in the sharps container approved by your local facility. A used needle is never permitted to go back into the packaging or into general trash.

Treatment Space Standards

The treatment space must be clean, private, and have an adequate amount of light to support safe placement of the needles. There must also be enough space allowed for a sterile area to set up equipment. You should expect a hand-washing facility to be close by.
Emergency planning and equipment must be available for any adverse events. The practitioner should have basic first aid supplies on hand and should be trained in response to complications.

Anatomical Precautions

If treating areas with heightened risks of nerves, it will be important for your therapist to identify the location of nerves before inserting needles. Often, practitioners will insert needles slowly and carefully, being attentive to the resistance of the tissue. The practitioner must choose the direction of needle insertion carefully to avoid concerns such as arteries, nerves, and organs.

Whenever something is reported to be a nerve sensation, needles will be withdrawn immediately. The practitioner should reposition their view to address the anatomy before proceeding again.

Different areas or regions of the body would require more consideration and care when inserting needles, including the neck or upper chest, and some regions around major nerves. Some practitioners will refer to the use of ultrasound guidance when there are significant areas of concern about anatomy or safety.

Documentation Requirements

Your therapist will have progress notes that detail your treatment. If there needs to be a record on the insertion and progression of the needles, your therapist should document the depth of the needle, patient response to needle insertion, locations where needles were inserted, and any undesirable incidents.

They will also provide detailed or summarized consent information. Informed consent will involve educating you on the risks and benefits, as well as a review of your consent for your treatment. Another common clinical standard will be providing written informed consent about your treatment. This will give you information about what to expect, warning signs, and when to contact the clinic.

What Should You Do If Dangers of Dry Needling Occur?

If you are experiencing nerve symptoms during your treatment, immediately speak up without hesitation. Your therapist will stop right away and carefully remove the needle at that time. The practitioner should also examine the symptoms to determine if the treatment needs to be adjusted or if it was something minor that does not require a change.

The practitioner should write down exactly what happened and describe the symptoms. They may test your sensation and movement in the area affected. Ice may be recommended to help with any inflammation.

Your therapist should then explain what happened, recap it with you, and, if they are going to treat you again, decide whether or not to proceed or treat other areas and avoid the area causing you problems.

After treatment, you should watch how you feel very closely for 24 to 48 hours following the needle treatment and speak to your therapist about what you experience after treatment with respect to your endurance symptoms.

If your symptoms take longer than expected to improve, don’t hesitate to get in touch with your therapist right away. If your symptoms worsen instead of improving, please get in touch with your medical provider as well.

Please keep a diary of what symptoms you are experiencing with respect to sensation, strength, and pain level. This can help your health care team monitor your recovery.

If your therapist recommends gentle heat to the area where the needle treatment was done, please apply heat only to that area, following the therapist’s recommendation. Most of the time, ice is the preferred treatment to help reduce inflammation when appropriate. You should also limit aggressive movement of the area for a day or two after treatment, to allow time to heal.

If your therapist has recommended some gentle nerve gliding exercises, these may potentially help facilitate the recovery process. It has been shown that gentle movement can minimize scar tissue formation and enhance healing. Follow your therapist’s directive regarding activity limitations or engagement.

When to Get Emergency Care?

If you experience severe or worsening symptoms related to your nerve injury, you should seek medical attention. Severe or worsening symptoms include: worsening weakness, complete numbness, or severe burning pain. If you have symptoms of infection (e.g., fever, red streaking, excessive swelling), be sure to get care right away.

If you develop difficulty breathing, chest pain, or symptoms of pneumothorax after undergoing chest needling, get emergency medical attention right away. Always get prompt evaluation of any unusual systemic symptoms.