There are patients who like to pepper you with questions to try to understand why a certain treatment is appropriate for their given condition. These are patients that we really enjoy (not that we don’t enjoy our other patients, who allow us to do what we do without inquiries). It just gives us an opportunity to explain our thought process, and of course, it is always gratifying to see patients connect the dots; this usually bodes well for quicker healing. Dry needling is always a treatment that elicits curiosity. To the best of our ability, we will attempt to break down the thought process to explain why it is appropriate for certain conditions.
Mechanical Pain (Pain That Can Be Fixed With Exercise)
Before considering dry needling, let’s address something less straightforward: pain originating in the spine. It’s important to determine whether a condition can be resolved quickly with exercises, because if you can fix yourself, what is better than that? Dating back to 2023, when I was suffering through two disc herniations that were causing pain to go down my back and into both of my big toes, it was straightforward that I was having radicular pain (pain coming from a spinal nerve root(s)) coming from spinal discs that had been compromised. The pain pattern was clearly defined as an L5 nerve root dermatome pattern, visible in yellow below the waist (See below).
Now, was my condition mechanical pain? Yes, to a certain extent it was, and I know this because there were exercises and positions that brought immediate relief to my pain where I could actually feel the pain area getting smaller, not ending in my toes but ending in my lateral legs, or into my lateral thighs and hips, and finally back to the center of my back. We call the movement of pain from a distant position to a closer position centralization, and that is a very good thing. This occurred over a nine-month period, which would indicate my condition wasn’t purely mechanical (it would have resolved much faster if it were). Could my bout with pain have been shorter with dry needling? It very well could have, depending on whether other areas outside the disc and spinal nerve roots were causing irritability. This is why it’s important to rule out mechanical pain first. This leads to the next question of where else the pain could be coming from?
Other Areas That Can Be Contributing To Low Back Pain
Although, dry needling can’t change the physical pressure being put on a nerve root by a herniated injured disc, or the injured disc itself that may be causing an inflammatory environment that affects a spinal nerve root (producing a sclerotome pain pattern, look that up), it can affect these other areas listed below by location and the specific nerve that supplies that location.
Intervertebral Disc (Annulus Fibrosus)
The Sinuvertebral Nerve innervates the outer 1/3 of a spinal disc, which is why it hurts like heck when it’s herniated (see the red line above).
Facet Joint
Medial (Anterior) Branch of Dorsal Ramus Nerve supplies each facet joint (the two nobs contacting each other), which gets dual innervation: from the same level and one above. Example: L4–L5 facet joint is innervated by L3 and L4 medial branches.
Muscles and Tendons (Paraspinals: multifidus, erector spinae, etc.)
Dorsal (Posterior) Rami of Spinal Nerves. These nerves provide motor and sensory innervation to deep back muscles (the blue area is the multifidus muscle, a deep back muscle that is a major stabilizer of your spine). Trigger points and strain can cause referred pain.
Ligaments (e.g., ligamentum flavum, interspinous, supraspinous)
The Dorsal Nerve and the Sinuvertebral Nerve supply the stated ligaments above. Ligaments are rich with pain receptors that can easily be the source of your pain.
Bone (vertebral body, pedicles, laminae)
The Sinuvertebral Nerve innervates the periosteum of the vertebrae, which houses blood vessels and nerves that supply the vertebrae’s bone
Don’t worry or get confused about the details of these nerves. If you’re curious, go look them up. It is important to appreciate the many different areas that contribute to spine pain. The great thing is dry needling is accessible to these areas of pain and can immediately lower the level of pain significantly, which allows you to feel good enough to perform customized exercises and return to your previous activities.
So What Happens When These Different Areas Are Affected?
Although dry needling can’t change the physical pressure of a nerve root being irritated by a herniated disc, or the damage to the disc itself, it has many benefits that will get you back to a pain-free status. This is quite extensive when gone in detail. So we’ll summarize the main points from Butts et al (2016), a 225-article literature review.
Dry needling does a great job of decreasing inflammation by essentially poking holes in the affected tissue (muscles, tendons, ligaments, and bone). This very minor damage to the affected tissues releases immune-cell signaling molecules (ATP, adenosine triphosphate) and proteins (bradykinin and substance P) to signal immune cells to come and clear up any “pre-poke” inflamed or damaged tissue areas; essentially resetting the healing process that may have gone stagnant. Tissues that have been protective guarding secondary to acute injury or chronic pain are now able to relax as more oxygenated blood floods into the area.
Pain nerve receptor sites of the affected tissue also get turned down (become less sensitive to alert the body of pain) as the ATP that was released by tissue that has just been poked by the dry needle breaks down into adenosine molecules, which flood the area by 24x the concentrated amount. Adenosine binds to these specific pain nerve receptors in the affected area which shuts down the sensing of localized pain. Pretty cool!
On top of that, dry needling stimulates the body’s feel good chemicals such as endorphins that are secreted up in the brain by your hypothalamus/pituitary gland complex and travel all the way down to the pain nerve receptors at the site of irritability to bind to receptors and stop pain. Another chemical, serotonin, which is produced in areas of our brainstem also are stimulated by dry needling to gate pain signals at the spinal cord level. There are tissues of our body that don’t receive adequate blood supply to attain healing after injury, especially if we haven’t been physically active to promote healing. Dry needling coupled with electrical stimulation has been shown in studies to provide an even more robust effect in providing further reach in blood flow to quicken the healing process by damping down pain.
As Always, What Does The Research Say?
In terms of osteoarthritic knee pain, the research is compelling as evidenced by Dunning’s 2018 randomized controlled trial. The study looked at 235 subjects who met the criteria for knee osteoarthritis and were split into two treatment groups. The results suggest that an average of 9 sessions of manual therapy and exercise plus electrical dry needling to subjects knees, using the same dry needling with electrical stimulation protocol (which was not observed in previous studies) targeting the knee locally at a frequency of 1 to 2 times per week over 6 weeks, resulted in greater improvements in pain (pain levels were 50% less)/stiffness/function (WOMAC, Score of 0 = Best), related-disability, and decrease in medication intake than the group who only received manual therapy and exercise alone; even up to 3 months after the start.
Tayyab Et al’s (2025) systematic review and metanalysis looking at only randomized controlled trials in regards to dry needling of tendinopathy issues of the patellar tendon, lateral elbow, and shoulder rotator cuff pain, saw results showing that dry needling with exercise produced moderate clinically relevant improvements in pain and function, with the highest effects observed at mid- and long-term follow-up (at 3-6 months) compared to subjects receiving exercise treatment alone. The common theme observed is the lasting effects of dry needling when exercise continues beyond the treatment end date. Dry needling appears to enhance recovery from injury when combined with exercise and aligns with my anecdotal observations with patients experiencing lower back pain. Electrical stimulation with dry needling to the lower back has been particularly effective in significantly decreasing pain, in as few as 1-5 sessions.
Take Away Message
As shown, dry needling is a great tool to decrease inflammation, reduce pain, and promote healing by improving blood flow. It also promotes cell-building processes within the body to restore injured tissues and stimulates the release of the body’s own anti-pain hormones. This will allow you to be able to resume therapeutic exercises because your pain levels will be lowered. This is key to attaining long-term function, pursuing your goals in life, and achieving your independence. It should be seen not as the main part of getting well (exercise will always be that), but as a valuable additional treatment that can help you break out of acute or chronic pain cycles and return to proactive solutions that get you physically moving. If you need guidance on getting on with your recovery, reach out. We got you from beginning to end, Mobile Spine Family!
Resources
Butts, R., Dunning, J., 2016. Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals. Int J Phys Med Rehabil 04.
Dunning, J., Butts, R., Young, I., Mourad, F., Galante, V., Bliton, P., Tanner, M., Fernández-de-las-Peñas, C., 2018. Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial. The Clinical Journal of Pain 34, 1149–1158.
Tayyab, M., Ahmad, Z., Tanveer, M., Ahmad, M., Akbar, R., Shah, S., Syed, R., Khan, A.A., Khan, A., Ali, M., Shabir, M., 2025. Effectiveness of Dry Needling Combined With Exercise Versus Exercise Alone in Various Tendinopathies: A Systematic Review and Meta-Analysis. Cureus.
