Frequently Asked Needling Questions - Answered

  •   June 7, 2019
  •  Nancy Littke, PT

Over the years an increasing proportion of physiotherapists have incorporated the use of needles (acupuncture, intramuscular stimulation needling) into their practice. As with any other type of treatment, it is important that you have a good understanding of these treatment approaches, so you can make an informed decision if your physiotherapist suggests needling as a part of your treatment.

Can every physiotherapist use needles in practice?

No. The Government Organization Act (GOA)1 identifies which health services are considered restricted activities. Individual health-care professionals must be authorized by their Regulatory College to perform the activities identified by the GOA. The use of needles in practice is a restricted activity and Physiotherapy Alberta - College + Association authorizes physiotherapists to use needles in practice if they meet requirements for authorization.2 Approximately 52% of Alberta physiotherapists have received authorization to use needles in practice. Your physiotherapist’s practice permit will identify if they have received authorization. You can also search for a physiotherapist who is authorized to use needles in the Find a Physiotherapist feature.

How do physiotherapists use needles?

Needling, when used by physiotherapists, is not a stand-alone treatment. It is used in combination with other physiotherapy treatment methods, such as exercises and manual therapy, to reduce pain and help improve movement and function (the ability to do day-to-day activities).3 It is another tool in a physiotherapist’s toolbox. There are two approaches to needling that are commonly used by physiotherapists: acupuncture and intramuscular stimulation.

Acupuncture is the practice of inserting thin, solid core needles into specific points in the body. It is sometimes done with manual or electrical stimulation to produce changes in nerves, muscles, connective tissue, hormones and circulation to improve function and reduce pain.3 There are two approaches to acupuncture which sometimes overlap. Traditional Chinese acupuncture is based on a belief that the needles stimulate energy flow in the body.3 Western medical acupuncture adapts the traditional Chinese approach and applies a scientific method to understand and explain its effects.3

Intramuscular Stimulation (IMS) involves inserting thin, solid core needles into tight, irritable muscles. It has been suggested that the approach creates changes to muscles and connective tissue near the needled areas.4 Needling may also stimulate nerves to help releases the body’s own painkillers.4

What is the evidence?

Although the number of physiotherapists using needles in physiotherapy practice is growing every year, there are two very different opinions about this treatment in the physiotherapy community, those that support, use and promote dry needling as a valuable component of physiotherapy treatment and those that do not believe the current research/evidence supports this use in physiotherapy practice.5 The evidence supporting the use of needles in physiotherapy is growing, however; much of the support for the technique comes from practitioners and their clinical experiences and observations.6

Here is what we do know:

  • There is a great deal of research activity around the use of needles in practice around the world.
  • There is still not clear evidence about how, why, or when needling is effective in the treatment of musculoskeletal conditions.5
  • The most recent studies suggest that needling may have short-term benefits and may be more effective in reducing pain and improving overall treatment outcomes than no treatment.6
  • There is evidence that needling may be more effective at reducing pain than soft tissue manual therapy techniques.6
  • When it comes to the long-term benefits of needling, the evidence is currently lacking.6
  • There is no evidence that needling alone is better than other physiotherapy treatments.6

A recent systematic review of the current literature concluded:

“When dry needling is utilized in appropriate patients, it may aid in decreasing musculoskeletal pain, allowing for additional, more active physical therapy interventions to maximize functional outcomes and reduce patient disability.”6

Are there complications I should be aware of?

Yes. Any technique that punctures skin has a risk of complications. It is important you know the risks before treatment. Your physiotherapist should discuss these risks before you consent to the treatment.

Common minor complications that usually resolve on their own include:3,4

  • Bleeding or bruising at the needle site
  • Pain during or following treatment
  • Post treatment drowsiness or fatigue

Less common complications that range from mild to significant include:3,4

  • Aggravation of symptoms
  • Feeling faint or shaky
  • Nausea
  • Headache
  • An emotional reaction
  • Numbness or nerve irritation

Serious complications are very rare and may include:3,4

  • A stuck or bent needle (may require medical attention)
  • Breakage of a needle in the body
  • Infection
  • Puncture of vital tissue (e.g., a puncture of lung tissue causing it to collapse which is called a pneumothorax)

Can I reduce the risk of these complications?

There are strategies you can use to reduce the impact of any of these potential complications:3,4

  • Inform your physiotherapist of any changes to medications such as blood thinners or pain relievers
  • Eat and be well rested before your appointment
  • Tell your physiotherapist if you have any concerns or fears related to needles, including past experiences where you have fainted from receiving a needle
  • Let your physiotherapist know if you experience pain, dizziness, nausea, shortness of breath or if you are feeling unwell either during or after your treatment
  • Follow your physiotherapist’s advice about positioning and movement during and after treatment

How do I know if needling is right for me?

  • If you and your physiotherapist are already trying other approaches to manage your symptoms but need a bit more help with pain relief – needling may be a good addition as part of a comprehensive approach to your active treatment.
  • If you are not afraid of needles and have never had a poor response to needles in the past (e.g., fainting when you received your flu vaccination).
  • If, after a thorough discussion of the benefits and risks of needling, you and your physiotherapist agree that using needles may assist with your ability to comply with or follow your current active treatment plan.

To find a physiotherapist who uses needles in practice, visit our Find a Physiotherapist search function and select “Acupuncture or IMS” under “Approval.”


  1. Government of Alberta. Government Organization Act. Available at http://www.qp.alberta.ca/1266.cfm?page=G10.cfm&leg_type=Acts&isbncln=9780779774517&display=html Accessed April 24, 2019.
  2. Government of Alberta. Physical Therapists Profession Regulation. Available at http://www.qp.alberta.ca/1266.cfm?page=2011_064.cfm&leg_type=Regs&isbncln=9780779757312&display=html Accessed April 24, 2019.
  3. Physiotherapy Alberta College + Association. IMS/Trigger Point Dry Needling Patient Information. Available at https://www.physiotherapyalberta.ca/files/needling_patient_info_ims_trigger_point_needling.pdf.
  4. Physiotherapy Alberta College + Association. Acupuncture Patient Information. Available at https://www.physiotherapyalberta.ca/files/needling_patient_info_acupuncture.pdf.
  5. Ries E (2015) Dry Needling: Getting to the Point. American Physical Therapy Association: PT in Motion. Available at http://www.apta.org/PTinMotion/2015/5/DryNeedling/ Accessed April 24, 2019.
  6. Gattie E, Cleland JA, Snodgrass S. (2017) The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy 47:3, 133-149