Patient Population for Dry Needling in Acute/Subacute Musculoskeletal Pain
Target Patient Characteristics
The patient is an adult (18+ years) presenting with acute or subacute musculoskeletal pain (lasting less than 4 weeks) from non-low back injuries, including strains, sprains, soft tissue injuries, and myofascial trigger points in the outpatient setting. 1
Specific Clinical Presentation
Pain Duration and Type
- Acute pain duration: Less than 4 weeks from onset 1
- Pain sources include: Strains, sprains, soft tissue injuries, whiplash, nonsurgical fractures, contusions, and myofascial trigger points 1, 2
- Location: Non-low back musculoskeletal injuries (extremities, neck, shoulder regions) 1
Treatment Context
- Setting: Outpatient care 1
- Prior management: Patients who have reached a plateau with conventional physical therapy interventions (manual therapy, therapeutic exercises) may be considered for dry needling 3
- Age range: Adults of all ages, though most evidence focuses on working-age adults 1
Critical Exclusions
Conditions NOT Appropriate for Dry Needling
- Chronic low back pain from degenerative lumbar disease: The American College of Neurosurgery provides Level II evidence (Grade B recommendation) against dry needling, as long-lasting benefit has not been demonstrated 4, 5
- Patellofemoral pain: High-quality evidence shows dry needling provides no additional benefit when combined with exercise therapy and demonstrates non-efficacy compared to sham needling 4
- Osteoarthritis: Multiple clinical practice guidelines recommend against dry needling for OA management 4
- Headache treatment: Insufficient evidence exists to recommend for or against dry needling 4, 5
Geographic and Practice Setting
- Location: Primarily outpatient clinics, physical therapy practices, and physician offices where musculoskeletal injuries are commonly treated 1
- Healthcare utilization: Musculoskeletal injuries accounted for over 65 million healthcare visits in the United States in 2010, with 4 of 5 injuries treated in physician offices being musculoskeletal 1
Practitioner Requirements
Training and Qualifications
- Minimum training: Practitioners should have >60 hours of formal training in dry needling technique 4, 5
- Experience considerations: Most practitioners have 21-60 hours of DN training (38.6%), with less than 2 years of experience being common (36%) 6
- Safety protocols: Comprehensive training on anatomical landmarks, needle insertion depth, cross-sectional anatomy, and patient monitoring is essential 6
- Ultrasound guidance: Access to ultrasound guidance is recommended for safety, though 85.5% of practitioners do not routinely use it 6
Common Clinical Scenarios
Typical Patient Presentations
- Shoulder impingement syndrome: Patients with mechanical shoulder pain who have plateaued with traditional physical therapy 3
- Cervical region strain: Acute onset neck pain from lifting or trauma, particularly with palpable trigger points in upper trapezius, levator scapula, supraspinatus, and infraspinatus 7
- Extremity injuries: Ankle sprains, muscle strains, and other acute soft tissue injuries 1