Patients ask me some version of the same handful of questions almost every week, about the needles, about my background, about whether this is all going to actually work for them. Rather than answer them one at a time in the treatment room, I put the honest, unfiltered versions here. Some of these have full articles of their own linked below if you want more depth. This one is meant to be the quick, direct version, in my own words.
Key Takeaways
- Dry needling and acupuncture use similar tools but rest on different reasoning, and I explain the distinction directly with every new patient.
- My approach is shaped by eight-plus years teaching dry needling to other physical therapists, not just performing it.
- I’ve worked with NFL players, tactical professionals, and patients managing complex chronic conditions, and the same clinical reasoning applies across all of them.
- I live with hypermobility myself, which shapes how I evaluate and treat patients with similar conditions.
- Knowing when not to treat is as much a part of my job as knowing when to.
What is dry needling, and how is it different from acupuncture?
Dry needling and acupuncture both use thin filiform needles, and that’s largely where the similarity ends. Acupuncture is rooted in traditional Chinese medicine and the concept of energy flow along meridians. Dry needling is grounded in Western anatomy and neurophysiology: I’m targeting a specific muscle, trigger point, or piece of dysfunctional tissue based on an exam, not a meridian map. The tool looks the same. The reasoning behind where it goes is not. I’ve written a full comparison in Is Dry Needling the Same as Acupuncture? if you want the longer version.
Does dry needling hurt?
Some discomfort is normal, and I tell every patient that upfront rather than downplay it. A local twitch response, a brief involuntary contraction when the needle reaches the right tissue, is one of the most important forms of feedback I receive during treatment because it helps confirm that I’ve reached the tissue I intended to treat, and it can feel like a quick cramp. Most patients describe it as manageable, and some areas are more sensitive than others. The full breakdown of what it actually feels like is in Does Dry Needling Hurt?.
What actually makes your approach different from another provider’s?
The letters after someone’s name are only part of the story. What matters as much is how often a provider needles, how many hours of education they’ve completed beyond an introductory weekend course, whether they treat conditions like yours regularly, and whether they teach the technique to other clinicians. Teaching requires a deep understanding of anatomy, safety, and clinical reasoning, and often reflects years of experience beyond an introductory certification course. I check all of these boxes myself, and I’d encourage any patient evaluating a provider to ask the same questions of whoever they’re considering.
You’ve taught dry needling for years. How did that change how you treat patients?
After more than eight years teaching dry needling courses, interacting with hundreds of physical therapists and discussing thousands of patient cases, I found that the classroom became one of my greatest learning environments. Explaining a technique clearly enough for another clinician to use it safely forces a level of precision that’s easy to skip when you’re only treating, not teaching. The same advanced techniques, safety principles, and clinical reasoning I teach to healthcare professionals are the same ones I use every day with my own patients, not a simplified version for the clinic and a more rigorous one for the classroom.
What’s this “window of opportunity” you talk about?
Dry needling creates what I often describe as a window of opportunity, a period where a muscle is less tense and moves more freely than it did before treatment. That window doesn’t last forever, and it doesn’t fix anything by itself. Releasing a muscle is only part of the process. The nervous system has to learn how to use that muscle again, which is why I pair every needling session with movement, whether that’s corrective exercise, a return-to-training plan, or something as simple as a specific stretch, rather than treating and sending someone home with nothing else to do.
Is there ever a time when dry needling isn’t the right choice?
Yes, and I’d be doing patients a disservice if I said otherwise. There are absolutely situations where dry needling is not the right treatment, whether that’s a nervous system too sensitized to tolerate it well yet, a condition that needs a different kind of care first, or simply a patient who isn’t comfortable with needles and would do just as well with manual therapy. One of the first things I tell clinicians when I teach dry needling is this: it’s more important to know when not to needle than when to needle. That principle guides my own patient care just as much as my teaching.
What conditions do you treat most often?
Neck pain and headaches, low back pain, shoulder pain, hip and labral-related pain, plantar fasciitis, tennis and golfer’s elbow, and muscular contributors tied to hypermobility and EDS come through the clinic regularly, along with jaw and TMJ-related pain. Several of these have their own detailed articles, including Dry Needling for Back Pain, Dry Needling for Tennis Elbow, and Dry Needling for Occipital Neuralgia.
Is dry needling actually proven to work, or is the evidence still shaky?
The best available research shows dry needling performed by physical therapists works better than placebo for reducing pain and improving movement in a range of musculoskeletal conditions, and it’s recommended by medical experts across many muscle and joint problems.1 I’d stop short of calling it proven for every condition it gets used for, and I’m upfront with patients when the evidence for a specific application, like sports performance, is thinner than for others.
Is dry needling covered by insurance?
It depends heavily on the plan and how the visit is billed, so I’d rather a patient confirm current coverage and pricing directly with our office than rely on a general answer here that might not match their situation. More detail on how this typically works is in Is Dry Needling Covered by Insurance?.
What was it like working with NFL players and tactical athletes?
I worked directly with Washington Commanders players for two NFL seasons, and helped educate clinicians associated with both the Commanders and the Baltimore Ravens organizations, alongside treating Special Forces and tactical professionals, collegiate and professional athletes, and performing artists. What stood out most wasn’t the level of competition. It was how little margin there was for an incomplete evaluation. At that level, a muscular dysfunction that a recreational athlete might never notice can be the difference between playing and not, which sharpened how carefully I look for what’s actually driving a problem, at any level of activity.
You live with hypermobility yourself. How does that shape your care?
I live with hypermobility and have lived with chronic pain, and I’ve recovered from multiple hip and shoulder surgeries of my own, so I’ve been on the patient side of the table more than once. That experience shapes how I evaluate hypermobile and EDS patients specifically, and it shapes something less specific too: I know what it feels like to be told a scan looks normal while still being in real pain, and I try never to make a patient feel that way in my own clinic.
Are you registered and regulated to perform dry needling in Maryland?
Yes. In Maryland, dry needling is performed by physical therapists who’ve completed extensive post-professional education, have at least two years of clinical experience as a licensed PT, are registered with the Maryland Board of Physical Therapy Examiners, and obtain written informed consent before a patient’s first treatment. Maryland has some of the most comprehensive dry needling regulations in the country, and I’d treat those requirements as a floor for safety, not a measure of how thorough a provider actually is.
What happens at a first visit?
Every new patient gets a 90-minute evaluation, not a rushed fifteen minutes before jumping straight to treatment. That time goes toward a full history, a movement and muscle exam, and, when appropriate, diagnostic ultrasound to look at the tissue directly. The goal is to walk out of that first visit with an actual explanation for what’s driving the problem, not just a treatment plan applied to a diagnosis on paper.
Where This Leaves You
If a question you had didn’t make this list, it’s a fair bet someone else has asked me the same thing in the clinic. Send it over, and I’m happy to add it here or answer it directly.
If you’re in the Baltimore area and have a question specific to your own situation, the fastest way to get a real answer is a free 20-minute consultation, not a search engine.