Treatment Guidelines and Decision Tree for Dry Needling Musculoskeletal Conditions: A Consensus Statement.
Tyler Waterway, Jonathon Beougher, Robert Butler and 8 others
Nine PT experts agreed on a structured framework for deciding when, where, and how aggressively to apply dry needling, organized around patient irritability and tolerance.
These are expert recommendations, not tested interventions.
Key findings
1DN dosage should be scaled to the patient's irritability and tolerance: high irritability with low tolerance gets 1-2 pistoning passes, moderate irritability gets 3-5 passes, and low irritability with high tolerance gets 10-20 passes per targeted tissue.
2A functional movement examination (e.g., SFMA, FMS, overhead squat, single-leg squat) should be performed before and after DN to assess pain limitations, movement asymmetries, and motor control deficits.
3Spinal DN should be considered when neurological assessment reveals dermatomal, myotomal, or reflex deficits, regardless of whether the patient's primary complaint is spinal or in an extremity.
Still to come
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Nine panelists, all experienced dry-needling practitioners, so the consensus reflects the views of people who do this daily rather than an independent evidence base. No patients were treated and no outcomes were measured. The statements are expert recommendations, not findings from a clinical trial. The authors themselves note that significant variability persists in the DN literature regarding dosage, outcome measures, and treatment sequencing, and that high-quality research is still needed. Multiple panelists have financial interests in dry-needling education (see conflicts), which may shape what they consider important to standardize.
Declared interests
Jon Beougher is Select Medical's National Coordinator for Dry Needling Services and teaches DN courses for them. Kelby Church teaches DN courses for Evidence In Motion. Gray Cook receives consulting fees and holds a fiduciary role for Functional Movement Systems. Susan Falsone owns Structure & Function Education, a DN continuing-education provider. Tyler Waterway and Edo Zylstra co-founded Tactical Physio, a DN education platform, and both teach through it.
The easy way to misread this
Do not read this as evidence that dry needling works. It is nine experienced practitioners agreeing on how to do it, not a study showing it produces better outcomes than other treatments. Every panelist also earns income from teaching or coordinating dry-needling services, which is a material conflict of interest that a hurried reader may miss.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →