Expert Q&A: What is Pelvic Floor Dry Needling?

If you have pelvic floor pain that's bringing on bowel, bladder, or sexual symptoms, the thought of sticking a needle into an area that's already sensitive might seem daunting, if not downright terrifying. We totally get that, but we're glad you're here and willing to learn more — because dry needling is a specialized physical therapy technique that could offer you significant relief.

As we'll dive into below, dry needling can decreasing pelvic floor pain and improve muscle function. After dry needling, many people experience a rapid improvement in symptoms. Pelvic floor dry needling can be especially helpful for “patients who have difficulty relaxing their pelvic floor with cuing and manual therapy alone, or for anyone who has suspected pelvic nerve involvement,” says Origin physical therapist, Dr. Christina McGee, PT, DPT. Dr. McGee finds that pelvic floor dry needling is also really helpful for patients whose pelvic pain symptoms are linked to scar tissue in the pelvic area, or for anyone who wants to try a new approach to treatment for their pelvic floor symptoms.

To help you feel more comfortable with pelvic floor dry needling as a option for your pelvic floor pain, we're bringing you answers to the most commonly asked questions about needling. If you have any other questions, or are interested in exploring dry needling for your pelvic floor pain, schedule and evaluation with one of our PTs, ASAP.

What is dry needling?

Dry needling is a treatment technique that physical therapists often use to help treat musculoskeletal pain and muscle movement issues. Dry needling is primarily used to help treat musculoskeletal conditions including acute and chronic pain, muscle tension, and spasm. It is helpful when incorporated into a more holistic physical therapy program to help treat conditions such as back pain, neck pain, shoulder impingement, tennis elbow, carpal tunnel syndrome, plantar fasciitis, and even pelvic floor dysfunction.

With dry needling, a thin needle — known as a monofilament needle — is inserted through the skin, directly into myofascial trigger points (taut bands of skeletal muscle that can cause pain and motor dysfunction) or other problematic tissues that are contributing to your symptoms. “Dry needling is a great intervention for muscular tension that is very dense, or does not release with stretching, cueing, and manual therapy alone,” explained Dr. McGee. 

The goal of putting a needle into a myofascial trigger point is to elicit a local twitch response (aka a brief contraction in your muscle) and deactivate it to relieve pain and restore the muscle’s function. Dr. McGee explains that dry needling causes a tiny, intentional tissue injury that is thought to initiate a biochemical response that resets hypersensitive nerves that are causing chronic pain, thereby restarting the healing process.

Dry needling can be used to treat many different types tissues that are contributing to neuromusculoskeletal pain including:

• Muscle
• Ligaments
• Tendons
• Fascia
• Peripheral nerves
• Scar tissue

How is dry needling different from wet needling?

While both include inserting a needle into pain-generating tissues, wet needling involves the injection of medications and other substances into your muscles. The goal of wet needling is to improve muscle pain and reduce inflammation, and may include the injection of:

• Cortisone
• Platelet-rich plasma (PRP)
• Botox
• Local anesthetics, including lidocaine 

Will pelvic floor dry needling help my pain?

Research suggests that dry needling can be an effective treatment modality for reducing pain and improving function in several musculoskeletal conditions, particularly in the short term and when combine with other physical therapy techniques.

For example, one systematic review found that dry needling was an effective treatment option for reducing myofascial pain in people with acute and chronic low back pain, and that pain improvements happened quicker than with other treatments. Another systematic review and meta-analysis found that adding dry needling to a traditional physical therapy treatment program for patients with neck pain, was more effective at improving pain and function in the short- and in the mid-term (for up to 3 months). Another large review found that dry needling was effective in improving pain in the short-term for various musculoskeletal pain conditions throughout the body, especially when combined with other traditional physical therapy treatments.

But, like most things related to pelvic health, research exploring the application of dry needling to pelvic pain conditions is still emerging. Some case studies have shown promising results. For example, case studies and case series have shown that dry needling may help:

• Ease bladder symptoms related to pelvic floor muscle tightness
• Ease muscle tenderness, and improve pain and muscle function when combined with manual therapy for a patient with overactive pelvic floor muscle dysfunction
• Improve chronic pain, and reduce other symptoms and functional limitations in patients with chronic pelvic pain when applied to the obturator internus muscle, gluteal muscles, and other pelvic floor muscles when combined with traditional physical therapy

Is pelvic floor dry needling internal?

No, pelvic floor dry needling is not an internal treatment. While many of your pelvic floor muscles are internal (mostly only able to be accessed for treatment through the vaginal or anal openings), there are several that can be accessed on the outside known as the superficial pelvic floor muscles. These are the muscles that are targeted during pelvic floor dry needling. 

Pelvic floor dry needling may also involve larger muscles outside of your pelvic floor, if they are involved in your symptoms. For example, you may expect dry needling in your glutes, thighs, abdomen, and even deep hip muscles like portions of the obturator internus muscle and piriformis. Trigger points in these muscles often refer to the pelvic floor area, so including them in your plan of care may be important.

And, if you have scar tissue in your vulva (which could remain after an episiotomy or perineal tear after a vaginal birth), or abdomen (like from past abdominal surgeries or a cesarean birth
), your physical therapist may also decide that dry needling scar treatment is an important part of your care program. 

If you do have muscle tightness and trigger points deeper in your pelvic floor, then the usual treatment options will help you with your deeper pain. For example, in addition to pelvic floor dry needling, intravaginal massage or myofascial release, biofeedback training, or vaginal dilator therapy may be included in your holistic plan of care.

Is dry needling helpful for scar tissue?

In addition to easing muscle tension and reducing irritability in myofascial trigger points, dry needling may be helpful for reducing scar pain, improving appearance, and reducing scar tissue restrictions. 

Instead of putting the needle directly into tight muscles, dry needling for scar tissue can look slightly different. Dr. McGee explains that for cesarean scars the needle is inserted either horizontally along the length of the scar, or directly into the scar tissue. And with this technique Dr. McGee says you can almost immediately feel a decrease in scar tissue restrictions, the patients note less tenderness, and you can see a reduction in the raised appearance of the scar.

“It's one of my favorite interventions for cesarean scars because of the speed of seeing change,” reports Dr. McGee.

The effectiveness of scar tissue dry needling is mostly supported by anecdotal evidence, but preliminary research findings support the potential of dry needling for scar tissue healing. 

This research review suggests that dry needling has shown promise in facilitating wound healing and reducing the raised appearance of scars. And this systematic review found that dry needling may be effective in improving the condition of scar tissue and reducing pain and other associated symptoms. High-quality, randomized controlled trials are needed to further validate the effectiveness of dry needling for scar treatment, understand its physiological mechanisms, and develop standardized treatment protocols

Will I be sore after dry needling?

It is very common to have some soreness in the treated area after dry needling. In fact this study shows that it is the most common symptom experienced after dry needling.

Origin physical therapist, Dr. Amethyst Guerrero, PT, DPT often tells her patients that they should expect some soreness — but that this soreness is not the same as the pain you are being seen for — and this is by design since creating an inflammatory response in your tissues is intended to encourage healing. “You are likely to feel a little sore after your visit, and you may experience bruising if you bruise easily. The soreness should be mild though, like you worked out,” Dr. Guerrero explains. She also recommends her patients avoid using cold or anti-inflammatories immediately after treatment to ease this soreness. These things will limit the intentional inflammatory process.

Is there anything else I should do after dry needling to help?

Other than holding off on icing sore muscles or taking anti-inflammatories for the discomfort, the downtime is pretty minimal. Dr. Guerrero recommends her patients continue to go about their day like they usually do.

When it comes to exercise though, you may want to take it easy for a few days. Dr. Guerrero usually tells her patients “You are good to workout after dry needling, but I would avoid super high intensity workouts at first. If you want to run, go for an easy run. If you want to go to Orange Theory, you can totally still go! I just wouldn’t make it your hardest effort ever.” 

I am afraid of needles — am I a good candidate for dry needling?

Probably not. While dry needling can be helpful for some, it is not the best, or most important, treatment tool for everyone. If the thought of needling is too scary — even after having the whole procedure explained to you, and you have all of your questions answered — then it is not a good treatment option for you. 

Often, the feelings of fear and anxiety can worsen pelvic pain and muscle tension. This is the opposite of the goal for dry needling. So if your fear of needles still feels too significant even after you have learned about what to expect and how it may help your symptoms, then it is not the best treatment option for you.

And this goes for any treatment option at Origin Physical Therapy. From internal pelvic floor muscle examinations to manual therapy or biofeedback — it is only a good treatment option after you are fully informed, have fully consented, and it makes sense for your symptoms and current life demands.

Dr. Mcgee makes sure that her patients feel fully informed about dry needling before starting treatment. She says, “If a patient and their symptoms might be a good candidate for benefitting from dry needling, we would start discussing why, how, and what to expect with the patient and let them decide if it's something they might want to pursue.”

In addition to fearing needles, you may not be a candidate for dry needling if you are:

• Unable or unwilling to give consent
• On blood thinners or have a blood clotting disorder
• Pregnant
• Immunocompromised

How long does dry needling last?

So far, research shows that dry needling really only provides short- to mid-term symptom improvements. In other words, you can expect an improvement in your symptoms relatively quickly – as soon as treatment is complete – and for up to around three months. 

This is why dry needling can be such an effective treatment when combined with other physical therapy techniques. Dry needling can help improve your symptoms and get you back to moving pain-free in the short-term, while other physical therapy techniques such as stretching, lifestyle adjustments, manual therapy techniques, and exercises can help you make more long-term improvements in your symptoms.

What is the difference between acupuncture and dry needling?

Before digging into the details, it can be easy to confuse the practice of acupuncture, and dry needling. In both practices, a monofilament needle is inserted into the skin for various therapeutic benefits. However, dry needling and acupuncture are used for different therapeutic purposes, and they are different in their theoretical bases and techniques. 

For example, acupuncture is rooted in the traditional Chinese concept of Qi (aka “life energy”) and meridians — the channels through which Qi flows within the body. Through specific acupoints within these meridians, acupuncture is intended to treat a wide range of conditions including pain, stress, infertility, and digestive dysfunction by restoring energy balance. 

On the other hand, dry needling is grounded in Western medicine and is an evidence-based treatment technique used to target myofascial trigger points to relieve musculoskeletal pain and stiffness, improve flexibility, and increase blood flow.

Is dry needling covered by insurance?

Unfortunately, dry needling is most often not covered by insurance. Currently, Medicare considers dry needling a “never covered service” and several other insurance providers consider dry needling experimental (or still investigational) and therefore they do not usually cover it. If dry needling is not covered by your insurance, and you and your PT feel it would be a good treatment option for you, you can self pay for this treatment. At Origin Physical Therapy, dry needling is directly billed to you at $33.00 per treatment session.

In addition to insurance coverage, it’s important to know that dry needling is included in the physical therapy scope of practice in some states, but not all. At Origin Physical Therapy, we provide dry needling throughout all of our Texas locations, as well as our Central City and Barlett TN locations.