What is dry needling in hand therapy?

Dry needling is an invasive (superficial or deep) technique used to treat myofascial pain syndrome, a condition that often presents in the muscles of the hand, wrist, forearm, and elbow. Myofascial pain syndrome is a regional muscular pain condition recognized by medical practitioners as contributing to or causing sensory, motor, and autonomic impairments. It is commonly associated with palpable muscle “knots” or taut bands known as myofascial trigger points, which can develop in small muscles of the upper extremity. Dry needling is a low-risk, cost-effective intervention that can only be performed by physical therapists or occupational therapists who are certified in the technique according to their state board regulations. In hand therapy, dry needling is often incorporated as part of a comprehensive rehabilitation program to restore hand strength, function, and range of motion.

The history of dry needling

The foundations of dry needling were pioneered by Dr. Janet Travell and Dr. David Simons in the 1940s. They discovered that injecting analgesic medication into muscular trigger points could decrease symptoms of pain and sensitivity. Further research found that mechanical insertion of a needle into these points, even without medication, produced therapeutic effects. This led to the development of what is now recognized as trigger point dry needling. The evolution of dry needling research has provided an effective, non-pharmacological tool for addressing musculoskeletal dysfunction. In hand therapy, its application has expanded with the resurgence of interest in non-invasive pain management, especially for conditions involving repetitive strain or muscular overuse in the hand and forearm.

Upper extremity conditions that benefit from dry needling

Dry needling in hand therapy can be beneficial for a range of conditions affecting the muscles, tendons, and soft tissues of the hand, wrist, forearm, and elbow, including:

• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golfer’s elbow)
• Wrist tendinopathies, such as De Quervain’s tenosynovitis
• Carpal tunnel syndrome (as an adjunct to nerve gliding and manual therapy)
• Trigger finger (stenosing tenosynovitis)
• Hand and wrist stiffness following immobilization
• Forearm muscle strains
• Myofascial pain syndromes of the hand and forearm
• Post-surgical muscular tightness following tendon repair or fracture
• Chronic hand or wrist pain without clear structural damage

How does trigger point dry needling work in hand therapy?

Dry needling uses a small, thin, solid filament needle that is inserted directly through the skin into an identified trigger point within a muscle. No medications or injections are used. The mechanical stimulation created by the needle can elicit a localized twitch response, helping to disrupt dysfunctional muscle fibers and promote tissue relaxation. This process assists in deactivating the trigger point, leading to a reduction in pain, improved soft tissue mobility, and restoration of hand and upper extremity function. In hand therapy, dry needling is typically integrated with manual therapy techniques, neuromuscular re-education, and targeted exercises to achieve optimal outcomes

What is a trigger point?

A trigger point is a focal area of muscle tissue characterized by a taut, hyperirritable nodule that is painful when compressed. In the upper extremity, trigger points often develop in muscles such as the extensor carpi radialis brevis, flexor carpi ulnaris, flexor digitorum superficialis, and intrinsic hand muscles. These points can cause local pain or refer pain to other areas, such as radiating pain from the forearm into the wrist or hand. Trigger points may result from acute trauma, chronic overuse (such as repetitive gripping), or prolonged immobilization. Symptoms often include pain, tenderness, stiffness, muscle weakness, limited range of motion, and altered hand function.

Common causes of trigger points include:

• Repetitive hand or wrist motions
• Overuse from typing, manual labor, or sports
• Acute injuries to the hand or forearm
• Postural imbalances or ergonomic issues
• Stress and muscle tension
• Prolonged immobilization (such as casting after a fracture)

Is dry needling the same as acupuncture?

Dry needling and acupuncture are distinct techniques despite the use of similar needles. Acupuncture is rooted in Traditional Chinese Medicine and aims to balance the body’s energy (qi) through stimulation of meridians. Dry needling, on the other hand, is a modern, evidence-based technique focused exclusively on musculoskeletal dysfunction. In hand therapy, dry needling specifically targets trigger points and muscular imbalances in the hand, wrist, and forearm to relieve pain and improve mobility. Therapists may use different techniques during dry needling, such as pistoning the needle or leaving it in place briefly, to elicit a therapeutic response.

How many dry needling treatments are needed in hand therapy?

The number of dry needling sessions required varies depending on the severity of the condition, the muscles involved, and the overall treatment goals. Improvement is primarily measured by functional gains such as increased grip strength, improved fine motor control, and reduced pain during daily activities. Research suggests that effects can be seen after just 1-2 sessions, although some patients may benefit from 3-6 sessions, depending on individual response. Long-term relief typically requires integrating dry needling with other rehabilitation strategies, including manual therapy, strengthening exercises, stretching, and ergonomic interventions.

What should I do after dry needling?

It is common to experience mild soreness in the treated muscles for 24-48 hours after dry needling. This soreness generally decreases each day. To optimize recovery following dry needling for hand or forearm muscles, patients are encouraged to:

• Perform gentle hand and wrist movements frequently throughout the day
• Use heat therapy to promote blood flow to the treated area
• Stay hydrated to support tissue healing
• Avoid prolonged static postures or gripping activities
• Gently stretch the hand, wrist, and forearm muscles
• Avoid icing the area, as it may restrict necessary circulation

Following these guidelines can help maximize the therapeutic benefits of dry needling and support overall rehabilitation goals.

Schedule a consultation

The experienced hand therapy team at CAO Sports Performance & Physical Therapy is specially trained in the use of dry needling for upper extremity conditions. Our certified physical and occupational therapists offer individualized dry needling treatment plans to address hand, wrist, forearm, and elbow dysfunctions. Schedule a hand therapy appointment at one of our offices in California, Leonardtown, or Waldorf, Maryland. We are proud to provide the highest level of hand therapy and rehabilitative care in Southern Maryland.