Dry Needling: Considerations with Workers’ Compensation

Musculoskeletal disorders (MSDs) are prevalent among workers, often leading to significant pain, reduced productivity, and increased absenteeism. While we’ve previously discussed treatment options like manual therapy or work conditioning that can help improve outcomes, one particular intervention continues to gain attention from patients, payers, and healthcare providers: Trigger Point Dry Needling (TDN).
In the paragraphs below, we’ll discuss details around the application of trigger point dry needling, evidence supporting its use, and opportunities for its use amongst patients in the worker’s compensation system.

Understanding Trigger Point Dry Needling

Trigger Point Dry Needling involves inserting a thin monofilament needle into myofascial trigger points — hyperirritable spots within taut bands of skeletal muscle fibers — to alleviate pain and improve function. Unlike acupuncture, which is rooted in traditional Chinese medicine and focuses on restoring energy flow (Chi or Qi), dry needling targets specific anatomical structures to address neuromuscular dysfunctions.
The procedure may elicit a local twitch response, leading to the relaxation of the targeted muscle and subsequent pain relief. One of the prominent theories around why trigger point dry needling is effective has to do with restoring metabolic balance to a dysfunctional muscle following the local twitch response. Additionally, there is evidence that needling promotes the release of endorphins, which is your body’s homemade pain medicine.¹

A Brief History of Trigger Point Dry Needling

Unlike acupuncture, which has been around for thousands of years,² trigger point dry needling is a relatively new intervention. Originating in the 1940s, trigger point dry needling arrived on the scene after Dr. Janet Travell (first women to be appointed White House Physician) and her colleague Dr. David Simmons extensively studied myofascial trigger points.
They expanded on earlier indications that dry needling could produce a similar outcome to “wet needling” (injections). This was further expanded on in the late 1970s by Czech Physician Karel Lewit, who further demonstrated positive clinical outcomes without the use of injected medicines.
Furthermore, and perhaps most importantly, Dr. Lewit’s research suggested that the positive outcome was separate and distinct from the effects of any injected substance. This work spurred on further research, which has significantly improved our understanding of TDN and its applications.³

Efficacy and Safety Considerations

Studies have showcased that TDN is safe⁴ and effective⁵. TDN by definition is invasive. Interventions of this nature possess certain risks. However, despite this risk, the adverse advents beyond minor bleeding, bruising and pain during dry needling were very small (studies confirm < .1%). This particularly study⁴ examined over 20,000 TDN sessions, further bolstering the statistical relevance that TDN is safe.
While there have been numerous studies over the years outlining the effectiveness of TDN, a recent 2023 publication outlined “There is strong evidence that TDN causes pain reduction across all body regions at short-term evaluation. The current evidence shows that TDN is superior to no intervention/sham/placebo for improvements in pain intensity.⁵”
To summarize, TDN is more than a placebo. Its use does create positive changes for a variety of musculoskeletal conditions. While this publication does acknowledge that TDN is not superior over other treatments, it does outline, as evidenced by research, that TDN, when used in addition to other physical therapy interventions, can have additional impact.⁵

Trigger Point Dry Needling and Worker’s Compensation

Considering the potential to enhance care, why is trigger point dry needling used so infrequently in workers’ compensation? One significant barrier to its use is the lack of approval from ODG (Official Disabilities Guidelines)⁶.
This resource is widely used by stakeholders within the worker’s compensation system as it prioritizes the use of “evidence-based medical literature (“evidence-based medicine”) with claims data analytics (“data-driven medicine”) to work in concert to optimize outcomes with the right levels of intervention.”
Despite the current evidence outlined in this blog (and discussed in a prior TDN post), this intervention has yet to be deemed an approved intervention by ODG. This is frustrating for patients and providers, as mounting evidence shows effectiveness and safety. There have even been studies using TDN in challenging cases where progress has stalled (a common theme in the worker’s compensation space), which showed that TDN showed clinically significant improvements in pain, range of motion, function and myofascial trigger points.⁷
It’s with this mounting evidence of functional and symptomatic improvements in mind that patients and stakeholders within workers’ compensation have been rethinking TDN use, albeit on a case-by-case basis.
Anecdotally, use of TDN has been implemented safely, effectively, and without stakeholder concern when all parties are informed. For example, if a therapist thinks that TDN would be an effective intervention, then the therapist needs to communicate the clinical rationale to the referring physician. Assuming there is consensus on its use, the clinical team can discuss with a nurse case manager, adjuster and/or payor. Again, assuming agreement, the patient can then be educated on the intervention and their consent obtained. While this approach does require some extra steps, it has been shown to allow access to TDN for some patients without stakeholder concern.

Conclusion

As the evidence continues to build regarding its effectiveness and safety, it’s likely only a matter of time before TDN becomes an approved intervention in worker’s compensation care. Considering the focus by workers’ compensation stakeholders on restoration of an injured worker’s functional ability, timely return-to-work, and ultimate claim closure, it seems prudent that all safe and effective treatment options shown to accomplish these goals be available and approved for use to treating therapists.
To learn more about how Upstream Rehabilitation and our family of brands can assist with Workers’ Compensation and how physical therapy plays an effective role in helping injured workers return to work, contact our Workers’ Compensation team today!

1. Cleveland Clinic. “Dry Needling & Physical Therapy | Cleveland Clinic.” Cleveland Clinic, 20 Feb. 2023, my.clevelandclinic.org/health/treatments/16542-dry-needling.
2. Johnson, Kara. “On Pins and Needles: Just What Is Dry Needling? – Mayo Clinic Health System.” Mayoclinichealthsystem.org, 2019, www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/on-pins-and-needles-just-what-is-dry-needling.
3. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul;7(7):746-761. doi: 10.1016/j.pmrj.2015.01.024. Epub 2015 Feb 24. PMID: 25724849; PMCID: PMC4508225.
4. Boyce D, Wempe H, Campbell C, Fuehne S, Zylstra E, Smith G, Wingard C, Jones R. ADVERSE EVENTS ASSOCIATED WITH THERAPEUTIC DRY NEEDLING. Int J Sports Phys Ther. 2020 Feb;15(1):103-113. PMID: 32089962; PMCID: PMC7015026.
5. Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med. 2023 Feb 2;12(3):1205. doi: 10.3390/jcm12031205. PMID: 36769852; PMCID: PMC9917679.
6. “ODG for Workers’ Compensation: Industry-Leading Medical Treatment & Return-To-Work Guidelines.” ODG by MCG, 13 May 2024, www.mcg.com/odg/workers-comp-guidelines/. Accessed 8 Apr. 2025.
7. Dry Needling Combined with Physical Therapy in Patients with … – JOSPT. https://www.jospt.org/doi/full/10.2519/jospt.2017.7089