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Treatment Guidelines and Decision Tree for Dry Needling Musculoskeletal Conditions: A Consensus Statement.

Tyler Waterway1, Jonathon Beougher2, Robert Butler3

  • 1KinetaCare Physiotherapy.

International Journal of Sports Physical Therapy
|May 5, 2026
PubMed
Summary

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This study established consensus guidelines for dry needling (DN) in musculoskeletal dysfunction. Experts agreed on patient selection, treatment parameters, and post-intervention strategies to optimize outcomes for pain and movement impairments.

Area of Science:

  • Musculoskeletal Rehabilitation
  • Physical Therapy Interventions
  • Pain Management

Background:

  • Dry needling (DN) is widely used for pain and movement impairments, aiming to enhance range of motion and functional movement.
  • Significant variability exists in current DN techniques and procedural parameters in both research and clinical settings, highlighting a need for standardization.

Purpose of the Study:

  • To develop consensus statements for guiding clinicians and researchers in the application of dry needling (DN) for musculoskeletal dysfunction.
  • To establish standardized guidelines for the therapeutic use of DN.

Main Methods:

  • A modified Delphi technique was utilized, involving nine physical therapist experts in DN.
  • Panelists engaged in four rounds of discussion and questioning to achieve consensus on DN implementation guidelines.
Keywords:
Clinical guidelinesDelphi consensusDry needlingMovement assessmentMusculoskeletal painPhysical therapyclinical decision-makingframeworkorthopedic physical therapy

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  • A decision tree was developed, covering patient candidacy, dosage, target tissue selection, and post-intervention strategies.

    • Main Results:

    • Consensus was reached on all statements guiding DN interventions.
    • Appropriate candidates for DN include individuals with musculoskeletal pain, mobility limitations, or movement dysfunction, after evaluating contraindications.
    • DN dosage, intensity, and aggressiveness should be tailored to patient irritability and tolerance, with treatment directed at spinal or peripheral structures based on functional and neurological assessments.
    • Post-DN interventions include therapeutic exercises and patient education on expectations and activity modification.

    Conclusions:

    • The consensus provides essential clinical guidance for dry needling (DN) utilization.
    • Recommendations cover patient selection, treatment scope, intensity, and targeting of spinal versus peripheral structures.
    • Emphasis is placed on post-treatment reassessment and patient education to improve therapeutic outcomes.