Question 1

Does dry needling hurt?

Accepted Answer

Usually far less than people expect. The needle is hair-thin — much finer than an injection needle — and most clients describe a brief, deep, cramping ache when a trigger point is engaged, sometimes with a quick involuntary muscle twitch, rather than sharp pain. Muscle soreness for a day or two afterward is common and normal. Discomfort is also a dial, not a fixed price: technique, depth, and dosage are all adjustable, and Dr. Paige treats to your tolerance, not to a quota of needles.

Question 2

What does dry needling treat?

Accepted Answer

Dry needling treats myofascial pain — trigger points and taut muscle bands that drive neck, shoulder and back pain, headaches, tennis elbow, hip and gluteal pain, hamstring and calf issues, and plantar heel pain. It helps most when a muscle both hurts and restricts how you move. It is one tool inside a plan, not the plan. Whether it belongs in yours is a clinical decision made after a full-body evaluation, and the rest of the plan works even if you decline it.

Question 3

How is dry needling different from acupuncture?

Accepted Answer

Both use a thin, solid filiform needle — and that is where the similarity ends. Dry needling is a Western, anatomy-based technique in which a physical therapist targets myofascial trigger points identified through movement examination. Acupuncture is a Traditional Chinese Medicine practice performed by licensed acupuncturists using a meridian framework. In Virginia each is regulated separately, and doing one doesn't rule out the other. The full comparison is on our dry needling vs. acupuncture page.

Question 4

Who should not get dry needling?

Accepted Answer

Dry needling is avoided or modified for people with needle phobia, infection or broken skin at the site, lymphedema in the limb being treated, bleeding disorders or blood-thinning medication, a weakened immune system, and in pregnancy — especially the first trimester. A screening conversation covers all of this before treatment is ever proposed. It's also simply optional. Consent is real here, and declining the needle never affects the rest of your care.

Question 5

Can dry needling really collapse a lung?

Accepted Answer

It has happened — NFL linebacker T.J. Watt's partially collapsed lung after a needling session made national news in December 2025 — but it is rare, and the risk is concentrated in one specific situation: needling over the rib cage and lung fields. Published estimates put serious adverse events below roughly four in ten thousand treatments. Risk management is anatomical knowledge, angle, depth, and the judgment to use a different technique near the lungs. This is exactly why advanced certification and a decade of practice matter more than a weekend course.

Question 6

How many dry needling sessions will I need?

Accepted Answer

Change often begins early, because needling here is paired in the same visit with movement retraining that helps it hold. Dr. Paige gives you a realistic estimate after your assessment, and revisits it as you progress. If nothing is changing by then, the trigger point probably isn't the driver, and the plan changes rather than the needling continuing. Because needling is folded into standard 75-minute sessions at no extra charge, "more needling" is never a billing strategy.

Question 7

Is soreness after dry needling normal?

Accepted Answer

Yes. A deep, worked-muscle soreness for 24–48 hours is the most common after-effect, sometimes with a small bruise. Gentle movement, hydration, and normal activity help it pass; ice or heat are fine if they feel good. Soreness beyond two to three days, spreading redness, or feeling unwell warrants a call. You'll leave every needling session knowing exactly what's normal, what isn't, and how to reach Dr. Paige directly if something feels off.

Question 8

Is dry needling covered by insurance or HSA/FSA?

Accepted Answer

You can pay for your sessions with an HSA or FSA card — physical therapy is usually a qualified medical expense, and dry needling at Divine Physical Therapy is included within the session rather than billed separately. Commercial insurance coverage for dry needling is inconsistent nationally, and Medicare does not cover it. As a direct-pay practice we provide an itemized superbill on request for possible out-of-network reimbursement — details on the rates and payment page.

Question 9

Do I need a referral for dry needling in Virginia?

Accepted Answer

No. Since July 2023, Virginia law allows physical therapists with direct-access certification to provide trigger point dry needling without a physician's order, under the Board of Physical Therapy's regulations. Your discovery call confirms you're an appropriate candidate before anything is scheduled. Some insurance plans still require a referral for reimbursement purposes — worth one phone call to your plan if you intend to submit a superbill.

Dry Needling, Explained By Someone Who Has Done It For A Decade

What Is Dry Needling?

Five Checks Before Any Needle Is Placed.

01

Screen

04

Needle With Intent

02

Find The Driver

05

Use Window

03

Consent

Where To Go Next

Manual Therapy & Dry Needling

Dry Needling Vs. Acupuncture

Back Pain Physical Therapy Services

Frequently Asked