Dry needling is performed by physical therapists, chiropractors, medical doctors, and in some states, athletic trainers and occupational therapists. The specific professionals allowed to do it depend heavily on where you live, since each state sets its own scope-of-practice rules. Physical therapists are by far the most common providers, but they need post-graduate training beyond their degree to legally offer it.
Physical Therapists
Physical therapists perform the vast majority of dry needling in the United States. However, dry needling is not something they learn in their standard doctoral program. It’s considered an advanced skill requiring additional post-graduate coursework. The exact training requirements vary by state. Nevada, for example, requires 150 hours of didactic education with at least 25 hours from a post-graduate course before a physical therapist can needle a single patient. Virginia’s regulations classify it as an advanced procedure requiring coursework in emergency preparedness, contraindications, palpation and needle techniques, and passage of both a written and practical exam.
Not every state allows physical therapists to perform dry needling at all. The legal landscape has shifted significantly over the past decade. States like Arizona, Delaware, Kentucky, and Utah specifically added dry needling to their physical therapy practice acts. Others, including California and parts of the Pacific Northwest, have historically restricted or prohibited it. The rules change frequently, so checking with your state’s physical therapy board is the most reliable way to confirm what’s allowed where you are.
One important distinction: physical therapist assistants cannot perform dry needling. Virginia’s regulations explicitly prohibit delegation to assistants or support personnel. The licensed physical therapist must do it personally.
Chiropractors
Chiropractors can perform dry needling in several states. Colorado’s chiropractic board, for instance, specifically includes “intramuscular stimulation/dry needling” within the chiropractic scope of practice. The requirements typically include documented competency and relevant certification. Colorado requires chiropractors to hold an electrotherapy certification and demonstrate the knowledge and skill to perform the procedure safely.
As with physical therapists, the rules are state-specific. A chiropractor licensed to needle in one state may not have that authority in another.
Medical Doctors and Other Providers
Physicians (MDs and DOs) can perform dry needling in virtually every state, since their broad medical licenses generally cover invasive procedures. In practice, though, most doctors don’t offer it. You’re more likely to encounter dry needling from a doctor in a sports medicine or pain management clinic where it fits into a larger treatment plan alongside exercise, manual therapy, and other rehab techniques.
Several other licensed professionals may also qualify depending on state law. Certification programs accept nurse practitioners, physician assistants, dentists, and occupational therapists alongside physical therapists and chiropractors. Utah introduced legislation in 2025 to formally expand its definition of occupational therapy to include dry needling, provided the therapist completes required training and registers with the state. Athletic trainers are another group gaining access in certain jurisdictions.
How Dry Needling Differs From Acupuncture
Both dry needling and acupuncture use thin filiform needles, but the training pipelines are vastly different. Licensed acupuncturists complete a minimum of three years (1,905 hours) of post-graduate education, including 660 hours of supervised clinical practice, before sitting for a national board exam. Physical therapists performing dry needling typically complete continuing education workshops ranging from about 27 to 54 hours total. There is no nationally standardized curriculum or psychometrically validated competency exam for dry needling the way there is for acupuncture.
The philosophical framework also differs. Dry needling targets myofascial trigger points, those tight, tender knots in muscle that can refer pain to other areas of the body. Practitioners select needle sites based on anatomy and physical exam findings. Acupuncturists may target those same points but also work from traditional Chinese medicine theory, using meridian-based point selections. Licensed acupuncturists are trained in both traditional and modern biomedical needling approaches, which is why some acupuncture organizations argue that dry needling falls within their existing expertise.
What Dry Needling Treats
Dry needling is used primarily for myofascial trigger point pain. These are hyperirritable spots in skeletal muscle that feel like small, hard nodules under the skin. Myofascial pain accounts for an estimated 30 to 85 percent of patients who visit a primary care office or pain clinic with a pain complaint, making it one of the most common musculoskeletal issues.
Common conditions treated with dry needling include low back pain, neck pain, tension headaches, jaw pain, shoulder impingement, and hip dysfunction. Research has shown the technique can reduce pain sensitivity, increase range of motion, and help deactivate trigger points. One study found that dry needling the jaw muscle in patients with trigger points significantly improved both their pain threshold and how wide they could open their mouth. It’s almost always part of a broader plan that includes stretching, strengthening exercises, and manual therapy rather than a standalone treatment.
Who Should Not Get Dry Needling
Dry needling is not appropriate for everyone. It’s not recommended for children under 12. People with needle phobia, active infections (local or systemic), vascular disease like varicose veins near the treatment area, compromised immune systems, or significant cognitive impairments that prevent understanding the procedure should avoid it. It’s also generally avoided during the first trimester of pregnancy.
Before your first session, the practitioner should obtain informed consent, explaining both the risks and benefits. Minor side effects like temporary soreness, bruising, or a brief increase in pain at the needle site are common and typically resolve within a day or two.
How to Verify Your Practitioner’s Qualifications
If you’re considering dry needling, ask your practitioner three things: whether dry needling is within their legal scope of practice in your state, how many hours of post-graduate dry needling training they’ve completed, and how long they’ve been performing the technique. A well-trained provider will answer these questions readily. You can also check with your state’s licensing board for physical therapy, chiropractic, or medicine to confirm that dry needling is permitted and whether any specific training standards apply.