When dealing with chronic pain, muscle stiffness, or an athletic injury, choosing the right treatment can feel overwhelming. Two popular therapies used by physical therapists today are Dry Needling and the Graston Technique. While both aim to reduce pain and improve movement, they work in very different ways to help your body heal.
Dry needling is a treatment where thin, solid needles are inserted into tight muscle areas called trigger points. These are the "knots" you might feel in your muscles that can cause pain and limit your movement. Unlike acupuncture, which comes from traditional Chinese medicine, dry needling is based on Western medicine's understanding of muscles and nerves.[1][2]
Research shows that dry needling is effective for reducing pain in various musculoskeletal conditions. A comprehensive review found that dry needling provides large reductions in pain immediately after treatment and these effects can last for several weeks to months. The treatment appears to work by stimulating the tight muscle areas to release tension and by triggering the body's natural pain-relief systems.[1][2]
Dry needling has been found particularly helpful for chronic neck pain, low back pain, and muscle tension in various parts of the body. Studies show it can reduce pain intensity, improve function, and increase range of motion when combined with stretching or exercise programs.[3][4][5]
What is Graston Technique?
The Graston Technique uses specially designed stainless steel instruments to massage and treat scar tissue and tight connective tissue (fascia). Instead of needles, your therapist applies controlled pressure with these smooth tools over your skin to identify and break up areas where the tissue has become stiff or restricted.[6]
The instruments create gentle friction that therapists believe helps improve blood flow and encourages the body to remodel damaged tissue. However, the research evidence on Graston and similar instrument-assisted techniques is mixed. While some studies show benefits for pain and function, the overall quality of evidence is low and many reviews have not found clinically meaningful improvements. [7][8]
For plantar fasciitis (heel pain), some studies suggest the Graston Technique combined with conventional physical therapy may speed recovery of heel pain and foot function compared to physical therapy alone. However, other research comparing instrument-assisted techniques to standard treatments like exercise found no significant additional benefit.[9][7][8]
The choice between these treatments should be made with your physical therapist based on your specific condition:
Consider Dry Needling if: You have deep muscle knots, chronic neck or back pain, or muscle-related pain that hasn't responded well to other treatments. Research strongly supports dry needling for these conditions.[1][2][5]
Consider Graston if: You're dealing with chronic plantar fasciitis or want a non-needle option for tight tissues. The evidence is weaker overall, but some people may benefit, particularly when combined with exercise.[9]
Important Safety Information: Dry needling is generally safe when performed by trained practitioners. Minor side effects like temporary soreness, bruising, or bleeding are common, occurring in about 40-70% of treatments. Serious complications are rare but can include pneumothorax (collapsed lung), especially with needling near the ribcage, which is why proper training is essential.[10][11][12][13]
For Graston and similar instrument techniques, adverse events are rarely reported in studies, though temporary bruising and discomfort during treatment can occur.[6][7]
Many physical therapists use both techniques together as part of a comprehensive treatment plan that includes stretching, strengthening exercises, and other therapies. Research shows that combining dry needling with exercise programs often provides better results than either treatment alone.[2]
Think of your body like a tangled garden. The Graston Technique is like using a rake on the surface to smooth out the topsoil and clear away debris, helping things move more freely at the surface level. Dry needling is like using a tool to break up the hard, compacted soil deep at the roots, allowing nutrients and water to finally reach where they're needed most.
The most important step is discussing your specific pain, preferences, and treatment goals with your physical therapist. They can help determine which approach, or combination of approaches, makes the most sense for your individual situation based on the best available evidence.
Click below to discuss with physical therapist, Dr. Trista Weimer, DPT.
Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Sánchez-Infante J, Navarro-Santana MJ, Bravo-Sánchez A, Jiménez-Diaz F, Abián-Vicén J. Physical Therapy. 2021;101(3):pzab070. doi:10.1093/ptj/pzab070.
Clinical Effectiveness of Dry Needling in Patients With Musculoskeletal Pain-an Umbrella Review. Chys M, De Meulemeester K, De Greef I, et al. Journal of Clinical Medicine. 2023;12(3):1205. doi:10.3390/jcm12031205.
Dry Needling in Active or Latent Trigger Point in Patients With Neck Pain: A Randomized Clinical Trial. Martín-Sacristán L, Calvo-Lobo C, Pecos-Martín D, Fernández-Carnero J, Alonso-Pérez JL. Scientific Reports. 2022;12(1):3188. doi:10.1038/s41598-022-07063-0.
The Effectiveness of Dry Needling in Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Study. Rajfur J, Rajfur K, Kosowski Ł, et al. Scientific Reports. 2022;12(1):15803. doi:10.1038/s41598-022-19980-1.
Effectiveness of Dry Needling for Chronic Nonspecific Neck Pain: A Randomized, Single-Blinded, Clinical Trial. Cerezo-Téllez E, Torres-Lacomba M, Fuentes-Gallardo I, et al. Pain. 2016;157(9):1905-1917. doi:10.1097/j.pain.0000000000000591.
The Effectiveness of Instrument-Assisted Soft Tissue Mobilization on Pain and Function in Patients With Musculoskeletal Disorders: A Systematic Review and Meta-Analysis. Tang S, Sheng L, Wei X, et al. BMC Musculoskeletal Disorders. 2025;26(1):257. doi:10.1186/s12891-025-08492-4.
Effectiveness of Instrument-Assisted Soft Tissue Mobilization for the Management of Upper Body, Lower Body, and Spinal Conditions. An Updated Systematic Review With Meta-Analyses. Nazari G, Bobos P, Lu SZ, et al. Disability and Rehabilitation. 2023;45(10):1608-1618. doi:10.1080/09638288.2022.2070288.
The Effectiveness of Instrument-Assisted Soft Tissue Mobilization in Athletes, Participants Without Extremity or Spinal Conditions, and Individuals With Upper Extremity, Lower Extremity, and Spinal Conditions: A Systematic Review. Nazari G, Bobos P, MacDermid JC, Birmingham T. Archives of Physical Medicine and Rehabilitation. 2019;100(9):1726-1751. doi:10.1016/j.apmr.2019.01.017.
Effectiveness of the Graston Technique on Pain and General Foot Health in Patients With Chronic Plantar Fasciitis: A Randomized Clinical Trial. Kiran N, Ahmed Awan W, Sahar W, et al. Alternative Therapies in Health and Medicine. 2023;29(6):214-219.
Adverse Reactions to Dry Needling Therapy: Insights From Polish Physiotherapy Practice. Trybulski R, Kużdżał A, Kiljański M, et al. Journal of Clinical Medicine. 2024;13(23):7032. doi:10.3390/jcm13237032.
Dry Needling Perceptions and Experiences: A Survey of Australian Physiotherapists. Jenkins LC, Summers SJ, Nasser A, Verhagen A. Musculoskeletal Science & Practice. 2024;69:102895. doi:10.1016/j.msksp.2023.102895.
AAPM&R Position Statement on Dry Needling. American Academy of Physical Medicine and Rehabilitation (2012).
Pneumothorax After Dry Needling of Intrascapular Muscles Using a Rib Bracketing Technique: Insights From the Clinician, Patient, and Clinical Expert. Mintken PE, Denman B, Dommerholt J. Physical Therapy. 2025;:pzaf078. doi:10.1093/ptj/pzaf078.
