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Real Life Claims: Dry Needling in Physical Therapy

In recent years, dry needling has increasingly been used in physical therapy settings to alleviate pain and increase range of motion for patients. During this procedure, thin needles are pushed through the skin into the muscle at specific trigger points to induce a twitch reflex. It’s generally a safe procedure. However, as with any procedure, there are potential complications.

In the story below—based on an actual claim—you’ll see through the eyes of a physical therapist one complication that can arise when using dry needling to alleviate a pain in a patient. We’ll then provide some best practices to help reduce this risk for you and your patients.

Dry Needling in Physical Therapy - The Case of the Mighty Pin

You’ve been treating Margaret, a woman in her 40s with a sport-related back injury she sustained coaching a youth basketball team. Unfortunately, she hasn’t seen much improvement from the normal course of treatments.

“Good morning, Margaret,” you say as she comes in. She gives a weak smile and slight nod as she hobbles back to meet you. “Back still causing you some pain, I see.”

“Yeah, I’ve been doing the home therapy you suggested,” she says. “It feels a little better, but it’s still not 100 percent.”

“Well, today, I’d like to try something new for you if you’re up for it.”

“You know me—I’m up for anything if you think it will help. What’d you have in mind?” she asks.

“Have you ever heard of dry needling?”

There’s a pause as she cocks an eyebrow at you. “Nooo, what’s that? It sounds…serious.”

“It’s really not that intense,” you say with a little chuckle. “It involves putting small needles into trigger points to help relax the muscle and reduce pain.”

“Hmm,” she says, “sounds a bit like acupuncture.”

“Well…we use similar tools, but this is a science-based method. I’ve actually had a lot of success with other patients who’ve had stubborn injuries like yours.”

Margaret gives a shrug, wincing a little with the pain. “I’m ready if you think it’ll help.”

You take Margaret back to the treatment room and get her ready for the procedure. “Okay, if at any point you feel any discomfort, please let me know. We can always stop if something doesn’t feel right.”

“What, like if I feel like you’ve punctured a lung or something?” Margaret chuckles.

“That would be one example, yes,” you say. “But rest assured that something like that is pretty much impossible. Mild bruising is the worst I’ve seen.”

“Well, that’s a relief,” she says, and you see the tension in her back relax a bit as you start the procedure.

You start inserting needles, and everything seems to be going well. On the last needle, she winces a little, though. You stop and ask, “Doing okay, Margaret?”

“Yeah, that one just felt…I don’t know…deeper.”

“The good news is, we’re all done. Other than that last one, how do you feel overall?”

“Pretty good actually.”

You go to her file and document that she experienced some pain on the last needle and record your conversation. “That’s good. Keep up with your home therapy, and be sure to call if you have any questions or concerns.”

Everything does seem good—she even seems to be hobbling less as she leaves the clinic. But several days later, you learn that Margaret started experiencing some shortness of breath, which she thought was unrelated to the dry needling. However, after her physician ran a number of tests, she was diagnosed with a pneumothorax—a small puncture in her lung—and it was located exactly at the site of the last needle.

Protecting Yourself and Your Patients

Fortunately, Margaret was fine. The needles used in this procedure are small, so the pneumothorax was minor and—in this case—resolved on its own without treatment. However, the tests needed to diagnose a pneumothorax can be costly. If you don’t take steps to mitigate the risks, not only could your business find itself on the hook for medical bills, you could also do serious harm to your reputation. Here are a few steps you can take to protect yourself and mitigate the costs associated with a claim.

Know the Risks

The first step in mitigating the risks to you and your patients is to be honest about those that exist. When Margaret half-jokingly mentions puncturing a lung in the story above, the physical therapist describes it as “pretty much impossible.” Unfortunately, this is a common myth about dry needling. It’s important to know that—while uncommon—pneumothorax is possible when performing dry needling. Additionally, other risks include bruising, puncturing other organs and tissues, and infection.

Educate Your Patients

Whether you’re billing for the procedure or not, discuss the risks associated with dry needling with your patient. Once you’re sure the patient understands the procedure and the potential risks, have them sign a consent form.

Keep Records

The best piece of advice we can give, regardless of the procedure or business setting, is to maintain detailed documentation. In addition to the signed consent form, be sure to record discussions with your patient like the physical therapist in the story above. Did they complain of any discomfort during the session? How did they feel once it was completed? The clearer you can be, the easier it will be for you, your insurance agent or broker, and your patient to resolve an issue should one arise.

Stay Current

Make sure you keep up with recent trends and techniques, including any updated indications and contraindications. If this is a technique you don’t use on a regular basis, review the procedure with experienced colleagues before performing it on your patients.

For more information about how you can minimize the risk of claims for your business, and to ensure you have adequate coverage, reach out to your VGM Insurance Services Account Manager or contact us today at or 800-362-3363.



Read Our Other Claims Case Studies

  • To read The Case of the Unopened Letter, click here
  • To read The Case of the Burning Questionclick here
  • To read The Case of the Shackled Systemclick here
  • To read The Case of the Vanishing Ventilatorclick here
  • To read The Leak and the Lesionclick here
  • To read The Unhitched Linchpinclick here
  • To read The Ascending, Rotating Chairclick here
  • To read The Case of the Uncoupled Shroudclick here


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