Dry needling (DN) is sometimes described as “low risk, high reward,” but we rarely talk about the actual risks in a structured way. Some clinicians gloss over the consent process or go the opposite direction and overwhelm patients with an exhaustive list of rare complications.
Two recent studies give us a better way forward. Ickert et al. (2023) defines which adverse events (AEs) should be disclosed during informed consent. Boyce et al. (2020) gives us large-scale data on how often these events actually happen. Together, they offer a clearer, more confident approach to safety and communication in DN practice and highlight why sound technique and anatomical precision matter.
The Ickert paper starts with a massive list, over 50 possible adverse events tied to dry needling. It’s a comprehensive review, but if you read it like a checklist of things to say before every session… it starts to feel like one of those American medication commercials:
“May cause bruising, dizziness, fainting, fatigue, neurological symptoms, local irritation, temporary worsening of symptoms… or death.”
You get the point.
Here’s the tension: how do we provide informed, ethical consent without undermining the intervention itself? When we front load risk with a giant list of common and rare events, it can shape expectations in a way that might work against the intervention.
That’s why process of care matters just as much as the intervention. How we frame, explain, and deliver any intervention, including DN, affects everything from safety to therapeutic alliance to outcomes.
Consent isn’t just about listing risks, it’s about creating clarity and confidence so the patient feels safe and hopeful.
This paper made me realize we don’t just need better lists, we want better scripts, grounded in real-world data and delivered with purpose.
🔎 Ickert et al. (2023) used a Delphi process with 39 dry needling experts to determine which AEs should be included in informed consent. Out of 50 potential AEs, only 14 made the final cut.
What didn’t make the cut? Nerve injury, infection, and organ puncture—often included in textbook-style risk lists, but deemed too rare to be part of routine consent.
📊 Boyce et al. (2020) backs this up with hard numbers from 7,629 DN sessions:
No serious adverse events Mild AEs in ~8.6% of sessions, including:
Bleeding (4.9%)
Bruising (2.9%)
Pain (1.4%)
Dizziness/fatigue (<1%)
Knowing what actually happens, based on the data and our experiences, helps us speak with calm, confident precision.
Try tightening up your DN consent script using the AEs that are both common and clinically relevant. Here’s a practical way to frame it:
“Most people have transient soreness, bruising, or redness. Occasionally, people feel dizzy or tired after. Serious reactions are quite rare, and with good technique we reduce those risks."
Then pause:
“Any questions or concerns before we start?”
That single pause can build more trust than a list of 50 risks ever could.
And remember, technique reduces risk. It’s not just what you say, it’s how you practice.
📚 Read the research:
Ickert et al. (2023) – Expert consensus on what AEs to include in consent
Boyce et al. (2020) – Observational safety data from 7,600+ treatments
But beyond reading, practice is what sharpens safety.
In our Dry Needling Refresher Courses, we go deep on:
Which muscles we believe are the “heavy hitters” for your clinical practice
How to find the bony backdrops, safe depth, and needle direction
Pre-course prep: articles, infographics, videos and more.
Live, hands-on, guided repetition to build skill and confidence
Slow walkthroughs of key techniques, with lots of feedback and time
Whether it’s been a few months or a few years since your certification, this is your chance to dial in your technique.
Join this waitlist now and we will contact you when the course opens up for early registration.
“Confidence in consent doesn’t come from knowing all the risks, it comes from knowing which ones matter, and how to reduce them.”
When you understand anatomy, apply sound technique, and communicate clearly, dry needling becomes a safer, high-trust, high-impact part of your clinical toolkit.
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Final reflection:
Your consent process is more than a form, they are key moments. A moment to connect, be transparent, clarify, make shared-decisions and lead. These two studies give you a data-backed foundation to speak with honesty. And if it’s been a while since you practiced those key muscles or updated your script our upcoming courses are designed to help.
🔁 Reps matter. So does how you talk about what you do. Let’s keep levelling up both.
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Stay nerdy,
Sean Overin, PT
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