Rob Satriano, PT, DPT, CMTPT, MLDT – Instructor
Each month, I hear from new patients who tell me they have “tried dry needling before, and it didn’t help”. Despite this, many are open to the receiving the treatment again and understand that all dry needling is not the same. Moreover, the public is starting to realize there are huge differences in skillset amongst clinicians.
The skill-set difference between an expert dry-needler and a very average one is vast. I dare to say, it’s as polar as a meal at a fast-food joint as compared to fine dining at a Michelin-rated restaurant. Thus, the efficacy of the procedure and patient results are wildly variable. This could mean a patient has no change in symptoms or, inversely, feels well enough to cancel an unnecessary surgical procedure.
Rather than focus on a specific muscle group or clinical pearl this month, I will instead discuss a simple yet critical topic related to the technique of dry needling.
As a dry needling instructor, I observe many clinicians practicing their craft. One of the most common habits I see in newer dry needling practitioners—and even some seasoned clinicians—is the tendency to insert the needle in a single direction and only vary the needling depth. Or, the needle is not withdrawn from the muscle back into the superficial fascial layer. In this case, the needle is usually bending, and the same 0.3 mm area of tissue (the thickness of many needles) is getting overtreated while missing several contracture knots and trigger points. While these approaches might yield results in some cases, they often fall short of the technique’s full therapeutic potential.
Let’s talk about why changing needle direction is clinically essential.
Muscles Are 3D. Your Needle Technique Should Be Too
Muscles aren’t linear. They are complex, three-dimensional structures with varying fiber orientations and layers. Trigger points may be nestled medially, laterally, deep, or superficial. When we insert a needle at a single angle or trajectory, we risk missing key portions of the muscle—especially those pesky, clinically-relevant trigger points that contribute to pain referral patterns and dysfunctional movement.
By redirecting the needle slightly within a safe and controlled range, you access more of the muscle’s landscape. This is particularly critical in multi-pennate or fan-shaped muscles like the gluteus medius or in tight spaces like the upper trapezius. A single path just doesn’t cut it.
Clinical Precision: Not Guesswork, But Guided Exploration
This isn’t about “fishing” blindly with the needle. Redirecting is an intentional act—based on palpation, anatomical knowledge, and patient feedback. When we slightly withdraw and redirect, we’re not just increasing our chance of deactivating a trigger point—we’re ensuring a more comprehensive and therapeutic intervention.
Many of my most effective treatments involve a subtle change in angle—posteriorly toward a hidden band, or laterally to pick up a taut fiber missed in the first pass. Without that redirection, the patient likely wouldn’t have the same outcome.
More Coverage, Fewer Sessions
Redirecting also boosts efficiency. If you’re treating a large muscle, it doesn’t make sense to pepper it with five separate insertions when a single well-placed needle, redirected thoughtfully, can address the same area with less tissue trauma and discomfort. Fewer insertions, more coverage, better outcomes.
As seasoned clinicians, we owe it to our patients to be better. Redirection of a filiform needle isn’t just a technique—it’s a form of clinical thinking. Every time we redirect the needle, we’re refining our assessment in real time. Where is the resistance? What tissue am I in? How is the patient responding?
Encouraging yourself to get comfortable with safe, anatomical redirection fosters more than just better results!
