Dry Needling the Quadratus Femoris: Lessons in Safety, Accuracy, and Training from a Cadaveric Study
A 2025 cadaveric study by Sánchez-Montoya and colleagues has added valuable insight to our understanding of dry needling safety and anatomical accuracy—specifically when targeting the quadratus femoris muscle. The results? Even with experienced clinicians, needle placement in this deep hip muscle showed only moderate accuracy, and the authors flagged noteworthy clinical risks when the technique was performed without ultrasound guidance.
For clinicians and educators in dry needling, these findings reinforce what we’ve long known: technical skill alone isn’t enough. Safety in dry needling comes from a combination of precise anatomical knowledge, patient communication, objective placement validation, and high-quality training environments.
At Dry Needling Academy (DNA), these principles aren’t optional—they’re at the core of every course we teach. Let’s look at what the study revealed, and how we translate that knowledge into safer, more effective practice.
1. The Study: What We Learned About Targeting the Quadratus Femoris
The quadratus femoris is a small, deep external rotator of the hip, positioned between the ischial tuberosity and the femur. It’s bordered by important neurovascular structures—meaning a misplaced needle could cause significant harm.
Key findings from the study:
Moderate accuracy in reaching the target muscle using a standardized, non-ultrasound-guided technique.
Notable clinical risks due to proximity to sensitive structures.
Limited inter-rater reliability — even trained physiotherapists varied in their placement accuracy.
These findings are important because they highlight that even skilled hands can miss the mark when relying solely on palpation and anatomical landmarks—especially with deep targets like the quadratus femoris.
2. Communication as a Built-In Safety Check
One of the best real-time safeguards we have—short of ultrasound—is the patient’s sensory feedback. When you can’t see the target muscle, you have to rely on both your tactile skill and your patient’s responses.
Before Needle Insertion
A clear, concise explanation helps your patient:
Understand what’s being treated and why.
Expect normal sensations (dull ache, twitch, pressure).
Recognize abnormal sensations (sharp, burning, unexpected radiating pain).
During Needle Advancement
Your patient is your second set of “eyes.” Neutral language phrases like:
“Do you feel that where I expect you to feel it?”
“Any unusual sensations?”
“Tell me if you feel anything other than the normal ache or pressure.”
This constant dialogue gives you immediate information about possible nerve contact, vascular proximity, or simply being off-target without sensitizing the patient. Be thoughtful and attentive to patients’ non verbal responses as well. Identify strong response and ask for verbalization about the sensation they are feeling.
Why it matters for deep muscles: In the quadratus femoris region, certain unexpected sensations could signal that you’re nearing the sciatic nerve or other structures—an invaluable early warning.
3. Electrical Stimulation: Objective Placement Validation
The Sánchez-Montoya study didn’t incorporate electrical stimulation as a placement confirmation tool, but this is where clinical practice can go a step further.
With e-stim, you can confirm the target muscle’s activation after needle insertion:
Correct placement → isolated contraction of the quadratus femoris without recruiting the gluteus maximus, hamstrings, or adductors.
Incorrect placement → activation of unintended muscles or diffuse contraction.
This not only boosts confidence in your technique but also helps reduce the margin for error in areas where anatomical depth and surrounding structures make accuracy challenging.
Bonus benefit: Patients often find the visible contraction reassuring—it shows them you’ve hit the intended target, making the session more collaborative and transparent. And there is good evidence that using electrical stimulation has additional physiologic benefits and reduces treatment soreness. Check out our blog post on DN with E-stim Here.
4. What the Study Means for Training Standards
The Sánchez-Montoya paper is a clear reminder that high-risk anatomical regions demand equally high standards in training. In many large courses, a crowded lab means less one-on-one supervision. That’s a recipe for poor habit formation and potential safety issues later.
Why DNA Keeps Instructor-to-Participant Ratios Low
At DNA, we structure our classes to:
Provide real-time corrections as you practice.
Ensure constant safety oversight in labs.
Allow every participant to ask detailed questions and get individualized feedback.
In a skill as precise as dry needling, the difference between “almost” and “exactly” is everything—especially in deep structures like the quadratus femoris.
5. Bridging the Gap Between Research and Practice
Research like Sánchez-Montoya’s provides the evidence base. As clinicians, our job is to apply those findings in a way that keeps patients safe and maximizes treatment effectiveness.
That means:
Acknowledging limitations — Landmark-guided techniques have boundaries, especially in deep anatomical areas.
Integrating patient feedback — Sensory reports are a built-in safety net.
Using objective confirmation — E-stim adds another layer of accuracy verification.
Prioritizing advanced training — Smaller ratios and experienced instructors help refine the skill beyond the basics. Skilled instructors know how to approach difficult and more technical techniques safely.
6. The DNA Difference: Safety First, Always
When you train with DNA, you’ll experience:
Live modeling of communication strategies for every muscle group, including high-risk areas.
Hands-on e-stim training to use for both therapy and placement confirmation.
Guided practice with an instructor close by, not across the room.
Clinical reasoning focus—so you don’t just know how to needle, you know why and when to choose a given approach.
By embedding these elements into our teaching, we aim to close the gap that the Sánchez-Montoya study exposed between theoretical knowledge and consistent, safe execution.
7. Final Thoughts
The 2025 Sánchez-Montoya cadaveric study is a valuable reminder that deep-target dry needling is not a “by feel” skill alone. It demands precise anatomy, vigilant communication, and, whenever possible, objective confirmation.
At Dry Needling Academy, we take that message seriously. Whether you’re targeting the quadratus femoris or any other high-risk structure, the safest approach is one rooted in evidence, collaboration, and deliberate training.
If you’re ready to elevate your dry needling practice with these principles at the core, our upcoming courses are the perfect place to start.
Ready to train with us?
View our course calendar → and join a learning environment designed for safety, precision, and clinical excellence.
Reference
Sánchez-Montoya M, Almazán-Polo J, Hernández NV, Cotteret C, Guerineau F, Monreal-Redondo DdG, González-de-la-Flor Á. Safety and anatomical accuracy of dry needling of the quadratus femoris muscle: a cadaveric study. Healthcare. 2025;13(15):1828. doi:10.3390/healthcare13151828
