Pins and Needles: Common Causes and When to See a GP

In short

Pins and needles is a prickling, tingling or numb feeling, most often in the hands, arms, legs or feet. The usual cause is pressure on a nerve, for example from sitting on your foot or sleeping on your arm, and it passes within minutes once you move. Pins and needles that keeps coming back, lasts a long time or has no clear cause needs a GP, because it can be linked to diabetes, low vitamin B12, circulation problems, some medicines or a trapped nerve.

Below we explain what pins and needles is, how it works, the common causes in the hands, legs and feet, and the signs that need urgent help. Physiotherapy has a place too. A physio can help when a nerve is being squeezed by posture or by a problem in the neck or back, while many other causes need a doctor first.

What is pins and needles?

Pins and needles feels like pricking, tingling, crawling or fizzing under the skin, sometimes with numbness or burning. Most people know it from a foot that has "gone to sleep" after sitting cross-legged. The medical term for pins and needles is paraesthesia (spelled paresthesia in American English). Doctors use it for any abnormal tingling or prickling that happens without anything touching the skin.

How does pins and needles work?

Nerves carry signals from the skin to the brain, and they need a steady blood supply to work properly. When you lean on a nerve, the pressure squeezes both the nerve and the tiny blood vessels that feed it, so the nerve stops sending normal signals and the area may go numb. When the pressure comes off and blood flows back, the nerve restarts and sends a burst of jumbled signals. Your brain reads that as tingling, which fades as the nerve settles.

Short-lived pins and needles of this kind is harmless and happens to everyone. When it comes on without any pressure, lasts, or keeps returning, a nerve is usually being irritated or affected in some other way, and the cause is worth finding.

What causes pins and needles?

The causes of pins and needles fall into two broad groups. Temporary pins and needles comes from pressure on a nerve and goes away quickly. Long-lasting or recurring pins and needles has many possible causes, and a lot of them are not muscle or joint problems at all. The NHS advises against self-diagnosing and suggests seeing a GP if you are worried.

Causes linked to nerves, joints and posture

• a trapped nerve in the neck, which can cause tingling down the arm into the hand
• a trapped nerve in the lower back, as in sciatica, causing tingling down the leg into the foot
• carpal tunnel syndrome, where a nerve is squeezed at the wrist
• pressure on the ulnar nerve at the elbow, which affects the ring and little fingers
• sustained postures, such as leaning on your elbows, sitting cross-legged or sleeping with your arm above your head

Causes that need a doctor

• diabetes, which is the most common cause of nerve damage in the hands and feet (peripheral neuropathy) in the UK
• low vitamin B12 or folate, which can also cause tiredness, a sore red tongue and problems with memory
• circulation problems, including Raynaud's, where fingers or toes change colour in the cold
• some medicines and treatments, such as chemotherapy, some antibiotics and some medicines for seizures
• drinking too much alcohol
• breathing too quickly (hyperventilation), often during anxiety or a panic attack
• conditions affecting the brain or spinal cord, such as multiple sclerosis

Because the list is long, a GP is the right first stop for pins and needles that is persistent or unexplained. They may arrange blood tests to check things like blood sugar and vitamin B12. If it turns out the tingling is coming from your neck, your back or a nerve being compressed, a physiotherapist can help with that part.

Pins and needles in both hands

Pins and needles in both hands has a slightly different list of likely causes from tingling in one hand. Carpal tunnel syndrome can affect both wrists, especially in people who grip, type or use vibrating tools, and in pregnancy. It is usually worse at night and affects the thumb and first fingers. Diabetes and low vitamin B12 tend to start in the feet but can reach the hands too, often affecting the whole hand, like a glove, instead of one or two fingers.

Tingling in both hands that comes with clumsiness, dropping things, trouble with buttons or a change in the way you walk needs a prompt GP appointment, as it can occasionally come from pressure on the spinal cord in the neck. Tingling in both hands with fast breathing and tingling lips often settles as your breathing slows down. Call 999 if it comes with chest pain, or if you are struggling to breathe.

Pins and needles in the feet and legs

Common causes of pins and needles in the feet include sitting with your legs crossed or tucked under you, tight shoes or boots, and long spells standing. Tingling, burning or numbness in both feet that does not go away is different. It can be an early sign of peripheral neuropathy, and in the UK diabetes is the most common cause. Low vitamin B12, heavy drinking and some medicines can do the same. See a GP, and if you have diabetes, keep up with your regular foot checks.

Pins and needles in one leg, such as the right leg

Pins and needles in the right leg or the left leg alone usually points to a nerve on that side. Tingling that runs from the lower back or buttock down the back of the leg to the foot is typical of sciatica, a trapped nerve in the lower back. Our page on sciatica physio at home explains how a physio helps with it.

Tingling and numbness on the outer thigh can come from a nerve squeezed near the hip by tight clothing, a tight belt or weight gain. Crossing your legs for a long time can press on a nerve just below the outside of the knee. One-sided leg tingling that comes on suddenly with weakness, especially if the arm or face on the same side is affected, is a different matter. Call 999 straight away, as it could be a stroke.

How do you get rid of pins and needles?

For ordinary pins and needles from sitting or lying on a limb, take the pressure off and move. Change position, stand up, wiggle your fingers or toes, and gently shake out the arm or bend and straighten the foot. The tingling usually fades within a few minutes as blood flow and nerve signals return. Wait until the feeling is back before walking on a foot that has gone numb, so you do not trip or turn an ankle.

If it keeps happening in the same way, look at the trigger. Common changes that help include:

• not leaning on your elbows on a desk, armrest or car door for long periods
• keeping your wrists fairly straight when typing or using a phone, and taking regular breaks
• sleeping with your arms below shoulder height rather than tucked under your head or pillow
• uncrossing your legs and changing position regularly when you sit
• loosening tight shoes, boots, belts or watch straps
• keeping active, which helps both circulation and nerve health

Pins and needles with no obvious trigger, or that lasts a long time or keeps coming back, needs its cause found. Any treatment depends on that cause, for example managing blood sugar in diabetes, replacing vitamin B12 if your levels are low, or reviewing a medicine with your GP. A physiotherapist can help when the cause is a nerve being squeezed in the neck, back, elbow or wrist.

UK Physio Tip: If you often wake with tingling hands, check how you sleep. Many people curl their wrists under their chin or stretch their arms above their head, and both positions squeeze nerves. Try keeping your arms by your sides, or ask a pharmacist about a simple splint that holds the wrist straight overnight. Then notice whether the tingling changes over the next week or two.

When pins and needles needs urgent help

Pins and needles on its own is rarely an emergency. These signs, though, need urgent medical help:

• Sudden numbness or weakness on one side of the body, a drooping face, arm weakness, slurred speech or confusion: call 999 straight away. These are signs of a stroke, even if they go away.
• Numbness or weakness in both legs, numbness around your bottom or genitals (the saddle area), or new problems controlling your bladder or bowels: go to A&E or call 999, as these can be signs of cauda equina syndrome.
• Pins and needles, numbness or weakness after a head or neck injury, such as a fall, a sports collision or a car accident: go to A&E or call 999.
• A hand, arm, foot or leg that turns cold, pale or blue, especially if the change is spreading: call 999 or go to A&E.
• Tingling with chest pain, or with breathlessness that does not settle: call 999.
• Numbness or weakness that keeps getting worse, or pins and needles that is constant or keeps coming back: see a GP, and ask for an urgent appointment if it is getting worse.

This platform facilitates booking only. It does not provide medical advice. If you are not sure how urgent your symptoms are, NHS 111 can help you decide. The NHS page on pins and needles and the NHS guide to peripheral neuropathy have more on the causes and when to see a GP.

How a physiotherapist helps with pins and needles

A physiotherapist can help when pins and needles comes from a nerve being squeezed or irritated by posture, or by a problem in the neck or back. Your physio will ask where the tingling goes, when it happens and what sets it off. They will then check your neck, back and limbs, test strength, reflexes and sensation, and look at how you sit, work and sleep. If the pattern does not fit a nerve compression or joint problem, they will advise you to see a GP.

When it does fit, treatment often includes:

• exercises to restore movement in the neck, upper back or lower back
• gentle nerve-gliding exercises, where they suit you
• strengthening for the muscles that support the spine and shoulders
• advice on your desk set-up, phone use, driving position and sleeping posture
• a plan for pacing the activities that bring it on, such as long spells of typing or gripping tools

If your tingling travels from the neck into the arm, our page on neck pain physio at home explains what a visit involves. Progress varies by person. Your physio will review the plan with you at each visit and change it if your symptoms change, or advise you to see a GP if something new appears.

Physiotherapy also has a role when pins and needles is part of a neurological condition. People with multiple sclerosis or peripheral neuropathy, or who are recovering from a stroke, often have altered sensation along with weakness or balance problems, and a physio can work on strength, balance and safe walking. Our neurological physiotherapy service and our guide to multiple sclerosis physiotherapy at home explain more.

Seeing a physio for pins and needles at home or online

With FlexAura, an HCPC-registered, DBS-checked physiotherapist can visit you at home anywhere in England, Scotland and Wales, or see someone at a relative's home, in sheltered housing or in a care home. A home visit lets the physio see the chair, desk or bed set-up that might be part of the problem. If you would rather start with advice, an online video consultation is available anywhere in the UK.

An online consultation is £45. A home visit is £110 for the first visit and £99 for follow-ups, and a 5-session home package is £450. Prices are the same across the UK and include the physio's travel. You pay after the visit, there are no cancellation fees and you do not need a GP referral. Full details are on our physiotherapy prices page.

We match a physiotherapist to every booking and confirm who is coming and when before the visit. If nobody can come, you pay nothing. If you have private health insurance, check your policy before you book. To get started, book a physiotherapist online, call 07782 610 633 or WhatsApp us.