Dry needling

1. What is dry needling?
2. How does dry needling work?
3. Dry needling vs acupuncture
4. What conditions can dry needling treat?
5. Does dry needling hurt?
6. Is dry needling safe?
7. Frequently asked questions
8. References

1. What is dry needling?

Dry needling is a technique that uses fine, solid needles — identical to acupuncture needles — inserted directly into myofascial trigger points within muscles. A trigger point is a hyperirritable spot within a taut band of muscle that can cause localised pain, referred pain, stiffness and reduced range of movement. The term "dry" distinguishes the technique from wet needling, in which a substance such as an anaesthetic is injected through a hollow needle. In dry needling, nothing is injected — the needle alone creates the therapeutic response.

Dry needling is primarily used to treat musculoskeletal pain and dysfunction. It targets the underlying muscular cause of pain rather than simply masking symptoms, making it a useful tool for patients who have not responded fully to massage, physiotherapy or medication alone.

2. How does dry needling work?

When a fine needle is inserted into an active trigger point, it disrupts the dysfunctional motor end plate activity that sustains the trigger point. This typically causes a brief, involuntary twitch response in the muscle — known as a local twitch response (LTR) — which is a reliable sign that the trigger point has been accurately located and deactivated. Following this twitch, the taut band of muscle relaxes, blood flow to the area is restored and the local chemical environment — which had become acidic and rich in sensitising substances — normalises.

Research suggests that dry needling works through several overlapping mechanisms. Locally, it reduces concentrations of inflammatory mediators such as substance P, calcitonin gene-related peptide (CGRP) and bradykinin at the trigger point site. Centrally, needle stimulation activates descending pain-inhibitory pathways — including the release of endogenous opioids, serotonin and noradrenaline — that dampen pain signal processing in the spinal cord and brain. This dual local and central mechanism explains why patients often experience pain relief both at the needling site and in remote areas of referred pain.

A 2021 systematic review and meta-analysis published in Pain Medicine found that dry needling significantly reduced pain intensity and improved pressure pain threshold in patients with myofascial pain syndrome compared to sham and control interventions (doi: 10.1093/pm/pnaa358).

3. Dry needling vs acupuncture

Dry needling and traditional acupuncture both use the same fine gauge needles, and both produce therapeutic effects through needle stimulation of tissue. However, they differ significantly in their theoretical framework and clinical application.

Traditional acupuncture is rooted in Traditional Chinese Medicine (TCM). Needles are inserted at specific acupuncture points located along meridian pathways to regulate the flow of Qi (vital energy), balance Yin and Yang, and address the underlying pattern of disharmony causing the patient's symptoms. TCM acupuncture treats the whole person — not just the local site of pain — and is used for a broad range of conditions beyond musculoskeletal pain, including anxiety, insomnia, fertility and digestive disorders.

Dry needling is rooted in Western anatomical and neurophysiological models. Needles are inserted into trigger points identified by palpation, based on patterns of muscle dysfunction and referred pain described by researchers Travell and Simons. Its application is focused primarily on myofascial pain and musculoskeletal conditions.

In practice, many experienced acupuncturists — including myself — draw on both frameworks. Classical acupuncture point locations frequently correspond anatomically with documented trigger points, and combining TCM theory with trigger point technique often produces better results than either approach alone. As a Doctor of Traditional Chinese Medicine with over 25 years of clinical experience, I integrate dry needling into my acupuncture treatment where appropriate.

4. What conditions can dry needling treat?

Dry needling is most commonly used to treat pain and dysfunction arising from myofascial trigger points. Conditions I treat using dry needling include:

• Neck pain and cervicogenic headache
• Back pain and lumbar dysfunction
• Shoulder pain and rotator cuff problems
• Frozen shoulder (adhesive capsulitis)
• Tension headaches and migraines
• Jaw pain and TMJ dysfunction
• Hip pain and gluteal trigger points
• Knee pain and iliotibial band syndrome
• Plantar fasciitis
• Tennis elbow and golfer's elbow
• Carpal tunnel syndrome
• Fibromyalgia
• Sports injuries and muscle strains
• Sciatica with a myofascial component

Dry needling is often used alongside electroacupuncture, cupping therapy and heat therapy to maximise results.

5. Does dry needling hurt?

Most patients are surprised by how little discomfort dry needling causes. The needles used are extremely fine — much thinner than a standard hypodermic injection needle — and insertion is generally barely perceptible. When the needle reaches an active trigger point, patients often feel a brief, deep ache, muscle cramping or the involuntary local twitch response. This sensation, while unusual, is brief and is actually a positive sign that the trigger point has been engaged.

After treatment, the area may feel slightly tender or bruised for 24–48 hours — similar to the sensation after an intense stretch or deep tissue massage. This is a normal response and typically resolves quickly. Most patients find that any initial discomfort is far outweighed by the pain relief and improved movement that follows.

6. Is dry needling safe?

Dry needling is a safe procedure when performed by a qualified and experienced practitioner. As a fully insured member of the British Acupuncture Council (BAcC) — the UK's leading professional body for acupuncture, accredited by the Professional Standards Authority — I follow strict hygiene and safety protocols. All needles are single-use, sterile and disposed of immediately after treatment.

Possible minor side effects include temporary local soreness, small bruising or slight bleeding at the needle site. Serious adverse events are rare when treatment is carried out by a properly trained practitioner. Dry needling is not appropriate for patients with bleeding disorders, those taking anticoagulant medication, or in areas of local infection or skin lesion.

If you are pregnant, please let me know before treatment — certain acupuncture and dry needling points are avoided during pregnancy. Dry needling is generally safe in pregnancy when performed by an experienced practitioner who is aware of the contraindications.

7. Frequently asked questions

How many dry needling sessions will I need?

The number of sessions depends on the nature and duration of your condition. Acute trigger point pain often responds within two to four sessions. Chronic or long-standing conditions may require a longer course of treatment. I assess your progress at each appointment and adjust the treatment plan accordingly. Most patients notice an improvement after the first or second session.

How long does a dry needling session last?

A dry needling session typically forms part of a broader acupuncture appointment, which lasts approximately 45–60 minutes for the first consultation (including a full TCM assessment) and 45 minutes for follow-up appointments. The needling itself takes 20–30 minutes depending on the number of trigger points being treated.

How long do the effects of dry needling last?

The duration of relief varies between patients and depends on the severity and chronicity of the trigger points. After a course of treatment, many patients experience long-lasting improvement as the underlying muscular dysfunction is resolved rather than simply suppressed. Maintenance sessions every four to six weeks can help prevent recurrence in patients with physically demanding jobs or active lifestyles.

Can I have dry needling alongside other treatments?

Yes. Dry needling works well alongside physiotherapy, osteopathy, massage and exercise rehabilitation. I will discuss your current treatments during your initial consultation and advise on the best approach. Cupping therapy and heat therapy are particularly complementary to dry needling within the same session.

Is dry needling the same as trigger point injection?

No. Trigger point injections use a hollow needle to inject a substance — such as local anaesthetic, saline or corticosteroid — into the trigger point. Dry needling uses a solid acupuncture needle and injects nothing. Both techniques target trigger points, but the mechanism and regulatory framework differ. Dry needling is performed by trained acupuncturists and allied health professionals; trigger point injections are a medical procedure requiring a prescribing clinician.

How does dry needling differ from deep tissue massage?

Both techniques target myofascial trigger points, but they work differently. Deep tissue massage applies manual pressure over a sustained period to mechanically release taut muscle bands. Dry needling accesses trigger points directly with a needle, producing a local twitch response that achieves deactivation more precisely and often more quickly. Many patients find dry needling effective for deep-seated trigger points that are difficult to reach with manual therapy alone.

8. References

1. Dommerholt J, Grieve R, Layton M, Hooks T. An evidence-informed review of the current myofascial pain literature — January 2015. Journal of Bodywork and Movement Therapies. 2015;19(1):126-137. doi: 10.1016/j.jbmt.2014.11.006
2. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain. 2009;13(1):3-10. doi: 10.1016/j.ejpain.2008.02.006
3. Liu L, Huang QM, Liu QG, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2015;96(5):944-955. doi: 10.1016/j.apmr.2014.12.015
4. Gattie E, Cleland JA, Snodgrass S. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2017;47(3):133-149. doi: 10.2519/jospt.2017.7096
5. Morihisa R, Eskew J, McNamara A, Young J. Dry needling in subjects with muscular trigger points in the lower quarter: a systematic review. International Journal of Sports Physical Therapy. 2016;11(1):1-14. PMID: 26900494
6. Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. Journal of Pain Research. 2019;12:1899-1911. doi: 10.2147/JPR.S154728
7. He Y, Li Z, Bhatt DL, et al. Dry needling versus acupuncture: the ongoing debate. Acupuncture in Medicine. 2015;33(6):485-487. doi: 10.1136/acupmed-2015-010911
8. Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Current Pain and Headache Reports. 2013;17(8):348. doi: 10.1007/s11916-013-0348-5
9. Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. Journal of Orthopaedic and Sports Physical Therapy. 2013;43(9):620-634. doi: 10.2519/jospt.2013.4668
10. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews. 2014;19(4):252-265. doi: 10.1179/108331913X13844245552986