Dry needling

What is dry needling, and how does it work?

Dry needling (also called myofascial or trigger point dry needling) is a skilled technique. A clinician puts a thin, solid needle, with nothing injected, through the skin to stimulate sore spots in a muscle, known as myofascial trigger points (tender knots in tight muscle)¹. The needles stay in for a few minutes and may be gently moved to make the muscle twitch².

How it eases pain isn't clear. Suggested explanations include less inflammation and better blood flow near the needle³, but these are theories. People also disagree about whether it's a separate treatment or a form of acupuncture⁴².

What is it used for, and how well does it work?

It's mainly used for muscle and tendon pain linked to trigger points. The best-supported benefit is short-term pain relief. For neck, shoulder and low back pain it's usually no better than other common treatments such as exercise².

Heel pain (plantar fasciitis) has the most research. In adults, adding dry needling to a home exercise program eased pain in the short term more than exercise alone⁵. It may take at least a month to take effect³. Compared with a fake treatment, the extra pain relief can be small⁶. For shoulder tendon pain (rotator cuff tendinopathy) in adults, shoulder exercises alone may be a reasonable first step, as needling may not add much⁷.

Relief may not last beyond 6 months⁸. It may work better alongside exercise or manual therapy¹. It isn't clear yet whether the benefit goes beyond a placebo effect².

Is dry needling right for me?

For most health conditions, the answer is extra care and an adjusted technique rather than a ban⁹. It may not suit you if you fear needles or have fainted during a needling procedure such as a blood test². Reasons not to needle at all include severe needle phobia, active infection, an open wound at the site, significant bleeding risk, the first six weeks after surgery, first-trimester or high-risk pregnancy, and being unable to give consent¹. Extra caution applies with weakened immunity and in children under 12¹.

Guidance on blood thinners differs: some say they aren't an absolute barrier if bleeding risk is assessed¹¹⁰, while Swiss guidelines say they are¹¹. Don't stop any prescribed medicine yourself; discuss it with your prescriber and practitioner.

What happens during a session?

Before the first needle, expect questions about your health and medicines, a look at your skin, and an explanation of the risks. Your practitioner should get your consent first, at least verbally¹⁰.

During the session, thin needles go into the sore muscle area and stay in for a few minutes, sometimes gently moved to make the muscle twitch². Tell the practitioner straight away if you feel unwell, or need to cough, sneeze or move. Afterwards, some soreness is common⁸.

No standard number of sessions has been shown, so ask how many are planned, how progress will be judged, and when the plan would change or stop. Keep up any exercises you've been given.

What are the risks and side effects?

Side effects are usually minor and short-lived: pain, bleeding and bruising. Rare serious complications can happen¹². In heel pain trials, side effects were mild and settled by themselves³.

Needling the chest area carries a risk of pneumothorax (a collapsed lung), which skilled technique can avoid¹³. Areas such as the chest, pelvic floor, neck and near major nerves and vessels should only be needled by someone with specific training¹. Infection is a bigger concern if your immunity is weakened⁹.

Sore spots can have other causes. Early kidney infection can mimic muscle pain, so unexplained symptoms need a doctor's check before any needling⁹.

How does it compare with other options?

Dry needling does about as well as other treatments, not clearly better. For short-term pain in some conditions it's generally better than a fake treatment or no treatment, and similar to other physical therapy¹. For neck, shoulder and low back pain it's no better than exercise², and for shoulder tendon pain exercise alone may be a reasonable first step⁷. In heel pain, adding it to home exercise helped more than exercise alone⁵.

A related technique, percutaneous electrolysis (a needle with an electrical current), may ease tendon pain slightly more than needling when both are paired with exercise, with no difference for muscle pain¹⁴. Other treatments may work as well with fewer potential side effects¹⁵. Ask about alternatives such as exercise, and ask for needling to be part of a plan that includes active care.