What Is Dry Needling? A Physio’s Guide to Treatment

What Is Dry Needling?

Dry needling is a technique used by physiotherapists and other trained health professionals to treat myofascial pain and dysfunction. It involves the insertion of fine, sterile, single-use acupuncture needles into myofascial trigger points—hyperirritable spots within taut bands of skeletal muscle that produce local and referred pain.

The term “dry” distinguishes the technique from “wet” needling, which involves injecting a substance (such as a local anaesthetic or corticosteroid) into the tissue. In dry needling, nothing is injected—the needle itself is the therapeutic tool.

Dry needling has grown significantly in popularity in Australian physiotherapy practice over the past two decades. It is used as one component of a comprehensive treatment approach, alongside exercise, manual therapy and education.

How Does Dry Needling Work?

The mechanisms underlying dry needling are multifactorial and continue to be researched. Current evidence suggests several physiological effects:

Local Effects

• Disruption of the trigger point – the needle mechanically disrupts the dysfunctional motor endplate within the trigger point, producing a local twitch response (a brief, involuntary contraction of the muscle)
• Increased blood flow – needling promotes local vasodilation and blood flow to the area, which may help clear inflammatory mediators and metabolic waste products
• Release of muscle tension – following the twitch response, the taut band often relaxes, reducing muscle stiffness and improving flexibility
• Biochemical changes – research by Shah et al. demonstrated that dry needling reduces concentrations of pain-producing chemicals (substance P, calcitonin gene-related peptide, bradykinin) in the local tissue

Neurological Effects

• Segmental pain inhibition – the needle stimulates A-delta nerve fibres, which can inhibit pain signalling at the spinal cord level (gate control theory)
• Central nervous system modulation – needling may influence descending pain inhibitory pathways, reducing central sensitisation
• Endogenous opioid release – some evidence suggests needling stimulates the release of endorphins and enkephalins

Dry Needling vs Acupuncture: What’s the Difference?

This is one of the most frequently asked questions about dry needling. While both techniques use the same type of needle, they differ in philosophy, assessment and application:

It is worth noting that there is overlap between the two approaches, and some techniques (such as periosteal needling and superficial dry needling) share characteristics with certain acupuncture methods. In Australia, both are regulated health practices, and practitioners must have appropriate qualifications and training.

What Conditions Can Dry Needling Treat?

Dry needling is most commonly used for conditions involving myofascial trigger points and muscle-related pain. Research supports its use for:

• Neck pain and cervicogenic headache – trigger points in the upper trapezius, suboccipital muscles and cervical extensors are common contributors (see our neck pain guide)
• Shoulder pain – rotator cuff pathology, subacromial pain and frozen shoulder (see our shoulder pain guide)
• Lower back pain – lumbar multifidus, quadratus lumborum and gluteal trigger points
• Lateral epicondylalgia (tennis elbow) – forearm extensor muscle trigger points
• Knee pain – quadriceps, hamstring and calf trigger points contributing to knee symptoms
• Plantar heel pain – calf and intrinsic foot muscle trigger points
• Temporomandibular (jaw) pain – masseter and temporalis trigger points
• Chronic pain conditions – as part of a multimodal approach to pain management

What to Expect During a Dry Needling Session

If your physiotherapist recommends dry needling as part of your treatment plan, here is what you can typically expect:

Before Treatment

1. Assessment – your physiotherapist will examine the relevant muscles to identify trigger points through palpation, noting taut bands and reproducing your familiar pain
2. Informed consent – your physiotherapist will explain the procedure, expected benefits, potential risks and alternatives, and obtain your verbal or written consent
3. Positioning – you will be positioned comfortably to allow access to the target muscles

During Treatment

1. Skin preparation – the skin is cleaned with an alcohol swab
2. Needle insertion – a sterile, single-use, fine filament needle (typically 0.25–0.30 mm diameter) is inserted through the skin into the trigger point
3. Needle manipulation – the physiotherapist may use gentle pistoning (in-and-out) movements to elicit local twitch responses
4. Sensation – you may feel a deep ache, cramping sensation or muscle twitch. The initial skin puncture is often barely felt due to the fine gauge of the needle
5. Duration – needles may be left in situ for a few seconds to several minutes, depending on the technique and condition being treated

After Treatment

• Some muscle soreness is common for 24–48 hours after treatment, similar to post-exercise soreness
• Bruising may occur at the needle insertion site
• Your physiotherapist will typically follow needling with stretching, movement or exercise
• Staying well hydrated and gently moving the treated area is recommended

What Does the Evidence Say?

The evidence base for dry needling has grown substantially over the past decade. Key findings from systematic reviews and meta-analyses include:

• A 2013 Cochrane-style systematic review found moderate evidence that dry needling reduces pain and improves function for myofascial trigger point pain in the short to medium term
• A meta-analysis in the Journal of Orthopaedic & Sports Physical Therapy found that dry needling of the upper trapezius significantly reduced neck pain compared to sham needling
• Research supports dry needling as an effective adjunct to exercise for conditions including lateral epicondylalgia, shoulder impingement and chronic low back pain
• The evidence is strongest when dry needling is combined with exercise rather than used in isolation

It is important to note that while many individual studies show positive results, some systematic reviews have highlighted methodological limitations in the literature. The overall direction of evidence is positive, particularly for short-term pain relief and when combined with active rehabilitation.

Risks and Side Effects

Dry needling is generally considered safe when performed by a trained practitioner. However, as with any invasive procedure, there are risks:

Common Side Effects

• Post-needling soreness – occurs in approximately 50–70% of sessions; typically resolves within 24–48 hours
• Bruising – minor bruising at the needle site
• Fatigue – some people feel tired after treatment
• Temporary increase in pain – symptoms may briefly worsen before improving

Rare but Serious Risks

• Pneumothorax – a punctured lung is a rare but serious complication when needling the thoracic region. Proper anatomical knowledge and technique minimise this risk. Physiotherapists are trained to use safe needle angles and depths in the thoracic area
• Infection – extremely rare with proper hygiene and single-use sterile needles
• Nerve injury – very rare; trained physiotherapists have thorough knowledge of relevant anatomy
• Vasovagal response – fainting or dizziness; more common in anxious patients or those being needled for the first time

Contraindications

Dry needling may not be appropriate for individuals with:

• Needle phobia (unless the patient wishes to proceed with appropriate support)
• Bleeding disorders or anticoagulant medication (relative contraindication; clinical judgement required)
• Compromised immune system or active infection in the treatment area
• Pregnancy (some areas are avoided as a precaution)
• Lymphoedema in the treatment area

Finding a Qualified Physiotherapist for Dry Needling

In Australia, dry needling falls within the scope of practice of physiotherapists who have completed appropriate post-graduate training. To ensure you are treated by a qualified practitioner:

1. Check registration – verify your physiotherapist is registered with the Australian Health Practitioner Regulation Agency (AHPRA)
2. Ask about training – ask whether they have completed a recognised dry needling certification course
3. Look for experience – a physiotherapist who uses dry needling regularly will be more proficient and confident in the technique
4. Ensure a comprehensive approach – a good physiotherapist will use dry needling as part of a broader treatment plan that includes exercise and education, not as a standalone technique

For more information on sports physiotherapy and how dry needling is used in athletic populations, see our dedicated guide.

Dry Needling and PhysioPal

Understanding your body’s pain patterns is the first step towards effective treatment. Whether you ultimately benefit from dry needling, exercise, manual therapy or a combination of approaches, having a clear picture of your symptoms helps guide your physiotherapist’s clinical decision-making.