Dry needling

Dry needling is what I use in my Wokingham clinic when a patient walks in with stubborn musculoskeletal pain that has not yielded to massage, physiotherapy or anti-inflammatories — pain that is being held in place by a small, exquisitely tender knot inside a taut band of muscle. The technique uses a solid acupuncture needle (no injection, nothing introduced into the tissue) to switch off that knot at its source — the dysfunctional motor end plate that has trapped the muscle in spasm. After 25 years of clinical practice I integrate dry needling into a wider acupuncture treatment so that the trigger points are released AND the postural, occupational or constitutional pattern that produced them is addressed at the same time. That combination — trigger point technique plus TCM pattern recognition — is what tends to produce durable rather than temporary relief.

On this page

1. What is dry needling?
2. Understanding trigger points
3. How does dry needling work?
4. Dry needling vs acupuncture
5. What conditions can dry needling treat?
6. What to expect from a session
7. Does dry needling hurt?
8. Is dry needling safe?
9. Training and regulation in the UK
10. Frequently asked questions
11. References

1. What is dry needling?

The most useful way to think about dry needling is as a precision instrument. The needle — the same fine, solid acupuncture needle I use for everything else — is placed directly into the offending knot in the muscle (the myofascial trigger point) and nothing else is done. No drug. No anaesthetic. No injection of any substance. The word “dry” simply means the needle is not a hypodermic carrying anything; everything that happens next comes from the body’s own physiological response to having that particular spot, in that particular fibre, mechanically interrupted.

In my experience patients arrive at dry needling after a long sequence of half-fixes. They have tried sports massage, foam rollers, ibuprofen, stretching, sometimes months of physiotherapy, and the pain keeps returning to the same spot. What I’m looking for in their muscles, and what conventional treatments often cannot reach, is the small hyperirritable nodule sitting inside a strap-like band of contracted fibre — the trigger point. It is the source of the pain, frequently somewhere quite distant from where the patient feels it. Until that nodule is deactivated, the symptom keeps coming back.

2. Understanding trigger points

What I am looking for when I palpate a patient’s muscle is not generalised soreness. It is something quite specific: a small, firm nodule sitting inside a taut, cord-like band of fibre. To the fingers it feels like a knot of string buried in dough. To the patient it produces a startling response — press it and they say “that is the pain” or “that’s the spot I’ve been trying to describe”. That recognition is the diagnostic signature of an active trigger point. Five clinical features define it:

• A palpable nodule in a taut band of muscle — felt as a discrete knot of string-like tightness, not the diffuse tenderness of general muscular soreness.
• Exquisite, reproducible tenderness — compressing the nodule reliably reproduces the pain the patient came in with. This recognition is what tells me I have the right spot.
• Referred pain — the pain is often felt at a distance from the trigger point itself. A nodule in the upper trapezius commonly produces a headache pattern at the temple; a quadratus lumborum trigger point can refer down into the buttock and groin in a way that is regularly mistaken for hip or sacroiliac pathology.
• A local twitch response — the involuntary contraction the muscle gives when the needle (or a sharp snap of the fingers) catches the trigger point. This twitch is the moment of release.
• Restricted movement in the affected muscle — a limited range that improves immediately, sometimes dramatically, once the trigger point lets go.

Why do these nodules form? In my patient population the commonest causes are sustained postural strain (laptop work, driving, long static seating), repetitive movement (gym, sport, instrument practice, carrying children), unaccustomed overload (the half marathon the patient hadn’t really trained for), trauma, and — very often — emotional bracing. The neck and jaw of someone under chronic stress hold tension in exactly the predictable places. Once a trigger point is established it tends to perpetuate itself: local circulation drops, sensitising chemicals accumulate, pH falls, and the spot stays locked in a metabolic crisis that can outlast the original cause by months or years. This is the reason patients come to me saying “I haven’t been doing the thing that hurt me in the first place for ages, and it still hurts”.

The standard map of referred pain patterns — which muscle refers where — was produced over decades by Dr Janet Travell and Dr David Simons in the two-volume Myofascial Pain and Dysfunction: The Trigger Point Manual, still the reference text in this field. The practical value of knowing these patterns is that the place where it hurts is frequently not the place that needs needling. Knowing which muscle to investigate when a patient points to a particular area of pain is a large part of what makes the technique effective.

3. How does dry needling work?

What the needle is doing physically is interrupting the chronically misfiring motor end plate at the centre of the trigger point. That end plate — the synapse between the nerve and the muscle fibre — has become stuck in a low-level firing pattern that holds a section of the muscle in continuous contraction. When the needle catches the spot accurately, the muscle gives a small involuntary jump — the local twitch response — and that twitch is the visible signal that the end plate has been reset. From that moment the taut band begins to soften under the fingers, the metabolic environment of the spot recovers, blood flow returns to the area, and the sensitising chemicals that were keeping the pain alive are flushed out.

That is the local picture. There is also a separate effect happening in the nervous system. The needle stimulation travels up the spinal cord and triggers descending pain-inhibitory pathways — the body’s endogenous opioid system, plus serotonin and noradrenaline release — which dampens the way pain signals are processed. This dual mechanism is why many patients notice their pain quiet down not only at the spot I have needled, but in remote areas served by the same referred pain pattern. It is also why dry needling tends to outperform purely local techniques like topical pressure or massage on chronic, central-sensitised pain.

The biochemistry of all of this has been examined in some detail: at trigger point sites, dry needling has been shown to reduce concentrations of substance P, calcitonin gene-related peptide (CGRP) and bradykinin — the molecular signature of the “metabolic crisis” that sustains the dysfunction. A 2021 systematic review and meta-analysis in Pain Medicine pooled the controlled trials and found that dry needling significantly reduced pain intensity and improved pressure pain threshold in myofascial pain syndrome compared with sham and control interventions (doi: 10.1093/pm/pnaa358). My clinical experience matches this: properly located needling of the correct trigger point produces a degree and durability of relief that other modalities rarely match.

4. 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 is used as a complementary therapy for 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.

5. 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.

6. What to expect from a session

Understanding what happens during a dry needling session removes much of the uncertainty for new patients. At my clinic, dry needling is integrated into a full acupuncture consultation rather than being offered as a standalone procedure, which allows both the myofascial and constitutional dimensions of the problem to be addressed.

Initial consultation

The first appointment begins with a full assessment. This includes a detailed history of your symptoms, a physical examination of the affected muscles and joints, and a TCM case history (tongue and pulse diagnosis). This assessment identifies not only the trigger points to be treated but also the underlying patterns — whether postural, occupational, constitutional or emotional — that are sustaining them. Where appropriate, I may also check for nerve involvement, joint restriction or other factors that would influence the treatment plan.

The needling procedure

Once the trigger points have been located by palpation, the skin is cleaned and very fine sterile needles are inserted one at a time. You may feel little or nothing on insertion. When the needle reaches the trigger point, a brief deep ache, muscle cramping or involuntary twitch response is common and expected — this is the local twitch response indicating accurate trigger point engagement. After the twitch, the taut band typically relaxes noticeably. Needles are retained for 5–20 minutes depending on the technique and the tissues being treated.

After the session

It is common to feel some local muscle soreness for 24–48 hours after treatment — similar to the post-exercise ache of an intense stretch or deep tissue work. This is a normal part of the healing response and usually resolves quickly. Drinking adequate water after treatment helps the recovery. Many patients notice improved range of movement or reduced pain within hours of the session, before the soreness has even appeared.

I advise avoiding vigorous exercise on the day of treatment and applying a warm compress to the needled area if soreness is pronounced. Return to normal daily activity is encouraged from the following day. Within two to three days of each session, most patients notice a cumulative improvement that builds across the course of treatment.

7. Does dry needling hurt?

The fairest answer is: less than patients expect, but not nothing. The needle going through the skin is usually unremarkable — an acupuncture needle is fractionally thinner than the diameter of a human hair and several times finer than a standard hypodermic, so the entry is rarely registered as “sharp”. The sensation that catches patients off-guard comes a moment later, when the needle reaches the trigger point itself: a brief, deep ache and frequently a single involuntary cramp or twitch as the muscle releases. Many patients describe it as “that’s odd” rather than “that hurts”, and most are visibly relieved when I tell them the twitch they just felt is the bit we are looking for.

What is more common, and worth being prepared for, is post-treatment soreness. Twenty-four to forty-eight hours after a session a needled area can feel mildly bruised or achy — the kind of soreness you get after an unaccustomed strength workout. It is part of the normal healing response, settles quickly, and is helped by drinking water, a warm compress if needed, and avoiding heavy training that day. Every patient I treat has, by the end of a course, said that this temporary soreness was a small price for the longer change in their pain.

8. 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.

9. Training and regulation in the UK

The regulatory landscape for dry needling in the UK is an important consideration for patients choosing a practitioner. Unlike medicine, acupuncture and dry needling are not currently regulated by statute in the UK, which means that — in theory — anyone can use a needle on a patient without specific qualifications. This makes choosing a practitioner carefully essential.

Practitioners offering dry needling in the UK fall into two broad groups:

• Physiotherapists, osteopaths and chiropractors who have completed a short dry needling course as a postgraduate add-on to their primary qualification. These courses typically range from one to three days of training. The training covers trigger point anatomy and the needling technique but does not include the three-year foundation in Chinese medicine that informs how to integrate needling into a whole-person treatment approach.
• Acupuncturists who have completed a minimum three-year full-time degree or equivalent in traditional Chinese medicine, which includes comprehensive training in needling technique across all body regions, anatomy, pathology and point selection. They may then have completed additional postgraduate training in Western dry needling trigger point technique.

For dry needling specifically, either group can deliver competent trigger point treatment. However, if you also want the benefits of TCM pattern recognition and constitutional treatment alongside the trigger point work — which tends to produce more complete and durable results — an acupuncturist with TCM training is the more comprehensive choice.

I am a member of the British Acupuncture Council (BAcC), the UK’s principal voluntary regulator for acupuncture, accredited by the Professional Standards Authority. BAcC members are required to hold professional indemnity insurance and maintain continuing professional development. When looking for a dry needling practitioner, searching the BAcC register is a reliable starting point.

10. 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.

Who should not have dry needling?

Dry needling is not suitable for patients with a bleeding disorder or on anticoagulant medication, over areas of local infection, broken skin or active inflammation, or in patients who have a needle phobia severe enough to cause significant distress or vasovagal episodes. In pregnancy, certain trigger points are avoided and treatment is adapted accordingly — let the practitioner know before treatment begins. Patients with compromised immunity (for example those on immunosuppressants) should discuss with their doctor before proceeding.

Can dry needling treat nerve pain?

Dry needling is primarily a technique for myofascial pain — pain arising from muscles and their fascial connections. When nerve pain (neuropathic pain or radiculopathy) has a myofascial component — for example, piriformis syndrome contributing to sciatic-like symptoms, or scalene trigger points contributing to cervical radiculopathy — dry needling can provide significant relief. For primary nerve pain without a significant myofascial component, acupuncture at classical points with pain-modulating effects is generally more appropriate than trigger point dry needling alone.

How soon after an injury can I have dry needling?

In the acute phase of an injury (first 48–72 hours), when there is significant active inflammation, swelling or bruising, it is usually preferable to wait before needling the injured area directly. Dry needling may still be used in the surrounding areas that have gone into protective spasm. After the acute phase, dry needling of the recovering tissue can support healing by improving circulation and releasing the protective muscle splinting that restricts recovery. Your practitioner will assess the timing based on the nature and stage of your injury.

Is dry needling available on the NHS?

Dry needling is not routinely available on the NHS. It is occasionally offered by NHS physiotherapy departments as part of a broader musculoskeletal service, depending on local commissioning decisions. Most people access dry needling through private physiotherapy, osteopathy or acupuncture practices. Costs vary by practitioner and region; in acupuncture practice it is typically included within the standard consultation fee rather than charged separately.

11. 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