Dry needling is a physiotherapy technique where a thin filament needle is inserted through the skin into muscle and other soft tissue to help manage musculoskeletal pain and dysfunction. It is called "dry" needling because nothing is injected. The needle is often aimed at a myofascial trigger point, a sensitive spot in a muscle. Dry needling is often studied and used together with other physiotherapy care rather than by itself, and the research suggests it can help with some types of muscle pain, mostly in the short to medium term.

How dry needling works

Researchers describe dry needling as a minimally invasive physiotherapy technique for neuromusculoskeletal problems. A fine needle passes through the skin and the tissue underneath and into muscle. The aim is to stimulate the tissue mechanically, reduce pain and improve movement.

In Australian physiotherapy, dry needling means needling tissue that has changed or isn't working properly, with the goal of improving or restoring function. That can include myofascial trigger points and, in some cases, the periosteum (the layer covering bone).

What is a trigger point?

Myofascial trigger points are very sensitive areas within a muscle. They are linked with a condition called myofascial pain syndrome. When a clinician presses on an active trigger point, it can cause pain at that spot or pain felt somewhere else (referred pain). Many dry needling studies focus on treating these points.

Is dry needling the same as acupuncture?

The two overlap, but they aren't the same thing. Dry needling uses the same kind of fine needle as acupuncture. Traditional Chinese acupuncture also includes needling the most painful point of a muscle, which it calls "Ah Shi" needling. In Australia, physiotherapists can train in dry needling, Western acupuncture and/or traditional acupuncture, so it's worth asking your practitioner which approach they're using and why.

What does the research say?

The evidence on dry needling is mixed. It's useful to know what it shows and what it doesn't.

• Upper body muscle pain: A 2013 systematic review and meta-analysis looked at upper-quarter myofascial pain (the neck, shoulders and upper body). It found that dry needling reduced pain straight after treatment compared with sham (fake) or placebo treatment. Two studies also suggested less pain at four weeks, but the authors noted a wide confidence interval, which weakens that finding. The quality of the included studies varied a lot.

• Neck and shoulder pain: A 2015 meta-analysis of 20 randomised controlled trials found that dry needling of trigger points could be "cautiously recommended" for neck and shoulder pain in the short and medium term compared with control or sham treatment. The same review found that wet needling (where a substance is injected) worked better than dry needling in the medium term.

• Neck pain: An updated 2020 meta-analysis found that dry needling reduced neck pain intensity more than sham, placebo or waiting-list groups, both immediately and in the short term.

• Musculoskeletal pain more broadly: The Australian Physiotherapy Association (APA) has reported on a 2021 meta-analysis that found dry needling reduced pain in people with musculoskeletal conditions. The effect lasted up to three weeks after treatment.

In summary, there is reasonable support for short-term pain relief in some conditions, especially neck and shoulder muscle pain. Evidence for long-lasting change is weaker. That's one reason to treat dry needling as one possible part of a rehab plan, not a fix on its own.

Is dry needling safe? Side effects to know about

Dry needling is minimally invasive, so it carries some risk. A survey of Australian physiotherapists in private practice asked about adverse events (side effects or complications) they had seen when using dry needling:

• Minor events were common: 62% of respondents reported patients having discomfort during treatment, and 56% reported bruising.

• Major events were less common but did happen: 8% reported prolonged worsening of symptoms, and 13% reported fainting (syncope).

These figures show how many physiotherapists had seen each event at some point. They are not the chance of a problem at a single treatment. The authors concluded that physiotherapists need to weigh up the benefits of dry needling against these risks. A separate survey of physiotherapists in Poland found that many respondents saw minor bleeding and bruising regularly.

Where the needle goes matters too. The APA recommends formal training so that dry needling is done safely across the body, "particularly in the region of the head, the suboccipital region, the upper and lower lungs and the kidneys". The APA also says physiotherapists should complete supervised practical training before using dry needling. It advises against learning informally from in-services, fast-track courses or colleagues, and recommends regular professional development to keep skills current.

Questions to ask before you try dry needling

You can ask questions before agreeing to dry needling, and you can say no. Some useful questions are:

1. What dry needling training have you done? The APA launched its Dry Needling Physiotherapy Level 1 course nationally in 2020, focusing on safety, scope, competency and recency.

2. Why do you think it suits my problem? Ask what the physio found in your assessment and what they hope dry needling will change.

3. What else is in my plan? Since most of the evidence covers short-term effects, it's reasonable to ask how dry needling fits with exercise and other treatment.

4. What might I feel during and after? Discomfort and bruising are common, so it helps to know what's normal and when to call the clinic.

5. Is there anything about my health I should mention? Tell your physio about your medical history, any medicines you take and whether you've fainted around needles before.

Where dry needling fits in physiotherapy

In the Australian survey, physiotherapists said they mainly used dry needling to reduce pain intensity and muscle tension. Whether it suits you depends on your assessment, your goals and how you feel about needles.

Pinnacle Physio & Performance offers dry needling on the Gold Coast as one of its services at Burleigh Heads. The clinic also offers sports physio, sports injury rehab, post-op physio and concussion physio. If dry needling comes up as an option, you can ask your physio to explain why they're suggesting it and what the risks are.

If you'd like to talk through whether dry needling is right for you, you're welcome to get in touch with the team at Pinnacle Physio & Performance.

Sources

• A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome

• Dry Needling in Physical Therapy Treatment of Chronic Neck Pain: Systematic Review

• Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety

• Acupuncture and Dry Needling by Australian Physiotherapists - HealthTimes

• Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis

• Effectiveness of Dry Needling for Myofascial Trigger Points Associated With Neck and Shoulder Pain: A Systematic Review and Meta-Analysis - ScienceDirect

• Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis - PMC

• APA

• Dry needling perceptions and experiences: A survey of Australian physiotherapists - ScienceDirect

• Adverse Reactions to Dry Needling Therapy: Insights from Polish Physiotherapy Practice - PMC

• APA

• APA Level 1 Dry Needling Course — Physio Educators