Many physiotherapists offer dry needling as a treatment option for pain, but how does it work on the body? Is it painful? And which conditions is it used for? Isn’t dry needling the same as acupuncture?

As a Neuromusculoskeletal (NMS) Physiotherapist, these are the kinds of questions I am asked when discussing dry needling (DN). While compared (and often confused) with acupuncture, DN holds distinct differences in characteristics and mechanisms that set it apart. Let’s delve deeper into these questions to explain more about DN, how it works, and how it differs from acupuncture. 

“DN encompasses the insertion of needles without injectate into, alongside, or around nerves, muscles, or connective tissues for the management of pain and dysfunction in neuromusculoskeletal conditions.” [1]

An example of dry needling

“Acupuncture is a system of medical treatment and ideology that is based on the principle of applying small needles or pressure to specific points in the body. The origins of this treatment system are grounded in traditional Chinese medicine (TCM), with underlying philosophical principles associated with Confucianism and Taoism. Under this ideology, health stems from the alignment of qi which means “vital energy” and encompasses the yin/yang dichotomy that flows through all of the physical worlds.” [2]

DN adopts a modern (western medicine) approach to needle placement, chosen through identifying anatomical trigger points for pain and dysfunction, whereas Acupuncture is rooted in traditional (Chinese) medicine and needles are inserted along meridians of energy flow – qi. 

The goals of treatment also differ in that whereas acupuncture aims to regulate or rebalance energy with the premise of restoring health (including internal organ disorder), DN primarily targets pain and dysfunction in musculoskeletal conditions (including chronic pain and sports injuries).

DN has been shown to help treat a myriad of conditions such as muscular tension and pain, lower back and neck pain, headaches, sinusitis, TMJ dysfunction (jaw joint) and Osteoarthritis.

So we know that DN is used to treat pain and dysfunction in patients battling with certain conditions, and it differs from the Chinese medicinal practice of acupuncture, but HOW does it work, exactly?

A “dry” needle (i.e. needle not used for injection of medication) is inserted directly into the myofascial trigger points, connective tissue and near, or onto the sensitive neurovascular bundles. This causes a local twitch response (LTR) in the muscle, and is a sign that you’ve found the ‘sweet’ spot (trigger point). The muscle feels as though it literally ‘jumps’ or twitches when this spot is found. This ‘twitch’ itself is not painful, but it has been described as dull, achy, heavy, numb, tingly, deep pressure, full and a spreading warmth. The reason for this is the LTR causes a strong neural impulse which breaks the pain cycle within the muscle.

All of this causes change in the tissue, such as increased blood flow/microcirculation, decreased pain and muscle tension, increased joint range of motion, flexibility and a release of endorphins leading to relaxation and healing.

So if DN has such positive effects and can treat a wide variety of conditions, why not use it for all of our patients complaining of pain?

Although DN is a useful tool, sometimes it can be inappropriate or even contra-indicating, in certain conditions (malignancy, pregnancy etc.). There are some risks with DN which should always be discussed between patient and physiotherapist prior to administering any intervention. Some patients may also feel uncomfortable, nervous or just have a fear of needles. In these cases, the Physiotherapist will use their specialised training in anatomy, biomechanics and assessment skills to determine whether it’s necessary and appropriate for the individual.

My personal experience with DN has shown fantastic results in the treatment of many different cases. My patients have shown improvements in their pain levels, muscle function and movement patterns. When combined with other treatment methods, DN can be a powerful tool to achieve physical well-being.

Lauren Jackson is a Neuromusculoskeletal Physiotherapist. She practices from Hanya House on Monday and Wednesday mornings. To contact Lauren: 061 942 8928.

References:

  1. Lucena-Anton D, Luque-Moreno C, Valencia-Medero J, Garcia-Munoz C, Moral-Munoz JA. Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review. Healthcare (Basel). 2022 Sep 24;10(10):1862. doi: 10.3390/healthcare10101862. PMID: 36292308; PMCID: PMC9602116.
  • Van Hal M, Dydyk AM, Green MS. Acupuncture. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532287/
  • Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014 Aug;19(4):252-265. doi: 10.1179/108331913X13844245102034. PMID: 25143704; PMCID: PMC4117383.