Dry Needling
Also known as: trigger point dry needling, intramuscular stimulation (IMS), myofascial dry needling
Dry needling is a physiotherapy treatment that releases tight muscles, reduces pain, and improves movement as part of a rehab plan.
What is dry needling?
Dry needling is a modern treatment technique used by physiotherapists to help manage muscle and joint pain. It involves inserting very fine, sterile needles into specific areas of muscle tissue to reduce pain, ease muscle tension, and restore normal movement.
Unlike injections, dry needling uses solid needles and does not involve any medication or injected substances; hence the term “dry”. Although both dry needling and acupuncture use thin needles inserted into the body, the techniques, training, and clinical reasoning underlying them differ.
In dry needling, the needles are placed into myofascial trigger points. These are small, sensitive areas of tight muscle that are often felt as painful “knots”. Trigger points can cause local tenderness and stiffness and may also refer pain to other areas. For example, trigger points in the neck muscles can contribute to headaches, facial discomfort, or pain spreading into the shoulders.
Dry needling is usually used as part of a broader physiotherapy treatment plan. It is commonly combined with hands-on therapy, tailored exercises, and advice on posture or activity modification to address the underlying cause of pain and support long-term recovery.
What trigger points does dry needling treat?
Dry needling is most commonly used to treat musculoskeletal pain and movement problems where muscle tightness and trigger points play a significant role. When muscles are overworked, injured, or exposed to poor movement patterns, these tight areas can develop and contribute to ongoing discomfort.
Dry needling may be used for conditions affecting the head and neck, including neck pain, muscle-related headaches, temporomandibular joint (TMJ) pain, and symptoms following whiplash injuries. In the shoulder and arm, it may help with shoulder pain (including rotator cuff–related pain and frozen shoulder), tennis elbow, golfer’s elbow, and biceps tendinopathy.
In the back and pelvis, dry needling is often used for low back pain and sciatica-like symptoms related to muscle spasm. In the lower limb, it may help manage knee pain (including patellofemoral pain and early osteoarthritis symptoms), hip and gluteal pain (e.g., piriformis-related discomfort and iliotibial band syndrome), calf and Achilles tendon pain, and plantar fasciitis.
Dry needling is also widely used in sports physiotherapy, particularly for athletes with overuse injuries. For runners, cyclists, and racket-sports players, addressing trigger points resulting from repetitive movement can support a safer and more efficient return to activity.
How is dry needling different to acupuncture?
Dry needling and acupuncture both involve the use of very fine needles and can appear similar at first glance. However, they are based on different training frameworks and clinical approaches.
Physiotherapists use dry needling to treat musculoskeletal and neuromuscular pain by targeting tight or painful muscle tissue identified during physical examination. The goal is to reduce muscle tension, improve movement, and relieve pain by addressing dysfunction within the muscle and nervous system.
Acupuncture is often used for its pain-relieving effects and influence on the central nervous system, helping stimulate the release of the body’s natural pain-relieving chemicals, such as endorphins. Traditional acupuncture also draws on principles of Chinese medicine, with needles placed at specific points selected according to the individual’s symptoms.
The choice between dry needling, acupuncture, or a combination of approaches depends on your symptoms, assessment findings, and personal preference. Your physiotherapist will discuss suitable options with you and ensure you feel informed and comfortable throughout your care.
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Before treatment
Every dry needling session begins with a detailed consultation. Your physiotherapist will take a thorough medical history, including previous injuries or surgery, current medications (particularly blood thinners such as warfarin or other anticoagulants), and any medical conditions such as diabetes, bleeding disorders, or reduced immunity.
They will ask about your symptoms in detail, including when the pain began, what makes it better or worse, whether it affects sleep, work, or sports, and how it affects your daily activities. A physical examination will then follow, using palpation and movement assessment to identify areas of muscle tightness, locate trigger points, and check for any signs that require further investigation or referral.
Safety and consent are an essential part of this process. Your physiotherapist will screen for contraindications, including pregnancy (particularly in the first trimester), uncontrolled anticoagulation, active infection at the treatment site, severe needle phobia, or certain systemic illnesses. The procedure, possible sensations such as a local muscle twitch, and potential side effects such as temporary soreness or bruising will be clearly explained before your informed consent is obtained.
How to prepare for your appointment
Wear or bring loose, comfortable clothing that allows easy access to the area being treated. Eating a light meal and staying well hydrated beforehand can help you feel more comfortable during the session. If you have previous imaging reports or consultant letters, bringing these along can be helpful. Writing down any questions in advance may also help you get the most out of your appointment.
During treatment
Dry needling is carried out in a private treatment room. Your physiotherapist will reassess the area, position you comfortably on a treatment couch, and clean the skin before treatment begins.
Very fine needles are gently inserted into the targeted muscle. You may feel a brief “scratch” as the needle enters, followed by a dull ache, pressure, or a short muscle twitch. This twitch response is normal and often indicates that the tight muscle has been effectively targeted.
The technique used may vary depending on your symptoms and how your muscles respond. Some needles may be gently moved, while others are left in place for a short period to allow the muscle to relax. Your physiotherapist will explain what is happening throughout and adjust the treatment if needed.
Most people tolerate dry needling well. Needling typically takes 10-20 minutes within a 30-45-minute physiotherapy session and is often combined with hands-on treatment, stretching, or exercise.
After treatment
Most people can return to normal daily activities straight away. It is common for the treated area to feel sore for 24-48 hours, similar to post-exercise muscle soreness.
Short-term effects may include mild aching, stiffness, or small bruises at needle sites, which usually settle within a few days. A small number of patients may experience temporary fatigue or lightheadedness, which typically resolves with rest and hydration.
Staying well hydrated, remaining gently active, and performing any recommended stretches can support recovery. Heat or cold packs may be advised depending on your symptoms. It is generally advisable to avoid heavy lifting or intense exercise involving the treated area for at least 24 hours, unless otherwise advised.
You should seek medical advice if pain increases rather than gradually settles, or if you notice persistent redness, swelling, warmth, or any unusual symptoms.
Most people benefit from a short course of treatment, often three to six sessions over one to three weeks. Dry needling is gradually combined with strengthening exercises, mobility work, and posture- or sport-specific rehabilitation. The aim is to reduce pain, improve mobility, and prevent symptom recurrence.
Appointment and Treatment Plan
Initial assessment
Your physiotherapist carries out a full assessment, including your symptoms, medical history, movement patterns, and muscle function, to identify trigger points and decide whether dry needling is appropriate for you.
Preparation and consent
The procedure is explained in detail, including what it involves, how it may feel, and any potential side effects. Safety checks are completed, and informed consent is obtained before treatment begins.
Dry needling treatment
Fine, sterile needles are inserted into targeted muscle trigger points to help release tension, reduce pain, and improve movement. You may feel a brief ache or muscle twitch, which is a normal response.
Immediate aftercare
The needles are removed, and your physiotherapist reassesses movement and symptoms. You may receive hands-on treatment, stretching, or exercises to support the effects of needling.
Recovery and rehabilitation
Mild soreness can occur for 24-48 hours. Dry needling is combined with exercise, movement retraining, and activity advice to address the underlying cause of pain and reduce the risk of symptoms returning.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
FAQs
Dry needling works by releasing tight, overactive muscles that are contributing to pain and restricted movement. Very fine needles are inserted into these tight areas to help relax the muscle, improve blood flow, and reduce pain.
You may experience a brief muscle twitch during treatment – this is normal and often a sign that the tight muscle has been effectively targeted. By reducing muscle tension, dry needling can help ease both local and radiating pain, making movement feel easier and more comfortable.
Dry needling also supports the body’s natural healing processes by improving circulation in the treated area. It is usually used alongside other physiotherapy treatments, such as hands-on therapy and exercise, to achieve longer-lasting results.
Dry needling is a safe treatment when performed by a trained physiotherapist, and most people tolerate it well.
The most common side effects are mild and short-lived. These can include temporary muscle soreness, slight bruising, or stiffness in the treated area. Many patients describe this as similar to post-exercise soreness, and it usually settles within 24-48 hours.
More serious complications are very rare. As with any treatment involving needles, there is a small risk of infection, nerve irritation, or injury to surrounding tissues. To minimise this risk, physiotherapists use single-use sterile needles, follow strict infection-control procedures, and carefully assess the area being treated. Your physiotherapist will also avoid sensitive structures and adapt the technique to your anatomy and symptoms.
Dry needling may not be suitable for everyone. It is generally avoided in children under 12, during the first trimester of pregnancy, and in people with severe needle phobia. Certain medical conditions, such as bleeding disorders or the use of blood-thinning medications, may require additional caution and prior discussion.
Your physiotherapist will conduct a comprehensive assessment, explain the treatment clearly, and ensure you are comfortable before proceeding. You can stop the treatment at any time, and alternative hands-on options are always available.
Most people find dry needling very manageable. You may feel a quick “scratch” as the needle goes in, then a dull ache, heaviness, or a brief muscle twitch. Afterwards, the area may feel sore for 24-48 hours (similar to post-gym soreness).
If you’re nervous about needles, tell your physiotherapist. They can go slowly, use fewer needles, or use other hands-on treatments instead.
The effects of dry needling are usually greatest when the technique is combined with exercise therapy and other treatments, rather than used in isolation. Dry needling is incorporated into a complete treatment plan designed to address the root causes of your pain.
Key potential benefits include:
- Reduction in local and referred pain – Direct dry needling of trigger points can help relieve pain and tenderness, both at the needle site and in areas where referred pain has been felt
- Improved range of motion – By releasing muscle tension, you may find it easier to move stiff joints and tight muscles. For example, many patients notice they can turn their neck further or reach overhead more comfortably after treatment
- Decreased muscle spasm and tightness – The twitch response triggered during treatment helps reset muscle tone, reducing that feeling of persistent “knots” or muscle tightness
- Support for faster recovery – For sports injuries, minor strains, and overuse conditions, dry needling combined with rehabilitation can help speed up your return to activity
- Improved blood flow – Stimulating the muscle tissue can increase blood flow to the area, supporting the body’s natural healing processes
- Better daily function – Whether it’s walking further, sitting more comfortably at work, or getting back to your sport sooner, the goal is always to improve your quality of life
Myofascial trigger points are small, sensitive areas within muscle tissue that can cause significant pain, stiffness, and reduced range of motion during daily activities. Often described as “knots”, these spots develop when muscle fibres become tight and irritated, sometimes due to overuse, injury, or poor posture that affects the body mechanics. Trigger points can be classified as either active, causing pain even at rest, or latent, causing discomfort only when pressed or during certain movements.
Myofascial trigger points are a common cause of muscle and joint pain. They can cause local pain or refer pain to other parts of the body, making everyday movements uncomfortable and limiting your ability to move freely.
Physiotherapists identify trigger points through careful assessment and hands-on examination. Once found, dry needling may be used as part of your personalised treatment plan to help release muscle tension and improve movement.