Dry Needling

Needling without an injected substance

A 2014 literature review by Dunning and colleagues distinguishes two forms of local needling. Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins or other agents, while dry needling inserts thin monofilament needles, of the kind used in acupuncture, without any injectate. The authors write that dry needling is typically used on muscles, ligaments, tendons, subcutaneous fascia, scar tissue and peripheral nerves for neuromusculoskeletal pain. Several of the authors teach dry needling courses, which they disclose, so the review is a practitioner-informed position as well as a literature summary.

The same review reports that the first peer-reviewed journal article on dry needling by a Western medical physician described 241 patients and that only 2 of its 14 target structures were muscular trigger points. It also quotes a 1977 statement by Ronald Melzack that trigger points are anchored in the anatomy of the neural and muscular systems. These are the review's own readings of the early literature, and the sources used here do not independently trace the full early history.

Adoption within physical therapy

According to Dunning and colleagues, the American Physical Therapy Association (APTA) recommended the term intramuscular manual therapy in 2009 for the intervention of dry needling. A January 2012 APTA resource paper defined it around trigger points, and a February 2013 revision described stimulation of myofascial trigger points, muscular and connective tissues. The reviewers criticized the 2012 paper for citing 23 randomized trials that were rated by one expert but not individually identified. This page does not cover the regulation of dry needling in any jurisdiction, because no regulatory material was reviewed.

Training also developed outside APTA. A 2014 Irish survey enrolled physiotherapists who had completed trigger point dry needling training with the David G Simons Academy, which shows that organized private courses existed by that time. The sources reviewed do not describe course content, hours or any accreditation standard.

Dry needling, trigger point needling and wet needling

The term dry needling refers to the absence of injected medication. Dunning and colleagues argue that trigger point dry needling and intramuscular manual therapy describe one framework within the wider field, since needles are also placed in connective tissue, near nerves and in areas away from the pain. A 2022 meta-analysis of neck pain studies uses wet needling as a synonym for trigger point injection, which delivers a substance, and compares it directly with dry needling.

Trials of the same procedure carry different labels. Dunning and colleagues list deep dry needling, superficial dry needling, trigger point acupuncture, paraspinal needling, needle release and electroacupuncture among the names used, which complicates searches and comparisons across studies.

Relationship to acupuncture

Proponents of dry needling in physical therapy state that it does not try to move qi along meridians and does not rely on traditional Chinese diagnoses. Dunning and colleagues also note that the most common term used in trials for needling without injectate is acupuncture, and that Ah-Shi points described in acupuncture practice correspond in location to trigger points. They cite a report that 93.3 percent of 255 common trigger points anatomically matched classical acupuncture points. These claims come from authors who teach dry needling, and whether the two practices are the same procedure under different names remains a matter of disagreement.

What the technique involves

Dry needling is described as the insertion of a solid, sterile, fine needle through the skin, most often aimed at myofascial trigger points, which are tender spots within a taut band of skeletal muscle. A 2024 meta-analysis of orofacial pain trials gives this definition and refers to the aim as deactivating those points. Dunning and colleagues describe in-and-out techniques known as pistoning or sparrow pecking, as well as approaches in which needles are manually stimulated and left in place. This page does not give procedural detail.

Practitioners describe the procedure as one element of a wider rehabilitation plan, typically combined with exercise, stretching or manual therapy. A 2019 review of manual therapy, cupping and dry needling for myofascial pain listed these as popular treatments that are often used alongside each other.

How trigger points are identified

Identification of the target relies on palpation. Dunning and colleagues summarize research indicating that there is no accepted reference standard for diagnosing trigger points and that examiners agree poorly on the precise location of a trigger point, although they agree more often on whether a muscle shows signs of one. One cited study reported inter-examiner agreement of 21 percent. The authors conclude that this limits how reliably any needle can be placed in a specific nodule, which affects how trial results are interpreted.

Conditions in which it is used

Dry needling is used by practitioners mainly for myofascial pain syndrome, which is pain attributed to trigger points. Published reviews have examined neck and upper back pain, low back pain and orofacial pain, including temporomandibular disorders. Dunning and colleagues also list shoulder pain, knee osteoarthritis, carpal tunnel syndrome, headache and plantar fasciitis among the conditions in which needling without injectate has been studied, often under the label acupuncture.

Practitioner-described mechanisms

Dunning and colleagues report that researchers such as Hong propose that the needle mechanically irritates sensitive nerve endings in the trigger point, producing a local twitch response that is described as interrupting a cycle of pain. They also cite studies of increased local blood flow after needling. These are proposed explanations from the dry needling literature, and the review itself notes that the diagnostic criteria for trigger points lack robust validation. The sources used here do not establish that any of these mechanisms accounts for clinical benefit.

Neck and upper back pain

A 2020 systematic review and meta-analysis of 28 trials examined dry needling for trigger points associated with neck pain. Compared with sham, placebo, waiting list or another form of dry needling, it found pain reductions immediately after treatment (mean difference -1.53 on the pain scale) and in the short term (-2.31), and a short-term disability effect. It found no difference against other physical therapy interventions, no effect on cervical range of motion and no between-group effect at mid-term. The authors rate the evidence as low to moderate in certainty.

A 2020 review of 6 randomized trials with 241 participants compared dry needling with trigger point manual therapy for neck and upper back pain. The difference between the two was not statistically significant for pain, pressure pain threshold or disability, and the authors concluded that neither was superior. A 2022 meta-analysis of 6 trials found low-certainty evidence that injecting trigger points reduced short-term neck pain more than dry needling, with no differences in disability or other outcomes.

Low back and orofacial pain

A 2023 review of myofascial pain in low back pain included 4 randomized trials and 2 meta-analyses published from 2000 to 2023. The authors state that dry needling reduced post-intervention pain intensity and disability compared with comparators that included sham needling, laser, physical therapy and ischemic compression, but that follow-up periods and outcomes varied and long-term data are lacking.

A 2024 systematic review of orofacial pain included 24 randomized trials with 1,318 patients. Most trials had unclear or high risk of bias, and the certainty of evidence ranged from very low to low. In the pooled analysis, dry needling added to usual care did not change pain intensity within 6 weeks, and the authors concluded that reliable evidence of effectiveness is scarce.

Overall certainty and limits

A 2019 systematic review of 23 dry needling studies, 8 manual therapy studies and 2 cupping studies rated the dry needling evidence as very low to moderate compared with control, sham or other treatments. Its authors report that evidence for dry needling was not greater than placebo, and they cite unclear methods, high risk of bias, inadequate blinding and small samples. Dunning and colleagues similarly write that high-quality evidence for direct needling of trigger points is limited and that long-term trials are absent. The reviews above evaluate different regions, comparators and time points, so a finding in one region should not be carried over to another.

Common minor effects

Two practitioner surveys describe how often adverse events occur. In an Irish study of 39 physiotherapists and 7,629 treatments, 19.18 percent of treatments were followed by a mild adverse event, most often bruising (7.55 percent), bleeding (4.65 percent) and pain during treatment (3.01 percent). No significant adverse events were reported, which gave an estimated upper risk rate of 0.04 percent or less for significant events.

A larger United States survey of 420 physical therapists reported on 20,464 sessions. It found minor adverse events in 36.7 percent of treatments, led by bleeding (16 percent), bruising (7.7 percent) and pain during needling (5.9 percent). Twenty major adverse events were reported, a rate under 0.1 percent, or about 1 per 1,024 treatments. Both surveys relied on self-reports from practitioners rather than independent assessment, and the larger study's abstract gives two slightly different session totals.

Serious events

Pneumothorax, a collapsed lung caused by needle penetration of the chest wall, is the best-documented serious harm. A 2025 case report describes a 24-year-old woman who felt unusually sharp pain during needling of the intrascapular muscles, developed breathlessness, chest pain and cough over the next two days, and had a moderate pneumothorax confirmed on a chest radiograph. She was treated with a chest tube and one night in the hospital, and recovered fully by one month. The authors question the safety of the rib bracketing technique and urge greater awareness of high-risk areas.

A 2024 survey of 102 Polish physiotherapists asked about severe adverse effects over their practice. Nerve palsy was reported by 14 percent of respondents, pneumothorax and shock by 3 percent each, infection by 2 percent and hospitalization by 1 percent. The survey was ad hoc and online, did not count treatments, and so cannot give an event rate per session.

Suitability and care boundaries

The sources reviewed do not provide a verified list of contraindications, interactions or training standards, and they do not cover use in children, during pregnancy or in people taking anticoagulants. Dry needling is described in these sources as an adjunct to broader care and not as a replacement for medical assessment. Symptoms such as chest pain or breathlessness after any needling procedure call for prompt medical evaluation, and dry needling should not delay or replace necessary care.