Dry Needling: An Evidence-Based Resource for Musculoskeletal Pain Management

Introduction

Dry needling is a therapeutic technique that uses thin, solid filiform needles to target and deactivate painful areas in muscle tissue known as myofascial trigger points (MTrPs). Unlike injections (“wet needling”), dry needling does not deliver any substance into the body. Instead, it relies solely on the mechanical stimulation provided by the needle to help relieve pain and improve function.

History of Dry Needling

Dry needling has its roots in early trigger point injection techniques developed in the mid-20th century. Pioneering work by Janet Travell and David Simons laid the foundation for understanding myofascial pain syndrome (MPS) and MTrPs (Travell & Simons, 1983). Over time, clinicians discovered that simply inserting a needle into a trigger point—even without injecting medication—could produce long-lasting pain relief. This observation led to the evolution of dry needling as a distinct, evidence-based approach (Legge, 2014).

Mechanisms of Dry Needling

How It Works

Dry needling is thought to work by disrupting abnormal neuromuscular activity at trigger points. When a needle is inserted into a trigger point, it often elicits a local twitch response—a brief, involuntary contraction of the muscle. This response may help release tension, improve blood flow, and interrupt pain signals. The technique may also stimulate small nerve fibers (Aδ fibers), which can modulate pain through the body’s natural pain control systems (Dommerholt, 2019).

Neurophysiological and Biochemical Effects

Research has shown that trigger points are associated with increased levels of inflammatory mediators and abnormal electrical activity at the motor endplate (Shah et al., 2008). Dry needling can help “reset” these dysfunctional areas by promoting tissue remodeling and reducing the biochemical imbalances that contribute to pain.

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Clinical Applications

Dry needling is used to treat a wide range of musculoskeletal conditions, including:

  • Chronic Neck Pain: Targeting trigger points in muscles like the trapezius and levator scapulae can reduce neck stiffness and headache.

  • Low Back Pain: Dry needling of lumbar paraspinal muscles can help alleviate chronic back pain.

  • Tension Headaches and Migraines: Needling trigger points in head and neck muscles may reduce the frequency and intensity of headaches.

  • Other Conditions: It is also applied in conditions such as temporomandibular disorders, plantar fasciitis, and post-stroke spasticity.

For more detailed treatment protocols, individual muscle pages (e.g., “Dry Needling for the Trapezius”) provide specific trigger point maps, needling techniques, and referral patterns.

➡️ Learn More: Dry Needling for Orthopedic Conditions

Safety and Best Practices

Dry needling is generally considered safe when performed by trained practitioners. Common minor adverse effects include temporary pain, bleeding, or bruising at the needle site. Major complications, such as pneumothorax, are rare when proper techniques and screening protocols are followed (Boyce et al., 2020). It is essential for practitioners to be well trained, to screen patients carefully, and to adhere to standardized protocols to ensure patient safety.

Research and Evidence

A growing body of literature supports the short-term efficacy of dry needling for reducing musculoskeletal pain. Recent systematic reviews and meta-analyses have demonstrated that dry needling can be more effective than sham or no intervention for immediate pain relief, and it is comparable to other physical therapy interventions in the short term (Chys et al., 2023; Wang et al., 2024). However, more high-quality research is needed to clarify long-term outcomes and optimal treatment protocols.

➡️ Learn More: Dry Needling Research

 

Additional Resources and FAQs

For further reading and detailed clinical guidelines, please see our linked subpages and Resource Library.

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➡️ Explore Dry Needling Facts & Statistics

Sources:

  • Boyce, D., Wempe, H., Campbell, C., Fuehne, S., Zylstra, E., Smith, G., Wingard, C., & Jones, R. (2020). Adverse events associated with therapeutic dry needling. The International Journal of Sports Physical Therapy, 15(1), 103–104. https://doi.org/10.26603/ijspt20200103

  • Chys, M., De Meulemeester, K., De Greef, I., Murillo, C., Kindt, W., Kouzouz, Y., Lescroart, B., & Cagnie, B. (2023). Clinical effectiveness of dry needling in patients with musculoskeletal pain—An umbrella review. Journal of Clinical Medicine, 12(3), 1205. https://doi.org/10.3390/jcm12031205

  • Dommerholt, J. (2019). Needling: is there a point? [Editorial]. Journal of Manual & Manipulative Therapy. https://doi.org/10.1080/10669817.2019.1620049

  • Legge, D. (2014). A history of dry needling. Journal of Musculoskeletal Pain, 22(3), 301–307. https://doi.org/10.3109/10582452.2014.883041

  • Shah, J. P., & Gilliams, E. A. (2008). Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies, 12, 371–384. https://doi.org/10.1016/j.jbmt.2008.06.006

  • Travell, J. G., & Simons, D. G. (1983). Myofascial pain and dysfunction: The trigger point manual (2nd ed.). Williams & Wilkins.

  • Wang, M., Zhao, T., Liu, J., & Luo, S. (2024). Global trends and performance of dry needling from 2004 to 2024: A bibliometric analysis. Frontiers in Neurology, 15, Article 1465983. https://doi.org/10.3389/fneur.2024.1465983