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Dry needling, also known as trigger point dry needling and intramuscular stimulation, is a treatment technique used by various healthcare practitioners, including physical therapists, , and , among others. Acupuncturists usually maintain that dry needling is adapted from acupuncture, but others consider dry needling as a variation of trigger point injections. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize pain, and improve or regulate structural or functional damage.
There is conflicting evidence regarding the effectiveness of dry needling. Some results suggest that it is an effective treatment for certain kinds of muscle pain, while other studies have shown no benefit compared to a placebo; however, not enough high-quality, long-term, and large-scale studies have been done on the technique to draw clear conclusions about its efficacy. Currently, dry needling is being practiced in the United States, Canada, Europe, Australia, and other parts of the world.
The founder of Integrative Systemic Dry Needling (ISDN), Yun-Tao Ma, has spearheaded the "dry needling" movement in the United States. Ma states, "Although ISDN originated in traditional Chinese methods, it has developed from the ancient empirical approach to become modern medical art rooted in evidence-based thinking and practice." Ma also states that, "Dry needling technique is a modern Western medical modality that is not related to traditional Chinese acupuncture in any way. Dry needling has its own theoretical concepts, terminology, needling technique, and clinical application."
The American Academy of Orthopedic Manual Physical Therapists states:
Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor end plates, and facilitates an accelerated return to active rehabilitation.Dry needling for the treatment of myofascial (muscular) trigger points is based on theories similar, but not exclusive, to traditional acupuncture; both acupuncture and dry needling target the trigger points, which are a direct and palpable source of patient pain. A high degree of correspondence is reported between myofascial trigger point dry needling and western medical acupuncture.
Unlike traditional Chinese acupuncture, which is based on concepts like Qi (energy flow) and meridians, Western medical acupuncture does not adhere to these traditional principles. Instead, it focuses on evidence-based medicine and is typically practiced by healthcare professionals trained in conventional Western medicine. The primary goals are pain relief, inflammation reduction, and promoting healing by stimulating nerves, muscles, and connective tissue.
Acupuncture and dry needling are similar in the underlying phenomenon and neural processes between trigger and acupuncture points. There is a high degree of correspondence between published locations of trigger points and classical acupuncture points for the relief of pain. Dry needling, and its treatment techniques and desired effects, would be most directly comparable to the use of 'a-shi' points in acupuncture. However, dry needling theory only begins to describe the complex sensation referral patterns that have been documented as "channels" or "meridians" in Chinese Medicine. What further distinguishes dry needling from traditional acupuncture is that it does not use the full range of traditional theories of Chinese Medicine, which is used to treat not only pain, but also other non-musculoskeletal issues that often cause pain. The distinction between trigger points and acupuncture points for the relief of pain is blurred.
In the treatment of for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple, hyperirritable contraction knots related to the production and maintenance of the pain cycle; essentially, myofascial trigger points will generate much local pain upon stimulation or irritation. Deep dry needling for treating trigger points was first introduced by the Czechian neurologist Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used.
Dry needling can be divided into categories in terms of depth of penetration: deep and superficial dry needling. Deep dry needling will inactivate myofascial trigger points by provoking a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Dry needling that elicits LTRs improves treatment outcomes, and may work by activating endogenous opioids. The activation of the endogenous opioids is for an analgesic effect using the gate control theory of pain. In addition, deep dry may also decrease pain, increase range of motion, and minimize myofascial trigger point irritability. In regards to the factor of pain reduction, relief occurs at four central levels: local pain, spinal pain through nerves, brain stem pain, and higher brain center pain.
The relief of myofascial trigger points has been more highly researched than the relief of connective tissues, muscle fascia, muscle tension, and scar tissue; however, the American Physical Therapy Association claims that there potentially may be some benefits of dry needling on these ailments according to some available evidence. The APTA also disclaims that dry needling should not be used as a standalone procedure, but should be used in conjunction with other treatment methods, including manual soft tissue mobilization, neuromuscular re-education, functional retraining, and therapeutic exercises. Once the needle is inserted, one can manually or electrically stimulate the filiform needle depending for the desired effect of treatment.
Three more recent reviews reached similar conclusions: little evidence supporting the use of trigger point dry needling to treat upper shoulder pain and dysfunction, evidence not robust enough to draw a clear conclusion about safety and efficacy, and that dry needling for the treatment of myofascial pain syndrome in the lower back appeared to be a useful addition to standard therapies, but stated clear recommendations could not be made because the published studies were small and of low quality. However, a retrospective analysis of 2,910 dry needling interventions as reported by Mabry, et al. identified no reported safety events when dry needling was performed by physical therapists.
Additional adverse effects of dry needling include cardiac tamponade and hematoma. During a recent study, a self-reported survey of almost 230,000 people, 8.6% (19726 patients) reported experiencing at least one adverse effect. 2.2% (4,963 patients) reported an adverse effect that required further treatment. However, since this study was based on the patient's self-reporting rather than actual incidence, the collective findings cited above are probably lower than the actual incidence. Because dry needling sometimes involves blood and other bodily fluids, there are sometimes risk of transmission of multiple forms of hepatitis as well as HIV.
Many physical therapists and chiropractors have asserted that they are not practicing acupuncture when dry needling; however, much of dry needling research has been done concerning acupuncture. They assert that much of the basic physiological and biomechanical knowledge that dry needling utilizes is taught as part of their core physical therapy and chiropractic education and that the specific dry needling skills are supplemental to that knowledge and not exclusive to acupuncture. Many acupuncturists have argued that dry needling appears to be an acupuncture technique requiring minimal training that has been re-branded under a new name (dry needling). Whether dry needling is considered to be acupuncture depends on the definition of acupuncture, and it is argued that trigger points do not correspond to acupuncture points or meridians. (2025). 9780763752835, Jones and Bartlett Publishers. ISBN 9780763752835 They correspond by definition to the ad hoc category of 'a-shi' acupoints. (2025). 9781588902214, Thieme. ISBN 9781588902214 It is important to note that this category of points is not necessarily distinct from other formal categories of acupoints. In 1983, Janet Travell described trigger point locations as 92% in correspondence with known acupuncture points. In 2006, a journal article concluded that the two point systems are in over 90% agreement. In 2009, Dorsher and Fleckenstein conclude that the strong (up to 91%) consistency of the distributions of trigger point regions' referred pain patterns to acupuncture meridians provides evidence that trigger points most likely represent the same physiological phenomenon as acupuncture points in the treatment of pain disorders.
A comparison of Western trigger points to traditional acupuncture points corroborates the 92% correspondence. In 2011, The Council of Colleges of Acupuncture and Oriental Medicine published a position paper describing dry needling as an acupuncture technique.
According to a qualitative review, dry needling combined with acupuncture was more effective in alleviating pain and achieved a higher response rate than dry needling alone. However, there is no clear research on whether dry needling is a better treatment choice over laser, physical therapy, or other combined treatments.
In January 2014, the Oregon Court of Appeals ruled that the Oregon Board of Chiropractic Examiners did not have the statutory authority to include dry needling in the scope of practice for chiropractors in that state. The ruling did not address whether chiropractors have the medical expertise to use dry needling or whether the training they were given was adequate. Pending further discussion of training requirements, the Oregon Physical Therapist Licensing Board has advised all Oregon physical therapists against practicing dry needling. They have not changed their ruling that dry needling is within the scope of practice for Oregon Physical Therapists.
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