Dry Needling: The Basics & Benefits

Pain management in the United States costs up to $635 billion annually¹. Most mainstream treatment options for pain include highly addictive opioid medications that are ultimately harmful to the body. That said, there is a great need for nonpharmacologic treatments that offer safe, effective alternatives to damaging medications. Dry needling is an excellent, drug-free option for treating myofascial pain and musculoskeletal injuries and one that has been used for decades. As dry needling becomes more popular in the Western medical world, there is increasing curiosity about what dry needling is and how it can help. I often receive questions about dry needling from current and prospective patients.  

What is Dry Needling? 

You may have heard dry needling (DN) referred to as intramuscular stimulation, trigger point (Trp) acupuncture, TrP needling, functional dry needling (FDN), myofascial TrP dry needling, or biomedical acupuncture. Needless to say, there are many terms for dry needling! Dry needling is a technique used to treat myofascial conditions with the goal of decreasing pain and restoring muscle function with long lasting results. The needles are thin and solid and do not contain or inject medicine. The ‘dry’ designation was coined to differentiate between hypodermic injections performed with ‘wet needles.’

Dry needling technique involves a practitioner inserting thin, solid needles through the skin directly into myofascial trigger points to release and lengthen knotted muscle fibers. A trigger point is a tender spot where muscle fibers have gathered into a knot or palpable nodule. When a trigger point is stimulated, it can elicit a local twitch response (LTR), a quick, intentional muscle spasm where the muscle quickly contracts and then immediately relaxes. LTRs lengthen knotted muscle fibers, help restore proper muscle and joint alignment, and improve circulation through the local area.

Dry needling is an effective treatment modality for addressing pain and orthopedic conditions. It can be used for both acute and chronic pain syndromes and excels at decreasing pain and promoting proper healing. Dry needling is often used with other tools and techniques, such as stretches, strength exercises, cupping, scraping (gua sha), or massage.

What is a Trigger Point (TrP)? 

A trigger point is a hyperirritable spot where muscle fibers have gathered into a knot or palpable nodule. When compressed or stimulated, trigger points can be tender and produce local and referred pain. For example, trigger points around the shoulder can cause radiating arm pain, while trigger points around the hip flexors can lead to lower back pain. Trigger points can be caused by several factors, including muscle overuse and strain, trauma, and alignment imbalances.  

What is a Local Twitch Response (LTR)? 

A local twitch response (LTR) is a quick contraction of tense muscle fibers responding to needle stimulation or palpation. Local twitch responses are involuntary spinal cord reflexes in which a taught band of muscle fibers contracts and immediately relaxes. LTRs can vary in intensity, depending on the fascia's texture and tone in the local area. With well-trained and experienced hands, LTRs can lead to long-term muscle relaxation and restore normal muscle strength, coordination, and tone to break the pain cycle and begin the healing process. LTRs unwind muscle knots to restore normal muscle length and reduce tension applied to tendons and joints. Local twitch responses offer both diagnostic and therapeutic benefits. 

Increase Range of Motion & Relive Joint Tension

I often use a rope analogy with my patients to explain how dry needling affects the muscles, tendons, and joints. If there’s a rope attached to two opposing points, each knot tied in the rope shortens and tightens the line and thus increases the force applied to both ends. Like a rope, when muscle fibers become knotted, the muscle physically shortens, increasing pressure on the tendons and joints. Dry needling can address problematic postural alignment, structural compensation patterns, movement imbalances, and pain conditions through unwinding and lengthening tight muscles. 

Increase Circulation to Decrease Inflammation 

Blood plays a crucial role in the functioning of muscle tissue as a transportation network that delivers nourishment and removes waste. Trigger points decrease the ability of blood to innervate and move through the sinews. Muscle knots bind up fibers, press on blood vessels, and decrease blood flow, restricting the ability to transport blood in and out of the affected area. Lack of blood flow and oxygen to a muscle diminishes its ability to recover and heal from stress and inflammation. Therefore, promoting blood flow through an area of injury is important so the body can deliver oxygen and nutrients and remove chemical waste.

When I explain how dry needling affects circulation, I like to relate trigger points to rocks in a river, restricting its ability to flow. The river's strength and flow return as we remove the rocks and debris. It’s the same for trigger points. When we remove muscle knots, circulation can flow through the injured area to deliver nourishment and remove waste. Treating trigger points improves circulation, reduces inflammation, speeds healing, and eliminates pain. 

What Does Dry Needling Treat?

Dry needling treats acute, chronic, and complex pain syndromes and many orthopedic injuries, such as tendonitis, arthritis, neuropathy, carpal tunnel syndrome, frozen shoulder, restless leg, and sciatica, to name a few. Dry needling can help relieve pain, improve blood flow, reduce inflammation, accelerate healing, and increase range of motion. It can also help nerve recovery and muscle activation, leading to strength and stability gains. Over time, physical injuries affect mental health, especially longer-term chronic issues. Dry needling may provide psychological benefits, such as improved mood and reduced stress, as pain decreases and injuries heal.

Dry needling is also an excellent therapy for athletes looking to increase endurance and performance and injury prevention and recovery. Dry needling can significantly reduce pain after injury and help with routine recovery, such as delayed onset muscle soreness (DOMS). When muscle function improves, performance improves.

Conclusion

Whether you struggle with mild muscle tightness, a frozen shoulder, or sciatica, dry needling is an excellent alternative treatment method for many physical injuries. The practitioner inserts thin, solid filament needles into targeted trigger points to lengthen knotted muscle fibers and release excess tension applied to joints and tendons. Dry needling is often used in conjunction with other therapies, such as strength exercises, stretches, cupping, and massage.

Dry needling offers a reset as it improves muscle mobility and the ability to fire, contract, and support the system. This unique modality can create a dramatic, immediate change in pain, mobility, and function associated with musculoskeletal injuries and produce long-lasting results.  

¹ Smith TJ, Hillner BE. The Cost of Pain. JAMA Netw Open. 2019;2(4):e191532. doi:10.1001/jamanetworkopen.2019.1532