Dry Needling

How it differs from acupuncture

The needles look similar, and that is where the similarity ends. Acupuncture comes from traditional Chinese medicine and selects points along meridians according to that system's theory of energy flow.

Dry needling is based on Western anatomy and pain science. The physiotherapist examines the muscle, finds the taut band and the specific tender spot that reproduces your symptoms, and needles that point because of where it sits anatomically. Two clinicians assessing the same shoulder should arrive at broadly the same spots, because they are working from the same anatomy rather than from a separate theoretical framework.

What it is used for

It is most useful when a clear trigger point is found on examination and pressing it reproduces the pain you came in with. If no such point exists, dry needling is not the right tool and we will say so rather than needle for the sake of it.

• Myofascial trigger points — the classic use. Tight, tender knots in muscle that are painful locally and often refer pain some distance away.
• Persistent muscle tightness that has not released with stretching, massage or exercise alone.
• Neck and shoulder pain, including the trigger points that commonly drive tension-type headaches.
• Lower back and gluteal muscle pain, often alongside treatment for the spine itself.
• Some tendon-related problems, such as tennis elbow and heel pain, where the surrounding muscle is contributing to the load.
• Jaw, calf and forearm muscle pain where a discrete trigger point can be identified.

What a session actually feels like

Most people are surprised by how little the needle insertion itself registers. The needles are far finer than an injection needle and there is often no sensation as one goes in.

What you may feel is a brief, deep, cramping ache as the muscle responds, sometimes with a quick involuntary twitch. That twitch is a normal muscular reflex, it lasts a fraction of a second, and it is generally a sign the right spot has been found. It can be startling the first time, which is why we explain it before starting rather than after.

A typical treatment uses a small number of needles, left in place for a short period or removed immediately depending on the muscle and how irritable it is. The needling portion of an appointment is usually brief — the rest of the session is assessment, hands-on treatment and exercise.

Afterwards, and what is normal

Post-needling soreness is common and expected. It typically feels like the ache after unfamiliar exercise, is worst in the first few hours, and settles within a day or two. Some people feel looser immediately; others feel a little sore first and better the following day. Both are normal.

Mild bruising at a needle site is occasional and harmless. Feeling briefly tired or light-headed afterwards is also reported, which is why we ask you to sit for a moment before leaving.

What is not expected is severe or escalating pain, spreading redness, or any difficulty breathing. These are rare, but tell us or seek medical advice promptly if they occur.

Who it is not suitable for

Dry needling is not appropriate for everyone, and this is assessed before it is offered rather than assumed. Tell your physiotherapist if any of the following apply:

• You take anticoagulant medication or have a bleeding disorder.
• You have a needle phobia — this is a common and completely reasonable reason to decline, and there are effective alternatives.
• The area is infected, has an open wound, or has significant skin disease.
• You have a compromised immune system, or lymphoedema affecting the limb.
• You are pregnant — certain sites are avoided, so tell us so treatment can be adapted.
• You have a pacemaker or implanted device, if electrical stimulation is being considered alongside the needling.

It is an addition, not a substitute

This is the part that matters most, and it is where dry needling is most often oversold. Releasing a trigger point can reduce pain and restore movement — but it does not, on its own, change why the muscle became overloaded in the first place.

If a tight upper trapezius is the product of a workstation that forces your head forward all day, needling it will help for a while and the trigger point will return. The lasting change comes from the strengthening, the movement retraining and the practical adjustments. Dry needling is valuable precisely because it can reduce pain enough to make that active work possible sooner.

So at Physio Motion it is offered as one component within a plan that also includes hands-on treatment and progressive exercise — see pain management for how that plan is usually built. If you would rather not be needled, say so; the rest of the treatment stands on its own.