Dry needling

What is dry needling?

With dry needling, a trained practitioner uses very fine needles to target trigger points, the tight, tender knots that form in your muscles. The needles hold no medicine at all, so there's no substance going into your body, which is where the name "dry" comes from.

What conditions can dry needling treat?

Dry needling may be used for a range of muscle and joint problems, including:

• problems with joints or with the discs in your spine
• tendonitis (swelling and irritation of a tendon, the tissue that joins muscle to bone), and other tendon problems
• migraines and tension-type headaches
• temporomandibular joint (TMJ) disorders, which affect the jaw joint and surrounding muscles
• whiplash
• repetitive strain injuries such as carpal tunnel syndrome
• pelvic pain and cramping muscles at night
• phantom limb pain, where pain seems to come from a limb that's no longer there
• muscle strains and joint pain linked to osteoarthritis.

What are the benefits of dry needling?

Loosening a trigger point this way can ease pain and stiffness in the muscle, and may help with flexibility and range of movement.

Evidence on how well it works is mixed. Some studies point to benefits for particular types of muscle pain, while others report results no better than a placebo (a dummy treatment with no active ingredient), and there isn't yet enough large-scale, high-quality research to say for certain how effective dry needling is.

Are there different types of dry needling?

There are two main approaches, depending on how deep the needle goes:

• superficial dry needling: the needle goes a short way, about 5mm–10mm, into the layer just under the skin, above the trigger point
• deep dry needling: the needle passes beyond that layer and into the muscle itself, to reach the trigger point directly.

Once placed, a needle may be left still for anywhere between a couple of seconds and 20 minutes, or worked gently up and down (known as pistoning) until it brings on a brief muscle twitch.

Although acupuncture and dry needling use similar needles, they come from different traditions. Dry needling draws on Western medicine and an assessment of your pain, posture and movement, whereas acupuncture comes from Eastern medicine and is delivered by licensed acupuncturists.

Dry needling is also different from a trigger point injection, which uses a needle to deliver medicine into the muscle; a dry needle carries no medicine at all.

What happens before dry needling?

Before you start, your practitioner asks about your medical history and carries out a physical examination to check the treatment is suitable for you, then explains what's involved and answers any questions.

• wear loose, comfortable clothing that gives easy access to the area being treated, or a gown can be provided
• you'll be taken to a private treatment space
• you'll be positioned appropriately for the area that's being treated.

What happens during dry needling?

1. Your practitioner cleans the area and prepares a sterile, single-use needle.
2. Using one hand, they press around the area to pinpoint the trigger point (called palpation), then use the other hand to hold the needle, inside its guide tube, over that spot.
3. They tap the needle in through the skin's outer layer and take away the guide tube.
4. Depending on the technique, the needle goes just under the skin (superficial) or further into the muscle to reach the trigger point directly (deep).
5. It may stay in place for anywhere between a couple of seconds and 20 minutes, or be moved gently up and down to bring on a brief muscle twitch.
6. The first session usually starts with just a needle or two; later sessions might use considerably more, with a back treatment sometimes calling for between 10 and 15.

What does recovery look like?

Straight after your session, your practitioner takes the needle out, checks your skin, and disposes of the needle safely. You'll be asked to get up slowly, and if you feel light-headed, you can sit and rest before leaving.

Once you're home, keep your fluids up and stay as active as you comfortably can, since gentle movement helps rather than resting completely. Soreness in the muscle is common and normally settles within 24 to 36 hours, and any bruising around the needle site tends to fade within a week.

What are the risks and complications?

Soreness during and shortly after a session is the side effect people notice most often. Beyond that, most side effects are minor, and can include:

• stiffness
• bruising close to where the needle went in
• feeling faint
• tiredness.

There's also a small chance of infection, so it's worth checking your practitioner is properly trained. Serious problems are extremely rare: firm pressure usually helps if you notice bleeding at the needle site, and you should get emergency help straight away for sudden shortness of breath, since needling near the chest can very rarely lead to a collapsed lung.

Certain groups should check with a doctor before having dry needling. These include children under 12, anyone who is pregnant (particularly in the first three months), people with a significant fear of needles, people with a weakened immune system, and anyone who has just had surgery, takes blood-thinning medicines, has a local or general infection, or has a vascular condition such as varicose veins.

It's worth discussing your own circumstances with your practitioner before going ahead.