What is dry needling — and does it hurt?

If you have been referred for dry needling or seen it mentioned as part of a physiotherapy programme, you may have questions about what it actually involves, whether it is the same as acupuncture, and — most practically — whether it hurts. This article explains what dry needling is, how it differs from acupuncture, what the experience typically involves, and the conditions it is commonly used for.

What is dry needling?

Dry needling is a clinical technique in which a physiotherapist inserts thin, solid filament needles — similar to acupuncture needles — directly into muscle tissue. The term “dry” refers to the fact that no fluid is injected; the needle itself is the treatment tool. The needles are typically inserted into areas of localised muscle tightness, commonly referred to as trigger points — regions where the muscle fibre appears to be in a sustained contracted state.

The aim of the technique is to address musculoskeletal presentations involving muscle tightness or trigger points. Physiotherapist-administered dry needling is performed as part of a broader treatment plan and is generally combined with other physiotherapy techniques such as exercise, manual therapy, or education.

How is dry needling different from acupuncture?

This is one of the most common questions people ask, and the distinction is meaningful. While both practices use similar needles, they differ significantly in their theoretical basis and clinical context.

Dry needling is grounded in a Western anatomical and neurophysiological framework. It targets specific muscles and trigger points identified through physiotherapy assessment. The practice is taught as part of post-graduate training for physiotherapists in Australia and is applied within a musculoskeletal clinical reasoning model.

Acupuncture originates from Traditional Chinese Medicine and operates within a different theoretical framework — one that includes concepts such as Qi (vital energy) and meridian pathways. Acupuncture points do not necessarily correspond to anatomical trigger point locations.

Both are needle-based interventions, but the conditions they are applied for, the reasoning behind needle placement, and the training backgrounds of practitioners differ. Physiotherapists who use dry needling have completed additional post-graduate training specific to the technique.

Most people find the needle sensation surprising rather than painful — though individual responses vary.

What does dry needling feel like?

This is a reasonable concern, and it is worth being honest: experiences vary between individuals and between sessions. The needle itself is very fine — far thinner than an injection needle — and needle insertion is often described as a brief mild sensation rather than a sharp pain.

When the needle reaches a trigger point, a brief involuntary muscle twitch response may occur. This twitch is considered a positive clinical sign and is often described as a short “grabbing” sensation or a dull ache. Most people find this sensation surprising rather than painful, though individual responses vary. Some areas of the body and some individuals are more sensitive than others.

After the session, it is not uncommon to experience some local muscle soreness in the treated area, which typically resolves within 24–48 hours. Your physiotherapist will advise you on what to expect and how to manage any post-treatment soreness.

Conditions where dry needling is commonly used

Dry needling is used as part of physiotherapy management for a range of musculoskeletal presentations, including:

• Neck pain and tension headaches associated with muscle tightness
• Lower back pain with identified muscle trigger points
• Shoulder pain including rotator cuff presentations
• Plantar fasciitis and heel pain
• Tennis elbow (lateral epicondylalgia)
• Hip and gluteal muscle tightness
• Sports injuries involving muscle strains or overuse presentations

Whether dry needling is appropriate for your presentation depends on a thorough physiotherapy assessment. It is not suitable for all conditions or all individuals.

Who can perform dry needling?

In Australia, physiotherapists who perform dry needling must have completed additional post-graduate training beyond their base qualification. This training covers anatomy, needle safety, infection control, and clinical indications and contraindications for the technique. Dry needling is considered an advanced clinical skill and is not performed by all physiotherapists.

If you are considering dry needling, it is worth asking the physiotherapist about their training and experience with the technique. At Alpha Physio, dry needling is performed by physiotherapists who have completed the required additional training. Your physiotherapist will assess your condition and discuss whether dry needling may be appropriate before proceeding.