Dry needling is a physiotherapy technique in which a trained practitioner inserts thin, solid needles into myofascial trigger points to release muscle tension, reduce pain, and restore normal movement. The needles contain no medication, which is why the technique is called “dry.” Dry needling targets tight, knotted bands of muscle tissue that cause local pain or referred pain in other parts of the body. A survey of Ontario physiotherapists published in BMC Complementary Medicine and Therapies found that over 95% of respondents endorsed needling as an effective and safe treatment for musculoskeletal disorders. This blog explains how dry needling works, what it feels like, how it compares to acupuncture, what conditions it treats, and what to expect before, during, and after a session.

What Is Dry Needling in Physiotherapy?

Dry needling in physiotherapy is a treatment technique that uses thin, sterile, single-use filiform needles to target myofascial trigger points in muscles that are causing pain, tightness, or dysfunction. In the word “myofascial,” “myo” refers to muscle and “fascial” refers to fascia, the thin connective tissue that wraps around every muscle in the body. Trigger points are hyperirritable spots within a taut band of skeletal muscle that produce local tenderness, referred pain, and restricted range of motion when compressed or stimulated.

Trigger points develop when a muscle is overloaded through injury, repetitive strain, poor posture, or sustained tension. The overloaded muscle fibres enter what researchers describe as an “energy crisis,” where the tissue does not receive adequate blood supply to return to its normal resting state. The area around the trigger point becomes acidic, the local nerves become sensitised, and the muscle stays locked in a shortened, painful position. Trigger points are extremely common: clinical data from Travell and Simons, the foundational researchers in myofascial pain, found that trigger points are present in approximately 85% of patients who visit pain clinics.

Dry needling is almost always used as one component of a larger physiotherapy treatment plan that includes manual therapy, exercise prescription, stretching, and patient education. The needle addresses the trigger point directly; the exercise programme prevents the trigger point from returning.

How Does Dry Needling Work?

Dry needling works by inserting a thin needle into or near a myofascial trigger point to restore normal blood flow, release muscle tension, and stimulate the body’s natural pain-relief mechanisms. The needle penetrates the taut muscle band and disrupts the dysfunctional motor endplate at the centre of the trigger point. The disruption causes a brief involuntary muscle contraction called a local twitch response (LTR). The local twitch response is a sign that the needle has reached the target and the muscle is beginning to release.

The physiological effects of dry needling occur at multiple levels simultaneously. At the tissue level, the needle draws fresh blood flow into the oxygen-deprived trigger point, flushing out the inflammatory chemicals and metabolic waste that accumulated during the energy crisis. At the neurological level, the needle stimulates sensory nerve fibres that signal the brain to release endorphins, the body’s natural pain-relieving chemicals. At the muscular level, the twitch response resets the shortened muscle fibres to their normal resting length, which restores range of motion and reduces the mechanical load on the surrounding joints.

Practitioners use two primary techniques. Superficial dry needling inserts the needle 5 to 10 millimetres into the subcutaneous tissue above the trigger point, according to Cleveland Clinic. Deep dry needling advances the needle beyond the subcutaneous layer directly into the muscle to penetrate the trigger point itself. The technique selected depends on the location of the trigger point, the depth of the muscle, and the patient’s comfort level. A practitioner may use 1 to 2 needles during a first session, scaling up to 10 to 15 needles for broader treatment areas like the back, according to Cleveland Clinic.

What Happens When Dry Needling Hits a Trigger Point?

When dry needling hits a trigger point, the muscle produces a local twitch response, which is a brief, involuntary contraction followed by an immediate release of tension in the taut muscle band. The local twitch response feels like a quick cramp or spasm that lasts only a second or two. Patients often describe it as a deep muscle “jump.” The twitch is a positive sign because it confirms the needle has reached the dysfunctional tissue. Research published in the Archives of Physical Medicine and Rehabilitation confirms that eliciting a local twitch response during dry needling is associated with greater reductions in pain and improved outcomes compared to needling that does not produce a twitch.

After the twitch response, blood flow rushes into the trigger point, the muscle fibres begin to lengthen, and the chemical environment around the nerve endings shifts from acidic to neutral. Many patients notice an immediate reduction in tightness and an increase in range of motion in the treated muscle. The needles typically remain in place for 10 seconds to 20 minutes depending on the technique, treatment location, and clinical goals, according to Mayo Clinic Health System.

How Painful Is Dry Needling?

Dry needling is mildly uncomfortable but not typically described as painful by most patients. The filiform needles used for dry needling are extremely thin, much thinner than the hypodermic needles used for injections or blood draws. Many patients do not feel the needle entering the skin at all. The sensation that patients notice most is the local twitch response, which produces a brief, deep ache or cramping feeling in the muscle that lasts one to two seconds.

After the session, mild soreness at the treatment site is common and typically lasts 24 to 48 hours, similar to the soreness felt after a deep tissue massage. The post-treatment soreness resolves on its own and is a normal part of the healing response. Patients who are nervous about needles should communicate this to their practitioner before the session. The practitioner can start with fewer needles, use the superficial technique, and progress gradually as the patient becomes more comfortable.

Is Dry Needling Basically Acupuncture?

No, dry needling is not basically acupuncture, although both techniques use the same type of thin, solid needle. The key difference lies in the clinical philosophy, the targeting system, and the treatment goals. Dry needling is rooted in modern Western anatomical and neurophysiological science. It targets myofascial trigger points, specific dysfunctional spots in muscles identified through physical examination and palpation. Traditional acupuncture is rooted in Chinese medicine and targets meridian points along energy pathways to restore the flow of Qi (life energy) throughout the body.

A third approach, called contemporary medical acupuncture, bridges the two. Contemporary medical acupuncture uses the same thin needles but applies them based on modern anatomical knowledge, neuroscience, and evidence-based practice rather than traditional meridian theory. The McMaster University Contemporary Medical Acupuncture programme, which trains physiotherapists and chiropractors across Canada, teaches practitioners to select needle insertion points based on neuroanatomy, segmental innervation, and myofascial trigger point anatomy. This approach shares significant overlap with dry needling in both technique and clinical reasoning.

Attribute	Dry Needling	Traditional Acupuncture	Contemporary Medical Acupuncture
Clinical basis	Modern Western anatomy and neurophysiology	Traditional Chinese Medicine (meridians, Qi)	Modern neuroanatomy and evidence-based practice
Targeting system	Myofascial trigger points identified by palpation	Meridian points along energy pathways	Neuroanatomical points, segmental innervation, and trigger points
Primary goal	Release trigger points, restore muscle function	Restore energy balance and promote whole-body healing	Modulate pain, reduce inflammation, restore function
Needle type	Thin, solid filiform needle (no medication)	Thin, solid filiform needle (no medication)	Thin, solid filiform needle (no medication)
Number of needles per session	Fewer (1-15 depending on area)	Multiple (often 10-20+)	Variable (based on clinical assessment)
Regulation in Ontario	Performed by physiotherapists and chiropractors with approved training	Regulated by the Traditional Chinese Medicine Act	Performed by physiotherapists and chiropractors with McMaster or equivalent training

Sources: Cleveland Clinic; Mayo Clinic Health System; Ontario Physiotherapy Association; McMaster University Contemporary Medical Acupuncture Programme; College of Physiotherapists of Ontario.

What Conditions Does Dry Needling Treat?

Dry needling treats a wide range of musculoskeletal and neuromuscular conditions where myofascial trigger points contribute to pain, stiffness, or movement restriction. A systematic review and meta-analysis published in the Archives of Physical Medicine and Rehabilitation found that dry needling for low back pain produced a statistically significant reduction in pain intensity (SMD -1.06) and functional disability (SMD -0.76) compared to other treatments. An updated systematic review in PMC found that dry needling reduced neck pain immediately after treatment (MD -1.53) and at short-term follow-up (MD -2.31) compared to placebo.

Common conditions treated with dry needling include:

• Neck pain and cervicogenic headaches
• Low back pain and sciatica
• Shoulder pain and rotator cuff tendinitis
• Tennis elbow and golfer’s elbow
• Hip pain and iliotibial band syndrome
• Knee pain, including patellofemoral pain syndrome
• Temporomandibular joint (TMJ) dysfunction
• Plantar fasciitis and Achilles tendinitis
• Whiplash and motor vehicle accident injuries
• Muscle strains and repetitive strain injuries
• Fibromyalgia-related myofascial pain

For patellofemoral pain specifically, a 2025 systematic review published in ScienceDirect found that dry needling on trigger points produced a significant decrease in pain intensity (SMD -0.53) and meaningful improvement in function at 1 to 3 months after intervention. Dry needling is most effective when combined with exercise rehabilitation and manual therapy rather than used in isolation.

Does Dry Needling Get Knots Out?

Yes, dry needling gets knots out by deactivating the myofascial trigger points that form the “knot” and restoring normal blood flow and muscle fibre length in the affected area. The knots that patients feel in their muscles are clusters of contracted muscle fibres that have locked into a shortened position due to the energy crisis described above. The dry needle penetrates the knotted tissue, provokes the local twitch response, and resets the muscle fibres to their resting length. The result is a softer, more pliable muscle with reduced tenderness and improved range of motion.

Stubborn trigger points that have been present for months or years may require multiple sessions to fully deactivate. Each session progressively reduces the size and sensitivity of the trigger point. Combining dry needling with laser therapy and targeted stretching accelerates the process because the laser reduces residual inflammation while the stretching maintains the restored muscle length between sessions.

Which Is Better, Dry Needling or a Massage?

Dry needling and massage therapy target different layers of the problem, and one is not categorically better than the other. Dry needling accesses deep trigger points that manual pressure alone cannot always reach, particularly in thick muscles like the gluteals, the deep hip rotators, and the paraspinal muscles along the spine. Massage therapy addresses broader patterns of muscle tension, improves circulation across larger tissue areas, and reduces stress-related holding patterns that contribute to trigger point formation.

For a single, deep, well-defined trigger point, dry needling often produces faster relief because the needle reaches the exact dysfunctional tissue. For widespread muscle tension, general tightness, and recovery from high-intensity physical activity, massage therapy provides broader coverage. At our clinic, we frequently combine both: dry needling to deactivate the specific trigger point followed by massage to release the surrounding tissue and improve overall circulation. A systematic review published in the Journal of Bodywork and Movement Therapies confirmed that both dry needling and manual trigger point therapy were effective in improving pain and function in the short to medium term.

What Shouldn’t You Do After Dry Needling?

After dry needling, you should not perform heavy exercise, apply strong pressure to the treated area, or consume alcohol for 24 hours. The treated muscle needs time to recover from the needling stimulus. Following these aftercare steps helps the muscle heal properly and maximises the benefit of the session:

1. Avoid intense exercise for 24 hours. Light walking and gentle stretching are fine, but high-intensity training, heavy lifting, and explosive movements should wait until the following day.
2. Stay well hydrated. Drink plenty of water after your session. Hydration supports the flushing of metabolic waste released from the trigger point during treatment.
3. Apply heat if you feel sore. A warm compress or heating pad applied for 15 to 20 minutes can ease the post-treatment soreness that sometimes develops in the treated muscle.
4. Perform the gentle stretches your practitioner recommends. Light stretching keeps the treated muscle at its new, restored length and prevents the trigger point from re-forming.
5. Avoid deep massage on the needled area for 24 hours. The tissue needs a brief rest period before additional manual pressure is applied.

Mild soreness, slight bruising at the needle site, and temporary fatigue are all normal after dry needling. These effects typically resolve within 24 to 48 hours. Contact your practitioner if soreness persists beyond 72 hours or if you notice unusual swelling or redness at the treatment site.

How Long Do Dry Needling Results Last?

Dry needling results last anywhere from a few days after a single session to several weeks or months with a full course of treatment. The duration depends on the chronicity of the trigger point, the underlying cause of the muscle dysfunction, and whether the patient follows through with the prescribed exercise and stretching programme between sessions. An acute trigger point that developed recently from a specific strain often resolves in one to three sessions with lasting results. A chronic trigger point that has been present for months tends to require a longer course of treatment and periodic maintenance sessions.

Research supports that dry needling produces significant pain reduction immediately after treatment and at short-term follow-up (up to 12 weeks), with the strongest evidence for pain improvement when dry needling is combined with exercise and other chiropractic or physiotherapy interventions. An updated systematic review published in PMC found that the combination of dry needling with other interventions reduced pain intensity at both short-term (SMD -1.46) and midterm (SMD -0.38) follow-up compared to the other interventions alone.

How Many Dry Needling Sessions Do You Need?

Most patients need 3 to 6 dry needling sessions to achieve meaningful, lasting improvement, though the exact number depends on the condition, the number of trigger points involved, and how the body responds to treatment. Sessions are typically spaced one to two weeks apart during the active treatment phase. The first session often uses fewer needles and a gentler technique to assess the patient’s response. Subsequent sessions can be more targeted as the practitioner identifies which trigger points respond and which require deeper work.

Patients with acute conditions, such as a recent muscle strain with one or two active trigger points, may feel significant relief after just one or two sessions. Patients with chronic conditions involving multiple trigger points across several muscle groups typically need the full course of 4 to 6 sessions. Periodic maintenance sessions every 4 to 8 weeks can prevent recurrence in patients with jobs or activities that predispose them to trigger point formation, such as desk work, repetitive manual labour, or endurance sports.

Who Is Not a Candidate for Dry Needling?

People who are pregnant, who have compromised immune systems, who take blood-thinning medications, or who have a severe fear of needles are generally not candidates for dry needling without additional medical consultation. Cleveland Clinic also notes that dry needling is not recommended for children under the age of 12 because of the discomfort involved, and that both the parent and child must provide consent before proceeding.

Other groups who should consult their physician before receiving dry needling include people who have recently had surgery near the treatment area, people with bleeding disorders, and people with active infections or skin conditions over the treatment site. Your practitioner will review your full health history before recommending dry needling and will always obtain your informed consent before inserting any needles. Here in Markham, our practitioners with McMaster University acupuncture training assess each patient individually to determine whether needle-based therapy is appropriate for their condition.

Frequently Asked Questions

What Hurts More, Acupuncture or Dry Needling?

Dry needling can produce a slightly more intense sensation than traditional acupuncture because the needle is intentionally directed into a trigger point to provoke a local twitch response. Traditional acupuncture inserts needles into meridian points, which typically produces a milder sensation described as a dull ache or tingling. Contemporary medical acupuncture, which targets anatomical points similarly to dry needling, produces a comparable sensation. Both are well tolerated by the vast majority of patients, and discomfort during either treatment is brief.

Can Dry Needling Make Pain Worse?

Dry needling can cause temporary increased soreness in the treated muscle for 24 to 48 hours after the session. This post-treatment soreness is part of the normal healing response and typically resolves on its own. Soreness that persists beyond 72 hours is uncommon and should be reported to your practitioner. Dry needling should not cause sharp, lasting pain or new symptoms that were not present before the treatment.

What Should I Wear to a Dry Needling Appointment?

Wear loose, comfortable clothing that allows your practitioner to access the treatment area easily. Shorts and a tank top work well for most sessions. Your practitioner needs direct skin access to the muscle being treated, so avoid thick or layered clothing over the treatment area. If you are coming from work, bring a change of clothes.

Is Dry Needling Covered by Insurance in Canada?

Dry needling performed by a registered physiotherapist or chiropractor is typically covered under extended health benefit plans in Canada, billed as part of a physiotherapy or chiropractic session rather than as a separate line item. Coverage depends on your specific plan. WSIB and motor vehicle accident insurance also cover physiotherapy and chiropractic sessions that include needling techniques. Check your benefits card or contact your insurer to confirm your coverage.

Can Chiropractors Perform Dry Needling?

Yes, chiropractors in Ontario can perform dry needling and acupuncture after completing approved training programmes and meeting the requirements set by the College of Chiropractors of Ontario. At our clinic, our chiropractors hold McMaster University Contemporary Medical Acupuncture certification, which includes trigger point needling techniques used in both acupuncture and dry needling contexts.

The Takeaway

Dry needling is a safe, evidence-supported physiotherapy technique that targets the specific muscle dysfunction behind many common pain conditions. The thin needle reaches trigger points that stretching and massage alone cannot always access, and the local twitch response it produces resets the muscle to its normal resting length. Research consistently shows that dry needling produces meaningful pain reduction and functional improvement, especially when combined with exercise, manual therapy, and other treatment modalities as part of a coordinated plan.

At KC Rehab, our physiotherapists and chiropractors use contemporary medical acupuncture techniques, including trigger point needling, as part of a comprehensive treatment approach built around each patient’s specific condition. If you are dealing with muscle pain, stiffness, or movement restriction that has not responded to stretching or exercise alone, needle-based therapy may be the missing piece. Call us at 905-205-1668 or book online to schedule an assessment.