Is Dry Needling Really Effective?

Should You Be Asking Your Physiotherapist for Dry Needling to Cure All of Your Stubborn Ailments?

Dry needling has become an extremely popular treatment method for physiotherapists and other allied health professionals treating musculoskeletal pain conditions. It is thought to help by relaxing or ‘releasing’ tight spots in the targeted muscles, but is it really effective in improving these pain conditions?

Understanding Dry Needling

Dry needling is a technique where thin, sterile needles are inserted into specific areas of muscle tissue known as myofascial trigger points. These trigger points are hyperirritable spots within taut bands of skeletal muscle fibers that can cause local and referred pain. The insertion of needles aims to elicit a “local twitch response,” which is believed to disrupt the contracted nature of the trigger point, leading to reduced muscle tension, decreased pain, and improved function.

While dry needling uses similar tools as acupuncture, it is based on Western medical principles rather than traditional Chinese medicine. The focus is on anatomical structures and physiological mechanisms related to musculoskeletal pain and dysfunction.

All Health Professionals Should Understand and Use Evidence Based Assessment and Treatment Methods

All health professionals should understand and utilise evidence-based assessment and treatment methods. As a patient seeking help for a musculoskeletal pain condition, you should have confidence that your chosen health professional will act in your best interest by delivering the best practice treatment methods. When deciding whether a treatment method such as Dry Needling should be used, three key considerations should be made:

1. The Available Evidence: What does the scientific research tell us? This includes both scientific studies and the clinician’s experience. The quality of evidence should be evaluated based on its methodology and risk of bias. Considering all available evidence helps make the best judgment on a treatment’s efficacy and effectiveness.

2. Synthesis of Evidence: This involves the therapist critically thinking about how the available evidence applies in their treatment room.

3. Patient Values and Circumstances: As the patient, you should be the primary decision-maker in your treatment. After your therapist explains the rationale behind their recommended techniques, including dry needling, using sound evidence and reasoning, the final decision should be yours.

These three steps can be thought of as a sequential process of narrowing down information to decide whether a treatment method is worthwhile. The picture below depicts this ‘funnel’ analogy:

Is Dry Needling Based on Sound Evidence-Based Principles?

Let's analyse dry needling using the important principles of evidence-based practice described above:

1. Is There Scientific Evidence for Dry Needling?

Numerous studies have investigated the effectiveness of dry needling for various ailments. However, many of these studies have limitations, such as small sample sizes or methodological flaws, making it difficult to draw firm conclusions. The current general consensus, based on research findings in key areas like pain reduction and function, includes the following:

Pain Reduction: Dry needling has shown potential for short-term pain relief in certain conditions, particularly in the upper body. A review by Kietrys et al. (2013) found that dry needling reduced pain immediately after treatment and up to four weeks later, though the quality of some studies raises concerns about reliability. Similarly, Gattie et al. (2017) reported short-term pain reduction, particularly in upper body conditions, but noted limited evidence for long-term benefits. Liu et al. (2018) also observed immediate pain relief and reduced muscle sensitivity for neck and shoulder pain, but the findings were based on studies of low to moderate quality. For chronic low back pain, Xie et al. (2017) found no significant difference between real dry needling and a sham treatment, suggesting that the benefits may be due to a placebo effect or other factors.

Functional Improvement: While dry needling may not significantly improve functional outcomes when used in isolation, it could be more effective when combined with other physiotherapy methods. Dunning et al. (2014) found that dry needling, when paired with treatments like exercise or manual therapy, led to better pain reduction and improved movement compared to standard care alone. This highlights the importance of incorporating dry needling into a comprehensive treatment plan rather than relying on it as a standalone therapy.

2. What Does Clinical Expertise Tell Us?

Most consensus statements from experts in the field, based on summaries of all available evidence, do not include dry needling as a first-line treatment for musculoskeletal conditions. When dry needling is recommended, it is typically in conjunction with other evidence-based treatments. Clinical expertise suggests that dry needling might be more effective as part of a comprehensive treatment plan rather than as a stand-alone therapy.

3. What Are Your Values and Preferences?

What type of treatment do you feel you need? Do you prefer hands-on deep tissue massage, stretches, therapeutic ultrasound, or exercise advice? Do you believe dry needling will work for you? Your beliefs and preferences, influenced by personal experience, advice from family and friends, and discussions with your physiotherapist, can affect how you respond to any treatments used, including dry needling.

Our Recommendation

As mentioned, current evidence is mixed and often of low quality, making it challenging to draw definitive conclusions. A critical perspective might suggest that dry needling is no more effective than a placebo. However, there is strong anecdotal evidence from therapists and patients reporting positive effects on pain and function. Emerging research continues to explore its effectiveness in various musculoskeletal conditions, though debate and lack of clarity on the underlying mechanisms persist.

So, do we still recommend and use dry needling? We believe you should be presented with all available information to make an informed decision. Many people come to us firmly believing that dry needling will benefit them due to past experiences, while others are unsure and rely on us for an unbiased view. Provided you are first treated with methods of proven efficacy and effectiveness whenever possible, the addition of dry needling may offer additional benefits when applied by an experienced therapist.