Acupuncture and Dry Needling: Evidence-Based Insight for Pain Relief and Recovery

As a physiotherapist, one of the most common questions I hear from clients is whether acupuncture and dry needling are the same — and which option is more effective for pain, injury recovery, or movement restriction.

Acupuncture and dry needling are both needle-based therapies that play unique roles in pain relief, injury recovery, and movement restoration. Though they look similar — fine, sterile needles inserted into muscles — the theory, training requirements, and clinical goals behind each technique differ in ways that matter for treatment outcomes, safety, and clinical decision making.

This guide offers a physiotherapy-informed, evidence-based comparison of what these treatments are, how they work, key benefits for athletes and everyday people, real-world examples from musculoskeletal care, and what current research says.

What Is Acupuncture?

Acupuncture is a traditional medical practice rooted in Chinese medicine. It involves the insertion of fine, sterile needles into acupoints — specific sites connected through a meridian system believed to balance Qi (energy) and influence physiological function. From a modern clinical perspective, acupuncture is often used to influence pain modulation, autonomic nervous system activity, and general tissue relaxation — particularly in chronic or widespread pain presentations.

These needles are typically left in place for 20 to 30 minutes. Most clients require a series of 3 or more sessions, as acupuncture has a cumulative effect, meaning its pain-relieving and healing benefits increase over time.

Today, acupuncture is often integrated into modern rehabilitation and pain management, with research supporting its use for:

• Chronic lower back pain

• Neck pain

• Tension headaches

• Sports-related pain and recovery

• Post-injury muscle tension

Studies have shown acupuncture can help reduce pain intensity and improve function when combined with active rehabilitation strategies such as exercise therapy and movement retraining.

Clinical Example: A runner experiencing tight calves and Achilles discomfort may find reduced tension and improved mobility after a course of acupuncture that targets both local points and distant acupoints associated with musculoskeletal balance.

What Is Dry Needling?

Dry Needling involves inserting thin needles directly into myofascial trigger points — tight, hyperirritable spots in muscles that can refer pain or restrict movement.

Unlike acupuncture, dry needling:

• Is not based on meridian theory

• Targets muscle physiology and trigger points

• Is commonly performed by physiotherapists as part of a structured musculoskeletal rehabilitation program

Dry Needling is typically used to reduce muscle tone, improve range of motion, and allow more effective participation in exercise-based rehab — rather than as a stand-alone treatment.

Clinical Example: A basketball player with shoulder pain due to myofascial tightness may receive dry needling to deactivate trigger points before a movement-based rehab session, improving pain levels and quality of motion.

Key Differences Between Acupuncture and Dry Needling

Feature	Acupuncture	Dry Needling
Origin	Traditional Chinese Medicine	Western biomedical approach
Target	Acupoints based on meridians	Myofascial trigger points and muscle tissue
Training	Years of study and certification	Postgraduate clinical training for physiotherapists
Typical Use	Pain, systemic balance, relaxation	Musculoskeletal pain, movement restriction, trigger point release

How do Acupuncture and Dry Needling Reduce Pain?

Although their theories differ, both therapies involve needle stimulation that influences the body in multiple ways:

🧠 1. Pain Modulation

Needling can activate body mechanisms that reduce pain signals, including stimulation of endogenous opioids and modulation of sensory pathways.

💉 2. Circulation & Tissue Response

Inserting a needle increases local blood flow and oxygenation, which can assist tissue repair and reduce ischemia (poor blood flow) near tight muscles or trigger points.

🔄 3. Neuromuscular Regulation

Dry Needling has been shown to influence neuromuscular function, restoring normal muscle tone and improving motor control in targeted areas - particularly relevant in neck pain, shoulder pain, and lower-limb injuries.

What Research Shows

Here's what the current research shows:

🧪 Pain and Function

A large review found that dry needling can reduce pain and improve pressure pain thresholds compared to sham or no treatment, though the evidence quality ranges from low to moderate.

🏃 Sports Recovery

Needling techniques may enhance short-term recovery outcomes such as pain reduction and mobility improvements in athletic populations, particularly when paired with load-managed exercise programs

🧠 Musculoskeletal Conditions

Evidence suggests both acupuncture and dry needling can be effective for short-term pain relief in musculoskeletal conditions, particularly when integrated into broader rehab programs.

Note: Some studies find similar outcomes between dry needling and certain injection therapies (e.g., cortisone or PRP), though long-term effects vary by condition and technique.

When Would a Physiotherapist Recommend Dry Needling Instead of Acupuncture?

A physiotherapist may recommend dry needling over acupuncture when pain or movement restriction is primarily driven by muscle dysfunction rather than systemic or centrally mediated pain mechanisms. This decision is based on clinical assessment, functional testing, and evidence-informed reasoning.

Specific Conditions Where Dry Needling Is Commonly Preferred

Dry Needling is often selected for conditions involving identifiable myofascial trigger points or muscle overactivity, including:

• Neck pain associated with muscle spasm and reduced cervical range of motion 

• Myofascial pain syndrome with local or referred pain patterns 

• Sports-related muscle injuries and overuse conditions such as calf strains, shoulder pain, and tendinopathies

• Movement-related pain where muscle inhibition limits rehabilitation progress, including shoulder impingement and lateral elbow pain

Patient Preferences and Comfort

Patient preference is a key factor in treatment selection. Some individuals prefer acupuncture due to its calming, whole-body approach, while others favor dry needling for its targeted effect on specific muscles. Clear education regarding expected sensations, benefits, and risks supports shared decision-making and improves treatment adherence. 

Real-World Examples of Use

🏃 Injury Recovery

Dry needling paired with exercise for tendinopathies (like tennis elbow or patellar tendon pain) has shown greater short-term pain reduction than exercise alone.

💪 Performance Preparation

Athletes sometimes use needling before intense training to reduce muscle stiffness and promote flexibility, which can support movement quality and reduce injury risk.

🧘 Pain Management

Acupuncture is often used for chronic pain that doesn’t respond well to passive treatments, and can be combined with dry needling for layered approaches.

Safety, Contraindications, and Clinical Considerations

Both acupuncture and dry needling are generally considered low-risk when performed by qualified clinicians, but minor side effects like bruising, soreness, or temporary discomfort are common. Rare but serious complications — including infection or pneumothorax — highlight the importance of clinical training, anatomical knowledge, and sterile technique, particularly when needling deep musculature. 

Acupuncture and Dry Needling may not be appropriate in the presence of:

• Bleeding disorders or anticoagulant therapy (relative contraindication)

• Local infection, inflammation, or compromised skin integrity

• Severe needle phobia or inability to provide informed consent

• Certain neurological or systemic conditions where risk outweighs benefit

• Pregnancy.

Who Might Benefit Most?

• Individuals with chronic musculoskeletal pain

• Athletes experiencing trigger points or stiffness

• Patients seeking drug-free pain relief

• People wanting enhanced recovery between training sessions

Summary: Choosing the Right Approach

• Acupuncture is rooted in traditional medicine and often supports systemic pain relief and balance.

• Dry Needling focuses on trigger points and muscular function in musculoskeletal conditions.

• Both approaches can be effective tools within evidence-based physiotherapy care

Not sure whether acupuncture or dry needling is right for you? A physiotherapy assessment helps determine the most effective treatment for your body, your goals, and your recovery — not just your symptoms.

If you’re interested in learning more about how these concepts fit into a bigger picture, explore our movement and recovery blog hubs.

References

1. Gattie E, Cleland JA, Snodgrass S. The effectiveness of trigger point dry needling for musculoskeletal conditions: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017. https://pubmed.ncbi.nlm.nih.gov/28158962/

2. Liu L, Huang QM, Liu QG, et al. Evidence for dry needling in the management of myofascial trigger points associated with neck and shoulder pain: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. https://pmc.ncbi.nlm.nih.gov/articles/PMC7602246/

3. Cagnie B, Dewitte V, Barbe T, et al. Physiologic effects of dry needling. Current Pain and Headache Reports. https://link.springer.com/article/10.1007/s11916-013-0348-5

4. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Archives of Internal Medicine. https://pubmed.ncbi.nlm.nih.gov/22965186/

5. Kużdżał, A., Trybulski, R., Muracki, J. et al. Dry Needling in Sports and Sport Recovery: A Systematic Review with an Evidence Gap Map. Sports Med 55, 811–844 (2025). https://doi.org/10.1007/s40279-025-02175-9

6. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: A prospective survey of chartered physiotherapists. Journal of Manual & Manipulative Therapy. https://pubmed.ncbi.nlm.nih.gov/25125935/

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