If you have a persistent knot in your neck, shoulders, or upper back that keeps returning despite stretching and massage — this one is for you. Dry needling is one of the most useful tools I reach for in exactly this situation, and I find it is one of the least understood options available to patients in this area.
This post covers what dry needling actually is, how it differs from acupuncture, what the evidence says, what to expect during a session, and who I find tends to benefit most.
What is dry needling?
Dry needling is a musculoskeletal technique that uses a thin filiform needle — the same type used in acupuncture — to target myofascial trigger points.
Trigger points were first classified in the 1980s and described as “highly irritable localised spots of exquisite tenderness in a nodule in a palpable taut band of skeletal muscle.” Under sustained or repeated load — whether from desk work, physical labour, sport, or postural strain — sections of muscle fibre can develop persistent contraction that does not fully release with passive stretching or rest.
The needle is inserted directly into the trigger point. The term “dry” simply means no substance is injected — the needle itself is the therapeutic tool.
How does it work?
This is where it gets interesting, and I will be honest that the research is still working some of this out.
The needle insertion into a trigger point can produce a local twitch response: a brief, involuntary contraction of the affected muscle fibres. While certainly not indicative of an effective treatment, research published in the Journal of Orthopaedic and Sports Physical Therapy found that eliciting this twitch response is associated with greater pain relief and improved range of motion in some studies, while other research suggests good outcomes occur without it. My clinical experience sits somewhere in the middle — the twitch is a useful signal, but it is not the only thing happening.
What the evidence does consistently support is that needling a trigger point triggers a real chemical response in the tissue. The body releases fewer of the irritating substances that keep the area sensitised and painful (including substance P and CGRP — calcitonin gene-related peptide) — and the nervous system’s own pain-dampening mechanisms kick in. A 2025 systematic review and meta-analysis confirmed these changes at a biomarker level, which is a fairly strong signal that something clinically meaningful is happening beyond placebo.
Put simply: the needle creates a stimulus at the site of the problem that the body responds to — reducing local chemical irritants and improving the muscle’s ability to function normally.
Is it the same as acupuncture?
I get asked this constantly, and I understand why — the needle looks identical.
Both dry needling and acupuncture use thin, sterile, single-use filiform needles. That is largely where the similarity ends.
Acupuncture is rooted in traditional Chinese medicine and works along a system of energy meridians. Dry needling is grounded in Western musculoskeletal anatomy and pain science. Where I place the needle is determined by what I find on assessment — specifically, identifying trigger points through palpation — not by meridian maps. The American Academy of Orthopaedic Manual Therapists describes dry needling as an evidence-based treatment method that requires comprehensive assessment of the neuromuscular system.
Both approaches can be clinically useful. They are different frameworks using a common tool.
In Australia, dry needling is recognised by the Chiropractic Board of Australia as within the scope of chiropractic practice when appropriate additional training has been completed.
What does dry needling feel like?
Honestly — it varies, and I would rather tell you what to expect than have you walk in unprepared.
The needle insertion itself is usually barely perceptible. It is extremely fine — significantly thinner than an injection or blood-draw needle — and passes through the skin quickly.
What most patients notice is the response at the trigger point itself. This may feel like a brief dull ache, a deep cramping sensation, or a sudden reflex twitch in the muscle. Some patients feel very little at all. The intensity depends on how active the trigger point is and which muscle we are working on.
After the session, the area is often tender for 12 to 48 hours — similar to the soreness you get after a hard workout. That is a normal tissue response, and it is usually followed by a meaningful reduction in background tension.
In my experience, the patients who are most apprehensive tend to be the most surprised by how manageable it is. The anticipation is almost always worse than the procedure.
Where do I use dry needling most often?
Upper trapezius and neck. The classic persistent knot between the neck and shoulder — loaded by prolonged desk work, forward head posture, or sustained upper limb use. A 2025 systematic review and meta-analysis in Surgical Neurology International confirmed dry needling produces significant reductions in pain and disability for mechanical neck pain. This is probably the presentation I needle most frequently.
Suboccipitals. The small muscles at the base of the skull are commonly overloaded in forward head posture patterns. Trigger points here are frequently linked to tension-type and cervicogenic headaches. Releasing them is often a meaningful part of managing recurring headache patterns.
Thoracic paraspinals. Persistent aching and stiffness between the shoulder blades — common in desk workers and manual labourers alike. Dry needling here integrates well with thoracic chiropractic work.
Gluteals. This one surprises patients. Trigger points in the gluteus medius and minimus can refer pain into the leg in patterns that mimic sciatica. A 2024 systematic review and meta-analysis in the Journal of Bodywork and Movement Therapies found that dry needling combined with stretching produces significant reductions in myofascial pain severity — supporting its role in hip and lower limb presentations.
Lower back. A 2023 systematic review in Arquivos de Neuro-Psiquiatria concluded that dry needling is effective for myofascial pain in both acute and chronic lower back pain, though the authors noted that further high-quality studies are needed to clarify long-term outcomes. That caveat is worth keeping — I use it as part of a broader approach, not as a standalone fix.
How does dry needling fit into a consultation here?
I do not offer dry needling as a standalone session, and I think that distinction matters.
When a patient comes in, I assess the full picture first — joint mobility, movement patterns, load habits, and soft tissue findings — before deciding whether needling is appropriate and where. The reason is straightforward: trigger points usually have a mechanical driver. A joint not moving well, a sustained postural load, a repetitive work demand. If I needle the trigger point without addressing what keeps reloading it, the relief tends to be temporary.
Integrating dry needling into a broader chiropractic and rehabilitation approach is what produces durable results — not just a good day after the appointment.
If you have had dry needling elsewhere and found it helpful short-term but the same spots kept coming back, that pattern usually means the underlying driver was never addressed.
Who tends to get the most out of it?
In my experience, dry needling works best for:
- Persistent trigger point pain that does not fully resolve with stretching, heat, or massage
- Neck and shoulder tension that keeps reloading despite regular self-management
- Upper back and thoracic stiffness with associated aching
- Headache patterns with a significant cervicogenic or muscular component
- Gluteal and hip presentations with referred pain into the leg
- Lower back pain with a myofascial component
It is not the right tool for every presentation. Acute injury, significant inflammation, or primarily joint-driven problems may respond better to other approaches first. That is something I work out during the assessment — it is not a decision I make before I have seen you.
Want to find out if it is right for you?
Bassendean Chiropractic is at 254 Beechboro Rd, Morley — five minutes from Embleton and easy to reach from across the Morley corridor.
Initial consultations are thorough — I look at the full picture before any treatment is applied. If dry needling is appropriate for what you have going on, we will talk through it and integrate it into your care plan.
New patients are welcome. I see patients Monday to Friday and Saturday mornings.