What does the research show about dry needling?

Dry needling

Pooled trials found dry needling eased musculoskeletal pain more than no treatment, sham needling and other therapies combined, mostly in the short term. When only adequately blinded sham trials were pooled, pain did not differ from sham. Neck function did not differ from other physical therapy. Bruising and bleeding after treatment are common. Collapsed lungs appear in case reports.

Checked 2026-11-13

Status: In the US, physical therapists deliver most dry needling under state practice rules. A 2026 scan of 56 US jurisdictions found 43 that permit physical therapists to dry needle, 5 that prohibit it and 8 that are silent, with training requirements that vary widely [1]. Dry needling uses the same solid filiform needles as acupuncture, and the two professions dispute where one ends and the other begins [2].
Also called: dry needling, trigger point dry needling, TrP-DN, TDN, deep dry needling, intramuscular stimulation, IMS, myofascial trigger point needling, electrical dry needling, needling, trigger point needling
Used for: neck pain, back pain, low back pain, shoulder pain, knee pain, knee osteoarthritis, tennis elbow, trigger points, muscle knots, myofascial pain, headache, tension headache, muscle tightness, sports injuries

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

StrongShown to ease musculoskeletal pain more than no treatment, sham needling and other therapies pooled together, from 72 hours to 24 weeks, in low-quality evidence.
ModerateShown to ease neck pain in the short term against sham, placebo, waiting list or other needling pooled together. Neck function did not differ from physical or manual therapy.
ModerateShown to ease low back pain more than other treatments right after treatment in 11 trials. Effects on disability were smaller and effects at later follow-up unclear.
ModerateShown to ease nontraumatic shoulder pain by a small amount, about half a point, and disability by a larger amount, in the short term only.
ModerateShown to ease tennis elbow pain and disability with large effects in the short term, and grip strength with a small effect.
LimitedLimited evidence: pooled small trials found less osteoarthritis pain and better function in the short term, with no difference at medium or long term.

Reported risks2

ModerateProspective surveys recorded mild effects after 19% to 37% of treatments, most often bleeding, bruising and pain during needling.Very common
ModerateProspective surveys recorded major adverse events after about 1 in 1,000 treatments or fewer. Case reports describe collapsed lungs after needling over the chest wall.Rare

What it is used for, and what was found

Shown to help6

Strong

Musculoskeletal pain, all comparisons pooled

Shown to ease musculoskeletal pain more than no treatment, sham needling and other therapies pooled together, from 72 hours to 24 weeks, in low-quality evidence.

Compared with no treatment, sham dry needling and other therapies, pooled together [3][4]

The numbers and sources

Effect: Across 42 trials, pain fell more than in the comparison groups within 72 hours (SMD -0.81, 95% CI -1.21 to -0.40), at 1 to 3 weeks (SMD -0.69, 95% CI -1.02 to -0.35), at 4 to 12 weeks (SMD -0.85, 95% CI -1.30 to -0.40) and at 13 to 24 weeks (SMD -0.81, 95% CI -1.64 to -0.03) [4]. An earlier review of 13 trials found less pain and higher pressure pain thresholds than control, sham or other treatment up to 12 weeks. At 6 to 12 months the difference in pain was not significant. Function improved against no treatment or sham, and did not differ from other physical therapy treatments [3].
Population: 42 trials of dry needling by physical therapists for musculoskeletal pain [4]. 13 trials of musculoskeletal pain conditions [3].
Sources: [3], [4]
Caveats: Both reviews pooled sham, no-treatment and other-treatment comparisons together, so the share of the effect beyond sham cannot be read from them. Heterogeneity downgraded the evidence to low quality at most time points [4], and the earlier review rated it very low to moderate [3]. The sham-controlled trials alone are in the next block.

Moderate

Neck pain

Shown to ease neck pain in the short term against sham, placebo, waiting list or other needling pooled together. Neck function did not differ from physical or manual therapy.

Compared with sham, placebo, waiting list or another form of dry needling, pooled together [7]; manual therapy [7]; other physical therapy interventions [7]; sham dry needling, physical therapy or no treatment [8]

The numbers and sources

Effect: Against sham, placebo, waiting list or another form of dry needling, pain was lower immediately after treatment (mean difference -1.53 points, 95% CI -2.29 to -0.76) and in the short term (-2.31 points, 95% CI -3.64 to -0.99), and pain-related disability was lower in the short term (SMD -0.87). Against manual therapy, short-term pain was 0.51 points lower (95% CI -0.95 to -0.06) and disability did not differ. Against other physical therapy, no outcome differed. Nothing differed at mid-term, and neck range of motion did not change against any comparison [7]. In chronic nonspecific neck pain, function did not differ from control groups (mean difference 3.51, p = 0.14) and pain relief was borderline higher (mean difference 0.94, p = 0.05) [8].
Population: 28 trials of people with neck pain and trigger points [7]. 5 trials of chronic nonspecific neck pain [8].
Sources: [7], [8]
Caveats: Sham and waiting-list comparisons were pooled together, so the effect beyond sham is not separable. No trial could blind the therapist [7]. Evidence was rated low to moderate [7].

Moderate

Low back pain

Shown to ease low back pain more than other treatments right after treatment in 11 trials. Effects on disability were smaller and effects at later follow-up unclear.

Compared with other treatments the review abstract does not list [9]; laser, physical therapy and other combined treatments [6]

The numbers and sources

Effect: Across 11 trials, dry needling of trigger points lowered pain intensity (SMD -1.06, 95% CI -1.77 to -0.36) and functional disability (SMD -0.76, 95% CI -1.46 to -0.06) more than other treatments after the intervention. Dry needling combined with other treatments lowered pain more than dry needling alone (SMD 0.83, 95% CI 0.55 to 1.11) [9]. A second review found results against laser, physical therapy and other combined treatments mixed, and called the evidence not robust enough for a firm conclusion [6].
Population: 802 people with low back pain and trigger points in 11 trials [9]. 16 trials of low back pain [6].
Sources: [9], [6]
Caveats: The reviewers call the effect on disability and at follow-up unclear [9]. Most trials were at high or unclear risk of bias [6].

Moderate

Shoulder pain

Shown to ease nontraumatic shoulder pain by a small amount, about half a point, and disability by a larger amount, in the short term only.

Compared with comparison groups the review abstract does not describe [10]

The numbers and sources

Effect: Trigger point dry needling, alone or added to other treatment, lowered shoulder pain (mean difference -0.49 points, 95% CI -0.84 to -0.13, SMD -0.25) and pain-related disability (mean difference -9.99 points, 95% CI -15.97 to -4.01, SMD -1.14) more than the comparison groups. The effect on pain was found only in the short term [10].
Population: 6 trials of nontraumatic shoulder pain [10].
Sources: [10]
Caveats: Evidence was moderate in quality for pain and low for disability, downgraded for heterogeneity [10].

Limited

Knee osteoarthritis, other comparisons

Limited evidence: pooled small trials found less osteoarthritis pain and better function in the short term, with no difference at medium or long term.

Compared with non-drug treatments, sham techniques or no added treatment, pooled together [13]; control, sham or placebo treatment [14]

The numbers and sources

Effect: Across 7 trials, dry needling lowered pain (SMD -0.76, 95% CI -1.24 to -0.29, I² 74%) and improved physical function (SMD -0.98, 95% CI -1.54 to -0.42, I² 75%) in the short term, with no difference at medium or long term [13]. A review of 9 trials found contradictory results for trigger point needling. Periosteal stimulation improved pain and function right after treatment, and intramuscular electrical stimulation lowered pain with marked heterogeneity [14].
Population: 291 people with hip or knee osteoarthritis in 7 trials [13]. 9 trials of knee osteoarthritis [14].
Sources: [13], [14]
Caveats: Evidence was rated very low quality for risk of bias, heterogeneity and imprecision [13]. Sham and no-treatment comparisons were pooled together.

Moderate

Tennis elbow

Shown to ease tennis elbow pain and disability with large effects in the short term, and grip strength with a small effect.

Compared with comparison groups the review abstract does not describe [15]

The numbers and sources

Effect: Dry needling, alone or with other treatment, lowered pain (SMD -1.13, 95% CI -1.64 to -0.62) and related disability (SMD -2.17, 95% CI -3.34 to -1.01), and raised pressure pain thresholds (SMD 0.98) and grip strength (SMD 0.48, 95% CI 0.16 to 0.81). The largest effects were in the short term [15].
Population: 320 people with lateral epicondylalgia in 7 trials [15].
Sources: [15]
Caveats: Evidence was low to moderate, downgraded for heterogeneity [15].

Mixed results3

Moderate

Musculoskeletal pain, compared with sham needling

Mixed results: in adequately blinded trials, pain did not differ from sham needling. Less well blinded sham trials favored dry needling, as did two small low back pain trials.

Compared with sham dry needling, penetrating or non-penetrating [5]; sham needling [6]

The numbers and sources

Effect: Across 24 sham-controlled trials, the 3 adequately blinded comparisons found no difference in short-term pain (SMD -0.40, 95% CI -0.96 to 0.15, 122 participants), and the 4 adequately blinded comparisons at 1 to 6 months found none in long-term pain (SMD -0.30, 95% CI -0.62 to 0.02, 202 participants). Inadequately blinded comparisons favored dry needling in the short term (SMD -0.71, 95% CI -1.05 to -0.38, 504 participants) and the long term (SMD -1.14, 95% CI -1.64 to -0.65, 284 participants). The one adequately blinded comparison measured right after treatment, in 31 people, favored dry needling (SMD -0.76) [5]. In low back pain, 2 sham-controlled trials favored dry needling for pain after treatment (SMD -2.74, 95% CI -3.77 to -1.71) and at follow-up (SMD -1.05, 95% CI -1.70 to -0.40), and disability at follow-up did not differ [6].
Population: 24 trials comparing dry needling with a sham that simulated it, searched to February 2016 [5]. 2 sham-controlled trials within 16 low back pain trials [6].
Sources: [5], [6]
Caveats: 19 of the 24 trials were at high or unclear risk of bias, and no trial tried to blind the therapist. The reviewers say the subgroups were small and the results are uncertain [5]. Most low back pain trials were at high or unclear risk of bias [6].

Moderate

Low back pain, compared with acupuncture

Mixed results: low back pain eased more than with acupuncture right after treatment in 6 trials, and pain and disability did not differ at follow-up.

Compared with acupuncture, including wrist-ankle acupuncture in one trial [6]

The numbers and sources

Effect: Across 6 trials with 467 participants, pain intensity after treatment was lower with dry needling than with acupuncture (SMD -0.96, 95% CI -1.80 to -0.12). At follow-up, pain and disability did not differ. In one trial of 60 people with acute low back pain, one 5-minute session lowered pain more than wrist-ankle acupuncture [6].
Population: 467 people with low back pain in 6 trials [6].
Sources: [6]
Caveats: Most trials were at high or unclear risk of bias, and the reviewers say the evidence is not robust [6].

Moderate

Headache

Mixed results: headache pain did not differ from other treatments in the short term, while headache-related disability improved more in tension-type and cervicogenic headache.

Compared with other interventions [16]

The numbers and sources

Effect: Short-term headache pain did not differ from other interventions in tension-type headache (SMD -1.27, 95% CI -3.56 to 1.03, 230 participants), cervicogenic headache (SMD -0.41, 95% CI -4.69 to 3.87) or mixed headache including migraine (SMD 0.03, 95% CI -0.42 to 0.48). Disability improved more in tension-type headache (SMD -2.28, 95% CI -2.66 to -1.91) and cervicogenic headache (SMD -0.72, 95% CI -1.09 to -0.34) [16].
Population: 11 trials, 9 pooled, of people with tension-type, cervicogenic or migraine headache [16].
Sources: [16]
Caveats: Only 4 trials were of high quality, and the evidence on pain was rated very low quality [16].

Not shown to help1

Limited

Knee osteoarthritis, compared with sham needling

Small trials found adding dry needling to exercise did not ease knee osteoarthritis pain or disability more than sham dry needling, through one year.

Compared with sham dry needling, both groups exercising [11][12]

The numbers and sources

Effect: At one year, pain differed from sham by 0.32 points (95% CI -1.12 to 1.18, P = 0.92) and WOMAC score by 0.29 points (95% CI -6.16 to 6.74). Both groups improved over time. In the dry needling group 90.3% reduced their medication, against 26.3% with sham [11]. In a 20-person pilot, pain and WOMAC scores improved in both groups with no group difference [12].
Population: 62 adults with knee osteoarthritis in a multicenter trial [11]. 20 adults aged 65 or older with thigh trigger points [12].
Sources: [11], [12]
Caveats: Two small trials from the same group, both adding needling to exercise.

Protocols studied

Most trials tested physical therapists needling myofascial trigger points, the tender spots in a muscle, with solid filiform needles [3][4]. The knee trials gave 6 sessions of dry needling or sham to the leg muscles alongside a supervised exercise program [11][12]. One low back pain trial gave a single 5-minute session [6]. Sham needling in the trials took several forms: non-penetrating needles, superficial needling above or away from the trigger point, and needling away from it. No trial tried to blind the therapist [5].

Risks

Reported risks2

ModerateVery common

Bruising, bleeding and pain at the needle site

Prospective surveys recorded mild effects after 19% to 37% of treatments, most often bleeding, bruising and pain during needling.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Among 20,464 treatment sessions by 420 US physical therapists, 7,531 minor adverse events were reported, 36.7% of treatments. The most common were bleeding (16%), bruising (7.7%) and pain during needling (5.9%) [17]. Among 7,629 treatments by 39 Irish physiotherapists, mild events followed 19.18%: bruising 7.55%, bleeding 4.65%, pain during treatment 3.01%, pain after treatment 2.19%, worse symptoms 0.88% and drowsiness 0.26% [18]. A review of 59 studies found minor events after 0% to 48.15% of treatments [19].
Population: 420 physical therapists over 6 weeks [17]. 39 physiotherapists over 10 months [18]. 59 studies including 1,947 patients in trials and observational studies [19].
Sources: [17], [18], [19]
Caveats: Therapists reported their own events, with no comparison group. Definitions of minor events varied between studies [19].

ModerateRare

Serious adverse events, including collapsed lung

Prospective surveys recorded major adverse events after about 1 in 1,000 treatments or fewer. Case reports describe collapsed lungs after needling over the chest wall.

The numbers and sources

How common: Rare: fewer than 1 in 1,000 people.
Effect: Twenty major adverse events occurred in 20,494 treatments, about 1 per 1,024 [17]. No significant events occurred in 7,629 treatments, an estimated upper risk of 0.04% or less [18]. Across 59 studies, major events per treatment ranged from 0% to 0.43%, while 0.98% to 39.14% of professionals reported one over their whole practice [19]. In one case, a 24-year-old woman needled between the shoulder blades developed a moderate pneumothorax that needed a chest tube and a night in hospital, and recovered within a month [20].
Population: 20,494 treatments [17]. 7,629 treatments [18]. 59 studies including 25 patients in case reports and 2,380 professionals in surveys [19]. One woman [20].
Sources: [17], [18], [19], [20]
Caveats: Major events in the largest survey included prolonged symptom aggravation and excessive bleeding as well as pneumothorax [17]. Case reports give no rate.

Claims tested and not found

That dry needling eases pain beyond sham in well-blinded trials. Adequately blinded trials found no difference from sham in short-term (SMD -0.40, 95% CI -0.96 to 0.15) or long-term pain (SMD -0.30, 95% CI -0.62 to 0.02) [5].
That adding dry needling to exercise eases knee osteoarthritis pain. Pain differed from sham by 0.32 points at one year in 62 adults [11].
That dry needling eases headache pain more than other treatments. Short-term headache pain did not differ from other interventions in tension-type, cervicogenic or mixed headache [16].

Acupuncture

Sources

Crocker N, Parent E. Environmental Scan of the United States Regulatory Practices of Physical Therapy Dry Needling. Physiotherapy Research International. 2026. https://doi.org/10.1002/pri.70225
Zhou K, Ma Y, Brogan MS. Dry needling versus acupuncture: the ongoing debate. Acupuncture in Medicine. 2015. https://doi.org/10.1136/acupmed-2015-010911
Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017. https://doi.org/10.2519/jospt.2017.7096
Sánchez-Infante J, Navarro-Santana MJ, Bravo-Sánchez A, et al. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Physical Therapy. 2021. https://doi.org/10.1093/ptj/pzab070
Braithwaite FA, Walters JL, Li LSK, et al. Effectiveness and adequacy of blinding in the moderation of pain outcomes: Systematic review and meta-analyses of dry needling trials. PeerJ. 2018. https://doi.org/10.7717/peerj.5318
Hu HT, Gao H, Ma RJ, et al. Is dry needling effective for low back pain? A systematic review and PRISMA-compliant meta-analysis. Medicine. 2018. https://doi.org/10.1097/md.0000000000011225
Navarro-Santana MJ, Sanchez-Infante J, Fernández-de-las-Peñas C, et al. Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2020. https://doi.org/10.3390/jcm9103300
de Sire A, Marotta N, Sgro M, et al. Effects of dry needling on functioning and pain relief in patients with chronic nonspecific neck pain: a systematic review and meta-analysis of randomized controlled trials. Disability and Rehabilitation. 2026. https://doi.org/10.1080/09638288.2025.2529423
Liu L, Huang QM, Liu QG, et al. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2018. https://doi.org/10.1016/j.apmr.2017.06.008
Navarro-Santana MJ, Gómez-Chiguano GF, Cleland JA, et al. Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Physical Therapy. 2021. https://doi.org/10.1093/ptj/pzaa216
Sánchez Romero EA, Fernández-Carnero J, Calvo-Lobo C, et al. Is a Combination of Exercise and Dry Needling Effective for Knee OA? Pain Medicine. 2020. https://doi.org/10.1093/pm/pnz036
Sánchez-Romero EA, Pecos-Martín D, Calvo-Lobo C, et al. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine. 2018. https://doi.org/10.1097/md.0000000000011255
Jiménez-del-Barrio S, Medrano-de-la-Fuente R, Hernando-Garijo I, et al. The Effectiveness of Dry Needling in Patients with Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Life. 2022. https://doi.org/10.3390/life12101575
Ughreja RA, Prem V. Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies. 2021. https://doi.org/10.1016/j.jbmt.2021.02.015
Navarro-Santana MJ, Sanchez-Infante J, Gómez-Chiguano GF, et al. Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Clinical Rehabilitation. 2020. https://doi.org/10.1177/0269215520937468
Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, et al. Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis. Physical Therapy. 2021. https://doi.org/10.1093/ptj/pzab068
Boyce D, Wempe H, Campbell C, et al. Adverse events associated with therapeutic dry needling. International Journal of Sports Physical Therapy. 2020. https://doi.org/10.26603/ijspt20200103
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. 2014. https://doi.org/10.1179/2042618613y.0000000044
Rabanal-Rodríguez G, Simón-Alonso MA, Navarro-Santana MJ, et al. Frequency and severity of adverse events associated with dry needling: a systematic review and meta-analysis. Physical Therapy. 2026. https://doi.org/10.1093/ptj/pzag050
Mintken PE, Denman B, Dommerholt J. Pneumothorax After Dry Needling of Intrascapular Muscles Using a Rib Bracketing Technique: Insights From the Clinician, Patient, and Clinical Expert. Physical Therapy. 2025. https://doi.org/10.1093/ptj/pzaf078

Everything in the library

Shown to help6

Reported risks2

What it is used for, and what was found

Shown to help6

Mixed results3

Not shown to help1

Protocols studied

Risks

Reported risks2

Claims tested and not found

Related

Sources