Dry needling: short-term relief, real risks

What just happened

Four physiotherapy and musculoskeletal health researchers from Western Sydney University, the University of Sydney, and the University of Technology Sydney published an analysis of the dry needling evidence base in The Conversation this week — and the findings are worth sitting with if dry needling has ever been offered to you, or if you are currently using it.

The numbers that frame this piece: a 2023 survey found that 64% of Australian physiotherapists use dry needling with patients. That is the majority of a whole profession. The procedure has spread quickly — and it has done so in an environment where, as the researchers note, roughly half of all published studies on dry needling fail to report whether adverse events occurred at all.

If you have ever felt the technique was being presented to you with more certainty than the evidence warranted, that instinct deserves attention.

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What dry needling actually involves

Dry needling uses thin, solid needles — the same type used in acupuncture — inserted into areas of muscle called myofascial trigger points. The needles are left in place for a few minutes and are sometimes gently moved to create a twitch response. Practitioners believe this relaxes the muscle, reduces inflammation, and eases pain.

The distinction from acupuncture: acupuncture selects points based on traditional Chinese medicine frameworks and meridian principles; dry needling targets the specific tissue believed to be causing symptoms. Different conceptual systems, same needles.

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Both-and

The short-term relief is real

Let’s be accurate about what the research shows before getting to its limits. Systematic reviews find dry needling provides genuine short-term pain relief for neck pain, shoulder pain, and low back pain in some patients. That is a real finding, worth taking seriously. Short-term pain relief is not a trivial outcome — particularly for someone who has been in pain long enough to seek treatment.

Practitioners who use dry needling report patient satisfaction, and many patients do feel better after procedures. That experience is real, even if the mechanism is contested.

But the research has important limits

Where the evidence becomes more complicated: controlled trials find dry needling equivalent to exercise and other standard physiotherapy in pain outcomes. There is no evidence it outperforms the alternatives. Few clinical practice guidelines recommend it, because the study designs are difficult to interpret — it is genuinely hard to design a credible placebo for a needle procedure — and the evidence base has quality concerns the field has not yet resolved.

Hold both of those things. The relief is real for some people. The claim that dry needling is superior to other available treatments is not currently supported by the research.

The risks deserve more airtime

The researchers report approximately 1 in 100,000 treatments results in a serious adverse event — including lung puncture (pneumothorax), arterial or venous damage, and nerve injury. That figure is extrapolated from large acupuncture studies, since roughly half of dry needling studies do not report adverse event data at all. The actual rate in dry needling practice is unknown.

The serious cases are not hypothetical. In June 2026, a Western Australian physiotherapist had their registration suspended after causing bilateral pneumothorax — both lungs collapsed — in a patient during a dry needling procedure.

Minor adverse effects are considerably more common: bruising, bleeding at the needle site, soreness, and temporary aggravation of symptoms. These are the everyday experience for many people who try the technique. If you take anticoagulant medications or have an immune condition, the risk profile shifts meaningfully upward.

The training question

This is the part of the picture I keep returning to. Physiotherapists, chiropractors, and osteopaths in Australia can all perform dry needling after completing a post-registration training course — often only a weekend in duration. That is a low bar for a technique that, at its most serious, can collapse a lung. Sound anatomical knowledge is the primary safeguard against serious adverse events. A weekend course does not guarantee that knowledge.

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My two cents

I am not suggesting you refuse dry needling if it has been recommended to you. Some people do get meaningful short-term relief from it, and your practitioner may be highly skilled and anatomically careful. What this analysis prompts is a conversation — a real one — before you go ahead.

The questions worth having with your practitioner:

• What alternative treatment options exist for my specific problem, and how do their outcomes compare?
• What are the potential benefits and risks in my situation, given my health history and current medications?
• What training and experience do you have in the anatomy of the area you are treating, and how many of these procedures have you performed?

These are not confrontational questions. A practitioner who knows what they are doing will welcome them.

The evidence at this point says dry needling can offer short-term pain relief for musculoskeletal complaints. It does not say it should be your first choice, or that it outperforms exercise and rehabilitation. The technique is widespread in Australian physiotherapy practice and growing — and the training standards have not kept pace with either the claims being made for it or the anatomical risks involved.

Verdict: maybe — short-term relief is real for some people, but the evidence does not support choosing it over other treatments. Ask your practitioner the questions above before proceeding.

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Sources cited

1. Jenkins LC, Ferreira GE, Zadro JR, Stubbs P. Dry needling is different to acupuncture. So what’s involved? And is it effective? The Conversation, 5 August 2026. https://theconversation.com/dry-needling-is-different-to-acupuncture-so-whats-involved-and-is-it-effective-286321
2. Navarro-Santana MJ et al. Effects of dry needling on spinal pain. J Clin Med 2023. https://doi.org/10.3390/jcm12031205
3. Gattie E et al. Effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017. https://doi.org/10.2519/jospt.2017.7096
4. Hayden JA et al. Adverse event reporting in dry needling randomised controlled trials. J Orthop Sports Phys Ther Methods 2026. https://doi.org/10.2519/josptmethods.2026.0022