Dry Needling: What the Latest Research Says About Pain, Muscle Stiffness, and Recovery

Written by Dr. Benjamin Kim, DPT, board-certified orthopedic specialist at Alliance Physical Therapy and Performance in Lombard, IL

Dry needling is a treatment technique used by physical therapists to address certain areas of muscle sensitivity, stiffness, and dysfunction. At Alliance Physical Therapy and Performance in Lombard, IL, dry needling is one of several tools we may use to help patients move better, manage pain, restore function, and return to the activities they enjoy.

But what does the research actually tell us about dry needling?

Several recent studies, including randomized controlled trials, systematic reviews, and meta-analyses, provide evidence that dry needling can influence muscle stiffness, pain sensitivity, and neurophysiological responses. At the same time, the research reinforces an important principle: dry needling is most appropriately viewed as one component of a comprehensive rehabilitation program rather than a stand-alone solution.

What Is Trigger Point Dry Needling?

Trigger point dry needling involves inserting a thin, sterile needle into targeted areas of muscle and surrounding tissue. Unlike an injection, nothing is injected into the body. Instead, the needle provides a mechanical stimulus to the targeted tissue.

Depending on the individual's presentation, a physical therapist may use dry needling to address areas of muscle sensitivity, trigger points, or altered muscle function. Trigger points are commonly described as either active or latent. Active trigger points may reproduce a person's familiar symptoms (or referral pain), while latent trigger points may be sensitive when stimulated without necessarily causing spontaneous pain.

Dry needling is therefore not simply about "putting a needle into a tight muscle." Proper patient selection, clinical assessment, treatment technique, and appropriate progression afterward are all important parts of the process.

What Does the Research Say?

A 2021 randomized controlled trial published in The Journal of Pain examined the effects of dry needling on latent trigger points in the upper trapezius. The study included 51 recreationally active individuals who were randomly assigned to either dry needling or sham treatment. Researchers used elastography to measure changes in muscle stiffness and also evaluated pressure pain sensitivity.

Following one dry-needling session, the researchers found reductions in muscle stiffness at 24 and 72 hours. They also found an increase in pressure pain threshold at 72 hours compared with the sham group. Post-needling soreness progressively decreased, with soreness resolved in all participants by 72 hours.

These findings suggest that dry needling can produce measurable short-term changes in the mechanical properties and sensitivity of muscle tissue. For someone experiencing localized muscle stiffness or sensitivity, this may create a temporary window in which movement becomes more comfortable or less restricted.

Importantly, this study examined short-term effects in latent trigger points of the upper trapezius. It does not mean that every painful or tight muscle will respond in the same way.

Dry Needling and the Nervous System

One of the most interesting areas of current dry-needling research involves the nervous system. A 2026 systematic review and meta-analysis published in Archives of Physical Medicine and Rehabilitation examined the neurophysiological effects of dry needling.

The researchers evaluated evidence involving pain-related biomarkers and different processes involved in how the nervous system processes and regulates pain. Their findings help expand our understanding of dry needling beyond the simple idea of "releasing a knot."

Pain is not generated solely by muscles and joints. The nervous system plays a primary role in how pain is experienced, amplified, and regulated. Dry needling may produce effects through several interacting mechanisms, including local tissue responses and changes in how the nervous system processes painful stimuli.

This is important because it helps explain why someone may experience a reduction in pain even when there isn't a dramatic structural change in the tissue. At Alliance Physical Therapy and Performance, we don't look at pain through a purely structural lens. We consider the entire person, including their history, movement pattern, strength, training load, recovery, and the nervous system's response to pain.

Dry Needling for Lateral Elbow Pain

A 2024 updated systematic review and meta-analysis published in Archives of Physical Medicine and Rehabilitation evaluated the therapeutic effects of dry needling for lateral epicondylitis, commonly referred to as tennis elbow.

The review examined outcomes including pain, disability, and grip strength. The researchers found evidence supporting therapeutic benefits from dry needling for people with lateral epicondylitis, including improvements in disability and grip strength.

This is particularly relevant for active individuals because elbow pain can interfere with lifting, gripping, racquet sports, golf, throwing, pull-ups, and everyday activities. Dry needling may be one component of treatment, but restoring elbow capacity requires more than simply reducing pain. A successful rehabilitation program also needs to progressively rebuild strength, tolerance, and function.

What About Dry Needling for Low Back Pain?

Low back pain is another area where dry needling has been studied extensively. A 2023 systematic review published in Arquivos de Neuro-Psiquiatria evaluated the evidence for dry needling in people with myofascial pain and acute or chronic low back pain.

The review included randomized controlled trials and meta-analyses examining the effects of dry needling. Overall, the evidence suggested that dry needling can reduce post-treatment pain intensity and pain-related disability. The authors also noted that combining dry needling with other treatments may be more beneficial than dry needling alone and emphasized the need for additional high-quality research to better understand long-term outcomes.

This is an important distinction. Reducing someone's pain is valuable, but it is only one part of rehabilitation.

If your back hurts when you squat, run, lift, work, or participate in recreational activities, our goal isn't simply to make the pain disappear temporarily. We want to help you build the strength, mobility, control, and physical capacity necessary to perform those activities with greater confidence.

What Does the Research Tell Us Overall?

When we look at these studies together, the evidence suggests that dry needling can influence several aspects of the pain and movement experience. Research has demonstrated short-term reductions in muscle stiffness following treatment of latent trigger points, changes in pressure pain sensitivity, and neurophysiological effects related to pain processing.

Research also supports potential benefits for certain musculoskeletal conditions, including lateral epicondylitis and myofascial low back pain. However, the effects of dry needling can vary depending on the condition being treated, the individual patient, and how dry needling is incorporated into the overall rehabilitation program.

One of the most important takeaways from the research is that dry needling should not be viewed as a replacement for exercise, progressive loading, education, or movement rehabilitation.

Does Dry Needling "Fix" the Problem?

This is where it is important to keep expectations realistic. Dry needling is not a magic fix.

The research does not support the idea that inserting a needle into a trigger point permanently corrects the underlying cause of pain or dysfunction. For example, if your shoulder hurts because of a combination of strength deficits, training volume, mobility limitations, and poor load tolerance, treating a trigger point alone isn't likely to solve the entire problem.

Likewise, if you're experiencing low back pain, simply reducing muscle sensitivity doesn't automatically restore strength, endurance, movement confidence, or tolerance to lifting.

That's why dry needling should be viewed as one tool within a larger rehabilitation strategy.

How We Use Dry Needling at Alliance Physical Therapy and Performance

At Alliance Physical Therapy and Performance, our goal isn't simply to make a muscle feel better for a few hours. Our goal is to help you move better, get stronger, and build the capacity to do more.

Depending on your evaluation and goals, dry needling may be combined with hands-on therapy, mobility exercises, progressive strengthening, neuromuscular training, movement retraining, load management, pain education, sport-specific rehabilitation, and strength and conditioning.

For an athlete, dry needling might be used to decrease muscle sensitivity so that we can more effectively work on mobility, strength, or movement mechanics. For someone with persistent neck or shoulder tension, it may be combined with mobility and strengthening exercises. For someone with tennis elbow, it may be incorporated into a progressive loading program designed to rebuild grip and upper-extremity capacity. For someone with low back pain, it may be combined with progressive trunk and hip strengthening, movement training, and education.

The needle is not the finish line. It is a potential tool that can help us move you toward the finish line.

Treat the Person, Not Just the Trigger Point

One of the most important principles of physical therapy is that pain and movement problems rarely exist in isolation.

A painful or tight muscle may be influenced by strength deficits, training volume, repetitive activities, mobility limitations, previous injuries, recovery, sleep, stress, movement strategies, work demands, or sport-specific demands.

That's why our evaluation goes beyond simply finding the spot that hurts.

We want to understand what is limiting you, why it is limiting you, and what you need to get back to doing. From there, we develop an individualized rehabilitation plan designed around your goals.

Is Dry Needling Right for You?

Dry needling can be an effective treatment option for certain patients, but it isn't necessary or appropriate for everyone. A physical therapist should first evaluate your symptoms, medical history, movement, strength, goals, and overall presentation before determining whether dry needling makes sense as part of your treatment plan.

It is also important to understand that temporary soreness following treatment can occur. In the 2021 randomized controlled trial discussed above, post-needling soreness decreased substantially over the following 24 to 72 hours.

Your physical therapist should discuss what to expect and how to appropriately progress your activity following treatment.

The Alliance Approach: Relief Is Only the Beginning

At Alliance Physical Therapy and Performance, we believe physical therapy should be about more than simply chasing pain.

We want to help you understand your body, regain confidence, build strength, and develop the physical capacity to live the life you want.

Dry needling can be one valuable tool in that process. But the bigger goal is to help you move better, get stronger, build resilience, and return to the activities you love.

If you're dealing with persistent muscle tightness, pain, restricted movement, or difficulty returning to exercise or sport, an individualized physical therapy evaluation can help determine whether dry needling and the rest of your rehabilitation plan may be appropriate for you.

Alliance Physical Therapy and Performance
Lombard, Illinois
www.allianceptperformance.com

References

Sánchez-Infante J, Bravo-Sánchez A, Jiménez F, Abián-Vicén J. Effects of Dry Needling on Muscle Stiffness in Latent Myofascial Trigger Points: A Randomized Controlled Trial. The Journal of Pain. 2021;22(7):817-825. doi:10.1016/j.jpain.2021.02.004.

Rabanal-Rodríguez G, Navarro-Santana MJ, Valera-Calero JA, et al. Neurophysiological Effects of Dry Needling: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation. 2026;107(2):299-314. doi:10.1016/j.apmr.2025.08.019.

Ma X, Qiao Y, Wang J, Xu A, Rong J. Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation. 2024;105(11):2184-2197. doi:10.1016/j.apmr.2024.02.713.

Dach F, Ferreira KS. Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain. Arquivos de Neuro-Psiquiatria. 2023;81(12):1169-1178. doi:10.1055/s-0043-1777731.