Staying Sharp: Reflections on Dry Needling and Peer Learning
Recently, I had the opportunity to join colleagues in my Dublin clinic, for a group CPD (Continuing Professional Development) session on dry needling—a technique many of us use but one that still sparks plenty of debate.
The session was a valuable reminder that good practice depends on staying current with the latest science while also valuing what we learn from clinical experience. This way, when we apply a technique like dry needling, we do it with confidence and a clear understanding of the why behind it.
If you’ve attended my clinic, you may have experienced dry needling. It’s not a tool I use with every patient and later in this post I’ll explain why.
So, What is Dry Needling?
At its simplest, dry needling involves inserting a very fine needle into a muscle or hypersensitive area with the therapeutic goal of reducing pain, increasing tissue pliability and providing access to further rehab opportunities.
For those curious about the science, we can consider not only the local effects in the muscle but also how the nervous system responds. (Skip this if the detail feels like too much!)
At the level of the muscle: Think of a “knot” or trigger point that feels tight and sore. Needling a trigger point can create a twitch response, which research suggests is strongly linked with pain relief, normalising abnormal electrical activity, improving muscle function and local circulation (Perreault, 2017; Liu et al., 2017; Physiotutors, 2024). During the CPD session, when Dylan elicited a twitch response in Jonathan’s shoulder, he described it as feeling “like the muscle contracting.”
At the level of the nervous system: The needle stimulates both pain- and touch-sensitive nerve fibers, which send signals to the dorsal horn of the spinal cord. Acting as a “gatekeeper,” the dorsal horn can dampen pain by reducing excitatory neurotransmitters such as substance P and glutamate. At the same time, it activates inhibitory pathways that release serotonin, noradrenaline and endorphins, altering how pain is processed and perceived (Cagnie et al., 2013; Dommerholt & Fernández-de-Las-Peñas, 2011; Evolution Sports Physiotherapy, 2020).
Science vs Experience: Finding the Balance
Here’s where things get interesting: the science of dry needling is far from settled. In Dylan’s 2018 dissertation, he asked the question: is dry needling a “silver bullet” or an ineffective modality? After reviewing over a hundred studies, the answer was clear—it’s neither. The evidence shows dry needling can help many people but results vary and the exact mechanisms remain debated.
To be clear, dry needling isn’t a standalone solution.
It tends to be most effective when combined with other approaches such as hands-on therapy and exercise rehab, which is how I use it in practice. Many patients leave a session experiencing greater ease, mobility and relief, while others may not respond in the same way—which is why I don’t apply it universally.
The reality is that no single treatment works for everyone.
This is where clinical experience becomes just as important as published science and why dry needling is best understood as a multi-faceted neuromodulatory tool. Good practice means balancing scientific research with clinical experience. Science gives us grounding—it keeps us honest and evidence-based. But our day-to-day work reminds us that therapy is not just about mechanisms; it’s about the individual patient and context.
My Biggest Takeaways
Pain science is complex and no single treatment has all the answers. By engaging with fellow therapists in sessions like this and staying current with research, I can ensure that when I use dry needling in my clinic, I’m doing so in a way that’s safe, thoughtful and tailored to each patient.
If you’d like to learn more about dry needling or explore whether it might help you, feel free to get in touch or book an appointment.
References
Perreault, T. (2017). The local twitch response during trigger point dry needling: Is it necessary for successful outcomes? Journal of Manual & Manipulative Therapy, 25(4), 213–222. Link
Liu, Q. G., Li, S., Wang, R., et al. (2017). Decreased spontaneous electrical activity and reduced acetylcholine release following dry needling in myofascial trigger points. Journal of Pain Research, 10, 2271–2278. Link
Physiotutors. (2024). Exploring the science behind dry needling – A comprehensive overview. Link
Cagnie, B., Dewitte, V., Barbe, T., et al. (2013). Physiologic effects of dry needling. Current Pain and Headache Reports, 17(8), 348.
Dommerholt, J., & Fernández-de-Las-Peñas, C. (2011). Dry needling in the management of myofascial trigger point pain. Journal of Bodywork and Movement Therapies, 15(3), 211–217. Link
Evolution Sports Physiotherapy. (2020). Central effects of dry needling.Link
