Dry needling vs acupuncture: what's the difference?

Two approaches, one kind of needle

Dry needling and acupuncture both use very fine, sterile, single-use needles placed through the skin, and to a patient they can look much the same. The difference lies in why the needle goes where it goes, and in the training behind it.

Acupuncture comes from traditional Chinese medicine, which describes channels (meridians) and points across the body. Needles are placed at those points with the aim of influencing the body's balance and function. In the UK, acupuncture is also practised by physiotherapists and doctors in a "Western medical" form, which uses the same points but explains their effects through the nervous system and the body's own pain-modulating chemistry.

Dry needling developed within Western musculoskeletal practice. "Dry" simply means nothing is injected. The needle is placed into a tight, tender band within a muscle — a trigger point — or into surrounding tissue, with the aim of reducing muscle tension and local pain sensitivity. Point selection follows the examination of your muscles and symptoms rather than a traditional map.

In practice, a physiotherapist trained in both may use elements of each in the same session.

Training and regulation

In the UK, dry needling and acupuncture are not separately regulated titles, so it is worth asking about your clinician's training. At UK Pain Clinic, needling is provided by HCPC-registered physiotherapists who are members of the Acupuncture Association of Chartered Physiotherapists (MAACP), the UK's professional body for physiotherapists using acupuncture and dry needling, with its standards for training, hygiene and safe practice. Our chiropractor also uses dry needling within chiropractic care.

What the evidence suggests

Research into both techniques is active but mixed. Reviews suggest that dry needling may reduce pain and improve movement in the short term for some muscle-related conditions, such as neck and shoulder tension, and that acupuncture may help some people with chronic pain, including some types of headache and low back pain. The effects tend to be modest, vary between people, and are generally stronger when needling is combined with exercise and other treatment rather than used alone.

For that reason we do not offer needling as a stand-alone treatment. It is added to your plan after assessment, when your clinician thinks it may help, and reviewed as you go.

What a session feels like

Needles are much finer than those used for injections, and many people feel little as they go in. Dry needling into a trigger point may produce a brief, deep ache or a "twitch" in the muscle, which usually settles within seconds. Acupuncture points may give a dull, heavy or tingling feeling. Needles are typically left in place for a few seconds to around 20 minutes, depending on the technique.

Afterwards the area may feel a little heavy or bruised for a day or so, and occasionally there is a small bruise. Most people carry on with their day as normal. Drink some water and avoid strenuous exercise for the rest of the day if the treated muscles feel tender.

Who it may not suit

Your clinician will check your medical history first. Needling may not be appropriate, or may need adapting, if you:

• have a strong fear of needles, or have fainted with needles before
• take blood-thinning medication or have a bleeding disorder
• are pregnant (some points and areas are avoided)
• have a weakened immune system, or an infection, wound or skin condition at the site
• have lymphoedema or have had lymph nodes removed from the area
• have a metal allergy, epilepsy or certain heart conditions
• are under 18, in which case parental consent and a discussion are needed

Needling is never compulsory. If you would rather not have it, your plan will simply use other approaches.

Conditions where it may be considered

Dry needling is most often used for tight, painful muscles in the neck and shoulders (see neck pain and rhomboid and trapezius strain), the lower back and buttock (see lower back pain and piriformis syndrome), and for some tension-type headaches. Acupuncture-style approaches are sometimes discussed for long-standing pain as part of a broader plan. Outcomes vary from person to person. Because needling is part of a physiotherapy or chiropractic session rather than a separate appointment, fees follow the usual session prices on our fees page.

When to book

If you have muscle tension or pain that has not settled with rest and gentle exercise, and you would like to know whether needling could be a useful part of your treatment, book an initial assessment at our Bloomsbury clinic. We will examine you, explain what we find and only suggest needling if it seems likely to help you.