Synapse Physiotherapy | Physio Center | Rehab Malaysia


What is dry needling

‘Dry needling’ involves the insertion of thin monofilament needles, akin to those used in acupuncture, without injection. This technique is commonly employed for the treatment of muscles, ligaments, tendons, subcutaneous fascia, scar tissue, peripheral nerves, and neurovascular bundles to manage various neuromusculoskeletal pain syndromes. Notably, the definition of dry needling has been refined by organisations such as the National Physical Therapy Association and several State Boards of Physical Therapy. According to their updated specifications, dry needling is specifically described as the insertion of needles into nodules within taut bands of muscle, more commonly known as ‘trigger points’ or ‘myofascial trigger points’ (MTrPs). If you’re seeking ‘physiotherapy near me,’ explore the benefits of dry needling with a qualified healthcare professional. This technique, when incorporated into physiotherapy, can be a valuable component in addressing musculoskeletal issues and pain syndromes effectively.

Mechanism of dry needling


The efficacy of dry needling in musculoskeletal conditions is evident through its immediate impact on pressure pain threshold, range of motion (ROM), muscle tone reduction, and pain alleviation. The proposed mechanisms of action encompass several intriguing aspects that contribute to its therapeutic effects.

One notable mechanism is the induction of a ‘local twitch response,’ an involuntary spinal reflex triggering localised muscle contractions within the needled area. This response not only influences the length and tension of muscle fibers but also stimulates mechanoreceptors like A Beta fibers, showcasing its multifaceted impact.

Furthermore, the impact on blood flow is a compelling facet. The sustained contraction of taut muscle bands in trigger points can induce local ischemia and hypoxia. Dry needling, in turn, prompts vasodilation in small blood vessels, enhancing muscle blood flow and oxygenation.

The neurophysiological effects of dry needling are equally intriguing, with documented local and central nervous responses. This prompts homeostasis at trigger points, resulting in decreased central and peripheral sensitisation to pain.

Lastly, the placebo effect should not be overlooked. The role of expectations in influencing pain perception is a critical aspect to consider when assessing the overall impact of dry needling.

Trigger point 

Trigger points, arising from an excessive release of acetylcholine at specific motor endplates, can be classified as Active or Latent myofascial trigger points. Active points may spontaneously cause local or referred pain, muscle weakness, restricted range of motion (ROM), and autonomic phenomena. In contrast, latent points remain asymptomatic unless stimulated, yet they can influence muscle activation patterns and contribute to limited ROM.

Both types induce allodynia at the trigger point site and hyperalgesia away from it when pressure is applied. The formation of trigger points involves the development of a taut band within the muscle, triggered by excessive acetylcholine release from the motor endplate. This process is coupled with the inhibition of acetylcholinesterase and an upregulation of nicotinic acetylcholine receptors.

Taut bands, initially a normal protective response to actual or potential muscle damage, often occur due to unaccustomed eccentric or concentric loading, sustained postures, and repetitive low-load stress. When sustained, these bands contribute to persistent pain.

Pain from trigger points is attributed to hypoxia and reduced blood flow, leading to decreased pH activating muscle nociceptors. This activation aims to restore homeostasis but ultimately causes peripheral sensitisation. Trigger points also play a role in central sensitisation, perpetuating nociceptive input into the dorsal horn, although the exact mechanism remains unclear. Understanding these mechanisms is crucial for the effective management and treatment of pain associated with trigger points.


Executing Trigger Point Dry Needling (TDN) demands a meticulous and decisive protocol to ensure optimal efficiency and patient safety. Initiate the procedure with a thorough examination to pinpoint neuromuscular impairments, using a targeted approach. Prioritise patient safety by confirming the absence of contraindications before proceeding.

Obtain informed consent, providing a detailed disclosure of potential adverse effects linked to TDN. Uphold stringent adherence to clean needle technique and universal precautions, incorporating essential measures like wearing gloves, skin cleaning, and using single-use filiform needles to minimise infection risks.

Accurately identify the trigger point before engaging in direct needling, employing techniques such as piston motion at the practitioner’s discretion to elicit a twitch response. Swiftly and efficiently remove the needle, ensure proper disposal, and promptly assess the patient for any adverse effects.

Post-needling, reassess the patient’s neuromuscular impairments to gauge the immediate effects of the intervention. Conclude the procedure by introducing additional therapeutic interventions tailored to further diminish impairments and enhance overall function. This protocol underscores precision, clarity, and a commitment to achieving definitive outcomes in the TDN process. Strive for efficiency, maintaining a resolute stance throughout each step for the benefit of both practitioner and patient.


Dry needling is a therapeutic technique with diverse applications, particularly in addressing musculoskeletal conditions and pain syndromes. One key indication for the use of dry needling is in the management of Myofascial Pain Syndrome (MPS). This technique proves effective in targeting myofascial trigger points, which are hyperirritable spots in skeletal muscle associated with localised pain and dysfunction. By inserting thin monofilament needles precisely into these trigger points, dry needling aims to alleviate pain and improve muscle function.

Another significant indication for dry needling is in the treatment of muscle strains, both acute and chronic. The targeted insertion of needles helps promote muscle relaxation, enhance blood circulation to the affected area, and reduce muscle tone. This proves beneficial in facilitating the healing process and restoring optimal muscle function, making dry needling a valuable modality for individuals dealing with injuries resulting from overuse, trauma, or repetitive stress.

Precautions and contraindications 

Absolute contraindications to Trigger Point Dry Needling (TDN) necessitate a balanced approach, combining innovation and practicality for the safety of individuals seeking this therapeutic intervention. Patient consent denial stands as a fundamental contraindication, underscoring the importance of respecting autonomy. Practitioner incompetence due to inadequate knowledge or training is a significant obstacle, emphasising the need for proper education and training. State-of-the-art equipment is imperative for a safe and effective TDN procedure.

Specific scenarios, such as the first trimester of pregnancy, delicate areas like the scalp in infants, and sensitive regions like nipples, umbilicus, and external genitalia, are absolute contraindications due to their vulnerability. Uncontrolled anticoagulant usage and the presence of local infection, skin lesions, or active tumors require careful assessment. The occipital region with Arnold-Chiari malformation, cardiac pacemaker areas, and over surgical implants or in areas of laminectomy also necessitate cautious consideration.

Precautions include needle phobia, cognitive impairment, communication barriers, a history of pneumothorax, hyperalgesia, allodynia, compromised immune systems, metal allergies, abnormal bleeding tendencies, and vascular diseases.

Frequently Asked Questions (FAQs) - Dry Needling at Synapse Physiotherapy

1. What is dry needling, and how does it differ from acupuncture?

Dry needling involves the insertion of thin needles into muscles, ligaments, and other tissues to manage neuromusculoskeletal pain. Unlike acupuncture, dry needling focuses on trigger points and follows a Western medical philosophy. Acupuncture, rooted in Eastern traditions, targets specific points along meridians to restore the flow of life force or “qi.”

2. How does dry needling work on trigger points, and what are the benefits?

Dry needling induces a ‘local twitch response,’ triggering muscle contractions and impacting muscle fibers and mechanoreceptors. It also promotes vasodilation, improving blood flow and oxygenation. The neurophysiological effects contribute to reduced pain sensitivity. Benefits include increased pressure pain threshold, enhanced range of motion, reduced muscle tone, and immediate pain relief.

3. What conditions can dry needling address, and is it a standalone treatment?

Dry needling is effective for musculoskeletal conditions, especially Myofascial Pain Syndrome (MPS) and muscle strains (acute or chronic). It targets trigger points, alleviating pain and improving muscle function. While often used as a complementary therapy, its effectiveness makes it suitable as a standalone treatment, particularly when integrated into a holistic approach to musculoskeletal health.

4. What is the protocol for Trigger Point Dry Needling (TDN), and what safety measures are in place?

The TDN protocol involves a thorough examination, confirming the absence of contraindications, obtaining informed consent, and adhering to clean needle technique. Accurate identification of trigger points and a swift, efficient needle removal process are crucial. Safety measures include stringent hygiene practices, wearing gloves, and using single-use filiform needles to minimize infection risks.

5. Who should consider dry needling, and how can I explore this at Synapse Physiotherapy?

Dry needling is suitable for individuals experiencing musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. If you’re looking for “physiotherapy near me,” exploring dry needling with a skilled and professional physiotherapist at Synapse Physiotherapy is recommended. Tailored dry needling services are offered to address specific needs and enhance overall well-being.


Dry needling is a viable option for individuals dealing with musculoskeletal pain, myofascial trigger points, or neuromuscular dysfunction. Often employed as a complementary therapy alongside other rehabilitative approaches, the decision to utilise dry needling is made following a comprehensive assessment by a qualified healthcare professional, such as a physiotherapist. If you’re considering the benefits of dry needling, you are encouraged to explore this option with a skilled and professional physiotherapist. Synapse Physiotherapy provides tailored dry needling services to address your specific needs whenever required.

Share This :