Does dry needling work, and does it hurt?

Does dry needling actually work, or is it placebo?

Yes, but modestly and briefly. In that same review, other physiotherapy outperformed needling at 9 to 28 days.

The honest picture is a real but short-lived effect sitting on top of an unusually strong placebo. Liu et al. (2015) found dry needling superior to sham or control in the short and medium term, but the confidence interval on the short-term figure ran from -3.10 to -0.73, which is a very wide range on which to base a treatment decision, and other physiotherapy beat needling at 9 to 28 days (SMD 0.62). Stieven et al. (2021) is the sobering counterweight: in 44 people with chronic neck pain, a single dry needling session was no better than hands-on myofascial release on pressure pain threshold (F = 0.63, P = .641), and neck pain fell significantly even in the sham needling group (P = .008). So it works, modestly, briefly, and not obviously better than good manual therapy plus loading. Anyone promising you more than that is ahead of the evidence.

Does dry needling hurt, and how sore will I be afterwards?

It feels like a deep cramping ache or a brief involuntary twitch, not a sharp sting. In 7,629 treatments logged by 39 physiotherapists, pain during needling was recorded as an adverse event in 3.01% of sessions and pain afterwards in 2.19%; bruising (7.55%) and minor bleeding (4.65%) were more common than either (Brady et al., 2014).

What most people describe is pressure, then a heavy ache that spreads along the pattern the muscle normally refers to. Recognising your own familiar pain is usually the moment people relax, because it confirms the target rather than announcing damage. The needle is roughly the thickness of a human hair and is not the part that hurts; the twitch is. Post-needling soreness feels like the day after unfamiliar training and generally settles within 24 to 48 hours, but that window is clinical convention, not a trial-derived number. What the surveyed data do tell us is that soreness is reported as a problem in about 2% of sessions and that symptom aggravation ran at 0.88% (Brady et al., 2014). If you are needle-phobic, say so before we start. The same muscles can be worked with pressure, TECAR and loading, and forcing it does not improve the outcome.

How many sessions before I know whether it is working for me?

Two to three, not ten. Reassessing after two or three sessions and stopping if nothing moved is clinical convention, not trial-derived.

The decision to continue should rest on re-tested markers, not on how the session felt: the range that was blocked, the pressure that reproduced the referral, the one task that hurt. If those have not changed after two or three sessions, more needling is unlikely to be the answer and the plan should change, usually towards progressive loading or towards questioning the diagnosis. This matters because the review that supports needling in the short term also found other physiotherapy did better in the 9-to-28-day window (SMD 0.62; Liu et al., 2015), and because the low back pain evidence base carries 'high' or 'unclear' risk of bias in most domains, which the authors themselves say is not robust enough for a firm conclusion (Hu et al., 2018). Nobody should be sold a twelve-session needling package on evidence this thin.

Is dry needling safe, and what can actually go wrong?

Mild reactions are common, serious ones are rare. Across 7,629 treatments delivered by 39 physiotherapists, 19.18% produced a mild adverse event and not one produced a significant adverse event, giving an estimated upper risk of significant events of 0.04% or less (Brady et al., 2014). The realistic list is bruising, a spot of bleeding, and short-lived soreness.

The rare events that matter are anatomical, and they are avoided by knowing what lies under the muscle rather than by needling gently: pneumothorax over the thorax, nerve or vessel contact in the neck and axilla. That is why the technique is depth- and direction-specific, and why some regions are needled obliquely or not at all. Drowsiness (0.26%), headache (0.14%) and nausea (0.13%) were logged as uncommon in the same survey (Brady et al., 2014), which is worth knowing if you drove yourself to the appointment. Tell us before the session if you take anticoagulants, have a bleeding disorder, are immunosuppressed, have lymphoedema in the limb, or are currently unwell with a fever. None of these is an automatic refusal, but each one changes the plan, and one or two of them belong to your physician rather than to a physiotherapist.

When can I go back to training after a dry needling session?

By criteria, not by a fixed number of hours. Most people train the same week; the day after needling is usually a light day.

Two practical rules. First, do not test your maximum on the day of needling: a muscle that has just twitched repeatedly is temporarily less reliable, and a bad session teaches you nothing about your injury. Second, the criteria above are clinical convention rather than trial-derived thresholds. No study has randomised return-to-sport rules after dry needling, so treat them as a sensible framework, not a proven protocol. What the evidence does support is that needling opens a window rather than being the treatment itself: it lowers the pain that was blocking the movement, and the loading you do inside that window is what actually changes the tissue. That is why every session here ends with something to do, and why two needling sessions plus a programme beats eight needling sessions alone.

• Palpation of the treated band no longer reproduces your referred pain pattern
• Full active range in the relevant direction, with no guarding or breath-holding
• Post-session soreness stayed under about 3/10 and cleared overnight
• The task that used to hurt (step-down, overhead reach, first hundred metres) is now tolerable
• No new numbness, weakness or spreading symptoms since the session

What happens in the first visit, and what does it cost?

480 ILS flat for a 50-60 minute one-to-one session, VAT included, no deposit and no referral needed. The visit starts as an assessment: history, movement testing and palpation to confirm whether trigger points are genuinely driving your pain. Needling is used only if the findings justify it, and it is never the whole session.

You see Alejandro Zubrisky, BPT, for the full hour. No rotation through assistants, no parallel treatment rooms. The clinic is at Yaakov Apter 9, Tel Aviv. Bring any imaging you have, or be ready to describe it, along with a list of your medication, and wear clothing that lets the relevant area be exposed. If the assessment says your problem is not myofascial, whether that is a tendon needing progressive loading, a nerve needing a different approach, or something that belongs to a physician, you will be told in the first session rather than sold a package. What is not offered here, so you can look elsewhere without wasting a visit: shockwave/ESWT, injections of any kind, surgery, telemedicine, home visits and group classes. Cancellation is 48 hours' notice by WhatsApp; a no-show without notice is charged in full.

When should I see a doctor instead of a physiotherapist?

See a physician first if you have any of these: unexplained weight loss, fever alongside the pain, night pain that wakes you and does not change with position, progressive weakness or numbness, changes in bladder or bowel control, a history of cancer, or new pain after a significant fall. Those are not physiotherapy problems until a doctor has cleared them.

Trigger point pain is mechanical. It changes with position, with load and with pressure on a specific band of muscle, and it refers in a pattern you can usually reproduce yourself. Pain that ignores position, wakes you every night, or arrives with systemic signs is behaving differently and deserves a different examination first. There are also conditions this clinic does not treat regardless of the picture: fibromyalgia, pregnancy-related and pelvic floor problems, vestibular disorders, neurological rehabilitation, and children under 12. Saying that early is more useful than a booking that ends in a referral. If you are genuinely unsure which side of the line you are on, send a short WhatsApp message before booking with what hurts, since when, and what makes it worse. Screening you out in advance costs nothing and wastes nobody's session.

Frequently Asked Questions