Dry needling (DN) is a therapeutic technique that uses thin, solid needles to target myofascial trigger points, which are tight, irritable spots within a muscle’s fascia. The primary goal of this intervention is to alleviate musculoskeletal pain and improve function. While the technique is generally safe and effective, the answer to whether it can make pain worse is yes, temporarily. A common, expected side effect following the procedure is mild soreness or a temporary increase in localized discomfort, which is a normal response to the muscle stimulation.
The Expected Temporary Increase in Pain
The transient worsening of pain, often described as muscle soreness similar to that experienced after an intense workout, is a frequent occurrence after a dry needling session. The practitioner aims to elicit a “local twitch response” (LTR), which is a rapid, involuntary contraction of the taut muscle band. The mechanical disruption of the tight muscle fibers and the LTR initiate a localized inflammatory cascade in the tissue. This temporary response is beneficial, as it helps flush out biochemical irritants and restore normal blood flow to the area. The discomfort is typically mild to moderate, peaking within the first 24 hours, and subsides quickly as the muscle begins to relax and heal.
When Does Pain Worsening Indicate a Problem
The discomfort that follows dry needling is expected to follow a predictable timeline, usually peaking within the first 24 to 48 hours and resolving almost completely within 72 hours. Pain that is significantly more intense than expected, rapidly spreads beyond the treatment area, or persists well beyond this three-day window warrants immediate communication with the healthcare provider.
Patients should be aware of specific warning signs that indicate a more serious adverse reaction, though such events are rare. Signs of a localized infection, such as fever, spreading redness, increased warmth, or pus at the needle insertion site, require prompt medical attention. Severe or rapidly expanding bruising, especially if the patient is taking blood thinners, should also be reported.
A very rare but serious complication is pneumothorax, or a collapsed lung, particularly when needling near the chest wall muscles. Symptoms of this condition can include sudden, sharp chest pain that may radiate, shortness of breath, or a persistent, dry cough. While the risk is extremely low when performed by a trained practitioner, these symptoms can appear immediately or several hours to a day after treatment.
Post-Treatment Care for Managing Discomfort
Staying well-hydrated is highly recommended, as drinking plenty of water helps flush out the metabolic waste products released from the treated muscle tissue. Patients should avoid intense physical activity or strenuous exercise for at least 24 to 48 hours after the session to allow the muscles to recover.
While resting is important, gentle movement and light stretching of the treated area are encouraged to prevent stiffness and maintain mobility. Applying heat, such as a warm shower or compress, can help relax the tight muscles and reduce soreness. Conversely, some practitioners may suggest using ice to reduce tenderness and localized inflammation in the immediate hours following the session.
Over-the-counter pain relievers, such as acetaminophen, can be used for discomfort, but consulting with the practitioner before taking nonsteroidal anti-inflammatory drugs (NSAIDs) is advised. Maintaining open communication with the therapist about the nature and duration of the soreness is important for optimizing future treatment sessions.