Anna Savina/Getty ImagesPhysiotherapists, chiropractors and osteopaths commonly use dry needling to treat neck, shoulder, back and other types of muscle pain.It involves inserting thin needles into sensitive parts of a person’s muscle, often termed “myofascial trigger points”. The needles remain in the muscle for a few minutes and can be gently moved to create a twitch response in the muscle. This therapy is thought to relax the muscle, reduce inflammation, promote healing and reduce pain. But does it actually work? And what are the risks?Similarities and differences to acupunctureDry needling is similar to acupuncture: they’re both applied to reduce pain. Both treatments use solid, single use needles. They’re commonly 30–75mm long and 0.2–0.3mm thick, although longer needles may be used for deeper muscles. Unlike injection needles, they aren’t hollow and don’t inject medication. A key difference is how the needle locations are chosen. Traditional acupuncture selects points based on symptoms and Chinese medicine concepts, including balancing qi as it flows through pathways called meridians. Dry needling is applied directly to tissue that’s thought to be the cause of symptoms. Dry needling is gaining popularityPeople seeing a physiotherapist for aches and pains are increasingly being offered dry needling. A 2023 survey of 203 Australian physiotherapists found 64% use dry needling on their patients.The surveyed physiotherapists believed dry needling was an effective pain reliever and thought it was particularly effective alongside treatments such as exercise or manual therapy (which encompasses massage and manipulation or “joint cracking”).In Australia, registered physiotherapists, chiropractors and osteopaths meet the safety standards required to use dry needling if they have completed training. The training usually involves a short (weekend) course.Does dry needling work?Several research studies have collated the available evidence on dry needling. Most conclude it provides short-term pain relief for conditions such as neck pain, shoulder pain and low back pain, but is no better than other common treatments such as exercise. Clinical practice guidelines are what health-care providers should use to dictate which treatments to provide and not provide. However, few clinical practice guidelines recommend dry needling. There are two main reasons why. Nearly all studies investigating the benefits of dry needling have serious concerns about how they’re conducted. This includes not being able to determine whether the benefits of dry needling are genuine or simply reflect placebo effects – when your health improves after receiving a fake treatment. So it remains unclear whether dry needling provides benefits beyond a placebo.Another reason is the potential risks of dry needling. What are the risks?Inserting thin and extremely sharp needles into the body requires an excellent understanding of anatomy. Health-care providers need to be extremely careful to avoid major arteries, veins and nerves when dry needling around the neck and avoid puncturing the lungs when dry needling around the “traps” (trapezius muscles) and torso. There have been cases of providers puncturing their patients’ lungs during dry needing, prompting a medical emergency. In June, it was revealed that a Western Australian physiotherapist had her registration suspended for three months after puncturing a patient’s lungs, causing bilateral pneumothoraxes – the collapse of both lungs.In November, Pittsburgh Steelers NFL player TJ Watts had to undergo emergency surgery after a similar injury caused a partial lung collapse.Despite the risks, half of the studies on dry needling don’t mention if any adverse events occurred. The studies that do report risks suggest serious risks such as a collapsed lung, infection or broken needle that gets stuck in a person’s body are very rare. But we don’t know exactly how rare this is. Data from a large study on acupuncture suggests these adverse events occur in approximately one in 100,000 patients. But it’s unclear if the risk is the same for dry needling. Less-serious side effects such as minor bleeding, bruising, soreness at the needling site or temporary symptom aggravation seem to be common. Some factors also increase some risks, such as taking blood thinning medication or having an immune disorder. I still want to try it. What should I ask my provider?Because the evidence on dry needling is uncertain and risks have not been adequately reported in the research, it’s important to discuss the benefits, risks and practicalities of dry needling with your health-care provider. If your goal is short-term pain relief, consider asking your provider if there are other options that could provide similar relief. If you have a fear of needles or have fainted when undergoing a needling procedure previously, such as a blood test, then dry needling might not be the best treatment for you. Before undergoing dry needling, it’s important you have had a chance to ask questions and been given sufficient information about the treatment before providing informed consent. Questions you might ask your health-care provider include: What are my treatment options?What are the potential benefits and risks of these options?How likely is it that those benefits and risks could happen to me?Although other treatments are as effective or more effective with fewer potential side effects, dry needling might be useful for some people. But a discussion of risks and benefits should always be transparent and ongoing.Giovanni E. Ferreira receives funding from the Australian National Health and Medical Research Council (NHMRC) Medical Research Future Fund (MRFF).Joshua Zadro receives funding from the Australian National Health and Medical Research Council (NHMRC) Medical Research Future Fund (MRFF).Luke C. Jenkins and Peter Stubbs do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.