Trigger Point Injections and Dry Needling Compared

What this page covers

Two treatments are often offered for tender, tight spots in muscle called myofascial trigger points. One is a trigger point injection, where a clinician places a needle and injects a liquid. The other is dry needling, where a solid needle is used with nothing injected. This page compares them in general terms. It is information only. It does not tell you how to do either one, and neither is something to try on yourself.

For what dry needling is, see What Is Dry Needling?. For how it differs from acupuncture, see Acupuncture vs Dry Needling.

The basic difference

A trigger point is a hyperirritable painful spot in a small group of muscle fibers.[3] Both treatments assume these spots are worth treating. That assumption has its own problems, covered below.

What head-to-head trials found

1. Neck pain, dry needling vs injection (6 trials)

   Low quality. The reviewers rated the evidence low because the trials differed and were imprecise.[4]

   Injection lowered short-term pain more than dry needling. There was no clear difference for disability, pressure pain threshold or neck movement.[4]

2. Older review, dry needling vs injection

   Insufficient evidence: small, older trials.

   All 3 trials that compared them found no difference in effect.[5]

3. Does the injected substance matter?

   Suggests the needle or expectation may drive part of the effect.

   In that same review, higher-quality trials found the effect was independent of what was injected.[5]

4. Chronic neck and back pain, injection types (14 studies)

   Mixed.

   The reviewers could not say whether one injectable mix was better than another.[1] One study of botulinum toxin vs dry needling showed no difference.[1]

Taken together, the honest summary is that neither approach has been shown to be clearly better across the board. One neck-pain review leaned toward injection for short-term pain, but with low-quality evidence.[4]

Does needling beat a sham?

A 2009 review of dry needling trials with placebo controls found needling was not significantly better than placebo, though the authors said the studies were small and poor quality.[2] A 2013 review of upper-quarter pain found an effect favoring dry needling over sham straight after treatment and at 4 weeks, with the authors noting few high-quality trials.[6] The older 2001 review concluded that whether needling therapies work beyond placebo was neither supported nor refuted.[5] That is the state of the evidence: mixed to insufficient. Sham-controlled needling trials are also hard to blind, so expectation can affect results.

A deeper problem: finding the trigger point

Both treatments depend on locating a trigger point by touch. A meta-analysis of six studies found that agreement between examiners on manual palpation was moderate at best and called the method unreliable.[7] An earlier review rated the methodological quality of most such studies as generally poor.[8] Other reviewers argue the trigger point idea still has clinical relevance.[3] This disagreement is a reason to treat confident claims about either treatment with caution.

Questions to ask

• Which treatment do you recommend for me, and what is the evidence for my problem?
• If an injection, what exactly is in it?
• What are the risks for me, and what happens if I react badly?
• How will we judge whether it is helping, and when do we stop?

For more on comparing needling with other care, see Acupuncture vs Medication and Injections.