Dry needling has been a popular treatment choice in the west. In dry needling filiform needlies are tapped through the skin to the target tissue to bring about a therapeutic effect. Unlike injection, no medicine is delivered, hence the name.

Although the needles used are similar to acupuncture, dry needling is different. Dry needling is based on physiology whereas acupuncture is explained by theories of traditional Chinese medicine. Many published studied have shown significant effectiveness of dry needling.

Dry needling is used to treat myofascial trigger points, control musculoskeletal pain and promote healing. Needling achieves these effects by release of endorphin through A- delta stimulation, mechanical transduction of fibroblasts, neuromodulation etc.

Dry needling basically is of 2 types, superficial (SDN) and Deep (DDN), depending upon the depth of the inserted needle. Additionally needle rotation, pistoning, periosteal pecking etc are also done to achieve specific effects. Different people respond to needling differently and are thus classified as strong, average and weak responders. A strong responder will need minimal needle stimulation to achieve needling effect; overstimulation can worsen patient’s pain.

Low TENS can be attached to the needles to increase the effect of analgesia by increasing the release of endorphin. This method of TENS has the dual advantage of bypassing skin resistance and delivering the stimulation at the site of origin of pain.

Dry needling being an invasive procedure, all aspect of safety has to be given importance. Usually it is a bloodless technique, thus a standard clean field technique along with disposable needles id used. Proper disposal of the used needles cannot be over emphasized. Apart from infection the other dangers are pneumothorax and nerve damage. Proper training is thus needed. As dry needling does not involve use of medicines it can be legally performed by the indian physiotherapists.