If you have been offered needling as part of physiotherapy, you may have heard it called dry needling, acupuncture, intramuscular stimulation or medical acupuncture, and wondered whether these are different names for the same thing. They are related, but not identical, and the differences matter for understanding what is being done and why.
This article explains both approaches in plain language, what treatment feels like, what the evidence suggests, the safety standards in Ontario, and how to decide whether needling makes sense for you.
The needles are the same
Both dry needling and acupuncture use solid, very fine needles called filiform needles — far thinner than the hollow needles used for injections or blood tests. Nothing is injected, which is where the term 'dry' comes from. The needles are sterile, pre-packaged and single-use, and are disposed of in a sharps container immediately after treatment.
Because they are so thin, insertion is often barely felt. The sensations people notice come more from the response of the tissue than from the needle passing through the skin.
Dry needling: targeting trigger points
Dry needling is based on Western anatomy and neurophysiology. It targets myofascial trigger points: small, tight, tender spots within a band of muscle that can cause local pain and refer pain to other areas. For example, trigger points in the upper trapezius muscle commonly refer pain up into the head, and those in the gluteal muscles can refer pain down the leg.
The clinician locates the trigger point by touch, then inserts the needle directly into it. Often this produces a local twitch response — a brief, involuntary contraction of the muscle band — which is associated with reduced muscle tension and pain. The needle may be moved gently in and out or left in place briefly. Treatment of a single area typically takes a few minutes.
Acupuncture: defined points
Acupuncture involves inserting needles at specific defined points on the body, often left in place for 15 to 30 minutes. Traditional Chinese medicine explains these points in terms of meridians and the flow of energy. Medical or contemporary acupuncture, which is how many physiotherapists use it, explains its effects through stimulation of nerves, muscles and connective tissue, triggering the body's own pain-modulating chemicals and changing how the nervous system processes pain.
Acupuncture points may be placed near the painful area, at a distance, or both. The needles may be gently twirled or stimulated with a small electrical current. Many people find acupuncture relaxing, and some feel drowsy afterwards.
Side by side
The table below summarises the main differences. In practice there is overlap: some acupuncture points sit at common trigger point locations, and some practitioners combine the approaches.
| Dry needling | Acupuncture (as used in physiotherapy) | |
|---|---|---|
| Rationale | Anatomy, trigger points, neurophysiology | Defined points; traditional or contemporary explanations |
| Where needles go | Directly into trigger points in muscle | Defined points, local and distant |
| Needle time | Seconds to a few minutes | Usually 15–30 minutes |
| Typical sensation | Local twitch, deep ache | Dull ache, heaviness, relaxation |
| Common uses | Muscle pain, trigger points, tension | Pain modulation, chronic pain, relaxation |
What does it feel like?
Insertion is usually felt as a quick pinch or nothing at all. With dry needling, the local twitch response can feel like a brief cramp or jolt, and a deep aching sensation is common. With acupuncture, people often describe a dull ache, heaviness, tingling or warmth around the needle, sometimes called de qi.
After treatment, muscles can feel sore, similar to after a hard workout, for 24 to 48 hours, particularly after dry needling. Gentle movement, heat and hydration help. Some people feel tired or light-headed after their first session, so it is sensible to eat beforehand and not rush away.
What the evidence shows
Research suggests that dry needling can reduce pain in the short term for myofascial pain in the neck, shoulders and back, and for some other musculoskeletal conditions. The effects are generally strongest within days to weeks of treatment. Longer-term benefits are more likely when needling is combined with exercise and other active treatment.
Acupuncture has been studied extensively for chronic pain, including back pain, neck pain, osteoarthritis of the knee and headache. Large analyses have found it modestly better than sham treatment and clearly better than no treatment. As with dry needling, it is most useful as part of a broader plan.
Neither approach is a standalone cure. Their main value is reducing pain and muscle tension enough to make movement and exercise easier, so that the underlying problem can be addressed.
Safety and regulation in Ontario
Inserting a needle below the skin is a controlled act in Ontario. Physiotherapists who perform dry needling or acupuncture must have completed recognised additional training and be authorised by the College of Physiotherapists of Ontario. You are entitled to ask your physiotherapist whether they are authorised.
When performed by a trained clinician, needling is safe. Minor side effects such as soreness, small bruises and a brief drop of blood at the needle site are common. Serious complications are rare. The most significant, a punctured lung when needling over the chest wall, is avoided with careful technique and knowledge of anatomy.
Who should avoid needling
Needling is not suitable for everyone. Tell your clinician if any of the following apply, so they can decide whether to proceed, modify treatment or choose an alternative.
- A significant fear of needles.
- Taking blood thinners or having a bleeding disorder.
- Pregnancy — certain points and areas are avoided.
- Having a pacemaker, if electrical stimulation would be used.
- Local infection, skin conditions or lymphedema in the area.
- A compromised immune system.
- Unstable epilepsy or diabetes.
How many sessions?
Most people know within two to four sessions whether needling is helping. If there is no meaningful change by then, it is reasonable to stop and focus on other approaches. When it does help, it is typically used for a limited period alongside exercise, then reduced as you become more active and independent.
What happens at a needling appointment
Needling is never the first thing that happens. Your physiotherapist assesses you first, and only suggests needling if it fits the problem they find. If it does, they will explain which approach they plan to use, where the needles will go, what you are likely to feel and the possible side effects, then ask for your consent — which you can withdraw at any point.
The skin is cleaned, and the clinician wears gloves throughout. You lie or sit in a supported position so that you can relax, because tense muscles make needling less comfortable. After the needles are removed, the area may be gently massaged or stretched, and the session usually continues with exercise or other treatment. Your physiotherapist will check in with you at the next visit about soreness and response, and adjust the plan from there.
Intramuscular stimulation and other names
You may also come across intramuscular stimulation, or IMS, a technique developed in Canada by Dr. Chan Gunn. It uses similar fine needles but focuses on muscles thought to be shortened by nerve irritation near the spine, so needles are often placed both near the spine and in the painful area. Functional dry needling, trigger point dry needling and medical acupuncture are other labels used for closely related approaches. The names matter less than the clinical reasoning: your physiotherapist should be able to explain clearly why they are needling a particular spot and how it fits into your overall plan.
Common conditions treated with needling
Needling is used for a wide range of musculoskeletal problems where muscle tension or pain sensitivity is a prominent feature. It is rarely the only treatment, but it can be a helpful addition for the following.
- Neck and upper shoulder tension, including desk-related pain.
- Tension-type and neck-related headaches.
- Low back pain with muscle guarding.
- Buttock and hip pain, including muscle-related sciatic-type pain.
- Tennis elbow and other tendon problems, as part of a loading programme.
- Knee and hip osteoarthritis pain.
- Jaw muscle pain in temporomandibular disorders.
Insurance coverage
When dry needling or acupuncture is provided by a physiotherapist as part of a physiotherapy session, it is usually billed as physiotherapy and covered under the physiotherapy benefit of most extended health plans. Some plans have a separate acupuncture benefit that requires a particular type of practitioner, so it is worth checking with your provider if you want to use that category.
Needling in Woodbridge
At Med Wellness in Woodbridge, dry needling and acupuncture are offered as part of a wider physiotherapy plan, never as a standalone fix. Before needling, your physiotherapist will explain the reasoning, the expected sensations and the risks, and will only proceed with your consent. If needles are not for you, there are always alternatives.
No referral is needed in Ontario. Call +1 (905) 605-8889 to book an assessment.
References
Written by Sandip Dhameliya, Registered Physiotherapist · Clinically reviewed by Paramjeet Kaur Bassi · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
