| How We Treat
Acupuncture & Dry Needling
Not magic, and not mysticism — a traceable chain from a fine needle to a spinal cord that turns its own volume down.
Western medical acupuncture and dry needling: the four levels it works at, what the evidence actually shows, what it feels like, and how we keep it safe.
Overview
What Acupuncture Actually Is
A needle a quarter of a millimetre wide goes into a muscle. Some minutes later, a shoulder that has ached for months lets go.
It looks like magic. It isn’t. What happens is a chain of events you could draw on paper: a small nerve fibre fires, your spinal cord turns its volume down, your midbrain releases its own painkillers, and pathways running back down from your brain flood the spinal cord with calming chemistry.
There are two ways of explaining acupuncture. The older one is Chinese, over two thousand years old, and describes energy flowing through channels. The newer one comes out of laboratories and brain scanners.
We use the second. This is Western medical acupuncture and dry needling — trained through the Hobbs Masters Needling Series and grounded in current research evidence rather than traditional philosophy.
So why keep the old point names?
Because the map is good, whatever you believe about who drew it. The classical points — LI4, GB21, BL23 — are a two-thousand-year-old, internationally standardised atlas of places on the body that respond well to needling. Most sit directly over or very close to significant nerves.
When researchers compared 255 common muscle trigger points with traditional acupuncture points, they found 93% anatomical correspondence, with 82% of pairs within one to two centimetres of each other. Two traditions, working in completely different languages, kept finding the same spots.
The Mechanism
Follow the Signal
A needle doesn’t do one thing. Depending on where it goes and how long it stays, it triggers effects at four different levels of your nervous system — and they build on each other. Tap each stage.
Local needling works fast, and locally. Distal needling works slower, but wider and for longer. Used together they reinforce each other — which is why a treatment for your knee might include a needle in your foot.
The Evidence
Does It Actually Work?
The strongest single study
The Acupuncture Trialists’ Collaboration pooled the individual records of 20,827 people across 39 high-quality trials — back and neck pain, osteoarthritis, chronic headache and shoulder pain.
Acupuncture beat both no acupuncture and fake acupuncture. The effects persisted over time. And — the finding that matters most — the pain reduction could not be explained by placebo alone.1
Muscle-driven pain
Response rate reported in primary care for myofascial (muscle and trigger point) pain — the single best indication.4
Pain from an irritated structure
Where the pain is coming from a grumpy joint, tendon or ligament rather than from muscle.4
Everything else
For other kinds of pain — closer to a coin toss. We’ll tell you honestly which of these three groups you’re in before we start.4
Cost per quality year
An NIHR review across 140+ trials found needling well below the NHS threshold of £20–30k, and better than usual care for quality of life.3
Where NICE stands
NICE recommends considering acupuncture or dry needling for chronic primary pain — long-standing pain without a clear underlying cause — delivered by a band 5–7 healthcare professional, up to a maximum of five treatment hours in total.2
That “primary pain” restriction matters and we won’t stretch it. Where your pain has an identifiable driver, acupuncture is one part of a plan here, not the plan.
Trigger Points
Dry Needling and the Knot That Isn’t a Knot
A trigger point is a small, angry, rope-like patch inside a muscle. The textbook version is “a hyperirritable spot in skeletal muscle associated with a hypersensitive palpable nodule in a taut band” — which is a long way of saying: a tender knot in a tight band, that hurts far more than it has any right to.
What makes it different from an ordinary sore spot is that pressing it reproduces the pain you actually came in with — and often somewhere else entirely. Points in the buttock can do a convincing impression of sciatica. Points in the neck can produce headache, jaw pain, even symptoms around the eye. It’s one of the more common reasons people are told nothing is wrong when something clearly is.
Why a knot stays knotted
Muscle squeezes its own blood supply along as it contracts and relaxes — a bit like a hand milking a hose.
In a trigger point, a small patch stays permanently switched on. The hose never gets released. Blood can’t get in, oxygen runs low, waste builds up, and the resulting mess irritates the nerve endings there — which makes the patch clamp down harder still.
It’s a loop that feeds itself, and that’s precisely why it doesn’t just settle on its own. Needling interrupts the loop directly — which is the one thing pressing on it from the outside often can’t do.
One honest note on technique
Many clinicians chase the “twitch response” — the visible flick of the muscle as the needle enters. Current evidence suggests it correlates poorly with pain and disability, may not be necessary at all, and that repeatedly pistoning the needle to get it is linked to more soreness, inflammation and injury afterwards.9
We needle to change your symptoms, not to produce a twitch.
What to Expect
What It Actually Feels Like
Going in is usually a brief prick, or nothing at all — these needles are a fraction of the width of the ones used for injections and blood tests.
What we’re often looking for a moment later is a dull, heavy, spreading ache that fades within seconds. It has a name — de qi — and it’s a good sign rather than a bad one. Needle a point in the leg and the whole leg can feel briefly heavy. What it should never be is sharp. If it is, say so and we’ll move it.
During the session
Some people feel pleasantly drowsy and relaxed almost immediately — traditionally called “strong reactors”. Others feel nothing at the time and notice it later the same day.
That evening
Many patients sleep unusually heavily on the night of their first treatment. Some feel briefly fatigued; some feel oddly energised.
The next day
You may notice an initial increase in your pain before it settles. This is common, expected, and doesn’t mean anything has gone wrong. Mild bruising at needle sites is also normal.
If you feel nothing at all
That does not mean acupuncture won’t work for you. Response varies enormously between people, and the effects build across a course rather than arriving in one session.
Safety
Stated Plainly
The numbers, from 20,494 treatments
The largest safety study in physiotherapy dry needling recorded what actually happens. Minor effects were common and trivial: bleeding 16%, bruising 7.7%, pain during 5.9%, pain afterwards 2.7%, drowsiness 0.9%.
Major adverse events totalled 20 across all 20,494 treatments — 0.1%. That included four faints and two infections.5
Systematic reviews put the risk of a serious complication somewhere between 1 in 10,000 and 1 in 100,000 — described by the authors as “very low”.6
When acupuncture does cause serious harm, it’s almost always because someone didn’t know their anatomy well enough — not because of acupuncture itself.
The infections in the historical record came from reusing needles. We use sterile, single-use needles, counted in at the start and counted out at the end, every time.
The lung punctures in the record cluster around a small number of points — most notoriously the top of the shoulder, where in a slim adult there can be as little as 3 cm between the skin and the lung. You cannot eyeball that from someone’s build. So needle length, depth and angle are chosen for your body, with you properly supported, on every single occasion.
When we won’t needle, or will test cautiously first
- Unstable epilepsy, or a history of unexplained blackouts
- Unstable heart conditions or valve disease
- Bleeding or clotting disorders, or anticoagulation with an unstable INR
- Poorly controlled diabetes
- Infected, broken or fragile skin
- Lymphoedema, or after lymph node surgery, on the affected side
- Directly into a joint replacement
- Pregnancy — with caution, and specific points avoided
- If you simply don’t want needles. That is a perfectly good reason, and there is always something else.
When to Seek Help
⚠ Contact us or seek medical advice if you notice
- Breathlessness or chest pain in the hours or days after needling near the shoulder, upper back or chest
- A needle site that becomes hot, red, swollen or increasingly painful after 24 hours
- Fever or feeling unwell following treatment
- New numbness, weakness or pins and needles that doesn’t settle within an hour
- Bleeding that doesn’t stop with a few minutes of pressure
Common Questions
Frequently Asked Questions
Does it hurt?
The insertion itself is usually a brief prick or nothing at all — these needles are a fraction of the width of an injection needle. What you may feel afterwards is a dull, heavy ache that fades within seconds. Sharp pain isn’t the aim and isn’t necessary; tell us and we’ll adjust.
Is this the same as dry needling?
Effectively yes — they are the same procedure described in two different vocabularies. Dry needling usually refers to needling a muscle trigger point; Western medical acupuncture usually refers to needling using the classical point map. Given the 93% anatomical overlap between the two, the distinction is largely historical.
How many sessions will I need?
The effects accumulate, so one session rarely tells us much. We usually judge the response over three to four treatments and then decide together whether to continue.
NICE caps chronic primary pain treatment at five treatment hours in total, and we work within that.
Do I have to believe in it for it to work?
No. The pooled trial data showed acupuncture outperforming fake acupuncture, which is the comparison designed specifically to strip out belief and expectation.1
That said, expectation genuinely affects outcomes for every treatment in medicine, including surgery — so it isn’t a criticism of acupuncture that it does here too.
Can I drive afterwards?
Most people can. But some feel notably drowsy or light-headed, especially after their first session — so if you’re unsure, plan not to drive straight away the first time, and see how you respond.
Will you needle me if I haven’t been diagnosed yet?
No. Effective pain relief can mask a problem that needs finding, and it’s professionally irresponsible to treat pain where serious pathology is suspected but hasn’t been investigated.
You’ll always get a full assessment before a needle comes out of its packet.
Where we won’t oversell it
Acupuncture is not a cure, and it is not a substitute for a diagnosis. Fake acupuncture isn’t an inert placebo, which makes trials in this field genuinely hard to interpret — no honest practitioner will tell you the debate is settled.
What acupuncture does best in a physiotherapy clinic is this: if pain is stopping you doing your rehabilitation, acupuncture can relieve it enough for the exercise to happen. The needle buys the window. The exercise does the work.
Where We Work
Acupuncture and dry needling in North Norfolk
Tidal Physiotherapy is based in Wells-next-the-Sea, and acupuncture and dry needling is available both at the clinic and on home visits across North Norfolk — including Fakenham, Holt, Burnham Market, Walsingham and Blakeney.
Appointments are with Brandon Dobson MSc, MCSP, HCPC registered. You do not need a GP referral, and we will tell you honestly at your assessment whether acupuncture and dry needling is the right tool for your problem — or whether something else on this list is.
Not Sure If This Is Right for You?
Nothing on this page is a plan until it’s pointed at your goal. An assessment is where we work out which of these tools — if any — belongs in yours. If you have a scan report you don’t understand, bring it with you.
Book Your AssessmentOther Treatment Modalities:
References
- Vickers AJ, Vertosick EA, Lewith G, et al. (Acupuncture Trialists’ Collaboration). Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 2018;19(5):455–474.
- National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline NG193, April 2021.
- NIHR Signal. Acupuncture shown to have benefits for treatment of some chronic pain. National Institute for Health Research, June 2017.
- Cummings M (1996), cited in White A, Cummings M, Filshie J. An Introduction to Western Medical Acupuncture, 2nd edn. Churchill Livingstone, 2018.
- Boyce D, Wempe H, Campbell C, et al. Adverse events associated with therapeutic dry needling. International Journal of Sports Physical Therapy, 2020;15(1):103–113.
- White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupuncture in Medicine, 2004;22(3):122–133; and White A, et al. 2008 review of serious adverse events.
- Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, 2nd edn. Williams & Wilkins, 1999.
- Dorsher PT, Fleckenstein J. Trigger points and acupuncture points: anatomic and clinical correlations. Medical Acupuncture, 2008; and Liu L, et al. Correlation between myofascial trigger points and acupoints. 2016.
- Perreault T, Dunning J, Butts R. The local twitch response during trigger point dry needling: is it necessary for successful outcomes? Journal of Bodywork and Movement Therapies, 2017;21(4):940–947.
- Chou P-C, Chu H-Y, Lin J-G. Safe needling depth of acupuncture point GB21; and Chu H-Y, et al. Safe needling depth with postural change. Cited in Hobbs Masters Needling Series safety module, 2025.
- Welsh L, Hobbs J, Buddle S. Applied anatomy for acupuncture. In: Shapiro L (ed.) How to Use 3D Printing Innovations and Digital Storage to Democratize Anatomy Education. Biomedical Visualization vol. 6. Springer, Cham, 2024.
- Hobbs J. Chapter 11: The physiology of acupuncture. In: A Comprehensive Guide to Sports Physiology and Injury Management. Elsevier, 2020.