Post-needlingsorenessaftermyofascialtriggerpointdryneedling:Currentstatusandfutureresearch

Myofascial trigger points (MTrPs) are hypersensitive nodules found in taut bands of skeletal muscle, and they contribute to a wide range of pain conditions including tension-type headache, migraine, temporomandibular disorders, shoulder pain, and knee osteoarthritis. Dry needling—the insertion of solid filament needles into MTrPs—has become a widely used treatment for relieving MTrP pain. However, a common and poorly understood complication is post-needling soreness, which occurs after the procedure. Despite its frequency, the prevention, management, and clinical relevance of this soreness remain uncertain.

This paper addresses the gap in knowledge by reviewing what is currently known about post-needling soreness and identifying priorities for future research.

The authors conducted a comprehensive narrative review of the existing literature on post-needling soreness after MTrP dry needling. They synthesized findings from multiple studies that examined the frequency, intensity, and duration of post-needling soreness, as well as factors that might influence it. The review covered studies using different needle types (filiform vs. beveled hypodermic needles), different needling techniques (superficial vs. deep dry needling, number of local twitch responses elicited), and different patient populations (those with active vs. latent MTrPs, healthy subjects vs. patients with pain conditions). The authors also examined potential interventions to reduce post-needling soreness and discussed how soreness might affect research outcomes and clinical practice.

Post-needling soreness was found to be very frequent after deep dry needling, with reported frequencies ranging from 50% to 100% in most studies using filiform needles. The duration was typically less than 72 hours when filiform needles were used, though one study found soreness lasting 72 hours or more. When beveled hypodermic needles were used, the duration was longer—a mean of five days. The intensity of post-needling soreness was reported to range between 3.5 and 5.6 on a 0–10 scale in studies that measured it.

The quality of soreness was described by patients as constant pressure or dull aching, distinguishable from the sharp, tight aching of MTrP pain.

Several factors were associated with greater post-needling soreness: higher number of needle insertions, greater pain perceived during needling, and use of larger or beveled needles. Latent MTrPs in healthy subjects produced higher levels of post-needling soreness frequency than active MTrPs in patients, possibly because patients' baseline myofascial pain masks the soreness. Psychosocial factors and gender may also influence soreness perception. Notably, no significant association was found between the number of local twitch responses elicited and post-needling soreness intensity.

Regarding clinical relevance, patients with higher levels of post-needling soreness, those not perceiving dry needling effectiveness in the first session, and those without high baseline myofascial pain intensity were most likely to find soreness distressing and functionally limiting, and more likely to abandon treatment. Fifty-one percent of subjects receiving lidocaine MTrP injections were reluctant to have further injections due to post-injection soreness in one study. Interventions that showed promise for reducing post-needling soreness included percutaneous electrical nerve stimulation, low-load exercise, ultrasound, spray and stretch, and ischemic compression.

Post-needling soreness is an expected and common consequence of deep dry needling that clinicians should discuss with patients before treatment. While usually mild and short-lived (under 72 hours with filiform needles), it can be more distressing for certain patients and may lead to treatment discontinuation. Clinicians should consider patient characteristics—particularly baseline pain levels, expectations, and prior experience with dry needling—when counseling patients and planning treatment schedules around work and lifestyle commitments.

For researchers investigating dry needling effectiveness, post-needling soreness poses a methodological challenge because it can overlap with and mask the original MTrP pain, potentially influencing pain ratings and functional outcomes, especially in immediate or short-term assessments. Future studies should separately evaluate post-needling soreness from original MTrP pain and consider its impact on treatment adherence and functional limitations. The authors recommend that clinicians present post-needling soreness as a positive sign of treatment response rather than a negative adverse event, though this framing warrants further investigation. More research is needed to establish standardized approaches to measuring, preventing, and managing post-needling soreness, and to clarify its clinical relevance across different patient populations and needling techniques.