Dry Needling is primarily aimed at relieving myofascial pain by selectively treating "trigger points". A myofascial trigger point is a "hyperirritable spot in a skeletal muscle." The spot is painful on compression and can give rise to characteristic referred pain as well as other disturbances such as sweating, nausea, reduced strength and impaired function. Myofascial trigger points (MTrPs) are commonly seen in both acute and chronic pain conditions and are a commonly missed diagnosis in chronic pain patients.

In most cases, commonly prescribed anti-inflammatory medications, opiates and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.

The basic mechanism of dry needling is simple. Trigger Point Dry Needling uses the same needles used by acupuncturists, although the technique is very different. The objective is to elicit a so-called local twitch response, which requires the needle to be precisely placed directly into the affected myofascial trigger points, which leads to local inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that muscles, ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the tissue that was treated and makes it stronger.

Trigger Point Dry Needling is highly effective at eliminating chronic pain due to ligament and tendon weakness, but results are dependent upon the technique and experience of the individual specialist and the general health of the recipient. The most important aspect is location and accurate positioning of the needle into the injured and weakened area. If this is done, the likelihood of success is excellent.

Dry Needling involves the treatment of three specific kinds of tissue: muscles, tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments and tendons generally have a poor blood supply, incomplete healing is common after injury - this incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.

The greatest stresses to the ligaments and tendons are where they attach to the bone, the fibro-osseous junction. The most sensitive structures that produce pain are the periosteum (covering of the bone) and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), the periosteum ranks first, followed by ligaments, tendons, fascia (the connective tissue that surrounds muscle), and finally muscle. Cartilage contains no sensory nerve endings. Patients who are told that their cartilage is the source of their pain, have been misinformed; cartilage cannot hurt because it contain no pain sensing nerves. If there is cartilage damage, the ligaments, tendons and muscles are typically the structures that hurt. Ligaments are weakest where they attach to bone. The periosteum enveloping the bone is the most sensitive area to pain and the ligaments second. It is now easy to understand why this area hurts so much. This is often where the needling must occur, and thus eliminate the chronic pain of many conditions including arthritis, mechanical low back pain, degenerative disc disease, cartilage injury, and sports injuries.

Surprisingly, periosteal dry needling is not very uncomfortable when performed by a skilled practitioner using a very fine acupuncture type needle. Periosteal dry needling works by exactly the same process that the human body naturally uses to stimulate the body's healing system, a process called inflammation. The technique involves micro dry needling that causes an inflammatory response which "turns on" the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligament, tendon and muscle cells produced after dry needling appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. The ligament and tendon tissue which forms as a result of dry needling is thicker and stronger than normal tissue, up to 40% stronger in some cases! This is the concept behind trigger point and periosteal dry needling. All of the injured tissue, including the affected spinal segment innervating the locus of pain must be treated for chronic pain to be eliminated. Trigger point and periosteal dry needling causes the proliferation of new ligament and tendon tissue exactly where the treatment is given. It is just like spot welding. It strengthens the exact spot where the weld or needling takes place. The more treatment, the stronger the weld.