Dry Needling for Shoulder Pain: Techniques, Types, and What to Expect

By Jiwon Bae, DC, L.AC

Shoulder pain is one of the most common musculoskeletal conditions seen in clinical practice. It can develop from poor posture, repetitive movements, sports injuries, prolonged desk work, or emotional and physical stress. In many cases, shoulder pain is not caused by a single structure but by a combination of tight muscles, irritated nerves, restricted fascia, and altered movement patterns. Dry needling has become a widely used treatment approach because it directly targets these underlying contributors rather than focusing only on symptom relief.

Dry needling is a therapeutic technique that uses thin, solid filiform needles to stimulate dysfunctional muscle tissue and connective tissue. The term “dry” means that no medication or substance is injected. Unlike acupuncture, which is based on traditional East Asian medicine theory, dry needling is typically grounded in modern anatomy, neurophysiology, and pain science. The primary goal is to restore normal muscle function, reduce pain, and improve mobility by addressing abnormal neuromuscular activity.

The shoulder is a highly mobile joint that depends heavily on surrounding muscles for stability and coordination. When these muscles become overactive, shortened, or inhibited, pain and movement limitation often follow. Dry needling helps shoulder pain by releasing myofascial trigger points, reducing excessive muscle guarding, improving local blood flow, and modulating pain signals within the nervous system. Many patients notice immediate changes in pain or range of motion, while others experience gradual improvement over a series of treatments.

Dry needling is commonly used for a wide range of shoulder-related conditions. These include rotator cuff strain or tendinopathy, shoulder impingement, frozen shoulder, chronic upper trapezius tension, neck-related shoulder pain, and postural overload from prolonged sitting or phone use. It is also frequently used in sports medicine for overuse injuries involving throwing, swimming, or weight training.

One of the most frequently applied approaches is trigger point dry needling. This technique targets tight, hypersensitive bands within muscles that often refer pain to the shoulder, neck, or arm. When the needle reaches the trigger point, a brief involuntary muscle twitch may occur. This response reflects a neurological reset of the muscle and is often followed by a noticeable reduction in pain and tension. Common shoulder muscles treated this way include the upper trapezius, levator scapulae, infraspinatus, supraspinatus, and deltoid.

Another commonly used method is the pistoning or dynamic technique, in which the needle is gently moved in and out of the tissue. This creates a stronger mechanical stimulus and helps break up dense muscle fibers while increasing circulation. This approach is often selected for chronic shoulder pain or long-standing trigger points that have not responded to more superficial treatment.

In contrast, static or retention dry needling involves placing the needle into the target tissue and leaving it in place for several minutes. This allows the muscle and nervous system to gradually relax rather than being actively stimulated. Static needling is often combined with slow breathing or relaxation cues and can be particularly helpful for patients whose shoulder pain is strongly linked to stress or nervous system overload.

For patients who are highly sensitive or anxious about needles, superficial dry needling may be used. In this approach, needles are inserted just beneath the skin rather than deeply into muscle tissue. Although gentler, this technique still affects pain perception by stimulating superficial nerves and fascial layers and can be surprisingly effective for certain types of shoulder pain.

In some cases, electrical stimulation is added to dry needling. Small clips are attached to the needles, and a low-frequency electrical current is applied. Electrical dry needling can enhance pain modulation, improve muscle activation, and support recovery in cases involving nerve irritation or rotator cuff weakness. The sensation is typically mild and rhythmic rather than painful.

During treatment, patients may feel a brief pinch, pressure, or deep ache when the needle is inserted. If a trigger point is stimulated, a short twitch or cramping sensation may occur. After treatment, it is common to experience mild soreness for one to two days, similar to the feeling after an intense workout. This soreness usually resolves quickly and is often followed by improved mobility and reduced pain.

When performed by a properly trained and licensed practitioner, dry needling is considered a very safe procedure. Sterile, single-use needles are always used, and the technique is adjusted based on anatomy, comfort level, and clinical presentation. A thorough assessment should always be performed before treatment to ensure that dry needling is appropriate for the individual.

In summary, dry needling is a powerful and targeted approach for shoulder pain because it addresses both muscular dysfunction and nervous system involvement. By releasing trigger points, restoring muscle balance, and calming pain pathways, it supports meaningful and lasting recovery rather than temporary relief. Dry needling is most effective when integrated into a comprehensive treatment plan rather than used as a standalone intervention.