Dry needling and acupuncture are two popular treatments for many physical conditions. But what exactly is the difference between them for sciatica nerve pain?
Below is a full guide to acupuncture and dry needling. Learn about trigger points, sciatica, where to get help, risks of treatment, and more – with photos for clarity.
- Acupuncture vs. dry needling
- What Is Acupuncture?
- What is dry needling and how does it work
- Dry Needling FAQ
- How dry needling treats sciatica
- Should I get dry needling or acupuncture for sciatica pain?
- Acupuncture points for sciatica
- The 5 best sciatica acupressure points
- What Are the Risks and Side Effects of Acupuncture?
- What Can You Do If dry needling or Acupuncture Doesn’t Work for You?
Acupuncture vs. dry needling
While both acupuncture and dry needling involve inserting thin needles, they are used for different purposes. Acupuncture is a holistic therapy that aims to promote overall health, while dry needling mainly targets muscle trigger points to relieve pain and dysfunction.
What is Sciatica?
Sciatica describes the pain from compression or inflammation of the sciatic nerve, the largest nerve in your body. It travels from the lower back down the back of the leg, and when it becomes compressed, it can cause what’s known as neuropathic pain.
It may radiate all the way from the lower back to the foot, in severe cases. Sciatica is most often caused by a herniated disc in the lumbar spine.
It can also be caused by other conditions such as lumbar spinal stenosis, or piriformis syndrome.
Sciatica can be a chronic condition, meaning long-term pain and discomfort. However, there are treatments available that can help to ease the pain and improve quality of life, from chiropractic care and physical therapy, to acupuncture and more.
What Is Acupuncture?
Acupuncture has been used for centuries as a form of traditional Chinese medicine. It involves the insertion of thin needles into the skin at specific points along the body – “meridians”.
This conservative treatment is said to help improve the flow of energy and blood, which in turn can promote healing.
Acupuncture has a long history in China, of around 3000 years. Western medicine became aware of it in 1680, when a European physician, Ten Rhijne, witnessed acupuncture in Japan. 
Fast forward, and more than 10 million Americans seek acupuncture treatment every year. It is widely accepted in the United States and abroad and has shown benefits for many health conditions, including:
- back pain
- dental pain
What is dry needling and how does it work
Dry needling is a treatment method in manual therapy and accupuncture that uses thin needles to release muscle tension. They are inserted into myofascial trigger points (“knots”) that form when muscles are tight and unable to relax.
By way of stimulating a response from the nervous system, dry needling can help to relieve pain and promote muscle relaxation around active trigger points.
The therapist may also use other techniques, such as stretching or massage, to further release the muscle tension before or after the needling procedure.
Dry needling is a relatively new therapy that has shown impressive results for various conditions, such as:
- tennis elbow and golfers elbow (epicondylitis)
- TMJ disorder
- frozen shoulder
- tension headaches
- sciatica pain
There is substantial research to support the use of dry needling, and conventional western medicine is certainly getting on board. Many avenues of formal training exist for practitioners such as physical therapists, chiropractors, medical doctors, and the like, to learn DN techniques.
At our clinic, we perform dry needling regularly. I find it an effective treatment for sciatica when used at the specific points I’ll show you below – along with piriformis muscle release, and chiropractic adjustments (spinal manipulative therapy).
Let’s explore exactly why dry needling works so well compared to acupuncture for sciatica. Expand the FAQ tabs below to learn more!
Dry Needling FAQ
What are trigger points (TrP), and what causes them?
Myofascial trigger points are focal areas of hyper-irritability within a muscle. They are most often caused by injury or overuse, such as from poor movement patterns or repetitive work activities.
Active trigger points often refer pain. For example, a shoulder TrP may send pain into the neck, head, or arm.
Why is dry needling so effective?
Dry needling is performed quickly with sterile needles, reaching deep into the muscle knot to directly stimulate the nervous system. This causes a reflexive response in the muscle that leads to a relaxation of the muscle fibers.
The results often include:
- reduced muscle tension,
- less pain, and
- improved range of motion.
Where can dry needling be used on the body?
Almost all muscles accessible by a needle-length distance can be treated, such as the neck, shoulders, lower back, piriformis, glutes, and calves. However, some areas are off-limits.
There may be a blood vessel or thick nerve nearby, or the lung fields, which we avoid with dry needling, to prevent adverse reactions.
So it’s generally a no-no to needle the mid and upper back, rib muscles, groin, and back of the knee.
Can I have acupuncture or dry needling if I’m pregnant?
Pregnant women often suffer from low back pain as their bellies grow. Despite the risks being minimal, and no evidence it causes miscarriage, around half of physiotherapists surveyed said they would prefer to wait until after pregnancy, according to this study.
So, you can have dry needling when pregnant if your healthcare provider decides it’s right for you, with your consent, and never near your abdomen.
Do I need a referral for dry needling?
No, you don’t need a referral for dry needling from a physiotherapist, chiropractor, or other qualified healthcare professional. In fact, many traditional Chinese medicine practitioners offer both acupuncture and dry needling together.
Please note that as of writing, in 5 states (Hawaii, Oregon, Washington, California and New York) it is only legal to receive dry needling from an acupuncturist or medical doctor – PT’s cannot perform it.
How dry needling treats sciatica
For the majority of people, sciatic nerve pain is caused by nerve compression in the lower back from bone spurs or a herniated lumbar disc. Sometimes (but far less commonly), it is caused by piriformis syndrome.
Piriformis syndrome results from the piriformis muscle becoming tight or spasmed. Applying pressure to the sciatic nerve, leading to pain, numbness, and/or tingling down the leg.
Dry needling of the piriformis muscle can release the muscle spasm and relieve pressure on the sciatic nerve, providing relief from piriformis sciatica.
What are the dry needling points for sciatica?
The common dry needling points for sciatica pain from lumbar disc or bone spurs are:
- lumbar erector spinae
- lumbar multifidi
- quadratus lumborum
- tensor fascia lata
- gluteus maximus
The common points for piriformis syndrome sciatica are:
- piriformis muscle
- gluteus medius
- gluteus maximus
- gastrocnemius muscle
How many times do you need dry needling
2-4 dry needling sessions are required for a new injury or acute pain, while chronic pain may need 4-6 treatments. The severity of the condition is considered, including any damage in the lumbar spine from degenerative disc disease, spinal stenosis, or arthritis.
The actual number of sessions varies, as often, dry needling produces instant results and standard manual trigger point therapy can be used after the more invasive needling sessions.
Should I get dry needling or acupuncture for sciatica pain?
Dry needling is a better treatment option for sciatica because the needles are inserted to a greater depth to access intramuscular trigger points in soft tissue. These specific points in the muscles are symptoms of the underlying issue.
If you have mild sciatica, and you’ve had good results with acupuncture in the past, then you should have a few sessions of acupuncture instead.
This is because you won’t feel as sore afterward, compared to dry needling. You can advance to dry needling later if you like.
What if dry needling hits the sciatic nerve?
The needles are inserted into muscles, not nerves. However, if the wrong size needles are used and it goes too deep, irritating the sciatic nerve, you will experience leg pain and a temporary worsening of your sciatica. Dry needling only hits the sciatic nerve if you have bad aim!
Theoretically, it’s possible to pierce a vessel or puncture nerve tissue, but adverse events are rare because practitioners are trained in where to put the needles.
Pain medications like NSAIDS may help in the short term after dry needling sessions as your tissues recover.
What are the chances sciatica is worse after dry needling?
There is less than a 2% chance your sciatica will worsen. Dry needling can cause temporary pain and soreness afterward, but this is a good sign. It means the needles were inserted deep enough to reach the target muscles.
The soreness generally lasts 24 hours. If your pain is still bad after two days, give your practitioner a call.
Acupuncture points for sciatica
There are a few key acupuncture points that help with sciatic nerve pain.
- The most important one is GB30, or “Gallbladder 30.” This point is located on the outside of the leg, about four finger widths below the bony protrusion on the side of the knee. Other often-used points according to acupuncturists include:
- GB29, and
These points are all located on the back of the leg, between the muscles. Many practitioners will also address the meridians at:
- The lower back point
- The stomach point
How Effective Is Acupuncture in Relieving Sciatic Pain?
Acupuncture is effective in the short term for treating sciatica. Acupuncture is thought to work by releasing endorphins in the nervous system – natural pain relief in the body. It may also help by increasing blood flow to help lower back pain.
It is a holistic approach. It will not work for everyone, due to the different causes and severity of sciatica.
What if my sciatica is caused by piriformis syndrome?
While rare, sciatica can arise from piriformis syndrome – a constant cramping and tightness in the muscle affecting the sciatic nerve. The best treatment is to release the sciatica acupressure points.
This is performed with manual soft tissue techniques, for example, deep tissue active release technique, or post-isometric relaxation. Dry needling is also a good option.
The 5 best sciatica acupressure points
Common acupressure points for sciatica are:
- GB30 – Gallbladder 30. This point is located on the outside of the leg, about four finger widths below the bony protrusion on the side of the knee.
- BL54 – Bladder 54. This point is located on the back of the leg, between the muscles.
- GB29 – Gallbladder 29. This point is located on the back of the leg, between the muscles.
- GB31 – Gallbladder 31. This point is located on the back of the leg, between the muscles.
- ST36 – Stomach 36. This point is located on the lower leg, about four finger-widths below the kneecap, and one finger-width to the outside of the shinbone.
Acupressure points are specific locations on the body, just like in acupuncture, that can be stimulated with finger pressure. This relieves pain, and/or produces other effects, such as increased energy or improved digestion, according to TCM practitioners.
Can acupuncture heal disc herniations causing sciatic compression?
Only your body can heal a disc herniation, but acupuncture can help with the pain, and possibly stimulate better conditions for healing. If you need surgery such as a microdiscectomy, acupuncture can help with the pain both before and after surgery.
What Are the Risks and Side Effects of Acupuncture?
Acupuncture is a relatively safe procedure when performed by a trained and licensed practitioner. The most common side effects are:
- soreness at the insertion site
- breaking off of the needle
- nerve irritation
What Can You Do If dry needling or Acupuncture Doesn’t Work for You?
If you’ve tried dry needling or acupuncture for your sciatica and it hasn’t worked, fear not. You have plenty of other options to consider!
- Physical therapy: learn how to strengthen the muscles in the lower back, improve range of motion, and release the sciatic nerve.
- Chiropractic care: correct posture and align the spine to relieve pressure on nerves. (especially useful for lumbar disc herniation patients).
- Deep tissue massage: loosen tight muscles and release trigger points without the acupuncture needles.
- Acupressure for sciatic nerve pain: applying pressure to these points can help to recover, along with other therapies.
Regardless of which treatment you choose, it’s important to work with a qualified healthcare professional to ensure that you’re getting the best care possible.
Have you tried any of the methods listed in this article for your sciatica? Tell us what worked below, so we can all learn more about sciatica.
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- Vickers, Andrew J et al. “Acupuncture for chronic pain: individual patient data meta-analysis.” Archives of internal medicine vol. 172,19 (2012): 1444-53. doi:10.1001/archinternmed.2012.3654
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3. Qin, Zongshi, et al. “Effectiveness of acupuncture for treating sciatica: a systematic review and meta-analysis.” Evidence-Based Complementary and Alternative Medicine 2015 (2015).