Dry needling for Achilles tendonitis is thought to relieve some symptoms of this pesky injury in two ways – by targeting the calf muscles and by targeting the tendon itself. Sports physio Alison Gould explains how this works and also discusses why dry needling on its own is very unlikely to get rid of your Achilles tendonitis. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
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What is dry needling?
Dry needling, also known as western acupuncture, uses the same thin needles (much thinner and bendier than that of a syringe) as traditional acupuncture. The main difference between dry needling and traditional acupuncture is where and how deep you place the needles.
With dry needling you insert the needles into tight or painful spots in the muscles or directly into the injured area. With traditional acupuncture you place the needles on “energy lines”, and they usually only puncture the skin.
The needle comes in a plastic tube, and the end of the plastic tube is placed on the patient’s skin. The practitioner then gives the top end of the needle a little tap to get its tip into the skin, and then guides the needle in deeper into the muscle by hand.
The practitioner knows that the needle has reached the target area when the muscle starts reacting to the needle. Patients describe it as a gripping, tightening sensation. I think the best description I’ve heard from a patient is that it feels “zingy”.
The feeling then starts to wear off after a while, and when it’s totally gone, the practitioner removes the needle.
The people in the white lab coats don’t know for sure how this relaxes tight muscles. The general thinking is that when a muscle is unhappy (i.e. irritated due to an injury nearby), there is tension inside it which then leads to a decrease in blood supply, which over time may cause pain. If we put a needle into that area, the body responds by increasing the blood flow to that area, and therefore the muscle is getting fed and starts to relax.
How might dry needling help for Achilles tendonitis?
Dry needling might help for Achilles tendonitis in two ways: getting tight calf muscles to relax and targeting the injured area of the tendon itself.
Getting tight calf muscles to relax
A tight feeling in your calf or restricted range of movement is really common with Achilles tendonitis, especially one that's been going on for an extended period of time (when it is referred to as a tendinopathy).
Some people think that tight calf muscles cause Achilles tendonitis. It is actually the other way around. However, getting your tight calf muscles to relax when you have Achilles tendonitis does help to improve your range of movement and reduce some of your symptoms.
Stretching your calf muscles to get rid of their tightness is not always such a great idea when you have Achilles pain. Calf stretches also stretch the Achilles tendon and compresses it against the heel bone – this often irritates an injured tendon even more.
So, techniques that relax the calf muscles but don’t directly impact the tendon often work better, e.g. massage, foam rolling, or dry needling.
We’ve previously discussed the pros and cons of massage for Achilles tendonitis.
Targeting the Achilles tendon itself
With Achilles tendonitis, it is usually only a very small part of the tendon that is injured – the collagen fibres in that part of the tendon lose their parallel structure, and a fluid-like substance accumulate between them. You can read more about what happens inside an injured Achilles tendon here.
Similar to dry needling for muscle tightness, the thinking is that by putting the needle into the injured part of an Achilles tendon it will cause an increase in blood flow to the area, triggering a healing response. However, this has not yet been proven through research.
What the research shows
A 2022 review of high-quality research into dry needling for tendinopathies found that dry needling is as effective for relieving pain and other symptoms in the short to medium term as PRP injections, autologous blood injections (injecting the patient’s own blood), and taking anti-inflammatory medication.
However, the authors of the review acknowledged that the research studies they looked at differed on things like how many needles they used, where they put the needles and for how long, and whether the practitioner moved the needle from time to time while it was in the patient. They concluded that more research was needed to establish what technique works best.
Also, the studies under review only looked at the effect of dry needling on the symptoms of the tendinopathies. They didn’t try to find out whether the dry needling contributed to actual healing of the tendon, i.e. whether it changed the structure of the injured tendon for the better.
So, while we know that dry needling can relieve some symptoms of Achilles tendonitis, we also know that dry needling of tight calf muscles won’t heal the injury, and the jury is still out on whether dry needling the Achilles tendon itself contributes to healing.
The best way to use dry needling for Achilles tendonitis
The wrong way to go about treating Achilles tendonitis with dry needling would be to make this treatment the star of the show. Yes, it may bring short-term pain relief, but the patient will probably be back (and paying) for more dry needling week in and week out without the injured tendon actually getting better.
If a patient with Achilles tendonitis were to see me face-to-face, I would first spend some time trying to find out what caused it, so that we can address that. Then I would put together a bespoke rehab programme consisting of the right mix of rest and exercise to restore the injured tendon’s strength and ability to handle the loads placed on it during sport and other activities.
If there were still some time left in the consultation, I would use it for dry needling or a calf massage to relieve some of the Achilles tendonitis symptoms in the short term.
For patients who consult me via video call, I would only suggest that they get dry needling if their calves feel really tight and uncomfortable and they can't effectively relieve it through foam rolling or self-massage.
How we can help
Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.