Creator: Görkem Paşa
Published: 2026-11-03

In dry needling, the muscle's response with a brief twitch (twitch response) may help a tense area to relax. A painful area does not always call for strengthening a weak muscle; sometimes the right muscle needs to relax.

In patients who come in with pain or restricted movement, the first thing that usually comes to mind is "strengthening the weak muscle". Sometimes, however, the problem is not that one muscle is weak but that another is working harder than it should. With pain, some muscles switch into a protective mode and stay constantly tense; meanwhile, the muscles that should be doing the main work switch on late or not fully.

What is the twitch response?

In dry needling, when the needle reaches a tender, tight spot within a muscle (a trigger point), the muscle may respond with a brief, involuntary twitch. This is called the local twitch response. The patient notices it as a sudden, brief jump or a cramp-like sensation inside the muscle; it passes within a few seconds.

The approach I use in dry needling aims for this response. The twitch is thought to be associated with a reduction in tension at the trigger point; a feeling of relaxation in the area is often described after treatment.

Not always about strengthening

An example: in someone who feels a pinching sensation in the shoulder when raising the arm, the upper trapezius muscle between the neck and shoulder often works too hard, while the muscles that should rotate the shoulder blade correctly lag behind. In this case, rather than tiring the already overworking muscle even further, helping it to relax can make room for the other muscles to switch on.

A small study showed that latent trigger points in the shoulder muscles changed the order in which the muscles switched on, and that this pattern returned to normal after these points were treated. In another study of patients with low back pain, those who had a twitch response during needling were able to contract the deep back muscle (multifidus) better immediately after treatment; this difference was not seen a week later.

Relaxing in the right place

Relaxing every tight muscle is not right either. Some muscles work to protect a joint; removing this protection can make the complaint worse. That is why which muscle and which point to needle is decided through examination: we observe the movement and test the muscles, identifying which muscle is overworking and which is switching on late. Immediately after treatment, we repeat the movement and the muscle test.

Is the twitch essential?

A twitch response may not occur in every treatment, and on its own it is not a measure of success. Research suggests that the twitch may be meaningful, but that it is not essential for a good outcome.

In research, the effect of dry needling is seen mostly as a reduction in pain in the short term; evidence for long-term effects is not yet sufficient. That is why needling is not a treatment on its own but a starting point. The window that opens when the muscle relaxes is worked on with exercise in the same session and carried over into everyday movements.

What does it feel like?

Treatment is carried out with thin, sterile, single-use needles. As the needle enters the muscle, you may feel a twitch or deep pressure. Mild muscle soreness lasting one to two days afterwards is normal.

If you take blood thinners, have a bleeding disorder, a fear of needles or a history of fainting, or if there is an infection in the treatment area, be sure to mention this during the assessment.

Treatments at our clinic: Dry needling · Exercise therapy

Sources

This article is for general information and does not replace a consultation. Please ask your doctor about your own situation.

Written by

Görkem Paşa

Physiotherapist

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Dry needling and twitch response: sometimes muscles need to relax