Back Pain Doctor

Wet Needling (Trigger Point Injection)

Wet needling is a trigger point injection. The needle is placed into a tender band of muscle and a small volume of solution is injected — in our clinic, 5% dextrose with 0.04% lignocaine — with the aim of reducing pain enough to let you move and load the area properly.

What it can help with

  • Focal myofascial pain in the neck, shoulder girdle or paraspinal muscles
  • Tender gluteal or calf muscle contributing to hip, knee or Achilles pain
  • Deeper tender points that are difficult to reach comfortably with dry needling
  • Muscle pain that has not settled with dry needling or manual treatment

Suitability depends on your individual diagnosis and is assessed at consultation.

Wet needling — more formally a trigger point injection — is used when examination finds a tender band of muscle that reproduces part of your pain. A fine needle is placed into that band and a small volume of 5% dextrose with 0.04% lignocaine is injected.

It sits at stage two of our treatment pathway: the stage concerned with settling pain enough to let you rehabilitate properly. It is not a treatment for a tendon or a joint, and we will not describe it as one.

The evidence for needling, wet or dry, is honest rather than impressive: small trials, short follow-up, and no clear advantage of one technique over the other. Most of that literature used local anaesthetic or saline rather than dextrose, so our choice of injectate is a reasoned one rather than a trial-proven one, and we say so. What is reasonably well established is that needling helps most when it is paired with movement and progressive strength work, and helps least when it is delivered as a course of passive treatment on its own.

Whether needling is relevant to your problem is decided by examination at consultation.

How it works

A trigger point is a localised, tender band within muscle that reproduces a recognisable pattern of pain when pressed. Needling it is thought to disrupt that sensitised area mechanically. What is injected alongside the needling is a separate decision.

We use 5% dextrose with 0.04% lignocaine. That is a deliberate choice and it differs from the more common practice of injecting local anaesthetic alone. The lignocaine concentration is very low — enough to take the edge off the procedure, not enough to produce the dense numbing of a conventional local anaesthetic injection. The dextrose is the same low concentration used in perineural injection therapy, where the rationale is an effect on small-fibre sensory nerves and neurogenic inflammation rather than a purely mechanical one.

The mechanism is not fully settled, and the honest position is that needling of any kind aims to reduce pain rather than to change the underlying structure. It does not treat a tendinopathy or an arthritic joint. Where muscle pain is a genuine contributor, settling it can make the loading work possible.

What the evidence shows

Trials comparing wet and dry needling for myofascial pain are small, heterogeneous and generally of low quality. Neither approach is clearly better than the other, and both show short-term pain reduction in some studies with limited longer-term follow-up. Reviews consistently note that needling works best as part of a plan that includes movement, stretching and progressive strengthening — not as a stand-alone treatment. A further caveat we would rather state than gloss over: most of that trial literature used local anaesthetic or saline, not dextrose. The rationale for using dilute dextrose here is drawn across from perineural injection therapy, where it has been studied more directly. Trial evidence for 5% dextrose specifically in myofascial trigger points is limited, and we are not going to present a reasoned choice as a proven one. We therefore label needling "only if relevant" on most condition pages. It has a real place when examination finds a tender muscle reproducing your pain, and no place at all as a routine treatment for a joint or tendon problem.

What to expect

The tender point is located by examination, the skin is cleaned, and a fine needle is placed into the muscle with a small volume of 5% dextrose and 0.04% lignocaine. A brief muscle twitch or a familiar ache during the injection is common. Because the lignocaine is very dilute, you should not expect the dense numbness of a standard local anaesthetic injection — most people feel some easing during or shortly after the treatment, followed by a day or two of local soreness. You will be given movement and loading work to do afterwards — that is the part that keeps the change.

Frequently asked questions

What is the difference between wet and dry needling?
Dry needling places a fine needle into the tender muscle with nothing injected. Wet needling injects a small volume of solution through the same needle — in our clinic, 5% dextrose with 0.04% lignocaine. Many clinics use local anaesthetic alone instead. Wet needling is often more comfortable and can be used where the tender area sits deeper. The evidence does not clearly favour wet over dry needling.
What exactly do you inject?
5% dextrose with 0.04% lignocaine. The dextrose is the same low concentration used in perineural injection therapy; the lignocaine is very dilute, included for comfort rather than to produce dense numbness. This differs from the more common practice of injecting local anaesthetic alone, and we would rather tell you what is in the syringe than describe it vaguely as an injection.
Does it hurt?
There is usually a brief ache or twitch as the needle enters the tender band. Because the lignocaine is very dilute you should not expect the dense numbness of a standard local anaesthetic injection. Local soreness for a day or two afterwards is common.
Is this the same as perineural injection therapy?
No, although both use 5% dextrose. Wet needling places the solution into a tender band of muscle to settle myofascial pain. Perineural injection therapy places small volumes just beneath the skin along tender superficial nerves, for a different problem, and sits at stage five of our pathway rather than stage two.
How many treatments will I need?
Often one or two, alongside a movement and strengthening plan. If pain keeps returning to the same spot, that usually means the underlying load or diagnosis needs revisiting rather than more injections.
Will this fix my tendon or arthritis pain?
No. Needling treats muscle pain. Where a tendinopathy or arthritic joint is the main problem, needling may reduce a contributing muscular component, but the plan still rests on diagnosis, load management and progressive rehabilitation.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

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