Dry Needling vs Massage vs Shockwave: Why They Feel Similar but Aren’t

Podiatry

Written by Chee Wai Siong Wesley, Director & Chief Sports Physiotherapist at Physio & Sole Clinic

One of the most common things patients tell me is this:

“I’ve tried massage, dry needling, even shockwave. They all helped for a while, but the pain keeps returning.”

And honestly, that makes sense.

Dry needling, massage, and shockwave therapy can all reduce pain, all target tight or sensitive tissues, and all feel quite intense in their own way. From a patient’s point of view, they can seem interchangeable.

But clinically, they are very different tools, designed for different problems, and meant to be used in different ways. Understanding why they feel similar, but work differently, is often the missing piece in choosing the right treatment (and getting lasting results).

Why this matters more than you think

Man sitting on the edge of a bed holding his neck and lower back, with highlighted areas indicating neck and back pain commonly associated with muscle or posture-related discomfort.

When the wrong treatment is matched to the wrong problem:

Pain relief is short-lived
You end up “chasing treatments”
Frustration builds (“Nothing works for me”)

As a physiotherapist, I don’t ask “Which treatment do you want?”

I ask, “What is driving your pain, and what tool fits that best?”

Let’s break this down clearly.

What is dry needling, and what does it actually do?

Close-up of a physiotherapist wearing blue gloves performing dry needling with a fine needle on a patient’s muscle, demonstrating anatomy-based treatment for muscle trigger points.

Dry needling involves inserting a very fine needle into specific muscle trigger points or areas of increased sensitivity.

Despite common myths:

It is not acupuncture
It is based on modern anatomy, pain science, and neuromuscular principles
It is performed by trained physiotherapists in Singapore

What does dry needling targets

Physiotherapist performing dry needling on a patient’s back, with multiple fine needles placed into muscle trigger points as part of evidence-based pain management treatment.

Dry needling works best when pain is driven by:

Overactive or tight muscles
Trigger points referring pain elsewhere
Protective muscle guarding after injury
Reduced muscle coordination due to pain

What it does (clinically)

In my experience, dry needling helps by:

Reducing excessive muscle tone
Modulating pain signals to the nervous system
Improving how a muscle activates afterward

This is why people often say:

“It feels sore… but lighter after.”

That’s a nervous system response, not the muscle being “released” in a mechanical sense.

Is dry needling better than massage for muscle pain?

Sometimes, but not always.

This is where nuance matters.

Physiotherapist performing hands-on massage therapy on a patient’s leg to relieve muscle tension and improve circulation as part of physiotherapy care.

Massage therapy works best when:

Tension is global or stress-related
You need relaxation and circulation
Pain is more diffuse and widespread

Dry needling works better when:

Pain is localised and specific
Trigger points reproduce your symptoms
Muscles are guarding despite stretching and exercise

In simple terms:

Massage	Dry Needling
Superficial + broad	Deep + targeted
Manual pressure	Neuromuscular stimulus
Relaxation-focused	Reset + retraining-focused
Short-term relief	Better carryover effects when paired with rehab

As a clinician, I often use both, but not at the same time and not for the same reason.

What does shockwave therapy treat compared to dry needling?

Physiotherapist applying shockwave therapy to a patient’s heel using a handheld device, commonly used to treat tendon-related pain such as plantar fasciitis and Achilles tendinopathy.

This is one of the biggest areas of confusion.

Shockwave therapy is not a muscle treatment.

It is designed for tendon and connective tissue problems, especially when pain has been present for months.

Shockwave is commonly used for:

Plantar fasciitis
Achilles tendinopathy
Tennis or golfer’s elbow
Proximal hamstring pain

How it works

Shockwave delivers controlled acoustic waves that:

Stimulate tissue healing
Improve blood flow
Encourage tendon remodelling

This is very different from dry needling, which focuses on muscle and nervous system behaviour.

If the main driver of pain is a degenerative or overloaded tendon, dry needling alone will not fix it.

Which treatment works best for chronic pain?

Physiotherapist applying shockwave therapy to a patient’s knee using a handheld device, targeting tendon-related pain as part of evidence-based physiotherapy treatment.

This depends entirely on what “chronic” means in your case.

From a clinical perspective, chronic pain can be driven by:

Persistent muscle guarding
Tendon overload
Poor load management
Altered movement patterns
Nervous system sensitivity

No single modality fixes all of these.

In practice:

Dry needling helps calm the system and restore movements
Shockwave supports tissue healing where tendons are involved
Massage supports recovery and reduces overall tension

What actually creates long-term improvement is:

Correct diagnosis
Load-appropriate exercises
Gradual return to activity

Treatments support this process, they don’t replace it.

Does dry needling or shockwave therapy hurt more?

This is a very common question.

Dry needling

Sensation: sharp, deep ache, twitch, or pressure
Duration: seconds
After-effects: soreness for 24–48 hours is normal

Shockwave therapy

Sensation: strong tapping or pulsing discomfort
Duration: a few minutes
After-effects: tenderness, sometimes temporary flare-up

Neither should be unbearable. If pain is excessive, treatment intensity should be adjusted. Pain is not a measure of effectiveness.

Can dry needling, massage, and shockwave be used together?

Physiotherapist guiding a patient through rehabilitation exercises using a resistance band and foam roller to restore strength, control, and movement as part of a structured physiotherapy programme.

Yes, and often, they should be. But the sequence matters.

A common example I see:

Dry needling to reduce muscle guarding
Shockwave to address tendon pathology
Rehabilitation exercises to restore strength and control

Using all three without assessment is guesswork. Using them strategically is clinical reasoning.

How do I know which pain treatment I actually need?

This is the most important question, and the hardest to answer without professional input.

You may benefit from dry needling if:

Physiotherapist wearing gloves performing dry needling on a patient’s upper back and shoulder area, targeting muscle trigger points to relieve localised muscle pain and tension.

Pain is muscle-dominant
Symptoms change with movement or posture
Stretching helps briefly but doesn’t last

You may need Shockwave therapy if:

Physiotherapist applying shockwave therapy to a patient’s forearm using a handheld device, targeting localised tendon pain as part of evidence-based physiotherapy treatment.

Pain is localised to a tendon or heel
Morning stiffness is prominent
Symptoms worsen with load and settle slowly

You may need neither, and instead need:

Load management
Strength progression
Movement retraining

This is why assessment matters more than modality choice.

A clinician’s perspective

As a physiotherapist, I don’t believe in “best treatments”.

I believe in best matches.

Dry needling is a powerful tool, but only when used for the right reasons, at the right time, and combined with proper rehabilitation.

If you’ve tried treatments before and felt temporary relief but no lasting change, it’s often not because the treatment failed, but because the plan was incomplete.