The exact mechanisms of trigger point dry needling are unknown. There are mechanical and biochemical effects. Based on the pioneering studies by Dr. Jay Shah and colleagues at the National Institute of Health, we know that inserting a needle into trigger points can cause favorable biochemical changes, which assist in reducing pain. It is essential to elicit the so-called local twitch responses, which are spinal cord reflexes. Getting local twitch responses with trigger point dry needling is the first step in breaking the pain cycle.