Dry needling is used primarily to reduce localised muscle tension, thereby reducing muscle related pain. It is a skilled therapy which uses fine filament needles to penetrate the skin and underlying muscle and connective tissue. It is targeted at myofascial trigger points, which are hyperirritable spots found in skeletal muscle, causing tenderness which may result in pain referral to other areas. This may involve dynamic needling, in which the needle is slowly moved in and out of the myofascial trigger point, and/or periosteal pecking, in which the tip of the needle contacts the periosteum (the connective tissue surrounding the underlying bone). Stimulation of the periosteal nerve endings activates the pain inhibiting mechanism in the central nervous system, thereby decreasing pain and inflammation. Dry needling is considered one of the fastest and most effective ways of treating myofascial trigger points.