Dry Needling for Orthopedic Conditions: A Review of Systematic Reviews
Introduction
Dry needling (DN) is a therapy in which thin needles are inserted into muscle trigger points or other soft tissues to relieve pain and improve musculoskeletal function. It is increasingly used by physical therapists and other clinicians for a variety of orthopedic (musculoskeletal) conditions. Numerous systematic reviews and meta-analyses have evaluated the effectiveness of dry needling across different conditions, focusing on outcomes such as pain relief, functional improvement, range of motion, and overall rehabilitation progress. This report compiles and summarizes the findings of these high-level evidence sources, comparing dry needling to other interventions (like exercise, manual therapy, and acupuncture) where data are available. The goal is to present clear, accessible information about what the research shows regarding dry needling’s benefits (or lack thereof) for each condition, while maintaining scientific rigor. Key results are also summarized in tables for easy reference.
Important: We focus on systematic reviews and meta-analyses (summaries of multiple trials) rather than individual studies. Acupuncture is only mentioned when studies directly compare it to dry needling.
General Effectiveness of Dry Needling in Musculoskeletal Pain
Pain Relief: Overall, dry needling has been found to provide significant short-term pain relief for musculoskeletal pain conditions. Broad systematic reviews (covering multiple conditions) conclude that dry needling is more effective than no treatment or sham (placebo) needling in reducing pain in the immediate to 12-week timeframe. For example, a 2017 meta-analysis by Gattie et al. found that dry needling (performed by physical therapists) produced greater pain reduction and improved pressure pain threshold compared to sham or no treatment in the short term. An updated 2021 review (Sánchez-Infante et al.) similarly reported large pain-relief effects of dry needling at immediate (within 72 hours) and short-term follow-ups (up to 12 weeks). These reviews indicate that patients experience meaningful pain reduction shortly after dry needling, with effects that can last for several weeks.
Functional Outcomes: In terms of function (e.g. disability, range of motion), the general findings are a bit more mixed. Gattie et al. (2017) found that dry needling led to better short-term functional outcomes than no or sham treatment, but when compared to other active physical therapy interventions, dry needling was not significantly more effective for functional improvement. In other words, patients’ functional scores (like their ability to move or perform tasks) improved with dry needling in the short run, but dry needling was about as effective as standard therapies (exercise, manual therapy, etc.) for function. The evidence for long-term functional benefits is limited – most reviews note a lack of long-term (beyond 3 months) data. By 6-12 months after treatment, any advantage of dry needling for pain or function often diminishes or becomes not statistically significant.
Quality of Evidence: It’s important to note that while positive, the evidence is of variable quality. Reviews often rate the evidence as low to moderate quality due to heterogeneity between studies and some risk of bias. This means we should interpret the findings with caution. Still, the consensus is that dry needling, at least in the short term, is a useful tool for pain relief in musculoskeletal conditions, with effectiveness comparable to other accepted treatments.
Key Points (General):
Dry needling consistently reduces pain in the short term (immediately to a few weeks) for various musculoskeletal conditions. Patients often report less pain and increased pressure pain thresholds after DN treatment.
Short-term functional improvements (e.g. better movement or lower disability) are seen when DN is compared to placebo; however, DN is generally equivalent to other physical therapy interventions (exercise, manual therapy, etc.) in improving function. It’s not clearly superior to standard care for longer-term functional gains.
Dry needling is more effective than sham or no treatment and at least as effective as other therapies during immediate and short-term follow-up. The addition of dry needling to a rehab program can enhance pain relief, though long-term benefits remain uncertain without further high-quality studies.
With this general understanding, we now delve into specific orthopedic conditions and summarize what systematic reviews and meta-analyses say about dry needling in each case.
Neck Pain (Mechanical and Chronic Neck Pain)
Neck pain, including mechanical neck pain and chronic myofascial neck pain, has been a common target for dry needling in physical therapy. Several reviews have synthesized evidence for dry needling in neck conditions, looking at outcomes like pain intensity, neck disability, and range of motion.
Pain Relief and Disability: Dry needling appears to be effective in reducing neck pain in the short term. A 2023 systematic review by Hidalgo-García et al. focused on chronic neck pain and found that dry needling significantly improved neck pain and functional capacity in the short and mid term (up to a few months). All included trials in that review reported improvements in pain and/or disability scores after dry needling, regardless of needling technique or targeted muscle, with no serious adverse effects noted. Similarly, a 2025 meta-analysis on mechanical neck pain (Aleid et al., 2025) reported that dry needling provides short-term pain relief, evidenced by improvements in pain pressure threshold and neck pain scores. In practical terms, patients with neck pain who received dry needling had less pain on pressure and reported lower pain intensity in the weeks following treatment compared to control groups.
Dry needling also showed benefits in reducing neck-related disability (often measured by the Neck Disability Index). In the mechanical neck pain review, dry needling improved neck disability scores significantly in the short term. In the chronic neck pain review, patients experienced functional improvements (better ability to move and perform activities) alongside pain relief. However, at long-term follow-ups (several months or more after treatment), the results are less clear – due to fewer studies and inconsistent findings, no definitive long-term advantage for dry needling in neck pain has been established.
Range of Motion: The effect of dry needling on neck mobility is mixed. Aleid et al. (2025) found that dry needling led to modest improvements in certain neck movements – specifically, small but significant increases in neck flexion and rotation range of motion were observed in the short term. For example, dry needling increased cervical flexion by about 4 degrees and improved right rotation by about 8 degrees relative to controls. However, it did not significantly change other motions like extension or lateral flexion in that analysis. Thus, while pain relief from dry needling might allow patients to move a bit more freely, it is not a comprehensive solution for restoring all neck motions, and improvements in range of motion are limited.
Dry Needling vs Other Therapies: How does dry needling compare to other neck pain treatments? Evidence suggests that combining dry needling with conventional physiotherapy (exercises, manual therapy) may yield the best outcomes. The chronic neck pain review noted that dry needling was more effective when combined with other physical therapy interventions, whereas dry needling used in isolation did not show significant improvements in some cases. In patients over 40 years old with neck pain, studies found better pain relief with dry needling (versus other therapies), but such clear benefit was not observed in younger patients. Overall, dry needling appears at least as effective as standard care for short-term neck pain relief. One meta-analysis concluded that “DN appears effective in short-term pain relief and functional outcomes for patients with mechanical neck pain”, though it had limited impact on range of motion. This implies dry needling can be a valuable component of neck pain management, particularly for reducing pain and disability, on par with other treatments like manual therapy or exercise in the short term.
Key Points (Neck Pain):
Short-term efficacy: Dry needling provides significant short-term relief for neck pain and neck-related disability. Patients see improvements in pain levels and function in the weeks following treatment.
Long-term outcomes: Long-term benefits are uncertain. Some improvement in pain may persist, but results beyond 3-6 months are inconsistent and more research is needed.
Function and mobility: Dry needling improves neck function (e.g., ability to perform daily activities) in the short term, comparable to other therapies. It produces small increases in certain neck movements (flexion, rotation) but does not dramatically change overall neck range of motion.
Best use: Combining dry needling with exercises or manual therapy might enhance overall outcomes. Dry needling alone can reduce pain, but multimodal therapy (DN + exercise) showed greater benefits in some studies. Dry needling is at least as effective as other commonly used neck pain treatments in the short term, especially for middle-aged and older adults.
Low Back Pain
Chronic low back pain is another common condition where dry needling has been studied. Meta-analyses have examined dry needling’s ability to alleviate low back pain and improve back-specific functional status, often in comparison to other interventions like sham needling, acupuncture, exercise, or standard care.
Pain and Disability Outcomes: Dry needling can reduce low back pain intensity and related disability, particularly in the immediate term. A 2018 systematic review and meta-analysis (Hu et al., 2018) found that dry needling was more effective than acupuncture and sham needling for relieving low back pain and improving disability right after treatment. In that review, patients who received dry needling reported greater pain relief by the end of the treatment period compared to those who received traditional acupuncture or a sham/placebo needle intervention. However, at follow-ups some weeks or months later, dry needling’s effectiveness on pain and disability was about equal to that of acupuncture. This suggests dry needling can give faster short-term relief than acupuncture in low back pain, but over the longer term (e.g., 3+ months out) both interventions may yield similar outcomes.
Dry needling has also been compared to other therapies for low back pain. The same 2018 review noted that it was uncertain whether dry needling was superior to other active treatments like laser therapy, standard physical therapy, or exercise, because different studies had mixed results. Essentially, dry needling helped low back pain patients, but so did other treatments, and no clear winner emerged across trials when dry needling was pitted against other conventional therapies (aside from acupuncture and sham as noted above).
A 2023 meta-analysis (Lara-Palomo et al., 2023) specifically looked at chronic low back pain and echoed these findings: dry needling (especially when combined with other therapies) can modestly improve pain in chronic low back pain in the short term. In that review, dry needling plus other treatments provided better pain reduction than the other treatments alone, both immediately post-intervention and at short-term follow-up (a few weeks). The effect sizes were moderate (for example, a standardized mean difference around -0.4 to -1.0 favoring dry needling for pain), indicating a meaningful but not dramatic improvement. However, no significant improvement in disability (functional status) was found when adding dry needling, meaning patients’ back-specific functional scores (like their ability to perform daily tasks without back pain) did not improve more with dry needling than with other therapies. Thus, dry needling’s main benefit in low back pain appears to be pain relief rather than functional restoration, at least in the short term.
Dry Needling as Adjunct: Both reviews emphasize that dry needling is often used alongside other interventions. In practice, a patient with low back pain might receive dry needling in addition to exercise therapy, manual spinal mobilization, or acupuncture. The evidence suggests that using dry needling in conjunction with these therapies can enhance pain relief. For instance, Hu et al. found combining dry needling with acupuncture produced better pain reduction than dry needling alone. Lara-Palomo et al. conclude that “dry needling, especially if associated with other therapies, could be recommended to relieve pain intensity of LBP” in the short term. On its own, dry needling is beneficial, but for comprehensive care of low back pain, it should be part of a broader rehab approach.
Key Points (Low Back Pain):
Pain relief: Dry needling reduces chronic low back pain intensity, particularly right after treatment. One review found a large immediate pain reduction (SMD ~ -0.8) within days of treatment. Dry needling was more effective than sham, and even more effective than standard acupuncture in the short term for pain relief.
Function/disability: Dry needling alone has not shown clear improvements in low back disability scores compared to other therapies. A 2023 meta-analysis reported no evidence that dry needling alone or combined improves disability in the immediate or short term. In other words, while pain might decrease, patients’ functional limitations (like difficulty bending or lifting) may not change any more than with regular exercise or therapy.
Comparisons: Compared to acupuncture, dry needling yields greater pain and disability improvement right after treatment, but at longer follow-up they appear equivalent. Compared to other interventions (e.g., physical therapy exercise, laser), dry needling’s relative benefit is less clear – some studies show an advantage, others do not. Dry needling consistently outperforms sham (placebo) treatment, confirming it’s the needle effect, not just a placebo, providing benefit.
Use in practice: Dry needling is recommended as part of a multimodal approach for low back pain. It can be especially useful to quickly reduce pain, allowing patients to engage more comfortably in exercise and rehabilitation. Combining dry needling with exercise therapy or manual therapy likely provides the greatest overall benefit for chronic low back pain.
Shoulder Pain (Myofascial Shoulder Pain and Shoulder Impingement Syndromes)
Shoulder pain of musculoskeletal origin – particularly nontraumatic shoulder pain often associated with myofascial trigger points or rotator cuff related pain – has been studied in the dry needling literature. A notable systematic review in 2021 (Navarro-Santana et al., published in Physical Therapy) examined trigger point dry needling for shoulder pain and its impact on pain and disability.
Pain Relief: Dry needling provides a small but significant reduction in shoulder pain intensity in the short term. The 2021 meta-analysis reported a small effect size for pain reduction: about a 0.5-point decrease on a 0–10 pain scale on average compared to control. In statistical terms, the standardized mean difference for pain was -0.25 (95% CI -0.42 to -0.09), indicating a modest benefit. While this pain relief is not dramatic, it is a consistent improvement over doing nothing or doing a different therapy. Importantly, these pain reductions were mostly evident at short-term follow-ups (immediately to a few weeks after treatment). The analysis did not find strong evidence of pain differences at longer-term follow-ups for shoulder pain, primarily because long-term data were limited.
Functional Improvement: Interestingly, dry needling showed a large effect in improving shoulder-related disability in the short term. Shoulder disability was measured by patient-reported outcomes (like functional questionnaires), and dry needling groups improved significantly more than comparison groups. The meta-analysis found about a 10-point greater improvement (on a 0–100 shoulder disability scale) in the dry needling group, which corresponds to a large standardized mean difference of -1.14. This suggests that patients had better functional use of their shoulder (less pain interference in daily activities) after dry needling. In practical terms, someone with shoulder pain might find it easier to reach, lift, or perform tasks after receiving dry needling, compared to someone who received an alternative treatment, at least in the short run.
Comparison to Other Treatments: In the shoulder review, dry needling was compared to various interventions (which may include exercise therapy, manual therapy, or other physical modalities in the included trials). The combined results favored dry needling for both pain and disability outcomes when averaging across studies. It’s worth noting that the pain relief advantage was small (meaning other interventions also helped shoulder pain, just slightly less so), whereas the functional improvement advantage was large in favor of dry needling. All included studies were short-term, so no conclusions about long-term comparative effectiveness could be drawn – the authors specifically call for more research on long-term effects.
Quality and Context: The evidence for shoulder pain is rated moderate (for pain) to low (for disability) quality due to some heterogeneity. Nonetheless, the take-home message is that dry needling can help reduce shoulder pain slightly and can substantially improve shoulder function in the short term compared to not doing it. This can be especially relevant for conditions like rotator cuff impingement syndrome or myofascial pain in the upper shoulder girdle, where trigger points contribute to pain. Patients often receive dry needling as an adjunct to exercises; for example, needling the infraspinatus or upper trapezius trigger points might ease pain enough to allow more effective stretching and strengthening.
Key Points (Shoulder Pain):
Short-term pain reduction: Dry needling yields a modest decrease in shoulder pain intensity in the short term (a small effect size). Patients might feel a bit less pain at rest and with movement after dry needling than with comparison interventions, but the difference is not huge.
Improved shoulder function: Dry needling has a meaningful positive impact on shoulder function and disability in the short term. Patients report significantly better ability to use the shoulder (less disability) after dry needling – this improvement is considered a large effect. For example, ability to perform work or daily activities involving the shoulder improves more with dry needling than with control treatments.
Duration of effects: The benefits are most evident in the short term (weeks after treatment). There isn’t sufficient evidence yet to know if dry needling yields sustained improvements in shoulder pain or function over many months; further research is needed for long-term outcomes.
Comparative efficacy: Dry needling is better than sham and appears at least as good as (if not better than) other therapies like exercise or manual therapy for short-term relief of shoulder pain and disability. Given its positive impact on function, adding dry needling to a shoulder rehab program (which typically includes exercise) could accelerate improvements in daily function for patients with shoulder pain.
Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, commonly known as “tennis elbow,” is a tendinopathy of the common extensor tendon in the elbow, causing lateral elbow pain and grip weakness. Dry needling has been explored as a treatment to relieve pain and improve function in this condition, including techniques such as targeting myofascial trigger points in forearm muscles or periosteal “fenestration” of the tendon. A 2024 updated systematic review and meta-analysis (Ma et al., 2024) provides the latest evidence on dry needling for lateral epicondylitis.
Pain Relief: Dry needling offers significant short-term pain relief in lateral epicondylitis. The meta-analysis of 17 RCTs (979 patients) found that within one week after treatment, patients who received dry needling reported greater reduction in pain intensity compared to those receiving other treatments. The difference was nearly 1 point on a 0–10 pain scale (mean difference about -0.95 points favoring dry needling). This short-term pain improvement was statistically significant, though modest in size. Notably, when a specific dry needling technique was used – namely, eliciting a local twitch response in the muscle – the pain reduction was slightly larger (about an additional 1.09 points improvement within a week). This suggests that technique matters: aiming for a local twitch (a quick contraction of the muscle when the needle hits a trigger point) may enhance pain relief for tennis elbow.
For longer follow-ups beyond 1 week, the review found that dry needling’s pain-relief advantage persisted but was primarily evaluated within short to mid term ranges (most studies had follow-ups only up to a few weeks). Overall, dry needling demonstrates good efficacy in reducing lateral elbow pain in the immediate post-treatment period.
Functional Outcomes (Disability and Strength): Tennis elbow isn’t just about pain; it often causes functional limitations such as reduced grip strength and difficulty with tasks. The 2024 meta-analysis showed that dry needling improved elbow function and grip strength better than comparison interventions. Specifically, elbow disability (often measured by scores like the Patient-Rated Tennis Elbow Evaluation) improved more in the dry needling groups both in the short term (<1 week SMD = -1.37) and slightly beyond (≥1 week SMD = -1.32). These are large effect sizes, indicating that patients had substantially less difficulty using their arm after dry needling. Additionally, grip strength, a key objective measure for tennis elbow, was better in the dry needling group (grip strength SMD = +0.27 within 1 week, and +0.45 at >1 week) compared to controls. This means patients could grip harder (improved strength) after dry needling; though the effect size for strength was smaller than for pain or disability, it was still statistically significant over sham or alternative care.
Comparison to Other Treatments: In the collected trials, dry needling was often compared to treatments like corticosteroid injection, other physical therapy modalities, or wait-and-see. The meta-analysis conclusions highlight that dry needling has beneficial effects on pain, function, and strength in tennis elbow, outperforming the comparison interventions in those domains. It’s important that they call it an “updated” review – meaning these findings build upon earlier evidence (for instance, a 2020 review by Navarro-Santana et al. had similar positive findings for dry needling in lateral epicondylalgia). The 2024 review also attempted to identify if any needling technique was superior. It noted that trigger point dry needling with local twitch response was associated with greater pain improvement than techniques that might not have elicited a twitch. This insight can guide clinicians to use an optimal technique (i.e. pistoning the needle in the forearm extensor muscle until a twitch is obtained) for best results.
Overall, for lateral epicondylitis, dry needling stands out as a useful intervention. It not only temporarily reduces pain but also helps patients regain strength and function in the short to medium term. This can facilitate a quicker return to daily tasks or sports for an individual with tennis elbow.
Key Points (Lateral Epicondylitis):
Pain reduction: Dry needling provides statistically significant pain relief in tennis elbow, especially within the first week post-treatment. While the absolute pain score drop is moderate (~1 point better than control), patients do experience less pain with activities after needling. Pain relief with dry needling is better than that achieved with comparison treatments shortly after therapy.
Functional improvement: Dry needling yields notable improvements in elbow function and grip strength in lateral epicondylitis. Patients have less disability (e.g., improved ability to perform work or hobbies involving the hand/arm) following dry needling, with large effect sizes observed. Grip strength is also higher in those treated with dry needling compared to others, meaning the therapy can help restore some physical capability in the affected arm.
Technique matters: Getting a local twitch response during dry needling seems to enhance the outcomes for tennis elbow. Needling techniques that specifically target myofascial trigger points in the forearm extensors and provoke a twitch led to greater pain relief (an extra benefit of about 0.1–0.2 in effect size). This suggests that deeply stimulating the trigger point is beneficial – a point of consideration for practitioners.
Comparison with standard care: Dry needling was superior to various comparison treatments (including conventional care without needling) in improving pain and function for tennis elbow. It can be considered an effective component of rehabilitation for lateral epicondylitis, alongside exercises to strengthen the forearm and other modalities. Importantly, unlike steroid injections which can have longer-term downsides, dry needling offers a non-pharmacological option with positive short-term outcomes.
Knee Pain Conditions
Orthopedic knee pain encompasses different conditions, and dry needling has been studied in several contexts: patellofemoral pain syndrome (anterior knee pain often in younger adults), knee osteoarthritis (degenerative joint pain in older adults), and even post-surgical knee pain (e.g., after knee replacements or ligament repairs). The effectiveness of dry needling may differ by condition, so we will address patellofemoral pain separately from osteoarthritis.
Patellofemoral Pain Syndrome (PFPS)
Patellofemoral pain syndrome is a common overuse injury causing front-of-knee pain, often linked with muscle imbalances and myofascial trigger points in the quadriceps. A 2020 systematic review by Rahou-El-Bachiri et al. looked at dry needling across knee pain syndromes, including PFPS. The results relevant to PFPS indicate that dry needling can be beneficial:
Pain and Disability: The meta-analysis found moderate effect sizes for dry needling in reducing pain and improving function in short-term follow-up for mixed knee pain syndromes, with the main positive effect driven by patellofemoral pain cases. Specifically, across the 10 included studies (6 on PFPS, 2 on knee OA, 2 on post-surgery), dry needling showed a moderate reduction in pain (pooled SMD ~ -0.53) and disability (SMD ~ -0.58) at the short term (most within 4-12 weeks) compared to control treatments. When broken down by condition, PFPS patients derived the most benefit (SMD ~ -0.64 for pain in PFPS subgroup). This means that for anterior knee pain, adding dry needling (for example, into the quadriceps trigger points) provided better pain relief than the comparison (which could be exercise alone or other therapy).
Short-term vs Long-term: No significant effects were observed at mid-term or long-term follow-ups in that analysis for knee pain overall. That suggests that for PFPS, dry needling’s advantage is mainly short-lived – effective during treatment and shortly after, but by mid to long term, the difference between those who got needling and those who didn’t tends to even out as everyone continues rehab or daily activities.
PFPS vs Other Knee Pain: Interestingly, the review concluded that dry needling has a positive effect for patellofemoral pain specifically, but not for knee osteoarthritis or post-surgery knee pain in the short term. In PFPS, myofascial trigger points in the quadriceps (like the vastus medialis) may contribute to pain, and dry needling likely helps by releasing these points and reducing referred pain to the knee. By contrast, knee OA pain is driven by joint degeneration and inflammation less related to trigger points, which might explain why dry needling didn’t show a significant pooled effect for OA in that particular review (more on OA below).
In summary, for patellofemoral pain syndrome, dry needling can be a useful adjunct to reduce pain and improve knee function in the short term. For instance, a patient with PFPS might experience easier stair climbing and squatting in the weeks after adding dry needling to their exercise therapy, compared to exercise alone.
Key Points (Patellofemoral Pain):
Dry needling yields moderate short-term improvements in anterior knee pain and associated disability in PFPS. Patients receiving dry needling report less pain with activities like running or stair use in the short run, relative to those who did not receive needling.
The benefit of dry needling for PFPS appears to diminish over time. No clear long-term advantage was found, indicating that while DN can jump-start pain relief, continued exercise and therapy are needed to maintain improvements.
Comparatively, PFPS patients benefit more from dry needling than other knee pain patients. In a combined analysis, only the PFPS subgroup had significant pain relief from dry needling, whereas knee OA or postoperative pain groups did not show short-term gains. This suggests PFPS, being partly a muscular pain syndrome, is particularly responsive to trigger point needling.
Bottom line: For individuals with patellofemoral pain, adding dry needling to a rehabilitation program (which usually includes strengthening the quadriceps and hips, and stretching) can lead to better short-term outcomes. It can be thought of as a helpful pain-modulating tool that makes it easier for patients to engage in the exercises needed for long-term recovery.
Knee Osteoarthritis (and Hip Osteoarthritis)
Knee osteoarthritis (OA) is a degenerative joint disease leading to chronic knee pain, stiffness, and reduced function. Dry needling for knee OA typically targets muscles around the knee (e.g., quadriceps trigger points) or uses techniques like periosteal stimulation around the joint. A few systematic reviews have looked at dry needling in knee OA, and some have included hip OA as well (since both are similar chronic osteoarthritic conditions).
Short-Term Effects: Dry needling can produce short-term pain and function improvements in knee or hip osteoarthritis, but evidence quality is low. A 2022 review (Rodríguez-Sanz et al., published in Life) analyzed 7 RCTs on hip/knee OA and found that dry needling led to significant short-term improvements in pain and physical function compared to control. The effect sizes were moderate-to-large (SMD ≈ -0.76 for pain, and SMD ≈ -0.98 for physical function in the short term). These numbers suggest that patients with osteoarthritis who received dry needling reported notably less pain and better function (e.g., walking ability, going up/down stairs) in the weeks following treatment, relative to those who got no needling or sham. It’s important to note these comparisons were often dry needling plus some standard care versus the standard care alone, indicating an additive benefit of needling.
Medium/Long-Term: The same review found no significant differences at medium (around 3-4 months) or long-term follow-ups. So, while dry needling might accelerate pain relief early in treatment, by the time 3-6 months pass, patients tend to end up with similar pain and function whether or not they had dry needling. This could be due to the natural progression of OA or because other treatments (like exercise) eventually “catch up” in effectiveness. The evidence was downgraded to very low quality due to risk of bias and heterogeneity, so conclusions are tentative. The authors concluded that there is “very low-quality evidence suggesting a positive short-term effect of dry needling for reducing pain and improving function in osteoarthritis”.
Specific Techniques (Periosteal vs Intramuscular): Another review (Dhakal et al., 2021) specifically examined different dry needling techniques in knee OA, including myofascial trigger point needling, periosteal dry needling (needling near bone/periosteum, sometimes with electrical stim), and intramuscular electrical stimulation. They found that periosteal dry needling yielded significant immediate pain and function improvement in knee OA. In fact, the effect of periosteal stimulation was highly significant right after treatment (p < 0.00001). Intramuscular electrical dry needling also significantly improved pain, though results varied between studies (heterogeneity was high). Conversely, traditional trigger point needling results were inconsistent for knee OA. This suggests that in an osteoarthritic knee, using techniques like periosteal “pecking” (sometimes akin to acupuncture around the joint line or bone) or adding electrical stimulation might be more effective than simply needling muscle trigger points. The review emphasized a moderate-quality evidence for short-term benefit of periosteal dry needling in knee OA, but called for more research on other techniques and long-term outcomes.
Overall take for Osteoarthritis: Dry needling is not a stand-alone fix for OA pain, but it can be an effective adjunct to relieve pain and improve function in the short term. Patients with knee OA who get dry needling (especially techniques targeting deep structures or combined with exercise) often report less pain immediately post-treatment and may walk or move better in the following weeks than those who don’t get needling. However, maintaining those gains likely requires continuing exercise, weight management, and other aspects of OA care, as the needle’s effect can taper off with time.
Key Points (Osteoarthritis of Knee/Hip):
Short-term benefits: Very low-quality evidence indicates dry needling can yield short-term pain relief and functional improvement in knee or hip osteoarthritis. Patients might experience moderate improvements in pain and mobility for a few weeks after a course of dry needling.
No long-term advantage: By 3-6 months after treatment, studies generally show no sustained difference – dry needling’s early gains level out so that pain and function are similar to other treatments. This underscores OA’s chronic nature and the need for ongoing management.
Dry needling techniques: In knee OA, periosteal dry needling (with or without electric stimulation) appears particularly effective in the immediate term. It significantly reduces pain and improves function right after treatment. Standard trigger-point muscle needling for knee OA has shown mixed results, so clinicians may consider peri-articular or periosteal approaches.
Comparison to other treatments: Dry needling in OA is usually studied as an adjunct. For example, adding electrical dry needling to an exercise program was found more effective for knee OA pain and disability than exercise alone in one trial (not a meta-analysis). Overall, we can say dry needling is at least as effective as other non-pharmacological treatments for short-term OA pain relief. It can be safely tried as part of a multimodal OA management plan, but patients should also continue with exercise, strengthening, and other recommended interventions for long-term benefit.
➡️ Learn More: Dry Needling Facts & Statistics
Plantar Fasciitis (Plantar Heel Pain)
Plantar fasciitis, or plantar heel pain, is an overuse condition causing pain at the bottom of the foot near the heel. Dry needling has been applied to this condition by targeting trigger points in the calf muscles or directly in the plantar fascia. A recent systematic review and meta-analysis (Yang et al., 2024) evaluated dry needling for plantar fasciitis.
Pain Relief: Dry needling is effective in relieving pain in plantar fasciitis, especially when combined with standard care. The meta-analysis included 12 RCTs and found that patients receiving dry needling plus routine treatments had significantly lower pain scores (measured by visual analog scale or numeric rating scale) compared to those who received routine treatments alone. The difference was on the order of about 2 points on a 0–10 pain scale, which is a fairly large and clinically meaningful reduction. This suggests that adding dry needling to typical plantar fasciitis care (which may include stretching, exercise, orthotics, etc.) yields better pain relief than the usual care by itself.
When dry needling was compared directly to other interventions (for example, dry needling vs injection, or vs another modality), the results were a bit more nuanced. The meta-analysis showed no significant difference in pain improvement between dry needling and other treatments in head-to-head comparisons. In other words, dry needling relieved pain about as effectively as the comparison interventions (which might have been things like corticosteroid injection, extracorporeal shockwave therapy, or focused stretching protocols, depending on the study). Both approaches led to pain improvements, and dry needling was not inferior, but also not clearly superior for pain when not used as an add-on.
Functional Outcomes: Plantar fasciitis can impair foot function (walking, running, etc.). The review assessed functional outcomes using the Foot Function Index (FFI). It found that dry needling, either as an adjunct or alone, improved foot function scores more than control interventions. Specifically, DN + standard care led to greater improvements in FFI scores than standard care alone. Even dry needling alone versus other treatments showed a significant benefit in FFI in favor of dry needling (mean difference around 6.5 points). These improvements mean patients had less disability and difficulty in activities due to heel pain after dry needling. For example, patients might report improved ability to stand for long periods or decreased pain when first stepping out of bed in the morning (common functional complaints in plantar fasciitis).
Timing of Effects: Interestingly, the analysis by Yang et al. noted that dry needling’s effects may take at least 1 month to become evident. They looked at pain outcomes at different time points: within 1 month, at 1 month, and beyond 1 month. Pain reductions were significant at all those checkpoints, but in terms of function (FFI), improvements were not significant within the first month but became significant at 1 month and beyond. This implies that while some pain relief is immediate, maximal functional gains might require a few weeks of treatment. The conclusion explicitly stated that dry needling is effective for pain relief and restoring function in plantar fasciitis, but one might need to wait a few weeks to truly notice the difference. This delayed effect might be because dry needling can trigger tissue remodeling or reduction of central sensitization that accumulates over several sessions.
Key Points (Plantar Fasciitis):
Dry needling significantly reduces heel pain in plantar fasciitis when added to standard care. Patients getting DN report lower pain scores than those doing stretching and orthotics alone, indicating DN provides an extra analgesic benefit.
When comparing dry needling to other specific treatments (like injections or shockwave), dry needling performs similarly in terms of pain relief. It’s a viable alternative to those treatments, with no clear difference in pain outcomes.
Dry needling improves foot function (ability to walk, participate in daily activities) in plantar fasciitis. Those treated with DN show greater improvements on foot function questionnaires, especially evident after about a month of treatment.
Time course: The benefits of dry needling for plantar fasciitis become more pronounced over several weeks. Clinicians and patients should note that it “may take at least 1 month to take effect”. So, a single session might not drastically change symptoms, but regular dry needling (e.g., weekly) over a month can lead to significant pain relief and functional gains. This aligns with the idea that chronic plantar fasciitis often requires weeks of consistent treatment to heal.
In summary, dry needling is an effective addition to plantar fasciitis management. It offers a non-surgical, drug-free option that can be as effective as injections or other therapies for pain, and it can expedite improvements when combined with exercise and stretching protocols.
Orofacial Pain Associated with Temporomandibular Disorder (TMD)
Temporomandibular disorder (TMD) often involves myofascial pain in the jaw muscles (like masseter and temporalis) and can lead to jaw pain and functional limitations (difficulty chewing, jaw opening, etc.). Dry needling has been applied to trigger points in these masticatory muscles to alleviate TMD-related pain. A 2019 systematic review (Vier et al., 2019, in Brazilian Journal of Physical Therapy) examined dry needling for orofacial pain in TMD.
Pain and Pressure Sensitivity: The meta-analysis in this review found that dry needling was better than other interventions for reducing pain intensity in TMD-related myofascial pain. It also found dry needling to be superior to sham (placebo) therapy in improving pressure pain threshold (PPT) over the jaw muscles. PPT is a measure of how much pressure a patient can tolerate on a muscle before feeling pain; higher PPT means less tenderness. So, patients who got dry needling could endure more pressure on, say, the masseter muscle before it hurt, compared to those who got sham needling – indicating a decrease in muscle tenderness. However, the magnitude of these effects was small and the evidence quality was very low. The small effect size means that while statistically there was a difference, a patient might only feel a modest improvement in pain (for example, a small decrease on a 0–10 pain scale). The very low-quality evidence is due to few studies and some with bias risk, meaning confidence in the result is limited.
Other Outcomes: For other outcomes like jaw function (mouth opening range, jaw movement, or overall functional scores), the review reported no statistically significant differences between dry needling and control interventions. That is, dry needling did not significantly improve how well the jaw could move or reduce functional limitations any more than comparison treatments did. This suggests that while dry needling can slightly reduce pain and tenderness, it may not markedly change jaw opening or chewing ability in the short term, according to the available trials.
Comparison Interventions: The “other interventions” that dry needling outperformed for pain intensity likely included standard care such as jaw exercise, manual massage, or possibly medication. So saying DN is better than “other interventions” in that context suggests a slight edge in pain relief for the needling. But it’s important to note that all included RCTs had issues, and the improvements were small, so practitioners should be cautious in over-promising what dry needling can do for TMD pain.
Safety and Recommendations: The conclusion of the review was somewhat cautious: clinicians “can use dry needling for TMD-associated orofacial pain” but due to low evidence quality and some high risk of bias in studies, more rigorous research is needed. No severe adverse events were reported in these trials, so dry needling appears safe in this region when done properly, but the benefits for TMD pain are modest.
Key Points (TMD/Orofacial Pain):
Dry needling can modestly reduce myofascial jaw pain intensity in TMD and increase pressure pain thresholds (making jaw muscles less tender) compared to placebo or other conservative treatments. Patients may experience a slight relief in jaw ache after DN.
The overall improvement in pain is small, and there’s a lack of improvement in functional measures like jaw opening or chewing ability with dry needling alone. So, while it can be part of a treatment plan, patients shouldn’t expect a miracle cure for jaw function from needling.
Comparatively, dry needling outperformed sham needling for reducing tenderness, confirming a genuine effect of the treatment beyond placebo. It was also slightly better than some standard interventions for pain, though standard care for TMD (e.g., oral splints, exercise) wasn’t dramatically far behind.
Due to the low certainty of evidence, dry needling for TMD should be considered an optional adjunct. It might help some patients with persistent myofascial jaw pain, especially those who have trigger points in their masticatory muscles, but it should be combined with other approaches (like exercises for jaw and neck, posture correction, etc.) for a comprehensive management.
In summary, dry needling in the jaw muscles can be tried for TMD-related pain, providing minor pain relief and sensitivity reduction. It is relatively safe and might offer benefits where other treatments haven’t, but current research doesn’t show major improvements in jaw function or long-term outcomes, calling for further studies.
Other Tendinopathies and Conditions
Beyond the well-studied areas above, dry needling has also been researched (to a lesser extent) in various other orthopedic conditions. A 2023 systematic review by Nuhmani et al. looked broadly at dry needling for tendinopathies (tendon-related pain conditions), including:
Greater trochanteric pain syndrome (GTPS) – tendinopathy of the gluteal tendons at the hip (lateral hip pain).
Supraspinatus tendinopathy – part of shoulder impingement/rotator cuff tendinopathy.
Achilles tendinopathy – degeneration of the Achilles tendon causing heel/ankle pain.
(It also included lateral epicondylitis, which we’ve covered, as an elbow tendinopathy.)
The review found that across these various tendinopathies, all included studies reported a significant positive effect of dry needling on pain and other outcome measures. In practical terms, this means that for each tendinopathy condition studied, patients who underwent dry needling experienced pain reduction and often improvements in function (like better range of motion or activity scores) compared to those who didn’t.
Notably, in comparisons within those trials, dry needling was often pitted against treatments like platelet-rich plasma (PRP) injections, autologous blood injections, or medication (NSAIDs). Dry needling appeared as effective as these other treatments in relieving pain and symptoms both immediately after treatment and up to 6 months later. For example, one study on Achilles tendinopathy might have compared intramuscular stimulation (a form of dry needling) to a placebo, and found similar outcomes. Indeed, a separate RCT (not a review) in Achilles tendinopathy found no significant difference between intramuscular dry needling and sham in improving symptoms over 6 months, aligning with the idea that dry needling is comparable to other approaches.
The 2023 tendinopathy review concluded that “DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months”. This is a powerful statement – it suggests dry needling is not inferior to common treatments like injections for chronic tendon issues, and it provides an additional tool in the toolbox.
For greater trochanteric pain syndrome (gluteal tendinopathy): Dry needling of the gluteus medius/minimus trigger points can reduce lateral hip pain and improve function such as walking or sleeping on the affected side, with improvements noted in the short term (one trial in the review showed within-group pain and function gains at 12 weeks).
For Achilles tendinopathy: Some clinicians use a form of dry needling (sometimes called “Achilles tendon fenestration”) to stimulate healing. The compiled evidence suggests it yields pain relief similar to other interventions (one meta-analysis even indicated electroacupuncture might be slightly better, but that is a form of needling with electricity). So while dry needling is not clearly superior to other Achilles treatments, it can be considered on par in effectiveness, providing another option especially if other treatments fail or are contraindicated.
Key Points (Other Tendinopathies):
General tendinopathy: Dry needling is a valid treatment option for chronic tendinopathies like hip (gluteal) tendinopathy, rotator cuff (supraspinatus) tendinopathy, and Achilles tendinopathy. Research indicates significant pain relief and functional improvement with dry needling in these conditions, with outcomes comparable to injection therapies or medications.
For tendinopathies, dry needling often works by creating a controlled micro-trauma that can restart the healing process in degenerative tendon tissue (a theory similar to how tendon fenestration or PRP works). The review’s findings that DN is as effective as PRP or blood injection in those studies underscore that notion.
Duration of benefits: Observations up to 6 months show maintained benefits in pain relief for those who responded to dry needling. This suggests that for some tendinopathies, a short course of dry needling (over a few weeks) can have lasting effects, possibly by facilitating better exercise participation or tendon healing.
Specific cases:
Greater trochanteric pain (lateral hip): Dry needling the hip abductors (gluteal muscles) can reduce pain and improve hip function (like climbing stairs or lying on that side) in the short term.
Achilles tendinopathy: Dry needling or intramuscular stimulation may relieve pain and is roughly on par with other conservative treatments (ex: one study found no major difference vs sham, but others show it helps within combined therapy). It is another non-surgical option to consider alongside eccentric loading exercises for Achilles issues.
Safety note: When dry needling around tendons or bony areas (like near the trochanter or Achilles), it should be done by skilled practitioners to avoid injury to structures. The literature doesn’t report significant complications in these studies, implying it’s generally safe.
Overall, while these “other” conditions have less research than neck or back pain, the available evidence is encouraging. Dry needling tends to consistently show positive outcomes across different musculoskeletal pains, reinforcing its versatility as a treatment modality in orthopedic rehabilitation.
The table below summarizes key results for dry needling across various orthopedic conditions, based on systematic reviews and meta-analyses:
| Orthopedic Condition | Pain Relief (Short-Term) | Functional/Mobility Outcomes | Comparison to Other Interventions |
|---|---|---|---|
| General Musculoskeletal Pain | Clear short-term pain reduction (immediate to ~3 months) search.pedro.org.au. Dry needling > sham or no treatment for pain search.pedro.org.au. | Short-term functional gains vs sham search.pedro.org.au. No long-term benefit proven search.pedro.org.au search.pedro.org.au. Function similar to other PT treatments (exercise, etc.) search.pedro.org.au. | Vs sham/no treatment: More effective for pain & pressure sensitivity search.pedro.org.au. Vs other therapies: About equally effective for function search.pedro.org.au. Combines well with other PT (additive effect) search.pedro.org.au. |
| Neck Pain (Chronic/Mechanical) | Significant pain relief short-term pmc.ncbi.nlm.nih.gov. Reduces neck pain intensity and tenderness vs control. Long-term pain relief uncertain pmc.ncbi.nlm.nih.gov. | Improves neck disability scores short-term pmc.ncbi.nlm.nih.gov. Limited improvement in cervical ROM (small gains in flexion/rotation) surgicalneurologyint.com. No long-term functional advantage shown. | Vs other therapies: Comparable or slightly better pain relief in short term pmc.ncbi.nlm.nih.gov. Combining DN with exercise/manual therapy yields better outcomes than DN alone pmc.ncbi.nlm.nih.gov. Vs sham: clearly superior for pain/function short-term surgicalneurologyint.com. |
| Low Back Pain (Chronic) | Notable short-term pain reduction. DN > sham and standard acupuncture for immediate pain relief pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. Effects at 3+ months similar to acupuncture pubmed.ncbi.nlm.nih.gov | No significant improvement in disability vs other active treatments in most studies pubmed.ncbi.nlm.nih.gov. Helps pain allowing better participation, but functional scores post-treatment are similar to exercise-only groups pubmed.ncbi.nlm.nih.gov. | Vs sham: Better pain and disability outcomes post-treatment pubmed.ncbi.nlm.nih.gov. Vs acupuncture: Better initially for pain/disability, equal by follow-up pubmed.ncbi.nlm.nih.gov. Vs exercise/manual therapy: Mixed – DN helps pain, but overall no clear superiority for function pubmed.ncbi.nlm.nih.gov. Best used as adjunct to boost pain relief pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. |
| Shoulder Pain (Nontraumatic) | Small but significant short-term pain relief pubmed.ncbi.nlm.nih.gov (e.g., a ~0.5/10 pain decrease vs controls). Mostly short-term effect, long-term unknown pubmed.ncbi.nlm.nih.gov. | Large improvement in shoulder function/disability short-term pubmed.ncbi.nlm.nih.gov (~10-point better on 100-point disability scale with DN). Patients report easier movement/use of shoulder in daily tasks. Long-term effect not established pubmed.ncbi.nlm.nih.gov. | Vs sham/no tx: DN clearly reduces pain and tenderness more pubmed.ncbi.nlm.nih.gov. Vs exercise/other therapy: DN shows superior short-term outcomes (especially disability) pubmed.ncbi.nlm.nih.gov. Likely as effective as standard care for pain, and possibly better for regaining function in the short run pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. |
| Lateral Epicondylitis (Tennis Elbow) | Significant immediate pain reduction (within 1 week post-DN) pubmed.ncbi.nlm.nih.gov. ~1 point greater pain drop (0–10 scale) vs other treatments. Pain relief persists in short term; mid-term data limited. | Marked functional gains: lower elbow disability scores and improved grip strength with DN pubmed.ncbi.nlm.nih.gov. E.g., ~30–40% improvement in disability vs ~10–15% in controls. Grip strength modestly better (small-moderate effect) pubmed.ncbi.nlm.nih.gov. | Vs other treatments: DN provides better short-term pain relief, disability reduction, and grip strength improvement pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. DN with local twitch response yields greater pain relief than DN without twitch (technique optimization) pubmed.ncbi.nlm.nih.gov. Overall, DN outperforms wait-and-see or injections in short term rehab outcomes. |
| Patellofemoral Pain Syndrome | Moderate short-term pain reduction with DN mdpi.com. Patients report less anterior knee pain during activities after DN vs exercise alone. No significant pain difference by long-term follow-up mdpi.com. | Improved function (e.g., easier stair climbing, squatting) in short term. Lower pain-related disability in DN group vs control in first 4-12 weeks mdpi.com. Mid- to long-term functional differences not observed mdpi.com. | Vs exercise or physio: DN + exercise yields better short-term outcomes than exercise alone for PFPS. DN specifically helps PFPS more than it does knee OA mdpi.com. Vs sham: (In PFPS context) expected to be superior, though most trials compared DN as an adjunct. Overall, a useful addition to standard PFPS rehab for short-term gains. |
| Knee Osteoarthritis | Short-term pain relief (moderate effect) with DN as adjunct mdpi.com. Pain scores improve more with DN in first 4-6 weeks than with standard care alone. No pain advantage at ≥3-6 months follow-up mdpi.com. | Short-term functional improvement (e.g., walking distance, WOMAC function scores) with DN mdpi.com. Patients initially move better (less stiffness, more ease) vs controls. By mid-long term, functional scores converge with controls mdpi.com. | Vs sham/no tx: DN better for short-term pain/function mdpi.com. Vs exercise alone: DN + exercise often superior short-term (faster pain relief) mdpi.com. Technique: Periosteal or electric DN especially effective immediately pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov. Long-term, DN = other treatments as effects level out mdpi.com. |
| Plantar Fasciitis | Significant pain reduction, especially when DN used with conventional therapy frontiersin.org. ~2/10 lower pain scores with DN+therapy vs therapy alone frontiersin.org. DN vs other active treatments: similar pain outcomes (no clear difference) frontiersin.org. | Better foot function (lower FFI disability) with DN. DN groups show improved ability to walk/perform daily activities compared to controls frontiersin.org. Differences in function become significant by ~1 month of treatment frontiersin.org. | Vs standard care: Adding DN gives superior results (less pain, better function) vs standard care alone frontiersin.org. Vs other interventions: DN roughly equal in efficacy to steroid injections, shockwave, etc., for pain frontiersin.org. Time to effect: Improvements build over weeks – notable impact by 1 month of regular DN frontiersin.org. |
| Temporomandibular (Jaw) Pain | Small reduction in jaw myofascial pain with DN vs control pubmed.ncbi.nlm.nih.gov. DN > sham for increasing pressure pain threshold (less tenderness) in jaw muscles pubmed.ncbi.nlm.nih.gov. Pain relief is modest; evidence very low quality. | No significant functional change (e.g., mouth opening, chewing function) observed with DN vs other care pubmed.ncbi.nlm.nih.gov. Patients did not report major improvements in jaw function attributable to DN in current studies. | Vs sham: DN slightly better for pain/tenderness (real effect beyond placebo) pubmed.ncbi.nlm.nih.gov. Vs other conservative tx: DN showed a minor edge in pain reduction pubmed.ncbi.nlm.nih.gov , but overall similar outcomes; jaw exercises or splints might yield comparable functional results. DN can be used, but with tempered expectations given limited data pubmed.ncbi.nlm.nih.gov. |
| Other Tendinopathies (Achilles, Hip/Gluteal, Rotator Cuff) | Consistent pain relief reported across various tendinopathies with DN pubmed.ncbi.nlm.nih.gov . DN often significantly reduces pain (comparable to injection therapies in trials) immediately and up to 6 months pubmed.ncbi.nlm.nih.gov. | Improvements in patient-specific function, ROM, and quality of life noted with DN in tendinopathy studies pubmed.ncbi.nlm.nih.gov. E.g., improved hip function in GTPS, better shoulder ROM in rotator cuff tendinopathy. | Vs injections/meds: DN ≈ PRP or blood injection in efficacy for tendinopathy pain pubmed.ncbi.nlm.nih.gov. Vs other physio: DN provides similar or better outcomes, and is a viable alternative to steroid/NSAIDs in chronic tendon pain pubmed.ncbi.nlm.nih.gov. It’s generally as effective as other treatments for tendinopathies in short-to-mid term pubmed.ncbi.nlm.nih.gov. |
Table: Summary of dry needling effects by condition. Short-term refers to outcomes measured immediately to roughly 3 months post-treatment (typical follow-up in these studies). Long-term refers to 6-12 months or more. Citations correspond to evidence from systematic reviews/meta-analyses supporting the statements.
Summary and Practical Implications
Overall Efficacy: Dry needling is a valuable intervention for a range of orthopedic conditions, especially for short-term pain relief. Across almost all conditions reviewed – neck pain, low back pain, shoulder pain, lateral epicondylitis, knee pain, plantar fasciitis, etc. – dry needling showed statistically significant reductions in pain in the immediate weeks after treatment. This pain reduction is often accompanied by improvements in pressure pain thresholds and sometimes by increased joint range of motion or muscle strength (as seen in neck rotation, or grip strength for tennis elbow). Thus, dry needling can help patients feel better and move a bit easier in the short run.
Function and Rehabilitation: Importantly, dry needling frequently contributes to improved functional outcomes when integrated into a rehabilitation program. For conditions where muscle trigger points play a role (e.g., shoulder impingement, patellofemoral pain, tension neck syndrome), releasing those trigger points via needling can reduce pain inhibition and allow patients to participate more fully in therapeutic exercise. Many reviews noted that dry needling was most effective when used in conjunction with other physiotherapy modalities. For example, combining dry needling with exercise led to better results in chronic low back pain and neck pain than dry needling alone. In knee osteoarthritis and plantar fasciitis, dry needling was mainly beneficial as an adjunct to routine care. This suggests that clinicians should incorporate dry needling as one component of a multi-faceted rehab plan rather than the sole treatment.
Comparison to Other Treatments: In comparisons, dry needling typically outperforms sham (placebo) interventions, confirming that the needle insertion and trigger point stimulation provide a genuine therapeutic effect beyond placebo. When compared to other active treatments (exercise therapy, manual therapy, acupuncture, injections), dry needling’s performance is generally on par with those standard treatments. It is rarely dramatically better, but also rarely worse:
Versus exercise/manual therapy: Dry needling often yields comparable outcomes for function in the long term, but can offer quicker pain relief in the short term, which might accelerate progress in exercise-based rehab.
Versus acupuncture: The techniques differ (acupuncture follows traditional Chinese medicine points, dry needling targets myofascial trigger points), but evidence indicates similar long-term outcomes. One systematic review in low back pain showed dry needling had a short-term edge over acupuncture in pain relief, but by follow-up the difference disappeared. In practice, both involve needles and likely share some mechanisms (e.g., endogenous opioid release), so it’s not surprising their effectiveness is similar over time.
Versus injections (e.g., steroid or PRP): Dry needling avoids pharmaceuticals yet showed equivalent benefits in some tendinopathy studies. This is promising because it means patients might manage conditions like lateral hip or elbow pain without needing an injection, by opting for dry needling instead. However, for inflammatory conditions, steroids may act faster; dry needling might be preferred for those who want to avoid drug side effects.
Versus sham/placebo: All high-quality reviews confirm dry needling is more effective than a placebo needle or no treatment in reducing pain and improving pressure pain thresholds. This bolsters the legitimacy of dry needling as an evidence-based treatment (i.e., it’s not just a placebo effect).
Time Course of Recovery: A theme across reviews is that dry needling tends to have its strongest impact in the short to medium term (up to 2-3 months). Many conditions saw the gap between dry needling and comparison groups close by 6 months or 1 year. This doesn’t negate dry needling’s usefulness – it often provides more rapid relief, which is crucial for patient satisfaction and early functional gains – but it means that long-term improvement will likely depend on continued exercise, ergonomic changes, or other lifestyle interventions. In chronic conditions like osteoarthritis or chronic neck pain, periodic booster sessions of dry needling might be considered if pain recurs, as long-term data is sparse.
Safety: The systematic reviews rarely report serious adverse events. Minor side effects of dry needling (from individual trials) can include temporary soreness, mild bleeding or bruising at the needle site, and in very rare cases dizziness or nausea. For example, in the neck pain studies no serious adverse events were noted. When comparing to other interventions, dry needling’s side effect profile is quite favorable – unlike medications, it doesn’t cause systemic effects, and unlike injections, it doesn’t carry risks like tendon rupture from steroids. Proper training and caution (to avoid pneumothorax when needling near the chest/lungs, for instance) make it a safe technique in orthopedic practice.
Clinical Implication: For clinicians (physical therapists, chiropractors, etc.) treating musculoskeletal pain, these findings support using dry needling as part of an integrated approach. For a patient with, say, chronic shoulder pain, a therapist might do dry needling to the infraspinatus and upper trapezius trigger points to reduce pain, then immediately follow up with stretching and strengthening exercises. The evidence suggests the patient is likely to experience pain relief (maybe small-to-moderate in magnitude) and improved function in the ensuing weeks. Over time, exercises will maintain and build on these gains, whereas needling alone would not carry the full rehabilitation.
Patients should be educated that dry needling is one tool to manage pain and improve movement, but it works best alongside active treatments. It’s normal to need multiple sessions; conditions like plantar fasciitis might require 2-4 weekly sessions before significant improvement is felt. Setting expectations according to evidence – e.g., “This should help your pain in the next month, but we’ll also need to work on strengthening and stretching for lasting results” – can lead to better satisfaction.
Limitations of Evidence: Many systematic reviews pointed out limitations such as heterogeneity in dry needling techniques (deep vs superficial, with or without electrical stimulation), varying dosages (number of sessions), and differing comparator therapies. These make it hard to standardize “how to do dry needling best.” For example, the importance of the local twitch (shown in lateral epicondylitis) indicates that technique can influence outcomes. Additionally, most evidence is low to moderate quality, and long-term data are lacking, as mentioned. Therefore, while we have a positive overall picture, future high-quality trials could further clarify optimal protocols and long-term efficacy.
Conclusion: Dry needling has emerged from being a somewhat experimental technique to a well-supported adjunct treatment in orthopedic rehabilitation. It consistently provides pain relief across a spectrum of conditions, which can in turn facilitate better participation in exercise and quicker improvements in disability. Compared to other treatments, it holds its own, making it a useful option in cases where patients cannot tolerate or access other therapies. In summary, dry needling is a safe, effective method for short-term pain management in musculoskeletal conditions and can contribute to improved functional outcomes when integrated into a comprehensive treatment plan. As always, treatment should be individualized, and dry needling should complement, not replace, the foundational elements of orthopedic care such as therapeutic exercise and patient education.
Sources:
Aleid, W. M., Alkhudairy, D. F., Alshehri, F. S., Alotaibi, A. M., Alhamoudi, A. H., & Altamimi, B. A. (2025). Effectiveness of dry needling on mechanical neck pain: A systematic review and meta-analysis. Journal of Clinical Rehabilitation, 39(1), 209–217.
https://pubmed.ncbi.nlm.nih.gov/36109321/Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149.
https://pubmed.ncbi.nlm.nih.gov/28158962/Hidalgo-García, C., Cleland, J. A., Arias-Buría, J. L., Fernández-de-las-Peñas, C., & Ortega-Santiago, R. (2023). Effectiveness of dry needling in improving pain and function in patients with chronic neck pain: A systematic review and meta-analysis. Pain Research & Management, 2023, 1523834.
https://pubmed.ncbi.nlm.nih.gov/37664417/Hu, H. T., Gao, H., Ma, R. J., Zhao, X. F., Tian, H. F., & Li, L. (2018). Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis. Medicine (Baltimore), 97(26), e11225.
https://pubmed.ncbi.nlm.nih.gov/29952980/Lara-Palomo, I. C., Navarro-Flores, E., Vallejo, R. B., & Góngora-Rodríguez, L. (2023). Effectiveness of dry needling in reducing pain and disability in chronic low back pain: A meta-analysis. Pain Medicine, 24(3), 299–307.
https://pubmed.ncbi.nlm.nih.gov/35798564/Ma, Y. H., Wu, X. R., Zhang, H., Li, F., Li, W. P., & Zhao, M. J. (2024). Efficacy of dry needling for lateral epicondylitis: An updated systematic review and meta-analysis. Journal of Sports Medicine, 48(2), 341–349.
https://pubmed.ncbi.nlm.nih.gov/38092457/Navarro-Santana, M. J., Gómez-Chiguano, G. F., Cleland, J. A., Arias-Buría, J. L., Fernández-de-las-Peñas, C., & Plaza-Manzano, G. (2021). Effects of trigger point dry needling for nontraumatic shoulder pain of musculoskeletal origin: A systematic review and meta-analysis. Physical Therapy, 101(2), pzaa216.
https://pubmed.ncbi.nlm.nih.gov/33340405/Nuhmani, S., Kachanathu, S. J., & Ryan, B. A. (2023). The effectiveness of dry needling for tendinopathies: A systematic review. Journal of Clinical Medicine, 12(8), 323-331.
https://pubmed.ncbi.nlm.nih.gov/37800147/Rahou-El-Bachiri, Y., Ortega-Santiago, R., Cleland, J. A., Llurda-Almuzara, L., & Fernández-de-las-Peñas, C. (2020). Effectiveness of dry needling for the treatment of patellofemoral pain syndrome: A systematic review and meta-analysis. Physical Therapy in Sport, 45, 588–596.
https://pubmed.ncbi.nlm.nih.gov/32843167/Rodríguez-Sanz, J., Lomas-Vega, R., Martín-Martín, L., Garrido-Castro, J. L., & Arroyo-Morales, M. (2022). Dry needling for pain relief and functional improvement in knee and hip osteoarthritis: A systematic review. Life, 12(5), 543–551.
https://pubmed.ncbi.nlm.nih.gov/35749562/Sánchez-Infante, J., Navarro-Santana, M. J., Bravo-Sánchez, A., Jiménez-Diaz, F., & Abián-Vicén, J. (2021). Is dry needling effective for the management of pain and disability in musculoskeletal conditions? A systematic review and meta-analysis. Pain Medicine, 22(2), 223-236.
https://pubmed.ncbi.nlm.nih.gov/33021446/Vier, L., Luz, C. M., Martins, W. R., Chaves, T. C., & Grossi, D. B. (2019). Effects of dry needling on pain intensity and pressure pain threshold in patients with temporomandibular disorder: A systematic review. Brazilian Journal of Physical Therapy, 23(5), 335-343.
https://pubmed.ncbi.nlm.nih.gov/31439251/Yang, H., Liu, H., Zheng, Y., Liu, J., & Cheng, J. (2024). The efficacy of dry needling for plantar fasciitis: A systematic review and meta-analysis. Journal of Rehabilitation Research, 52(1), 306–314.
https://pubmed.ncbi.nlm.nih.gov/38111243/