Dry needling and targeted stretching effectively reduce trapezius muscle tightness.
the verdict
INSUFFICIENT LEANING
refutedsupported
the weight of evidence
11 sources for · 0 against
Multiple systematic reviews and clinical trials report that dry needling effectively reduces pain and muscle stiffness in the upper trapezius, but the provided evidence lacks evaluation of targeted stretching.
Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs associated with neck pain were identified in electronic databases. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The Cochrane risk of bias tool and the Physiotherapy Evidence Database (PEDro) score were used to assessed risk of bias (RoB) and methodological quality of the trials. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated (3) Twenty-eight trials were finally included. Dry needling reduced pain immediately after (MD -1.53, 95% CI -2.29 to -0.76) and at short-term (MD -2.31, 95% CI -3.64 to -0.99) when compared with sham/placebo/waiting list/other form of dry needling and, also, at short-term (MD -0.51, 95% CI -0.95 to -0.06) compared with manual therapy. No differences in comparison with other physical therapy interventions were observed. An effect on pain-related disability at the short-term was found when comparing dry needing with sham/placebo/waiting list/other form of dry needling (SMD -0.87, 95% CI -1.60 to -0.14) but not with manual therapy or other interventions. Dry needling was effective for improving pressure pain thresholds immediately after the intervention (MD 55.48 kPa, 95% CI 27.03 to 83.93). No effect on cervical range of motion of dry needling against either comparative group was found. No between-treatment effect was observed in any outcome at mid-term. Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms asso
[ 8 ] defined a TrP as “a hypersensitive spot located in a taut band of skeletal muscle which stimulation induces referred pain symptoms and motor phenomena”. There is evidence showing that the referred pain elicited by active TrPs from neck musculature reproduces neck pain symptoms of insidious or traumatic origin [ 8 ]. Chiarotto et al. [ 9 ] found that TrPs in the upper trapezius is the most common finding in individuals suffering from neck pain. Among the several approaches proposed for the treatment of TrPs, dry needling has received particular attention in the last decades [ 8 , 10 ].
Dry needling is defined as a “skilled intervention using a thin filiform needle to penetrate the skin that stimulates myofascial TrPs, muscles, and connective tissue for the treatment of musculoskeletal pain disorders” [ 11 ]. A few previous reviews have investigated the effectiveness of dry needling for inactivating TrPs associated with neck pain. Cagnie et al. concluded that dry needling can be recommended for upper trapezius muscle TrPs treatment; however, no quantitative analysis was conducted [ 12 ]. Liu et al. concluded that TrP dry needling could be recommended for the management of neck/shoulder pain of myofascial origin at short and mid-term follow-ups [ 13 ].
Study Characteristics Table 2 summarizes features of the participants on each trial. All studies targeted active TrPs (i.e., those that referred pain reproduced the patient’s symptoms) with the needle; seventeen (61%) targeted upper trapezius TrPs, seven (25%) targeted active TrPs in posterior cervical muscles, and the remaining four (14%) targeted just one muscle, e.g., levator scapulae, lower trapezius, anterior scalene, or sternocleidomastoid. Although all trials included one group receiving TrP dry needling, only 18 (65%) reported the presence of local twitch responses during the needling intervention.
jcm-09-03300-t003_Table 3 Table 3 Characteristics of the dry needling intervention of the included studies. Study Group TrP criteria Technique Used No. Punctures for Patient in Every Intervention Needle Approach (Targeted Muscles or Tendon) Gauge (mm) Depth (mm) Time of DN Frequency of Incisions (Hz) Number of Incisions in Every Needle Intervention LTR Therapist that Performed Intervention Ibuldu et al. 2004 [ 36 ] G1: DN Yes NR 1 Upper trapezius 0.25 × 25 NR NR NR NR NR Physician Itoh et al.
2012 [ 27 ] G1: DN Yes Repeated fanning needling insertion 1 Upper trapezius 32 × 0.25 mm No less than 10 mm 90 sg NR Elicit and exhaust LTR Yes Clinician G2: Superficial DN Yes The needle inserted into the epidermis until 1 Upper trapezius 32 × 0.25 mm 5 mm 90 sg 1 1 No Clinician Tekin et al. 2012 [ 46 ] G1: DN Yes Needle moved forward until the TrP was reached 6 Neck and shoulder muscles 0.25 × 0.25 mm Until muscle NR 1 1 No Physician G2: Sham-DN Yes The blunted needle for sham dry needling 6 Neck and shoulder muscles 0.25 × 0.25 mm Until skin NR 1 1 No Physician Llamas-Ramos et al.
2016 [ 37 ] G1: DN Yes Manual stimulation was produced (at the TrP) by rotating the needle counterclockwise 3 Trapezius 0.25 × 25 mm Inside of muscle 10–20 min 1 1 No NR Segura-Ortí et al. 2016 [ 50 ] G1: DN Yes Hong 1 Upper trapezius 0.25 × 25 mm Inside of muscle NR NR Needling at the TrP was continued until the LTR was exhausted Yes Physiotherapist Ziaeifar et al. 2016 [ 23 ] G1: DN Yes Hong 1 Upper trapezius 0.30 × 50 mm Inside of muscle NR NR The procedure was repeated until there was no more LTR Yes Therapist Fernández-Carnero et al.
If no twitch was elicited, needling was stopped after 2-3 stellate movements Yes Therapist Sukareechai et al. 2019 [ 48 ] G1: DN Yes Multiple needle entry technique NR Upper trapezius, rhomboid and infraspinatus muscle 0.25 × 50 mm NR NR NR NR No NR Arias-Buría et al. 2020 [ 43 ] G1: DN Yes Hong 1 Anterior scalene muscle 0.30 × 30 mm Until TrP 25–30 sg 1 Until the first LTR was obtained Yes Physiotherapist García-de-Miguel et al.
The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n=27) and a sham-DN group (n=24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44±15.97 to 35.78±11.65 kpa; p<0.01) and at 72-hours (35.04±12.61 kpa; p<0.01) and with strain elastography at 72-hours (from 1.75±0.50 to 1.36±0.40 AU; p<0.01). The DN-group showed higher values of PPT than the sham-DN group at 72-hours (4.23±0.75 vs. 5.19±1.16 kg/cm2; p<0.05). There was a progressive decrease in post-needling soreness compared to pain during needling of 33.13±21.31% at 30-min, 80.92±10.06% at 24-hours, and a total decrease in post-needling soreness in all participants at 72-hours. DN therapy is effective in reducing short-term muscle stiffness and increasing the PPT in volunteers with LTrPs in the upper trapezius after a treatment session. PERSPECTIVE: This study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group. CLINICALTRIALS.GOV: NCT04394741.
BACKGROUND
Myofascial pain syndrome (MPS) is a chronic condition caused by sensitive pressure regions within the muscles known as myofascial trigger points (MTrPs).
OBJECTIVE
The purpose of this randomized controlled trial (RCT) was to assess the effectiveness of adding dry needling (DN) to activate MTrPs in the upper trapezius muscle compared with usual physiotherapy among individuals with chronic neck pain.
METHODS
Thirty participants were recruited from a private clinic in Saudi Arabia. Their mean age was 29.7 ± 4.4 years. The subjects were randomized into two groups: the experimental group (application of DN to the MTrPs coupled with usual physiotherapy (n = 15)) and the control group (usual physiotherapy alone (n = 15)). The primary outcomes were pain (assessed using the visual analog scale) and disability (Neck Disability Index), and the secondary outcomes were neck active range of motion (AROM; assessed using cervical ROM) and depression (Beck's Depression Inventory).
RESULTS
Significant between-group difference in pain intensity was observed immediately post-intervention. Participants in the experimental group had significantly higher pain (mean difference = 1.27, 95% confidence interval [CI] 0.20, 2.33, p = 0.022, Cohen's d = 0.889) than those in the control group. There was no significant difference between both groups in pain intensity during the follow-up. There were no between-group differences in disability immediately post-intervention. However, there was a between-group difference in disability at follow-up; participants in the experimental group had significantly lower disability (mean difference = -3.13, 95%CI -5.07, -1.20, p = 0.003, Cohen's d = 1.211) than those in the control group. Immediately post-intervention, the experimental group showed greater flexion AROM compared to the control group, with no differences in other AROM measures. At follow-up, the experimental group exhibited significantly higher neck AROM in extension, flexion, right and left side bending, and lower depression, while no differences were observed in right- and left-rotation AROMs between groups.
CONCLUSIONS
The addition of DN to standard physiotherapy effectively improved disability, AROM (extension, flexion, and side bending), and depression among patients with chronic neck pain.
Dry needling is most commonly used in the subacute and chronic phases of an injury; therefore, it is imperative to understand the use of dry needling in the acute phases of an injury. There are four main reasons to use dry needling during the acute phase of injury: to relieve pain, decrease edema, increase range of motion and flexibility, and increase strength and power. Dry needling can be used pregame, postgame, during half time or an intermission, or following an injury. Although further research is needed, acute dry needling can be used to bolster athletes' health and possibly improve sports performance.
Objective: This systematic review of randomized controlled trials aimed to evaluate the efficacy of dry needling (DN) in improving pain and function among patients with myofascial trigger points in the upper trapezius muscle. Design: Systematic review conducted according to PRISMA guidelines, including randomized controlled trials. Methods: Studies were identified by searching PubMed, Scopus, The Cochrane Library, and Physiotherapy Evidence Database. Studies identified by electronic searches were screened against established, pre-defined inclusion criteria. These studies were randomized controlled trials that used DN for treating patients with active trigger points in the upper trapezius muscle with conventional treatments as controls. There are no specific limitations on the duration of treatment, the type of needling, or the severity of symptoms. These studies must have assessed pain sensitivity. Results: Four studies were included in this systematic review. The mean difference of pain sensitivity in all four studies for DN group was 0.59 kg/cm2, while in the control group was 0.05 kg/cm2, mean difference of pain intensity in DN group was 3.7 and control group was 0.7 and regarding to the range of motion (ROM) in DN group was 12.8 and control group was 6.3. Conclusions: This study showed significant positive outcomes in pain sensitivity, pain intensity, and range of motion following the intervention of DN, compared to the control group. Further high-quality randomized clinical trials with established protocols for applying DN are required.
AS, MHA, SMM: guidance on conceptualization, methodology, and reviewing all sections written by the first author. SSB: guidance on methodology, data collection, and data analysis. This article is licensed under a CC Attribution-NonCommercial-NoDerivatives 4.0 License LEVEL OF EVIDENCE: 1 ABSTRACT Objective: This systematic review of randomized controlled trials aimed to evaluate the efficacy of dry needling (DN) in improving pain and function among patients with myofascial trigger points in the upper trapezius muscle. Design: Systematic review conducted according to PRISMA guidelines, including randomized controlled trials.
While the evidence for impacts on functionality and quality of life is minimal, new systematic reviews indicate DN as a potential short- and medium-term treatment for patients with neck pain who have trigger points in the upper trapezius muscle[1,27,28]. This systematic review aims to evaluate the effectiveness of dry needling (DN) on pain and function in adults with active myofascial trigger points in the upper trapezius muscle, based on an analysis of available randomized controlled trials. METHODS This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [29].
One study scored 7 [34], two studies scored 9 [36,37], and one study scored 8[35]. These scores indicate that all studies met the criteria for high-quality trials based on the PEDro scale. The detailed scores for each study are summarized in T able 2. Effects of dry needling on the outcome measures Pain sensitivity In total, all 4 studies [34-37] showed that the DN intervention was effective in improving pain sensitivity (pain pressure threshold) in patients with trigger points in the upper trapezius muscle compared to sham/placebo intervention or no intervention. A study by Mejuto-Vázquez et al.
Range of motion We found one study that evaluated the effects of DN on ROM. The study of Mejuto-Vázquez et al., published in 2014, showed that the mean difference for the contralateral ROM in the DN group was increased to 12.8 degrees while in the comparison group it was increased to 6.3 degrees [34]. Finally, they found that increase in ROM in treating trigger points in the upper trapezius muscle compared to sham/placebo intervention or no intervention. T able 2. Studies that compared dry needling against no intervention, a sham intervention, or placebo.
Because taut bands with TrPs have a greater stiffness than the surrounding muscle tissue[45] TrPDN may reduce muscle stiffness. Clinical implications The results of this systematic review support the short- term effectiveness of dry needling (DN) in managing active myofascial trigger points in the upper trapezius muscle. These findings suggest DN may be considered a valuable tool within multidisciplinary pain management programs for patients with neck pain, particularly when rapid symptom relief is desired.
De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial. Journal of manipulative and physiological therapeutics. 2017;40(1):11-20. 6. Saeedzadeh M, Khoshkrodi DS, Khademi-Kalantari K, Akbarzadeh Baghban A, Khalkhali Zavieh M. Neck Muscles Sense of Force in Healthy Individuals and Subjects with Trigger Points of the Upper Trapezius Muscle. Muscles, Ligaments & T endons Journal (MLT J). 2023;13(2). 7. Vernon H, Humphreys K, Hagino C.
Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. Journal of Manipulative and Physiological Therapeutics. 2007;30(3):215-27. 8. Hakim IK, T akamjani IE, Sarrafzadeh J, Ezzati K, Bagheri R. The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. Journal of back and musculoskeletal rehabilitation. 2019;32(5):717-24. 9. Fishbain DA, Goldberg M, Meagher RB, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986;26(2):181-97. 10.
2005;99(5):1977-84. 44. Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal
Objective: To analyze the efficacy of the dry needling technique in the treatment of trigger points of the trapezius muscle. Material & Methods: A systematic search was carried out in the databases: PubMed, Scopus and Web of Science with the terms neck pain, trapezius, dry needling and acupuncture therapy. The results were analyzed following two inclusion criteria: studies published after 2014, and studies that aimed to evaluate the effects of dry needling on trapezius muscle. Seventeen articles were obtained, which were evaluated according to their methodological quality with the JADAD Scale and analyzed according to: study objective, experimental design, sample, intervention applied, variables analyzed, instruments used to quantify the results and results obtained. Results: Thirteen articles were selected in which, practically all, show that dry needling decreases pain intensity, improves range of motion, increases the painful threshold to pressure and eliminates, in most cases, trigger points. Conclusions: The dry needling has effects on cervical pain and disability, generated by myofascial dysfunction, have been identified. This technique did not show significant improvements compared to other techniques analyzed, but it did prove to be a treatment as valid as other more conventional ones. Keywords: Dry needling; Trigger point; Cervical pain; Trapezius; Rehabilitation
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<h4>Background</h4>Dry needling (DN) is used in sports medicine for myofascial pain, injury and recovery, but athlete-specific effects over time are uncertain. Objective: To synthesize evidence on DN applied to cervical and related upper-quarter regions in athletes, distinguishing (i) symptomatic athlete trials from (ii) post-exertion recovery trials, and to summarize injury-related outcomes only when prospectively reported.<h4>Data sources</h4>PubMed, Scopus, and Web of Science searched 11 Feb 2026. Study selection: Trials/prospective studies in athletes comparing DN (alone or add-on) with sham/no intervention or active comparators.<h4>Methods</h4>Two authors independently screened/extracted data and assessed risk of bias (RoB 2; ROBINS-I).<h4>Results</h4>Eight studies were included. In symptomatic overhead/throwing athletes, DN improved pain and shoulder ROM immediately versus no treatment in one trial, while several trials showed no differences versus active comparators or sham. Recovery trials showed inconsistent differences in hemodynamic indices and inflammatory markers, and their short follow-up and proxy endpoints limit inference about next-session performance, training continuity, or injury risk.<h4>Conclusion</h4>DN may provide short-term symptom modulation in sport athletes. Evidence for consistent recovery/readiness enhancement, performance benefit, or injury prevention remains highly uncertain and is constrained by proxy outcome selection and short time windows. Registration: OSF osf.io/fsg6w (11 February 2026).<h4>Systematic review registration</h4>OSF (Open Science Framework; ID: osf.io/fsg6w (11 February 2026).
The Importance of the Number of Incisions in the Effectiveness of Dry Needling
The dry needling technique is a procedure increasingly used by health professionals. Dry needling consists of the use of a filiform needle to treat musculoskeletal pain. Currently, the mechanisms by which it is an effective technique are not well understood. One of the aspects not yet evaluated is the best dose in terms of the number of times it is necessary to insert the needle into the patient to achieve the best result. This research work aims to assess which treatment obtains the best results in the management of patients with chronic neck pain. With the objective of demonstrating how the dose used during the application of the dry needling technique is related to the effectiveness of the treatment, we have designed a study where three different doses of the dry needling technique for the treatment of myofascial trigger points will be compared in the upper trapezius muscle in participants with neck pain.
To the authors' knowledge, no previous studies have evaluated the effectiveness of IC or any manual therapy methods for the treatment of post-needling soreness. The aims of this study were: (a) to evaluate the effectiveness of IC on reducing post-needling soreness after dry needling of one latent MTrP in the upper trapezius muscle, and (b) to investigate the effect dry needling combined with IC, compared to dry needling alone and dry needling combined with placebo IC will have on cervical range of motion (c) to determine whether psychological factors are predictive of postneedling pain and (d) to analyze if the relationships between psychological variables and postneedling pain varied as a function of postneedling soreness treatment
<h4>Background</h4>Dry needling is an increasingly popular technique used in sports and regenerative medicine contexts. However, there is no comprehensive overview of investigations of dry needling in sports and sport recovery.<h4>Objectives</h4>The objectives were to perform a systematic review of dry needling in sports athletes with an evidence gap map, to identify current gaps in the literature, and to provide stakeholders with direction for future research.<h4>Methods</h4>Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines were followed. Studies on healthy and injured athletes receiving dry needling were included. Three databases (PubMed, Scopus, and Web of Science) were searched, data were synthesized narratively, key data were summarized quantitatively, and an evidence gap map was created.<h4>Results</h4>The authors incorporated 24 studies into the current study, encompassing 580 athletes, predominantly involving talent/developmental and highly trained/national-level athletes across 13 sports. Most studies used passive or placebo controls, with 37.5% incorporating active controls. Interventions focused mainly on the lower limbs (58.3%). Around 69% of studies reported pain perception outcomes, while six examined muscular strength, activity, and range of motion. While results varied, dry needling generally showed a more positive effect on pain than on athletic performance.<h4>Conclusions</h4>Dry needling studies seem to describe general effectiveness and safety for reducing pain and muscle stiffness in a wide variety of body regions. However, further research is needed on underrepresented populations such as elite, world-class, and Paralympic athletes, as well as expanding investigations into long-term effects and a broader range of muscle groups, particularly the hamstrings. The results may be valuable for medical professionals, sports medicine specialists, and researchers.<h4>Registration</h4>OSF project no.: osf.io osf.io/h3yeq.
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