The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis
Authors: Eric Gattie, PT, DPT

Study Design
Systematic review and meta-analysis.

Background
Dry needling is being utilized by an increasing number of physical therapists in the United States and throughout the world in the treatment of musculoskeletal pain.

Objective
To examine the short and long term effectiveness of dry needling delivered by a physical therapist for any musculoskeletal pain condition.

Methods
Electronic databases were searched. Eligible randomized controlled trials included human subjects with musculoskeletal conditions that were treated with dry needling performed by a physical therapist compared with control or other intervention. The overall quality of the evidence was assessed using the GRADE approach.

Results
Initial search returned 218 articles. After screening 13 were included. PEDro quality scale scores ranged 4-9 out of maximum score of 10 with a median score of 7. Eight meta-analyses were performed. In the immediate to 12 weeks follow-up period studies provided evidence that dry needling may decrease pain and increase pressure pain threshold when compared to control/sham or other treatment. At 6 to 12 months dry needling was favored for decreasing pain, but the treatment effect was not statistically significant. Dry needling when compared to control/sham treatment provides a statistically significant effect on functional outcomes, but does not when compared to other treatments.

Conclusion
Very low to moderate quality evidence suggests that dry needling performed by physical therapists is more effective than no treatment, sham dry needling, or other treatments for reducing pain and improving pressure pain threshold in patients presenting with musculoskeletal pain in the immediate to 12 week follow-up period. Low quality evidence suggests superior outcomes with dry needling for functional outcomes when compared to no treatment or sham needling. However, no difference in functional outcomes exists when compared to other physical therapy treatments. Evidence of long-term benefit of dry needling is currently lacking.

Level of Evidence
Therapy, level 1a. J Orthop Sports Phys Ther, Epub 3 Feb 2017. doi:10.2519/jospt.2017.7096