Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review

Abstract

Purpose of Review Tendinopathy describes a combination of pain, swelling, and impaired performance of the tendon and around structures. There are various treatment options for tendinopathy with unclear efficacy. Dry needling involves inserting needles into the affected tendon, and it is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation. The purpose of this review is to review the use of dry needling as a treatment modality for tendinopathy. Recent Findings The effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. The following sites were studied: wrist common extensor origin, patellar tendon, rotator cuff, and tendons around the greater trochanter. There is considerable heterogeneity of the needling techniques, and the studies were inconsistent about the therapy used after the procedure. Most systematic reviews and randomized controlled trials support the effectiveness of tendon needling. There was a statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. Two studies reported complications. Summary Current research provides initial support for the efficacy of dry needling for tendinopathy treatment. It seems that tendon needling is minimally invasive, safe, and inexpensive, carries a low risk, and represents a promising area of future research. In further high-quality studies, tendon dry needling should be used as an active intervention and compared with appropriate sham interventions. Studies that compare the different protocols of tendon dry needling are also needed.

Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper’s knee: A randomized controlled trial

“…Several conventional interventions have been used for tendinopathy and are found to be non-reflective to address any destruction to the healthy tissues. Several conventional interventions such as eccentric muscle strengthening, iontophoresis, ultrasound, phonophoresis, low-level laser treatment, and extracorporeal shockwave therapy have been advocated for the treatment of patellar tendinopathy (54). The effectiveness of different conventional interventions appears to be unproven for the treatment of patellar tendinopathy.…”

“…In another study, it has been reported that ultrasonography guided treatments facilitate the development of percutaneous procedures of regenerative healing in tendinopathy (55). The efficacy of DN under the guidance of sonography has been evaluated in several reported studies and found to be statistically significant for the treatment of tendinopathy, rotator cuff, and tendons around the greater trochanter (54). Hence, it is demonstrated that this technique can be adopted and utilized as a first-line therapy or as a secondary treatment for the treatment of tendinopathy.…”

Molecular and Structural Effects of Percutaneous Interventions in Chronic Achilles Tendinopathy

“…The hypothesis is that dry needling could stimulate a healing response. Repeated passages of the needle would produce physical trauma to the tendon which induces bleeding and in turn releases growth factors that stimulate a healing response [ 80 ]. Another hypothesis is that passages of the needle could change a chronic tendon injury into an acute inflammatory state leading to the formation of granulation tissue.…”

Hamstring Injuries: Critical Analysis Review of Current Nonoperative Treatments

“…This leads to alterations to the length and tension of the selected muscle fibers, which further activate nearby mechanoreceptors 71,73 . In previous studies, authors have suggested that dry needling is most effective when a local twitch response is elicited 70 . In addition, in several studies, authors have suggested that dry needling increases local blood flow through the release of vasoactive substances such as calcitonin gene-related peptide (CGRP) and Substance P, which provide downstream vasodilatory effects 70,72 .…”

“…To date, most investigations of dry needling have focused on the rotator cuff, patellar tendon, and lateral epicondyle as tissue targets 70 . In 2020, a narrative review of the available literature on dry needling and tendinopathy noted general improvement in patient-reported symptoms with limited complications and low morbidity in most studies 70 . With regard to hamstring tendinopathy specifically, case reports have been published showing significant improvements in pain and self-reported outcomes that were sustained 6 months after the intervention 72 .…”