Dry Needling vs. Standard Therapy for Tennis Elbow

Overseen By James Dunning, DPT PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Alabama Physical Therapy & Acupuncture

Disqualifiers: Hypertension, Diabetes, Heart disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 4 weeks

110 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine which treatment more effectively relieves pain from tennis elbow, also known as medial epicondylalgia. It compares two strategies: one involves manual therapy, exercise, and ultrasound, while the other includes electric dry needling (a technique using thin needles). The trial seeks participants who have experienced elbow pain for at least six weeks, have not received certain treatments for it in the last six months, and exhibit specific pain patterns. Participants must not have undergone elbow surgery or have certain other medical conditions. As an unphased trial, this study offers participants the chance to explore innovative pain relief strategies for tennis elbow.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that dry needling is generally safe for treating conditions like tennis elbow. One study found that participants who tried dry needling experienced better results after six months compared to those who used ibuprofen and a forearm brace, indicating it is well-tolerated. Another study suggested that dry needling can help reduce pain and improve movement in elbow issues.

In contrast, manual therapy, exercise, and ultrasound are already common treatments for elbow pain. Physical therapists often use these methods to help with pain and movement, and they are generally considered safe.

Both treatment options in the study have been used before and have good safety records. Participants can feel confident about the safety of the treatments being tested. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about the potential of electric dry needling combined with manual therapy, exercise, and ultrasound for treating tennis elbow. Unlike standard treatments that typically involve just physical therapy and ultrasound, this approach introduces electric dry needling, which targets trigger points in the muscle tissue to relieve pain and improve function more directly. By integrating this technique, the treatment could enhance muscle relaxation and accelerate recovery, offering a promising alternative to conventional methods.

What evidence suggests that this trial's treatments could be effective for tennis elbow?

Research has shown that dry needling can reduce pain and improve movement in conditions like tennis elbow. Studies have found that patients experience less pain and have a stronger grip after dry needling. This trial will compare two treatment approaches: one group will receive a combination of manual therapy, exercise, ultrasound, and electric dry needling, while the other group will receive manual therapy, exercise, and ultrasound without dry needling. Combining these treatments with dry needling may provide the experimental group with even better relief from elbow pain and improved overall function. ^{1 2 3 6 7}

Who Is on the Research Team?

James Dunning, DPT PhD

Principal Investigator

American Academy of Manipulative Therapy

Are You a Good Fit for This Trial?

This trial is for adults aged 18-60 with medial epicondylalgia (tennis elbow) pain for at least 6 weeks, who haven't had related treatments in the past 6 months. Participants must speak English and have a specific diagnosis of medial epicondylalgia. Pregnant individuals or those with certain medical conditions like severe hypertension, diabetes, heart disease, previous elbow surgery or injuries are excluded.

Inclusion Criteria

I haven't had treatments like physical therapy for elbow pain in the last 6 months.

I have been diagnosed with pain on the inside of my elbow, worsened by certain wrist and forearm movements.

I have had elbow and forearm pain for at least 6 weeks.

Exclusion Criteria

I have had issues with my joints, ligaments, or nerves in my elbow.

I have had elbow surgery, dislocation, fracture, or tendon rupture in the past.

I have nerve or spinal issues, including recent severe neck or back injuries.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either manual therapy, exercise, and ultrasound or manual therapy, exercise, ultrasound, and electric dry needling

4 weeks

8 treatments (2 treatments per week)

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

What Are the Treatments Tested in This Trial?

Interventions

• Manual Therapy, Exercise and Ultrasound
• Manual Therapy, Exercise, Ultrasound and Electric Dry Needling

Trial Overview The study compares two treatment strategies for tennis elbow: one group receives manual therapy, exercise and ultrasound; another group gets these plus electric dry needling. The goal is to determine if adding electric dry needling improves outcomes.

How Is the Trial Designed?

Group I: Experimental: Electric DN, Manual therapy, exercise and US Experimental Treatment 1 Intervention

Dry needling, manual therapy, exercise and ultrasound

Group II: Active comparator: Manual therapy, exercise and ultrasound Active Control 1 Intervention

Active comparator: Manual therapy, exercise and ultrasound

Who Is Running the Clinical Trial?

Alabama Physical Therapy & Acupuncture

Lead Sponsor

Trials

15

Recruited

2,200+

Universidad Rey Juan Carlos

Collaborator

Trials

137

Recruited

10,300+

Published Research Related to This Trial

In a study of 78 patients with lateral epicondylitis, both Kinesio Taping (KT) and dry needling (DN) showed significant short- and long-term improvements in pain, functionality, and muscle strength compared to exercise alone.

Dry needling was found to be more effective than Kinesio Taping in improving clinical parameters and tendon characteristics, as measured by ultrasonography, indicating it may be the preferred treatment option for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The comparison of the effectiveness of Kinesio Taping and dry needling in the treatment of lateral epicondylitis: a clinical and ultrasonographic study. Altaş, EU., Birlik, B., Şahin Onat, Ş., et al.[2022]

In a study of 62 participants with chronic lateral epicondylosis, ultrasound-guided dry needling showed similar effectiveness to open-release surgery in reducing pain and improving function, with no adverse events reported.

Both treatments had high success rates (83% for surgery and 81% for dry needling), suggesting that dry needling could be a viable first-line treatment option before considering surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of chronic lateral epicondylosis: a randomized trial comparing the efficacy of ultrasound-guided tendon dry needling and open-release surgery. Bureau, NJ., Tétreault, P., Grondin, P., et al.[2023]

In a study of 80 patients with lateral epicondylitis (tennis elbow), local steroid injections (triamcinolone acetate) provided significantly quicker pain relief and functional improvement compared to therapeutic ultrasound over a two-week period.

Patients receiving steroid injections reported almost complete pain relief and tenderness reduction within one week, while those receiving ultrasound showed only mild to moderate improvements, highlighting the superior efficacy of steroid injections for immediate treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Efficacy of Local Steroid and Therapeutic Ultrasound for Quicker Functional Improvement in Tennis Elbow. Rahman, MS., Salek, AK., Ullah, MA.[2019]

A 40-year-old retired elite athlete with chronic elbow pain experienced significant improvement in pain and disability after just one session of dry needling, marking a successful intervention after two years of ineffective treatments.

This case highlights the potential of dry needling as an effective therapy for conditions like Golfer's elbow, especially when other therapies have failed to provide relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute effects of one session dry needling on a chronic golfer's elbow disability. Shariat, A., Noormohammadpour, P., Memari, AH., et al.[2020]

Dry needling significantly reduces pain intensity and related disability in patients with lateral epicondylalgia, showing large effect sizes in a meta-analysis of 7 studies involving 320 patients.

The treatment also improves pressure pain thresholds and grip strength, particularly showing the most significant benefits in the short term, although the overall evidence quality was downgraded due to variability in results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of trigger point dry needling on lateral epicondylalgia of musculoskeletal origin: a systematic review and meta-analysis. Navarro-Santana, MJ., Sanchez-Infante, J., Gómez-Chiguano, GF., et al.[2022]

In a study of 58 patients with tennis elbow, low-level laser therapy (LLLT) was found to be more effective than brace or ultrasound treatments in improving grip strength after treatment, although all methods reduced pain severity.

While all treatment groups showed significant pain reduction, the brace treatment had a shorter beneficial effect compared to ultrasound and laser therapy, indicating that LLLT may provide longer-lasting benefits for grip strength.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. Oken, O., Kahraman, Y., Ayhan, F., et al.[2015]

In a study of 76 patients with lateral epicondylitis, those receiving ultrasound treatment showed a significant improvement in recovery (63% improvement) compared to only 29% in the placebo group, indicating the efficacy of ultrasound therapy.

Patients treated with ultrasound also demonstrated better outcomes in specific clinical measures such as pain score, weight lifting ability, and grip strength, highlighting the therapeutic benefits of ultrasound in managing this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is therapeutic ultrasound effective in treating soft tissue lesions? Binder, A., Hodge, G., Greenwood, AM., et al.[2019]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38484834/

Therapeutic Effects of Dry Needling on Lateral Epicondylitis Dry needling demonstrates good therapeutic effects on pain intensity (within 1 week), function, and grip strength among patients with ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11378533/

Effectiveness of dry needling to treat lateral epicondylosis This study presents the use of dry needling (DN) as an intervention to support functional rehabilitation for an adult diagnosed with lateral epicondylosis.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT03167710

Dry Needling, Manipulation and Stretching vs. Manual ... The purpose of this research is to compare two different approaches for treating patients with lateral epicondylalgia: electric dry needling, thrust ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1556370721000316

Comparative Effect of Dry Needling and Neural ... This study protocol will provide data regarding the effects of dry needling and neural mobilization in people with lateral epicondylitis.

5. journals.sagepub.com journals.sagepub.com/doi/10.1177/02692155241249968

Percutaneous tendon dry needling and thrust ... The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, ...

6. jospt.org jospt.org/doi/10.2519/jospt.2022.0302

Lateral Elbow Pain and Muscle Function Impairments Clinicians should use either tendon or trigger point dry needling for the treatment of pain and functional deficits associated with LET.

7. sciencedirect.com sciencedirect.com/science/article/pii/S1877056819302609

Review article Management of lateral epicondylitis A randomised trial found better 6-month outcomes after dry needling of the painful epicondylar area than after ibuprofen and forearm bracing [54]. An ...