Dry Needling for Shoulder Pain

Overseen By Sharon Wang-Price, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Texas Woman's University

Must not be taking: Anticoagulants

Disqualifiers: Arthritis, Neurological disease, Cancer, others

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

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

30 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking a blood thinner.

What data supports the effectiveness of the treatment Dry Needling for Shoulder Pain?

Research shows that dry needling can help reduce pain and improve movement in people with shoulder pain, especially when used alongside other treatments like physical therapy. However, one study found that dry needling did not provide extra benefits when added to personalized physical therapy for nonspecific shoulder pain. ^{1 2 3 4 5}

Is dry needling generally safe for humans?

Dry needling is generally well tolerated, but mild adverse events can occur, and there are rare reports of severe complications like spinal epidural hematoma. It's important for practitioners to screen patients for underlying conditions and take precautions, especially when needling near sensitive areas like the spine. ^{6 7 8 9 10}

How is dry needling treatment different for shoulder pain?

Dry needling is unique because it involves inserting thin needles into specific muscle areas called myofascial trigger points to relieve pain, unlike other treatments that may use medication or physical therapy alone. It is particularly used for short-term pain relief and improved function in shoulder injuries, especially in athletes during competitive phases. ^{1 4 11 12 13}

What is the purpose of this trial?

Segmental facilitation, originally proposed by Korr in the 1950s, suggests that certain spinal segments can become hyperexcitable, leading to chronic pain development. In a facilitated segment, neurons governing sensory, motor, and autonomic functions are in a state of heightened sensitivity, making them responsive to normally weak stimuli. Clinical signs include non-fatigable muscle weakness, brisk reflexes, muscle hypertonicity, tenderness upon palpation, and trophic changes like an orange-peel appearance in the affected segment's innervated areas. It's hypothesized that increased synaptic excitability in facilitated segments could cause vasoconstriction and reduced blood flow, contributing to trophic changes and muscle hypertonicity. Manual therapies like dry needling have been shown to alleviate muscle inhibition in the extremities. Previous studies have demonstrated that mobilization of the C5-6 joint can reduce non-fatigable weakness in shoulder external rotators primarily innervated by these segments. However, the neurophysiological effects of dry needling (DN) on muscle inhibition due to a facilitated segment remain unclear. While DN has been observed to increase local tissue blood flow, its potential to mitigate the clinical signs of segmental facilitation is uncertain. While DN has been observed to increase local tissue blood flow, its potential to mitigate the clinical signs of segmental facilitation is uncertain. Therefore, this project aims to investigate whether DN applied at a facilitated segment could normalize blood flow to its associated muscles. Specifically, this study will explore whether DN at the C5-6 level improves blood flow in the infraspinatus muscle, enhances shoulder range of motion, and influences muscle strength over time. The secondary purpose is to determine whether C5-6 DN will reduce the number of tender points in the muscles supplied by C5-6.

Eligibility Criteria

This trial is for individuals experiencing shoulder and neck pain, possibly due to hyperexcitable spinal segments. Participants should have signs like muscle weakness, brisk reflexes, or tenderness in the neck area. Those with conditions that might interfere with dry needling or who cannot commit to the study duration are likely excluded.

Inclusion Criteria

I have pain in at least one of the specified muscles near my neck or shoulder.

I experience neck or shoulder pain averaging 2 or more out of 10.

Exclusion Criteria

I have cancer.

I have had surgery on my neck before.

Currently pregnant

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 visit

1 visit (in-person)

Pre-intervention Assessment

Participants undergo assessments for blood flow, shoulder range of motion, and shoulder external rotation strength

1 visit

1 visit (in-person)

Dry Needling Intervention

Participants receive dry needling at the C5-C6 multifidus of the cervical spine

1 visit

1 visit (in-person)

Post-intervention Assessment

Participants are assessed for changes in blood flow, shoulder range of motion, number of tender points, and shoulder external rotation strength

1 visit

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the intervention

4 weeks

Treatment Details

Interventions

• Dry Needling

Trial Overview The trial tests if Dry Needling (DN) at the C5-6 spinal level can improve blood flow to muscles, increase shoulder movement and strength, and reduce pain over time. It also looks at whether DN decreases tender points in affected muscles.

Participant Groups

Group I: Experimental: Individuals with neck-shoulder pain Experimental Treatment 1 Intervention

Individuals with neck-shoulder pain will receive dry needling to C5-C6 multifidus of the cervical spine.

Dry Needling is already approved in United Kingdom, United States for the following indications:

Approved in United Kingdom as Dry Needling for:

• Knee osteoarthritis pain management
• Muscle strength improvement
• Leg function enhancement

Approved in United States as Dry Needling for:

• Chronic knee pain relief
• Musculoskeletal pain management
• Myofascial pain syndrome treatment

Who Is Running the Clinical Trial?

Texas Woman's University

Lead Sponsor

Trials

90

Recruited

5,900+

Findings from Research

Dry needling of myofascial trigger points (MTrPs) is effective for reducing neck and shoulder pain in the short term (up to 3 days) and medium term (up to 28 days), based on a meta-analysis of 20 randomized controlled trials involving 839 patients.

However, wet needling (which includes the use of lidocaine) was found to be more effective than dry needling for relieving MTrP pain in the medium term, suggesting that while dry needling is beneficial, other treatments may provide better outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Liu, L., Huang, QM., Liu, QG., et al.[2022]

A study involving 39 patients with shoulder impingement syndrome showed that both dry needling (DN) and muscle energy technique (MET) effectively reduced pain and improved shoulder range of motion (ROM) over three treatment sessions.

While all treatment groups experienced significant improvements, dry needling was particularly more effective in enhancing shoulder flexion and abduction compared to MET alone.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of dry needling & muscle energy technique separately and in combination in patients suffering shoulder impingement syndrome and active trigger points of infraspinatus. Jalilipanah, P., Okhovatian, F., Serri, RA., et al.[2021]

In a randomized controlled trial involving 88 patients with shoulder adhesive capsulitis, intramuscular electrical stimulation (IMES) combined with therapeutic exercises showed significantly greater improvements in shoulder pain severity, disability, and range of motion compared to dry needling (DN) combined with therapeutic exercises.

Both treatment groups experienced significant improvements in pain and function, but IMES did not reach the minimal clinically important differences for pain and disability scores, indicating that while effective, further improvements may be needed for optimal patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intramuscular Electrical Stimulation Combined with Therapeutic Exercises in Patients with Shoulder Adhesive Capsulitis: A Randomised Controlled Trial. Shanmugam, S., Mathias, L., Manickaraj, N., et al.[2022]

In a study involving 120 patients with nonspecific shoulder pain, the addition of dry needling to personalized physical therapy did not show any significant benefits compared to physical therapy alone.

Both treatment groups experienced improvements over time, indicating that personalized physical therapy is effective on its own for managing shoulder pain, while dry needling did not enhance these outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. Pérez-Palomares, S., Oliván-Blázquez, B., Pérez-Palomares, A., et al.[2022]

Moderate-quality evidence indicates that trigger point (TrP) dry needling can reduce shoulder pain intensity with a small effect, based on a meta-analysis of 6 randomized clinical trials involving various participants.

There is low-quality evidence suggesting that TrP dry needling significantly improves pain-related disability, showing a large effect, although these benefits are primarily observed in the short term.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Navarro-Santana, MJ., Gómez-Chiguano, GF., Cleland, JA., et al.[2021]

In a study involving 39 physiotherapists and 7629 treatments, trigger point dry needling (TrP-DN) was found to have a high incidence of mild adverse events (AEs), with 1463 reported cases, but no significant AEs occurred, indicating a very low risk of serious complications (≤ 0.04%).

Common mild AEs included bruising (7.55%) and bleeding (4.65%), but the overall safety profile suggests that TrP-DN is a safe treatment option for myofascial pain when performed by trained physiotherapists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Brady, S., McEvoy, J., Dommerholt, J., et al.[2022]

This study will evaluate the effectiveness of combining dry needling with manual physiotherapy and therapeutic exercise for treating chronic shoulder pain in 36 participants over 6 weeks, with a follow-up period of 6 months.

The main outcome measure will be pain reduction assessed using the Visual Analogue Scale, aiming to provide new insights into the treatment of chronic shoulder pain associated with myofascial trigger points.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial. Tejera-Falcón, E., Toledo-Martel, NDC., Sosa-Medina, FM., et al.[2018]

Dry needling is generally safe and well tolerated for treating myofascial pain, but there is a risk of severe complications, such as an acute spinal epidural hematoma, as highlighted in this case report.

Healthcare providers should exercise caution when performing dry needling near the spine, and any sudden neuropathic pain following the procedure should be evaluated immediately with advanced imaging to ensure spinal cord integrity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute Spinal Epidural Hematoma as a Complication of Dry Needling: A Case Report. Berrigan, WA., Whitehair, CL., Zorowitz, RD.[2020]

Myofascial trigger points are linked to various systemic and psychological factors, making it essential for clinicians to thoroughly screen patients for underlying conditions before using dry needling as a treatment.

Clinicians should be aware of specific medical conditions and comorbidities that could affect the safety and efficacy of dry needling, including those that may present with similar symptoms to musculoskeletal issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New perspectives on dry needling following a medical model: are we screening our patients sufficiently? Kearns, G., Fernández-De-Las-Peñas, C., Brismée, JM., et al.[2020]

In a study involving 40 overhead athletes, combining dry needling (DN) with manual therapy (MT) significantly reduced pain and disability while improving scapular dyskinesia compared to MT alone.

The treatment group experienced substantial improvements in pain and function (P < 0.05), while no adverse effects were reported, highlighting DN as a safe and effective method for treating shoulder dysfunctions in athletes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison between dry needling plus manual therapy with manual therapy alone on pain and function in overhead athletes with scapular dyskinesia: A randomized clinical trial. Kheradmandi, A., Kamali, F., Ebrahimian, M., et al.[2021]

A single session of dry needling targeting both a latent and an active myofascial trigger point in the infraspinatus muscle significantly reduced pain intensity and increased pressure pain threshold in older adults with nonspecific shoulder pain.

The treatment showed benefits immediately and one week post-intervention, but did not result in significant improvements in grip strength, indicating its primary efficacy in pain management rather than functional strength.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial. Calvo-Lobo, C., Pacheco-da-Costa, S., Martínez-Martínez, J., et al.[2022]

A study involving 57 volunteers with unilateral subacromial pain syndrome showed that dry needling the infraspinatus muscle significantly improved pain sensitivity and shoulder range of motion (ROM) in the affected shoulder, with benefits observed 3-4 days post-treatment.

While participants reported increased pressure pain thresholds and improved internal rotation and horizontal adduction ROM, there were no significant changes in muscle thickness, indicating that dry needling may primarily affect pain and mobility rather than muscle function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome. Koppenhaver, S., Embry, R., Ciccarello, J., et al.[2022]

Dry needling of scapulohumeral muscles in four international female volleyball athletes resulted in significant short-term improvements in range of motion, strength, and pain relief during a month of intense competition.

The treatment allowed athletes to continue overhead activities without pain, suggesting that dry needling can effectively support shoulder injury management in elite athletes during competitive phases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Management of shoulder injuries using dry needling in elite volleyball players. Osborne, NJ., Gatt, IT.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

The effect of dry needling & muscle energy technique separately and in combination in patients suffering shoulder impingement syndrome and active trigger points of infraspinatus. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Intramuscular Electrical Stimulation Combined with Therapeutic Exercises in Patients with Shoulder Adhesive Capsulitis: A Randomised Controlled Trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Acute Spinal Epidural Hematoma as a Complication of Dry Needling: A Case Report. [2020]

9. England pubmed.ncbi.nlm.nih.gov

New perspectives on dry needling following a medical model: are we screening our patients sufficiently? [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Comparison between dry needling plus manual therapy with manual therapy alone on pain and function in overhead athletes with scapular dyskinesia: A randomized clinical trial. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial. [2022]

12. Scotland pubmed.ncbi.nlm.nih.gov

Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome. [2022]

13. England pubmed.ncbi.nlm.nih.gov

Management of shoulder injuries using dry needling in elite volleyball players. [2022]