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: Anti-coagulants

Disqualifiers: Systemic joint disease, Cancer, Neurological disorders, Pregnancy, Others

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

Compensation: Varies

Number of Visits: 3

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether dry needling—a technique using thin needles—improves blood flow and reduces pain in people with shoulder issues. The focus is on those with persistent shoulder pain, particularly where myofascial trigger points, or tender spots in the shoulder muscle, are involved. Participants will receive either real dry needling or a sham (fake) version to compare results. This trial may suit those who experience shoulder pain without a specific injury and feel pain in certain shoulder muscle spots. As an unphased trial, it offers participants the chance to contribute to foundational research that could lead to new pain management strategies.

Do I have to stop taking my current medications for the trial?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are using anti-coagulants (medications that prevent blood clotting).

What prior data suggests that dry needling is safe for treating shoulder pain?

Research has shown that dry needling is generally safe for treating shoulder pain. Studies have found it effectively reduces pain and improves movement. For instance, one study reported a significant decrease in pain after treatment. Another study highlighted that dry needling is both safe and effective in reducing pain and disability in shoulder issues like subacromial syndrome, a type of shoulder pain. Most people tolerate dry needling well, with few reports of serious side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Most treatments for shoulder pain, like physical therapy or medication, focus on reducing inflammation or improving mobility. But dry needling works differently by directly targeting and releasing muscle trigger points, potentially reducing pain and improving function more quickly. Researchers are excited about this technique because it offers a hands-on approach that might provide relief without the need for medication. Plus, dry needling could be a great option for those who haven't had success with traditional therapies.

What evidence suggests that dry needling is effective for shoulder pain?

Research has shown that dry needling, which participants in this trial may receive, might help reduce shoulder pain. Studies indicate it can lower pain levels and make muscles less sensitive to touch compared to sham treatments, which are also being tested in this trial. Some research suggests that the pain relief from dry needling can last for several days after treatment. However, the evidence is mixed, with some studies not finding long-term benefits. Overall, dry needling might provide temporary relief for shoulder pain, but its long-term effectiveness remains uncertain. ^{2 3 4 6 7}

Who Is on the Research Team?

Jace A Brown, DPT

Principal Investigator

Texas Woman's University

Are You a Good Fit for This Trial?

This trial is for individuals aged 18-65 with unilateral shoulder pain of non-traumatic origin, a self-reported pain level of at least 2/10, and at least one myofascial trigger point in the infraspinatus muscle. It excludes those with systemic joint diseases, red flags like fractures or tumors, cancer, pregnancy, anti-coagulant use, previous shoulder surgery, immunocompromised conditions (like diabetes), repeated infections or neurological disorders.

Inclusion Criteria

I am between 18 and 65 years old and have shoulder pain rated at least 2/10.

My pain is not due to an injury.

I have a painful spot in my shoulder muscle that hurts when pressed.

Exclusion Criteria

I frequently get infections, including fevers and red skin.

I have had shoulder surgery before.

I am currently taking blood thinners.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

Participants undergo baseline assessments including demographic information, pain characteristics, and initial outcome measures such as blood flow parameters, shoulder ROMs, and PPTs.

1 visit

1 visit (in-person)

Intervention

Participants receive either real dry needling or sham dry needling to the infraspinatus muscle.

1 session

1 visit (in-person)

Immediate Post-Intervention Assessment

Outcome measures are reassessed immediately following the intervention to capture immediate changes.

Immediate

1 visit (in-person)

Follow-up

Participants are monitored for any adverse events and changes in outcome measures post-intervention.

2-4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Dry Needling
• Sham Dry Needling

Trial Overview The study tests whether dry needling can improve blood flow in the infraspinatus muscle using color Doppler imaging. Participants will also be assessed for changes in shoulder motion and pressure sensitivity post-treatment compared to sham dry needling.

How Is the Trial Designed?

Group I: Dry Needling Experimental Treatment 1 Intervention

Individuals with shoulder pain will receive dry needling to the two to four most tender points in the infraspinatus based on examiner palpation

Group II: Sham Dry Needling Placebo Group 1 Intervention

Individuals with shoulder pain will receive sham dry needling to two points in the muscle belly of the infraspinatus near the insertion and below the midpoint of the spine of the scapula

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9917679/

Clinical Effectiveness of Dry Needling in Patients with ... In general, there was low quality evidence suggesting a positive effect at mid- and long-term for neck pain, but not for shoulder pain (mid-term results were in ...

2. jospt.org jospt.org/doi/10.2519/jospt.2017.7096

The Effectiveness of Trigger Point Dry Needling for ... Studies provided evidence that dry needling may decrease pain and increase pressure pain threshold when compared to control/sham or other treatment.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0003999324007998

The Impact of Dry Needling with Electrical Stimulation on ... Conclusions. DNES may provide clinically significant improvements in pain and disability in patients with shoulder pain. However, DNES does not provide ...

4. painsa.org.za painsa.org.za/wp-content/uploads/2022/09/Dry-needling-has-lasting-analgesic-effect-in-shoulder-pain.pdf

Dry needling has lasting analgesic effect in shoulder pain Pain reduction scores were significantly different on the second day after needling and persisted so until the seventh day and were accompanied by improvement ...

5. journals.humankinetics.com journals.humankinetics.com/view/journals/jsr/30/2/article-p333.xml

The Long-Term Effectiveness of Trigger Point Dry Needling ... Strength of Recommendation. Grade A evidence exists that TDN with exercise is no more effective than exercise alone at reducing pain long term.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8240781/

Dry needling has lasting analgesic effect in shoulder pain Results: Dry needling led to significant larger pain intensity reduction (from 6.30 ± 2.05 to 2.40 ± 2.45 in the active group; P = 0.02, effect size = −1.3 (95 ...

7. ijspt.scholasticahq.com ijspt.scholasticahq.com/article/35693-dry-needling-a-clinical-commentary

Dry Needling: A Clinical Commentary Outcomes. A systematic review and meta-analysis by Gattie et al16 revealed that dry needling is more effective for reducing pain and improving ...