Effects of Dry Needling for Neck Pain – Medical Article

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Written By Dr. Carlos Roberto Babá

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

A new literature review examines the effects of trigger point dry needling on neck pain in adults. The author of the review is Grace Truesdale, an undergraduate student at Western Washington University. She conducted the review as part of her senior capstone project for the Honors College[1]Truesdale G. The Effects of Trigger Point Dry Needling on Neck Pain in Adults: A Review..

The impetus for the review stems from the high prevalence of neck pain worldwide, which is estimated to impact over 220 million individuals. Neck pain can greatly impact people’s daily lives and lead to lost productivity if left untreated. One potential treatment is trigger point dry needling, which involves inserting thin needles into trigger points in muscles to release them.

Truesdale reviewed 19 studies on dry needling for neck pain to synthesize the current evidence. The studies used varying methodologies but most cited the technique established by Hong in 1994. This involves moving the needle in and out of the skin over a trigger point without fully removing it to elicit local twitch responses. Outcome measures included pain levels, range of motion, and pressure pain thresholds.

The review found that many studies reported dry needling effectively reduced pain and improved range of motion both short and long-term. It was more effective than passive stretching alone in some studies. However, other studies found it equally effective as manual therapies or sham needling. Limitations include small sample sizes, differences in therapist techniques, and minimal long-term data.

Overall, Truesdale concluded that despite some contradictory findings, dry needling should be considered as a treatment option for neck pain in adults. More research is still needed, especially larger studies examining long-term impacts. But the current evidence suggests it can provide pain relief when applied properly by a trained professional.

A preliminary randomized, sham-controlled study found that previous experience with dry needling influenced blinding effectiveness and pain outcomes in patients with neck pain[1]. Another study suggested that stress-induced analgesia, produced by the activation of the sympathetic nervous system, could be a possible antalgic mechanism of the dry needling technique[2].

A systematic review and meta-analysis comparing dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome found that both techniques improved pain and function in the short to medium term, with neither being more superior than the other[4]. Another systematic review and meta-analysis found that combining dry needling with other physical therapy interventions was effective in improving pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion in people with neck pain associated with trigger points at short-term, but no midterm or long-term effects were observed[5].

A 2015 meta-analysis concluded that dry needling can be recommended for relieving myofascial trigger point pain in the neck and shoulders in the short and medium term, but wet needling was found to be more effective than dry needling in the medium term[6].

Key takeaways

  • Neck pain impacts over 220 million people globally and poses economic and productivity issues if untreated
  • Myofascial trigger points (MTrPs) contribute to neck pain; releasing them through dry needling can reduce pain
  • Dry needling involves inserting a thin needle into the skin to target a trigger point and move the needle to release it
  • Outcome measures tracked in studies include pain intensity, pressure pain threshold (PPT), range of motion (ROM)
  • Many studies found dry needling effective at reducing neck pain and improving PPT, ROM short- and long-term
  • Dry needling was more effective than passive stretching alone and manual trigger point compression alone
  • Some studies found dry needling equally effective as manual therapies and sham needling
  • Limitations: small sample sizes, differences in therapist technique, limited long-term data
  • Potential harms: soreness, bleeding; more serious injury possible but avoidable with proper technique

Key study questions and answers:

Study QuestionAnswer
Is dry needling an effective treatment for reducing neck pain?Many studies found dry needling effectively reduced neck pain intensity and improved range of motion and pressure pain threshold, both short- and long-term.
Is dry needling more effective than other therapies?Some studies found dry needling more effective than passive stretching alone and manual trigger point compression alone. Others found it equally effective as manual therapies and sham needling.
What are the potential harms of dry needling?Common harms are local soreness and bleeding, but more serious injury is possible if improper technique is used.
What are limitations of the research?Small sample sizes, differences in therapist technique, and limited long-term data.

The Importance and Mechanisms of Dry Needling for Neck Pain

Neck pain is a highly prevalent condition worldwide, with over 220 million cases estimated globally. It can greatly impact individuals’ daily functioning and productivity. Myofascial trigger points contribute to neck pain, and releasing them through dry needling has been shown to provide pain relief.

Mechanisms of Dry Needling

  • Involves inserting thin, filiform needles into myofascial trigger points in muscles
  • Goal is to elicit local twitch responses to release trigger points
  • Repeatedly move needle in and out of skin over trigger point without fully removing
  • Most studies cited technique established by Hong in 1994

Possible Mechanisms of Dry Needling for pain relief

Several possible mechanisms have been proposed to explain the effectiveness of dry needling in treating myofascial pain, including neck pain. Some of these mechanisms include:

  1. Local twitch response: Dry needling can elicit a local twitch response, which is an involuntary spinal cord reflex contraction of the muscle fibers in the taut band of the muscle. This response is thought to disrupt the vicious cycle of pain, muscle spasm, and muscle ischemia, leading to pain relief3.
  2. Release of biochemicals: Dry needling has been shown to modulate various biochemicals associated with pain, inflammation, and hypoxia. In an animal study, dry needling at the myofascial trigger spots of rabbit biceps femoris muscles led to changes in these biochemicals, suggesting a potential mechanism for pain control4.
  3. Neurophysiological effects: Dry needling has been found to exert neurophysiological effects that can activate pain modulation mechanisms. Spinal manipulative therapy, which includes dry needling, has been shown to have an impact on the central nervous system, leading to pain relief5.
  4. Peripheral and central sensitization: Chronic myofascial pain syndromes, including neck pain, have been associated with peripheral and central sensitization mechanisms. Dry needling may help modulate these sensitization processes, leading to pain relief6.
  5. Changes in muscle tissue: Ultrasound imaging and elastography have shown abnormalities in the muscle tissue containing palpable myofascial trigger points. Dry needling may help address these abnormalities, contributing to pain relief7.

Outcomes Assessed in Studies

  • Pain intensity, often measured on 0-10 visual analog scale (VAS)
  • Pressure pain threshold (PPT) measured in kg/cm2 or other units
  • Range of motion (ROM) measured via cervical lateral flexion, rotation, etc.
  • Muscle stiffness measured via shear wave elastography

Review of Select Studies

Mejuto-Vázquez et al. (2014):

  • 17 patients with neck pain randomized to dry needling (n=9) or control (n=8)
  • Single session of dry needling in upper trapezius
  • Significant improvements in VAS pain, PPT, and cervical ROM at 10 min and 1 week vs control

Cerezo-Téllez et al. (2016):

  • 128 patients randomized to dry needling + stretching (n=64) or stretching alone (n=64)
  • Up to 4 sessions of dry needling in upper trapezius trigger points
  • Dry needling group had significant increases in active ROM through 6 months

Hakim et al. (2019):

  • 26 patients with chronic neck pain randomized to two dry needling groups
  • 3 sessions of dry needling in upper trapezius
  • Both methods improved VAS pain, PPT, lateral flexion ROM at 4 weeks
  • Needling without eliciting twitch more effective

Overall, studies support dry needling as an important therapeutic technique for managing neck pain and associated disability.

Common Muscles treated

Common muscles treated for neck pain include the cervical flexor muscles, cervical extensor muscles, and the subscapularis muscle.

  1. Cervical flexor muscles: These muscles are responsible for flexing the neck and include the longus capitis, longus colli, and the anterior scalene muscles. Dysfunction or tightness in these muscles can contribute to neck pain and limited range of motion1.
  2. Cervical extensor muscles: These muscles extend the neck and include the splenius capitis, splenius cervicis, semispinalis capitis, and the upper trapezius muscles. Imbalances or tightness in these muscles can also contribute to neck pain and restricted movement1.
  3. Subscapularis muscle: Although not directly located in the neck, the subscapularis muscle is part of the rotator cuff and can contribute to neck pain when it becomes tight or dysfunctional. Myofascial pain syndrome involving the subscapularis muscle can cause atypical chest pain and neck pain7.

Treatment for neck pain often targets these muscles through various techniques, such as myofascial release, neurodynamics, and trigger point therapy.


In summary, dry needling appears to be effective in treating neck pain associated with myofascial trigger points, particularly in the short and medium term. However, the effectiveness of dry needling may vary depending on the specific technique used, the combination with other therapies, and the individual patient’s experience with the intervention.

Further research is needed to determine the optimal approach for using dry needling to treat neck pain and to better understand the underlying mechanisms of its effectiveness.

[1] https://pubmed.ncbi.nlm.nih.gov/35085999/
[2] https://www.semanticscholar.org/paper/ec9b364620a28ed19f861a016d4d71feefb02446
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9718692/
[4] https://pubmed.ncbi.nlm.nih.gov/32962567/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872772/
[6] https://pubmed.ncbi.nlm.nih.gov/25576642/
[7] https://www.semanticscholar.org/paper/c40b4ff63b5196eda988dc87676c7e4db804474e
[8] https://pubmed.ncbi.nlm.nih.gov/33740346/
[9] https://www.semanticscholar.org/paper/06724eecce3485bd97c3460f3094bb7bd617e219
[10] https://www.semanticscholar.org/paper/b297456b6540a0848d9aba04b8fea4cc8baf4e32
[11] https://pubmed.ncbi.nlm.nih.gov/31775405/
[12] https://pubmed.ncbi.nlm.nih.gov/34114639/
[13] https://pubmed.ncbi.nlm.nih.gov/30893405/
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873236/
[15] https://www.semanticscholar.org/paper/0db4d3723d5c2001c320433ac6d8b07b7db7d775
[16] https://www.semanticscholar.org/paper/9f6b2d5273ca483fa39d21e72867fc2df74bf1c4
[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355914/
[18] https://pubmed.ncbi.nlm.nih.gov/25269764/
[19] https://pubmed.ncbi.nlm.nih.gov/25768071/
[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374203/

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M.D. Orthopaedic Pain Management - University of São Paulo


1Truesdale G. The Effects of Trigger Point Dry Needling on Neck Pain in Adults: A Review.

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