Interventions to Reduce Soreness After Dry Needling: A Systematic Review

Abstract

OBJECTIVE: To evaluate the effects of interventions to reduce soreness after dry needling. METHODS: This review was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. It was registered on PROSPERO. ELIGIBILITY CRITERIA: Our search included randomized controlled trials (RCTs), published in English, that evaluated interventions to reduce soreness in people after dry needling against a comparative group, and had a primary outcome of pain. Trials including postsurgical populations were excluded to minimize confounding of etiology of patients’ pain. DATA SOURCES: We searched MEDLINE, Embase, and Cochrane CENTRAL from database inception to October 26, 2023, using truncated key words and MeSH (Medical Subject Headings) terms. RISK OF BIAS: Two authors assessed each trial with the Cochrane Risk of Bias 2.0 tool. RESULTS: A total of 8 RCTs including 534 participants were included. Two RCTs evaluating exercise demonstrated that low-load eccentric exercise significantly reduced post-DN soreness, while the other, evaluating isometric vs concentric vs eccentric exercises, did not. Additionally, RCTs evaluating concomitant percutaneous neuromodulation therapy, spray and stretch, and ischemic compression all significantly decreased post-DN soreness compared to placebo. Kinesio taping and verbal suggestions regarding postprocedural soreness had evidence of no effect on post-DN soreness compared to placebo. Meta-analysis was not performed due to clinical heterogeneity. CONCLUSIONS: There was limited evidence to guide decision-making for clinicians when seeking to decrease post-DN soreness. Four RCTs described positive results of various interventions to decrease post-DN soreness; the results have not been examined in subsequent trials. Low-load eccentric exercise, percutaneous neuromodulation therapy, spray and stretch, and ischemic compression compared favorably to placebo and may benefit from additional study. JOSPT Open 2024;2(3):194-201. Epub 2 April 2024. doi:10.2519/josptopen.2024.0610