07/04/2026
This article highlights that physiotherapy, including manual therapy and exercise, works. However, when real acupuncture is added, patients may experience improved short–mid term outcomes and are ~65% less likely to need further shoulder-related care compared to sham or no acupuncture.
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📖 https://www.jospt.org/doi/10.2519/jospt.2025.13460
■■ 𝗗𝗼𝗲𝘀 𝗗𝗿𝘆 𝗡𝗲𝗲𝗱𝗹𝗶𝗻𝗴 𝗔𝗰𝘁𝘂𝗮𝗹𝗹𝘆 𝗛𝗲𝗹𝗽 𝗦𝗵𝗼𝘂𝗹𝗱𝗲𝗿 𝗣𝗮𝗶𝗻?𝗔 𝗗𝗲𝗲𝗽 𝗗𝗶𝘃𝗲 𝗶𝗻𝘁𝗼 𝗮 𝗡𝗲𝘄 𝗦𝗵𝗮𝗺-𝗖𝗼𝗻𝘁𝗿𝗼𝗹𝗹𝗲𝗱 𝗧𝗿𝗶𝗮𝗹
⬛ Subacromial pain syndrome (SAPS) is a common shoulder condition typically managed without surgery.
⬛ The recommended first-line interventions usually involve a combination of therapeutic exercise and manual therapy such as joint and soft-tissue mobilizations.
⬛ However, many physical therapists also use dry needling—a technique where thin monofilament needles are inserted into symptom-generating soft tissues—to help treat this condition.
⬛ Despite its popularity, the true value of dry needling for SAPS has remained heavily debated.
⬛ A rigorous new randomized clinical trial published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) by Benjamin R. Hando and colleagues aimed to settle this by investigating whether adding dry needling to a standard physical therapy program actually improves clinical outcomes.
⬛ Here is a thorough breakdown of the research, its findings, and what it means for treating shoulder pain.
■■ 𝗧𝗵𝗲 𝗦𝘁𝘂𝗱𝘆 𝗗𝗲𝘀𝗶𝗴𝗻
🧪 The researchers conducted a three-arm, randomized controlled trial involving 121 participants seeking care for a new episode of shoulder pain at a U.S. Air Force hospital in Texas.
⬛ Participants were divided into three treatment groups:
1. 𝗣𝗧 𝗢𝗻𝗹𝘆
⬛ Standard physical therapy consisting of exercise and manual therapy.
2. 𝗣𝗧 + 𝗦𝗵𝗮𝗺 𝗗𝗿𝘆 𝗡𝗲𝗲𝗱𝗹𝗶𝗻𝗴 (𝗣𝗧+𝗦𝗗𝗡)
⬛ Standard physical therapy plus a "fake" dry needling procedure that utilized a guide tube and a wooden toothpick instead of an actual needle.
3. 𝗣𝗧 + 𝗗𝗿𝘆 𝗡𝗲𝗲𝗱𝗹𝗶𝗻𝗴 (𝗣𝗧+𝗗𝗡)
⬛ Standard physical therapy plus actual dry needling targeting trigger points in the shoulder and neck, most commonly the infraspinatus, supraspinatus, teres minor, and upper trapezius muscles.
⬛ Patients received between 8 and 12 therapy sessions over a 6-week period.
🔬 Crucially, the sham procedure was highly successful at keeping patients blinded.
⬛ 89% of the participants in the sham group and 92% in the real dry needling group believed they had received the actual dry needling treatment.
⬛ This protects the study against the placebo effect, isolating the true physical impact of the needles.
■■ 𝗧𝗵𝗲 𝗠𝗮𝗶𝗻 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗔 𝗠𝗶𝘅𝗲𝗱 𝗣𝗶𝗰𝘁𝘂𝗿𝗲
⬛ The primary measure of success for this study was the Shoulder Pain and Disability Index (SPADI) evaluated at 1 year post-enrollment.
🔎 𝗧𝗵𝗲 𝗣𝗿𝗶𝗺𝗮𝗿𝘆 𝗢𝘂𝘁𝗰𝗼𝗺𝗲
⬛ Overall, adding dry needling to an evidence-based manual therapy and exercise program did not result in statistically significant improvements in SPADI scores at 1 year compared to the other groups.
⬛ While patients in all groups saw substantial improvements by the 6-week mark, the addition of needles did not give the PT+DN group a statistically definitive edge in overall shoulder disability.
■■ 𝗧𝗵𝗲 𝗦𝗲𝗰𝗼𝗻𝗱𝗮𝗿𝘆 𝗢𝘂𝘁𝗰𝗼𝗺𝗲𝘀 (𝗪𝗵𝗲𝗿𝗲 𝘁𝗵𝗶𝗻𝗴𝘀 𝗴𝗲𝘁 𝗶𝗻𝘁𝗲𝗿𝗲𝘀𝘁𝗶𝗻𝗴)
⭐ While the primary disability scores didn't show a massive difference, the secondary outcomes heavily favored the real dry needling group.
🩹 𝗣𝗮𝗶𝗻 𝗜𝗻𝘁𝗲𝗿𝗳𝗲𝗿𝗲𝗻𝗰𝗲
⬛ Participants in the dry needling group reported significantly less pain interference at both 6 months and 1 year compared to the PT Only group.
🏃 𝗣𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝗙𝘂𝗻𝗰𝘁𝗶𝗼𝗻
⬛ The dry needling group showed significantly better physical function scores at 6 weeks and 6 months, though this difference leveled out by the 1-year mark.
🙂 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 𝗦𝗮𝘁𝗶𝘀𝗳𝗮𝗰𝘁𝗶𝗼𝗻
⬛ The researchers used the Patient Acceptable Symptom State (PASS) to ask patients if they considered their current state satisfactory.
⬛ At 6 months and 1 year, over 80% of the dry needling group responded "yes"—a significantly greater proportion than both comparison groups.
🏥 𝗥𝗲𝗱𝘂𝗰𝗲𝗱 𝗛𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗨𝘀𝗲
⬛ Perhaps most notably, patients who received actual dry needling were much less likely to seek out additional healthcare for their shoulder.
⬛ By 1 year, only 26% of the PT+DN group sought further care, compared to 46% of the PT Only group and 50% of the sham group.
⬛ Participants receiving dry needling had significantly lower odds of requiring additional care (OR = 0.35).
■■ 𝗪𝗵𝘆 𝗗𝗶𝗱 𝗗𝗿𝘆 𝗡𝗲𝗲𝗱𝗹𝗶𝗻𝗴 𝗛𝗲𝗹𝗽 𝘄𝗶𝘁𝗵 𝗣𝗮𝗶𝗻 𝗮𝗻𝗱 𝗦𝗮𝘁𝗶𝘀𝗳𝗮𝗰𝘁𝗶𝗼𝗻, 𝗯𝘂𝘁 𝗡𝗼𝘁 𝗢𝘃𝗲𝗿𝗮𝗹𝗹 𝗗𝗶𝘀𝗮𝗯𝗶𝗹𝗶𝘁𝘆?
🧠 The researchers suggest that dry needling modulates pain through peripheral and central pathways, reducing pain signaling at the spinal level and decreasing muscle tone.
⬛ Even if these reductions in pain are transient, they might allow patients to participate more effectively in their therapeutic exercises, leading to better pain management and higher long-term satisfaction.
■■ 𝗟𝗶𝗺𝗶𝘁𝗮𝘁𝗶𝗼𝗻𝘀 𝘁𝗼 𝗞𝗲𝗲𝗽 𝗶𝗻 𝗠𝗶𝗻
⚠️ No study is perfect, and the authors noted a few key limitations.
📉 𝗦𝗮𝗺𝗽𝗹𝗲 𝗦𝗶𝘇𝗲 𝗮𝗻𝗱 𝗣𝗼𝘄𝗲𝗿
⬛ Due to the COVID-19 pandemic, recruitment was slowed, and the study fell slightly short of its target sample size.
⬛ 121 enrolled versus 130 targeted, with 105 in the final analysis.
⬛ This means the trial may have been statistically underpowered to detect modest, yet clinically relevant, improvements in the primary SPADI scores.
👥 𝗗𝗲𝗺𝗼𝗴𝗿𝗮𝗽𝗵𝗶𝗰𝘀
⬛ The participants were younger than typically seen in SAPS trials, average age approximately 36, and were largely active-duty military.
⬛ This might limit how these results apply to the general civilian population.
📅 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗔𝗱𝗵𝗲𝗿𝗲𝗻𝗰𝗲
⬛ Many participants did not attend the targeted number of dry needling visits, which was supposed to be up to six, potentially muting the therapeutic effects.
■■ 𝗧𝗵𝗲 𝗙𝗶𝗻𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆
✅ While dry needling is not a magic cure-all that will drastically change overall shoulder disability more than standard exercise and manual therapy, it shows immense potential as a supplementary treatment.
⬛ By reducing long-term pain interference, keeping patients out of the doctor's office for follow-up care, and drastically improving patient satisfaction with their recovery, dry needling remains a highly valuable tool in a physical therapist's arsenal for treating Subacromial Pain Syndrome.
