DOI: 10.32098/mltj_2026_6514

Effect of dry needling on pain and function in adults with an active trigger point in the upper trapezius muscle: A systematic review of randomized controlled trials

Authors

  • Karrar Hasan Albomahmood Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
  • Azadeh Shadmehr Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
  • Mohammad Hossein Ayati Traditional Medicine Department, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
  • Seyed Mohsen Mir Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
  • Sakineh Shab-Bidar Nutritional Sciences, Tehran University of Medical Sciences, Tehran, Iran

shadmehr@tums.ac.ir

Keywords

Myofascial trigger point, dry needling, upper trapezius, trigger point needling, musculoskeletal pain, pain management

Abstract

Objective: This systematic review of randomized controlled trials aimed to evaluate the efficacy of dry needling (DN) in improving pain and function among patients with myofascial trigger points in the upper trapezius muscle.

Design: Systematic review conducted according to PRISMA guidelines, including randomized controlled trials.

Methods: Studies were identified by searching PubMed, Scopus, The Cochrane Library, and Physiotherapy Evidence Database. Studies identified by electronic searches were screened against established, pre-defined inclusion criteria. These studies were randomized controlled trials that used DN for treating patients with active trigger points in the upper trapezius muscle with conventional treatments as controls. There are no specific limitations on the duration of treatment, the type of needling, or the severity of symptoms. These studies must have assessed pain sensitivity.

Results: Four studies were included in this systematic review. The mean difference of pain sensitivity in all four studies for DN group was 0.59 kg/cm2, while in the control group was 0.05 kg/cm2, mean difference of pain intensity in DN group was 3.7 and control group was 0.7 and regarding to the range of motion (ROM) in DN group was 12.8 and control group was 6.3.

Conclusions: This study showed significant positive outcomes in pain sensitivity, pain intensity, and range of motion following the intervention of DN, compared to the control group. Further high-quality randomized clinical trials with established protocols for applying DN are required.

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References

  1. Navarro-Santana MJ, Sanchez-Infante J, Fernández-de-Las-Penas C, Cleland JA, Martín-Casas P, Plaza-Manzano G. Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: an updated systematic review and meta-analysis. Journal of clinical medicine. 2020;9(10):3300.
  2. Gemmell H, Miller P, Nordstrom H. Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: A randomised controlled trial. Clinical Chiropractic. 2008;11(1):30-6.
  3. Cohen SP, editor Epidemiology, diagnosis, and treatment of neck pain. Mayo Clinic Proceedings; 2015: Elsevier.
  4. Cerezo-Téllez E, Torres-Lacomba M, Mayoral-del Moral O, Sánchez-Sánchez B, Dommerholt J, Gutiérrez-Ortega C. Prevalence of myofascial pain syndrome in chronic non-specific neck pain: a population-based cross-sectional descriptive study. Pain medicine. 2016;17(12):2369-77.
  5. De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial. Journal of manipulative and physiological therapeutics. 2017;40(1):11-20.
  6. Saeedzadeh M, Khoshkrodi DS, Khademi-Kalantari K, Akbarzadeh Baghban A, Khalkhali Zavieh M. Neck Muscles Sense of Force in Healthy Individuals and Subjects with Trigger Points of the Upper Trapezius Muscle. Muscles, Ligaments & Tendons Journal (MLTJ). 2023;13(2).
  7. Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. Journal of Manipulative and Physiological Therapeutics. 2007;30(3):215-27.
  8. Hakim IK, Takamjani IE, Sarrafzadeh J, Ezzati K, Bagheri R. The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. Journal of back and musculoskeletal rehabilitation. 2019;32(5):717-24.
  9. Fishbain DA, Goldberg M, Meagher RB, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986;26(2):181-97.
  10. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral surgery, oral medicine, oral pathology. 1985;60(6):615-23.
  11. Tough EA, White AR, Richards S, Campbell J. Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature. The Clinical journal of pain. 2007;23(3):278-86.
  12. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. International journal of osteopathic medicine. 2006;9(4):120-36.
  13. Yap E-C. Myofascial pain-an overview. Annals-Academy of Medicine Singapore. 2007;36(1):43.
  14. Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual: Lippincott Williams & Wilkins; 1992.
  15. Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of physical medicine and rehabilitation. 2008;89(1):16-23.
  16. Simons DG, Travell JG, Simons LS. Travell & Simons’ myofascial pain and dysfunction: upper half of body: Lippincott williams & wilkins; 1999.
  17. McPartland JM, Simons DG. Myofascial trigger points: translating molecular theory into manual therapy. Journal of Manual & Manipulative Therapy. 2006;14(4):232-9.
  18. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of electromyography and kinesiology. 2004;14(1):95-107.
  19. Hong C-Z. Myofascial pain therapy. Journal of Musculoskeletal Pain. 2004;12(3-4):37-43.
  20. Chen J-T, Chen S-M, Kuan T-S, Chung K-C, Hong C-Z. Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Archives of physical medicine and rehabilitation. 1998;79(7):790-4.
  21. Hong C-Z. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupuncture in Medicine. 2000;18(1):41-7.
  22. Hong C-Z. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. American journal of physical medicine & rehabilitation. 1994;73(4):256-63.
  23. Tekin L, Akarsu S, Durmus O, Cakar E, Dincer Ü, Kiralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clinical rheumatology. 2013;32:309-15.
  24. Dommerholt J. Dry needling in orthopedic physical therapy practice. Orthop Phys Ther Pract. 2004;16(3):15-20.
  25. Rickards LD. Therapeutic needling in osteopathic practice: An evidence-informed perspective. International Journal of Osteopathic Medicine. 2009;12(1):2-13.
  26. Dommerholt J, Mayoral del Moral O, Gröbli C. Trigger point dry needling. Journal of Manual & Manipulative Therapy. 2006;14(4):70E-87E.
  27. Liu L, Huang Q-M, Liu Q-G, Ye G, Bo C-Z, Chen M-J, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2015;96(5):944-55.
  28. Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. American journal of physical medicine & rehabilitation. 2015;94(7):573-83.
  29. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372.
  30. Granot M. Can we predict persistent postoperative pain by testing preoperative experimental pain? Current Opinion in Anesthesiology. 2009;22(3):425-30.
  31. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191-7.
  32. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion—comparison of three methods. Physical therapy. 1991;71(2):98-104.
  33. Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physiotherapy. 2002;48(1):43-9.
  34. Mejuto-Vázquez MJ, Salom-Moreno J, Ortega-Santiago R, Truyols-Domínguez S, Fernández-de-Las-Penas C. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(4):252-60. doi: 10.2519/jospt.2014.5108.
  35. Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupunct Med. 2017;35(2):85-92. doi: 10.1136/acupmed-2016-011082.
  36. Valera-Calero JA, Sánchez-Jorge S, Buffet-García J, Varol U, Fernández-de-Las-Penas C, Álvarez-González J. Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial. Acupunct Med. 2023;41(3):121-9. doi: 10.1177/09645284221104831.
  37. Chys M, Bontinck J, Voogt L, Sendarrubias GMG, Cagnie B, Meeus M, et al. Immediate effects of dry needling on pain sensitivity and pain modulation in patients with chronic idiopathic neck pain: a single-blinded randomized clinical trial. Braz J Phys Ther. 2023;27(1):100481. doi: 10.1016/j.bjpt.2023.100481.
  38. Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Current pain and headache reports. 2013;17:1-8.
  39. Chou L-W, Kao M-J, Lin J-G. Probable mechanisms of needling therapies for myofascial pain control. Evidence-Based Complementary and Alternative Medicine. 2012;2012(1):705327.
  40. Dommerholt J. Dry needling—peripheral and central considerations. Journal of Manual & Manipulative Therapy. 2011;19(4):223-7.
  41. Fernández-de-las-Penas C. Trigger point dry needling: an evidence and clinical-based approach: Churchill Livingstone; 2013.
  42. Hsieh Y-L, Yang S-A, Yang C-C, Chou L-W. Dry needling at myofascial trigger spots of rabbit skeletal muscles modulates the biochemicals associated with pain, inflammation, and hypoxia. Evidence-Based Complementary and Alternative Medicine. 2012;2012(1):342165.
  43. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal of applied physiology. 2005;99(5):1977-84.
  44. Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of manipulative and physiological therapeutics. 2012;35(9):685-91.
  45. Chen Q, Bensamoun S, Basford JR, Thompson JM, An K-N. Identification and quantification of myofascial taut bands with magnetic resonance elastography. Archives of physical medicine and rehabilitation. 2007;88(12):1658-61.
  46. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. Journal of Manual & Manipulative Therapy. 2014;22(3):134-40.
  47. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of physical medicine and rehabilitation. 2001;82(7):986-92.
  48. Bedford S. Sports performance massage: Routledge; 2021.
  49. Aleid AM, Aljabr AA, Aldanyowi SN, AlAidarous HA, Aleid ZM, Alharthi AS, et al. Dry needling for mechanical neck pain: A systematic review and meta-analysis of randomized controlled trials. Surgical Neurology International. 2025;16:44.
  50. Kuzdzal A, Trybulski R, Muracki J, Klich S, Clemente FM, Kawczynski A. Dry Needling in Sports and Sport Recovery: A Systematic Review with an Evidence Gap Map. Sports Medicine. 2025:1-34.

Published

2026-03-31

How to Cite

1.
Albomahmood KH, Shadmehr A, Ayati MH, Mir SM, Shab-Bidar S. Effect of dry needling on pain and function in adults with an active trigger point in the upper trapezius muscle: A systematic review of randomized controlled trials. MLTJ [Internet]. 2026 Mar. 31 [cited 2026 Nov. 12];16(1). Available from: https://mltj.online/index.php/mltj/article/view/6514