Dry Needling and Exercise in the Treatment of Musculoskeletal Pain: A Systematic Review.

Musculoskeletal pain presents a major global public health burden as it is a highly prevalent and disabling health condition. Non-pharmacologic treatments such as therapeutic exercise and dry needling are increasingly utilized in current practice although uncertainty remains regarding their comparative and combined effectiveness. This study aimed to systematically review contemporary evidence regarding the effectiveness of dry needling and exercise, alone and in combination, for the management of musculoskeletal pain. A systematic search adherent to PRISMA guidelines was conducted of PubMed, Web of Science, and Scopus databases for relevant studies from 2000-2023. After screening 642 records, 22 studies comprising a total of 1585 participants were analyzed. Seventeen studies (73.9%) found that dry needling provided no additional benefits over exercise alone for the reduction of musculoskeletal pain. Three studies demonstrated no improvements with either intervention alone. However, three studies showed greater improvements when dry needling was combined with exercise in knee osteoarthritis, trapezius myofascial pain, and low back pain. The most frequently utilized dry needling technique involved rapid in-and-out needling for 25 seconds to 15 minutes with 12-15 insertions per muscle, delivered over at least five weeks (twice weekly). Current evidence supports dry needling plus exercise as efficacious for musculoskeletal pain, although dry needling offers no additional benefit versus exercise alone. The heterogeneity of methods underscores the need for further high-quality comparative effectiveness trials across diverse populations and pain conditions to identify optimal protocols.