The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.

The interest in dry needling as a treatment option for myofascial pain has flourished for the last decades and will probably continue to do so, because multiple clinical effects can be attributed to this technique. However, evidence about the underlying physiological mechanisms of its effects is still underrepresented in scientific research and caution must be taken in generalizing results from acupuncture or animal research. This review offers an overview of the possible mechanisms involved in the pathophysiology of myofascial trigger points, that is, the formation of the taut band, the presence of local pain and inflammation, and the occurrence of referred pain. Subsequently, the effect of dry needling on these same aspects will be discussed. The goal of this article is to provide clinicians with the most up to date insights in the underlying (neuro)physiological mechanisms of trigger point dry needling and to identify the opportunities for further research on this topic.

Background/Objectives: Cervicogenic headache (CeH) is linked to upper cervical dysfunctions. The obliquus capitis inferior (OCI) muscle may contribute to restricted cervical rotation at the C1–C2 level, altered proprioception and pain. Dry needling (DN) of the OCI is hypothesized to target these dysfunctions. The aim of this study was to investigate whether a single intervention combining DN and manual therapy (MT) compared to sham needling (SN) and MT, improves C1–C2 rotation, functional, headache-related and psychological outcomes in a subgroup of CeH patients with a positive cervical flexion–rotation test (CFRT). Methods: Thirty-four participants were randomly assigned to (1) DN or (2) SN. The primary outcome was C1–C2 rotational mobility. Secondary outcomes included headache-related parameters (frequency, intensity, duration and perceived effect), functional parameters (cervical mobility, pain pressure thresholds, motor control and proprioception) and psychological parameters (central sensitization, pain catastrophizing, coping strategies and kinesiophobia). Outcomes were re-evaluated at one-week follow-up. Results: Linear mixed-effects models showed a significant and clinically relevant increase of C1–C2 rotation in the DN group compared to the SN group post-intervention (mean difference [MD]: 4.51°; 95% confidence interval [CI]: 1.74; 7.28), which was maintained at the 1-week follow-up (MD: 5.44°; 95% CI: 2.55; 8.33). No clinically relevant changes were observed in other secondary outcome measures. Conclusions: Targeting the OCI may be of added value in restoring atlanto-axial dysfunction. While short-term mobility gains were observed, a single intervention appears insufficient as a stand-alone treatment to impact functional or psychological outcomes. Future research involving larger samples should examine DN effects as part of a multimodal approach with long-term follow-up.

1. Healthcare professionals are often faced with high interindividual variation in clinical presentation of individuals with non-specific low back pain (LBP). Motor control alterations are commonly...