Mansfield CJ, Vanetten L, Willy R, et al. The Effects of Needling Therapies on Muscle Force Production: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2019 Mar;49(3):154-170. doi: 10.2519/jospt.2019.8270. Epub 2018 Nov 30. (Systematic review)

BACKGROUND: Needling has been shown to decrease pain in the short term; however, its effects on muscle force production are unclear.

OBJECTIVE: To evaluate the evidence regarding the comparative effects of needling on muscle force production.

METHODS: In this systematic review, an electronic search was performed using key words related to needling. Methodological quality of articles was appraised and effect sizes were calculated. The strength of evidence was determined, and meta-analysis was performed when similar methods were used in studies for similar conditions.

RESULTS: Twenty-one studies were included in this review, of which 9 were deemed to be of high quality (greater than 6/10 on the Physiotherapy Evidence Database [PEDro] scale), 11 of fair quality (5 to 6/10), and 1 of poor quality (less than 5/10). Three meta-analyses were performed. There was moderate strength of evidence and medium effect sizes for needling therapy to enhance force production in those with neck pain, and very low strength of evidence of no effect for individuals with nonspecific and postoperative shoulder pain and those with lateral epicondylalgia. Other studies not included in the 3 meta-analyses demonstrated no significant effect of needling on force production. These studies included individuals with carpal tunnel syndrome, knee osteoarthritis, ankle sprains, knee arthroscopy, or delayed-onset muscle soreness.

CONCLUSION: The majority of studies suggest no effect of dry needling on force production. High-quality studies with adequate power that control for the placebo effect and follow accepted reporting standards could make valuable contributions to the literature. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42017080318).

LEVEL OF EVIDENCE: Therapy, level 1a. J Orthop Sports Phys Ther 2019;49(3):154-170. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8270.

Discipline Area Score
Nurse 6 / 7
Physician 5 / 7
Comments from MORE raters

Nurse rater

Dry Needling is spoken about frequently. It was interesting to read such a comprehensive review of past studies involving pain reduction (albeit temporary) and force. There was little mention of range of movement alterations. There was also no mention of the fact that very often it is in the immediate post op period when some assistance with pain or movement is desired. After this period there may be reduced need for assistance. This research paves the way for a more in-depth study relating to the pain relieving effects of dry needling as well as effects on movement and force. This is a very comprehensive paper.

Nurse rater

The use of dry needling has increased as an intervention to reduce/manage pain among physical-therapists and sports physiologists over recent years. This systematic review and meta-analysis, aimed to evaluate the existing evidence on the effects of dry needling on improving muscle strength and function. The main conclusion that there is inadequate evidence to promote the use of this intervention to improve muscle strength suggests that practitioners need to proceed with caution. Further research is recommended controlling for study limitations.

Nurse rater

As a primary care provider, I often have requests for complementary and alternative modalities. This information is important to help guide my patients into evidence-based care.

Nurse rater

I thought this was an interesting meta-analysis. It was well thought out and flowed nicely. It was a little lengthy to describe the levels of evidence; however, I appreciated the content and rate it highly. I'd like to see it more concise (to keep the reader's interest and engagement into the content). Overall, very nice.
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