Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis

J Man Manip Ther. 2021 Jun;29(3):136-146. doi: 10.1080/10669817.2020.1822618. Epub 2020 Sep 22.


Background: Patients with myofascial pain syndrome of the neck and upper back have active trigger points and may present with pain and decreased function. Dry needling (DN) and trigger point manual therapy (TMPT) techniques are often used to manage MPS.

Objective: To compare DN and TPMT for reducing pain on the Visual Analog Scale (VAS) and Pressure Pain Threshold (PPT) scores and improving function on the Neck Disability Index (NDI) in patients with neck and upper back MPS.

Methods: PubMed, PEDro, and CINAHL were searched for randomized controlled trials within the last 10 years comparing a group receiving DN and the other receiving TPMT. Studies were assessed using PEDro scale and Cochrane risk-of-bias tool to assess methodological quality. Meta-analyses were performed using random-effect model. Standardized mean differences (Cohen's d) and confidence intervals were calculated to compare DN to TPMT for effects on VAS, PPT, and NDI.

Results: Six randomized controlled trials with 241 participants total were included in this systematic review. The effect size of difference between DN and TPMT was non-significant for VAS [d = 0.41 (-0.18, 0.99)], for PPT [d = 0.64 (-0.19, 1.47)], and for NDI [d = -0.66 (-1.33, 0.02)].

Conclusions: Both DN and TPMT improve pain and function in the short to medium term. Neither is more superior than the other.

Keywords: Myofascial pain syndrome; dry needling; manual therapy; trigger point.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Dry Needling*
  • Humans
  • Musculoskeletal Manipulations*
  • Myofascial Pain Syndromes* / therapy
  • Neck Pain / therapy
  • Trigger Points