Is a Combination of Exercise and Dry Needling Effective for Knee OA?

This double-blind randomized clinical trial investigated whether adding dry needling to an exercise program offers benefits beyond exercise alone for patients with knee osteoarthritis (OA). The research was motivated by the high prevalence of knee OA, which affects 14 million people in the United States and represents a significant healthcare expenditure, along with evidence suggesting that myofascial trigger points may contribute to pain in knee OA.

The study included 62 older participants (mean age 72 years) with knee OA diagnosed by American College of Rheumatology criteria and the presence of at least one active or latent trigger point in the lower limb muscles. Participants were randomized into two groups: exercise + real dry needling (n=31) and exercise + sham/placebo needling (n=31). Both groups received the same supervised exercise program for 12 weeks, twice a week, including aerobic, strengthening, and stretching exercises for the lower limb muscles. The experimental group additionally received six sessions of real dry needling at the identified trigger points, while the control group received placebo needling using needles that did not penetrate the skin.

Dry needling was applied to the tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, using the fast-in/fast-out technique with 15 manipulations per point, aiming to elicit local twitch responses. The primary outcomes were pain intensity (0-10 numerical scale) and function (WOMAC questionnaire), assessed at baseline, immediately after the intervention, and at 3, 6, 9, and 12 months of follow-up.

The results demonstrated clinically significant improvements in both groups for pain and function, but with no statistically significant differences between groups. At 12 months, the between-group difference was only 0.32 points on the pain scale and 0.29 points on the WOMAC total, far below the minimal clinically important difference. Both groups maintained the gains achieved throughout the entire 1-year follow-up period. Interestingly, 90.3% of patients in the dry needling group reduced their medication use, compared with only 26.3% in the placebo group, a statistically significant difference.

In terms of safety, dry needling was well tolerated, with post-needling soreness being the most common adverse effect (96.8% of cases), followed by hematoma and minor bleeding. Secondary outcomes, including quality of life, functional status, balance, and fall rate, also showed no significant differences between groups.

Study limitations include the absence of a control group receiving exercise only (without any type of needling), the use of placebo needling that may have mechanical effects on the skin, and the relatively small sample size. In addition, the study population was homogeneous (institutionalized older adults), limiting the generalizability of the results.

The clinical implications suggest that, although dry needling is safe and may reduce medication use, it does not offer significant additional benefits for pain and function compared with exercise alone in patients with knee OA. Therapeutic exercise remains the cornerstone intervention, with robust evidence of efficacy. The reduction in medication use in the dry needling group may be clinically relevant, considering the potential adverse effects of analgesics in older adults, but this finding requires replication in future studies.