Dry Needling in Sports and Sport Recovery: A Systematic Review with an Evidence Gap Map
Kużdżał et al. · Sports Medicine · 2025
Evidence Level
STRONGOBJECTIVE
Map evidence on dry needling in sports and athletic recovery
WHO
580 healthy and injured athletes from 13 sports modalities
DURATION
Studies from 2015-2024 with review through January 2024
POINTS
Mainly lower limbs (58.3%) and shoulder muscles
🔬 Study Design
Experimental studies
n=17
Dry needling vs control
Case reports
n=7
Dry needling in injuries
📊 Results in numbers
Studies with pain outcomes
Focus on lower limbs
Active controls used
Talent/development-level athletes
Percentage highlights
📊 Outcome Comparison
Efficacy by context
This study shows that dry needling is more effective at reducing pain in injured athletes than at improving performance in healthy athletes. The technique appears to be safe, but more research is still needed for elite athletes.
Article summary
Plain-language narrative summary
This comprehensive systematic review examined 24 studies involving 580 athletes to map evidence on dry needling in the sports context. Methodology rigorously followed PRISMA 2020 guidelines, analyzing three main databases through January 2024. The population studied predominantly included talent/development-level athletes (62.5%) and highly trained/national athletes (20.8%), with balanced representation between sexes. Analysis revealed that 69% of studies investigated pain perception as the primary outcome, while 58.3% of interventions focused on lower limbs, especially the gastrocnemius and thigh muscles.
Dry needling demonstrated consistent efficacy in reducing pain in athletes with musculoskeletal injuries or dysfunctions, with significant reductions reported in multiple studies. For example, Ceballos-Laita et al. observed a reduction of 82.5% in pain intensity, while Etminan et al. reported a decrease of 88.4% in pain rate.
However, results were more variable in post-exercise contexts with healthy athletes. As for effects on athletic performance, the evidence was less compelling. Studies on muscle strength, range of motion, and physiological parameters showed inconsistent results. The technique seemed to offer some benefits for range of motion and balance in injured athletes, but limited effects on muscle force production.
Evidence mapping identified significant gaps in the literature, particularly the lack of longitudinal studies, underrepresentation of elite and Paralympic athletes, and inconsistency in documentation of adverse effects. The safety of the technique was well established, with only minor adverse events reported in three studies. Clinical implications suggest that dry needling can be a valuable tool for pain management in injured athletes, but its usefulness for performance improvement in healthy athletes remains questionable. Methodological variability between studies, including differences in needling protocols, duration, and dosing, represents an important limitation to comparability of results.
Strengths
- 1Rigorous methodology following PRISMA 2020 guidelines
- 2Comprehensive evidence mapping with visual analysis
- 3Analysis of multiple outcomes including pain, performance, and safety
- 4Clear identification of gaps in current literature
Limitations
- 1Methodological variability between included studies
- 2Inconsistent documentation of dosing protocols
- 3Lack of longitudinal studies for long-term effects
- 4Underrepresentation of elite and Paralympic athletes
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
The systematic review by Kużdżał et al. provides robust mapping that consolidates and delimits the clinical space of dry needling in sports medicine: the technique clearly positions itself as a resource for pain management in athletes with musculoskeletal injuries or dysfunctions, and not as a strategy for performance enhancement in healthy athletes. This distinction is clinically relevant because, in practice, we receive athletes with very distinct demands—the runner with gastrocnemius tendinopathy who needs to return to training versus the sprinter seeking strength gain. The focus of 58.3% of studies on the lower limbs dialogues directly with the most prevalent injuries in our sports patient population. The technique fits well within a multimodal return-to-sport protocol, with a safety profile consolidated throughout this analysis of 24 studies and 580 athletes.
▸ Notable Findings
The magnitudes of pain reduction reported in individual studies, such as 82.5% by Ceballos-Laita et al. and 88.4% by Etminan et al., are expressive and deserve attention, even though they represent specific findings within a heterogeneous literature. The fact that 69% of studies used pain perception as primary outcome reflects both the predominant therapeutic focus and a methodologically sound choice for an acute athletic population. What stands out is the contrast between the consistency of analgesic effects and the absence of robust results in strength, physiological parameters, and performance—suggesting that the mechanisms of action of dry needling operate primarily on peripheral sensitization and trigger point dysfunction, without direct impact on contractile capacity or neuromuscular adaptations in healthy tissue.
▸ From My Experience
In my practice at the sports medicine outpatient clinic, dry needling occupies a well-defined role: it comes in when there is an active trigger point limiting function, generally after the acute inflammatory phase is already controlled. I usually see relevant analgesic response between the second and fourth session, which aligns with the protocols of up to four weeks described in this review. For athletes with musculoskeletal dysfunction of the lower limbs—gastrocnemius, vastus lateralis, biceps femoris—I combine dry needling with supervised eccentric exercise and, when there is a central sensitization component, with an adjuvant pharmacological approach. The profile that responds best in my experience is the elite athlete with well-localized myofascial pain and without dominant neuropathic component. Athletes with generalized hypersensitivity or comorbid fibromyalgia respond less predictably, and in these cases I tend to be more conservative in the indication.
Full original article
Read the full scientific study
Sports Medicine · 2025
DOI: 10.1007/s40279-025-02175-9
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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