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Randomized Controlled Trial
. 2024 Aug;38(8):1063-1079.
doi: 10.1177/02692155241249968. Epub 2024 Apr 26.

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial

James Dunning  1   2   3 , Firas Mourad  4   5 , Paul Bliton  2   6 , Casey Charlebois  2 , Patrick Gorby  2   7 , Noah Zacharko  8 , Brus Layson  9 , Filippo Maselli  10 , Ian Young  11 , César Fernández-de-Las-Peñas  1   12
Affiliations
Randomized Controlled Trial

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial

James Dunning et al. Clin Rehabil. 2024 Aug.

Abstract

Objective: The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy.

Design: Randomized, single-blinded, multicenter, parallel-group trial.

Setting: Thirteen outpatient physical therapy clinics in nine different US states.

Participants: One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized.

Intervention: Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone.

Main measures: The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake.

Results: The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group.

Conclusions: The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy.Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

Keywords: Lateral epicondylalgia; dry needling; elbow tendinopathy; exercise; manipulation; mobilization.

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Conflict of interest statement

Declaration of Conflicting InterestsJ.D. is the Director of the American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy. The American Academy of Manipulative Therapy provides postgraduate training programs in musculoskeletal sonography, vestibular rehabilitation, spinal manipulation, spinal mobilization, dry needling, extremity manipulation, extremity mobilization, instrument-assisted soft-tissue mobilization, therapeutic exercise, and differential diagnosis to licensed physical therapists, dentists, osteopaths, and medical doctors. J.D., I.Y., P.B., P.G., and N.Z. are senior faculty of the American Academy of Manipulative Therapy Fellowship. None of the authors were directly involved with subject recruitment, treatment sessions, or data collection. None of the treating therapists were reimbursed in any way for subject recruitment, treatment sessions, or data collection. The other authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
Standardized protocol for percutaneous tendon dry needling for lateral elbow tendinopathy.
Figure 2.
Figure 2.
CONSORT flow diagram of patient recruitment and retention.
Figure 3.
Figure 3.
Evolution of elbow pain related disability (Patient-Rated Tennis Elbow Evaluation) throughout the course of the study, stratified by randomized treatment assignment. Values are mean and standard error.
Figure 4.
Figure 4.
Evolution of elbow pain intensity (Numeric Pain Rating Scale) throughout the course of the study, stratified by randomized treatment assignment. Values are mean and standard error.
Figure 5.
Figure 5.
Evolution of elbow function (Tennis Elbow Function Scale) throughout the course of the study, stratified by randomized treatment assignment. Values are mean and standard error.
See this image and copyright information in PMC

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