Comparing Dry Needle Therapy and Extracorporeal Shockwave Therapy for Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective

To conduct a systematic review and meta-analysis to assess the effects of extracorporeal shockwave therapy (ESWT) and needling therapy in the treatment of tendinopathy.

Data sources

PubMed (Medline), the Cochrane Library, and Web of Science were searched from August 5, 2024, to August 25, 2024, for comparative studies of needling therapy and ESWT for the treatment of tendinopathy published between January 1, 2000, and August 5, 2024.

Study Selection

Two reviewers independently reviewed randomized controlled trials (RCTs) that reported a comparison of needling therapy and ESWT for tendinopathy for inclusion eligibility.

Data Extraction

Outcomes of interest were the visual analog scale (VAS) score and pressure pain threshold (PPT) score. Two reviewers independently assessed the quality of the included RCTs with the Cochrane risk of bias tool. Effect sizes were estimated using mean differences (MDs), and the significance level was estimated using the P value of the overall effect.

Data Synthesis

Nine RCTs involving 528 patients were deemed suitable for inclusion. Six RCTs involving 318 patients revealed that VAS scores showed no significant difference between ESWT and dry needling in either the immediate (MD, 0.06; 95% CI, −0.30 to 0.43; P=.73) or delayed effects (MD, −0.46; 95% CI, −2.10 to 1.18; P=.59). Two RCTs involving 132 patients revealed that PPT scores showed no significant difference between ESWT and dry needling in delayed effects (MD, −0.08; 95% CI, −0.30 to 0.14; P=.49). Three studies that enrolled 161 subjects concluded that ESWT combined with dry needling therapy was statistically more effective in reducing VAS scores in patients with tendinopathy than pure ESWT for delayed effects (MD, −1.79; 95% CI, −2.60 to −0.97; P<.0001).

Conclusions

This meta-analysis shows that the combination of ESWT with needling therapy is more effective in reducing pain indices in patients with enthesopathy than using ESWT or needling therapy alone. ESWT, combined with needling therapy, should be prioritized for conservative treatment in patients with tendinopathy.