A Systematic Review of Dry Needling Parameters for Improvements in Muscle Performance

BACKGROUND: Despite strong physiological evidence supporting dry needling (DN), clinical findings on muscle performance remain inconsistent, likely due to treatment parameter variability. OBJECTIVE: To evaluate the evidence for the effect of DN on muscle performance and identify parameters associated with improvement. METHODS: This systematic review followed PRISMA guidelines. PubMed, CINAHL, Embase, and SPORTDiscus were searched through April 2025. Randomized controlled trials (RCTs) of DN for musculoskeletal dysfunction were synthesized by subject characteristics, muscle performance measures, follow-up, and DN parameters. Methodological quality was assessed using the PEDro scale, and certainty of evidence via GRADE. RESULTS: Eleven RCTs met the inclusion criteria (PEDro 5-8); nine reported improvements in local muscle performance. Heterogeneity in DN protocols and patient characteristics precluded meta-analysis. LTR elicitation in the targeted muscle was reported in eight of the nine studies demonstrating improvement. GRADE certainty was low for immediate outcomes and moderate for short- and mid-term outcomes. CONCLUSION: Evidence from the included trials suggests that DN intended to improve muscle performance may be effective when delivered as a localized, muscle‑specific intervention targeting MTrPs with the goal of eliciting an LTR. DN may serve as an effective adjunct to therapeutic exercise to enhance muscle performance in select musculoskeletal conditions.