Dry Needling for Tendon Tears
Dry needling can be used as a treatment option for chronic tendinopathy and partial tendon tears, but it is not appropriate for acute complete tendon ruptures. The evidence supports its use primarily in chronic degenerative tendon conditions where it may disrupt the degenerative process and promote healing through localized bleeding and fibroblastic proliferation 1.
Clinical Application and Evidence Base
Ultrasound-guided dry needling is recommended when treating tendon abnormalities to ensure accurate needle placement and avoid complications 2. The American College of Radiology guidelines specifically note that ultrasound can be used to guide direct intratendinous dry needling interventions 2.
Effectiveness for Specific Tendinopathies
The evidence demonstrates benefit for dry needling in several tendon conditions:
Chronic tendinopathy (not acute tears): A 2020 systematic review found that most randomized controlled trials support the effectiveness of tendon needling, with statistically significant improvement in patient-reported symptoms 1.
Partial tendon tears with chronic degenerative changes: Some studies reported objective improvement assessed by ultrasound following dry needling 1.
Multiple anatomical sites: Evidence exists for wrist common extensor origin, patellar tendon, rotator cuff, and greater trochanteric tendons 1.
Mechanism and Rationale
Dry needling works by creating fenestrations in the degenerative tendon tissue, which initiates localized bleeding and brings growth factors that activate healing and regeneration 3. This disrupts the chronic degenerative process that characterizes tendinopathy 1.
Treatment Protocol Considerations
The optimal needling technique remains unclear due to considerable heterogeneity in the literature 1. However, most studies that demonstrated benefit used:
- Manual needle stimulation with retention times of 10-30 minutes 4
- Multiple needle insertions to create fenestrations 3
- Ultrasound guidance for accurate placement 2
Important Caveats and Contraindications
Do not use dry needling for acute complete tendon ruptures - these require surgical evaluation and repair 2. The technique is intended for chronic degenerative tendinopathy, not acute traumatic tears.
Avoid intratendinous corticosteroid injections as they may inhibit healing and reduce tensile strength, predisposing to spontaneous rupture 2. This is distinct from dry needling, which does not involve injection of substances.
Safety Profile
Dry needling appears to be minimally invasive, safe, and inexpensive with low risk 1. The most common adverse events are post-needling soreness and bent needles, with severe events rarely reported 5. However, comprehensive training in anatomical landmarks, needle insertion depth, and cross-sectional anatomy is essential to avoid accidental puncture of non-desired structures 5.
Integration with Other Treatments
Dry needling should be combined with:
- Eccentric exercise programs, which have proven beneficial for Achilles and patellar tendinopathy 2
- Relative rest that allows continued activities not worsening pain, avoiding complete immobilization 2
- NSAIDs for pain relief if needed 2
The evidence suggests dry needling provides short-term benefit (immediate to 12 weeks) for pain reduction and functional improvement when compared to control treatments 6. However, long-term benefit beyond 6-12 months is currently lacking 6.