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.

Tennis elbow, or lateral elbow tendinopathy, is often treated with a mix of exercise, joint mobilization, and ultrasound, but recovery can be slow and frustrating. This trial asked whether adding two manual therapy techniques, dry needling of the tendon using electrical stimulation and spinal or extremity thrust manipulation, to that standard multimodal program would improve outcomes compared with the multimodal program alone. Across thirteen outpatient clinics in the United States, 143 people with lateral elbow tendinopathy were randomly assigned to one of the two approaches and followed for three months. Those receiving the added dry needling and manipulation reported significantly greater improvements in pain, disability, and function than those receiving multimodal therapy alone, with the difference described as large for pain and disability.

Because participants and clinicians knew which treatment was given beyond the assessor being blinded, and because the trial tested a specific combination of techniques rather than each one separately, it isn't clear which individual component drove the benefit.

If you've dealt with tennis elbow, you know how stubborn the pain and weakness can be even with regular physical therapy exercises, stretching, and ultrasound treatment. This study looked at whether adding two extra manual therapy techniques, a specialized needling treatment for the tendon and spinal or joint manipulation, to that standard care would help more than standard care by itself. Researchers followed 143 people with tennis elbow for three months.

Those who received the added treatments reported bigger improvements in pain, disability, and elbow function than those who received the standard multimodal program alone. The difference in improvement was described as large for pain and disability specifically. It's worth keeping in mind that everyone involved, patients and therapists, knew which treatment they were getting, which can influence how people report their symptoms.

The study also tested several techniques bundled together, so it doesn't tell us which specific part of the combined treatment made the biggest difference. This was one trial, not a large collection of studies confirming the result.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This multicenter, single-blinded randomized controlled trial (NCT03167710) compared multimodal physical therapy (exercise, mobilization, ultrasound) alone versus the same program plus percutaneous electrical dry needling of the tendon and cervical/extremity thrust manipulation in 143 patients with lateral elbow tendinopathy across thirteen US clinics. The primary outcome, Patient-Rated Tennis Elbow Evaluation, showed significantly greater improvement in the combined intervention group at three months (F=19.675, P<0.001), with a large between-group effect size (standardized mean difference 1.13, 95% CI 0.78 to 1.48).

Secondary outcomes, including Numeric Pain Rating Scale (F=22.769, P<0.001) and Tennis Elbow Function Scale (F=13.269, P<0.001), followed the same pattern favoring the added manual therapy interventions. Assessor blinding was used, but patients and treating clinicians were not blinded, which is a relevant source of potential bias given the subjective, patient-reported nature of the outcomes. The intervention combined multiple techniques (dry needling plus manipulation) as a package, so the trial cannot isolate which component, or combination, is responsible for the observed effect.

While the sample size and multicenter design offer reasonable statistical power, this is a single trial, and replication with blinded providers or component analysis would strengthen confidence in generalizing these findings.