Subacromial Pain Syndrome (SAPS) remains one of the most persistent and challenging conditions managed in orthopedic physiotherapy. While manual therapy and exercise constitute the gold standard for conservative management, the adjunctive value of dry needling (DN) has long been a subject of debate. Does adding needles to the mix actually change long-term outcomes, or is it merely a placebo? A rigorous new Randomized Controlled Trial (RCT) published in the January 2026 issue of The Journal of Orthopaedic and Sports Physical Therapy (JOSPT) by Hando et al. sheds critical light on this question.
Study Design: A Rigorous Three-Arm Comparison
To isolate the specific effects of dry needling, the researchers conducted a sham-controlled trial involving 121 participants diagnosed with SAPS. The study was designed to minimize bias, randomizing patients into three distinct treatment arms:
- PT Only: Standardized manual therapy and exercise.
- PT + Sham Dry Needling (SDN): Standardized care plus a sham needling procedure.
- PT + Dry Needling (DN): Standardized care plus true dry needling.
The primary outcome measure was the Shoulder Pain and Disability Index (SPADI) at one year, providing a long-term view of recovery.
Primary Outcomes: The Null Result
For clinicians expecting dry needling to drastically alter pain scores, the primary results may seem surprising. At the one-year mark, there were no statistically significant differences in SPADI scores between the PT+DN group and the PT Only group, nor between the PT+DN and the PT+Sham group. All groups improved, reinforcing the efficacy of the foundational manual therapy and exercise program, but the needles did not provide a statistically superior reduction in the SPADI score specifically.
Secondary Outcomes: Where the Value Lies
However, dismissing the intervention based solely on the SPADI would be a mistake. The study revealed compelling data in its secondary outcomes, specifically regarding the Patient Acceptable Symptom State (PASS) and healthcare utilization.
Differences in PASS were significant. At 6 months, patients receiving true dry needling were significantly more likely to report their symptom state as “acceptable” compared to both the PT Only and Sham groups. This trend continued at the 1-year mark against the Sham group. This suggests that while the raw disability numbers (SPADI) were similar, the patients’ subjective experience of their condition and their quality of life were notably better with the inclusion of dry needling.
Healthcare Utilization: The Economic Argument
Perhaps the most clinically relevant finding for practice management and health economics was the utilization data. Participants in the true dry needling group were significantly less likely to seek additional care for their shoulder in the year following enrollment (Odds Ratio = 0.35). Essentially, adding dry needling reduced the likelihood of patients returning to the medical system for injections, further imaging, or physician consults by nearly two-thirds compared to the other groups.
Clinical Implications
This study suggests that dry needling for SAPS serves as a valuable adjunct, not necessarily for lowering pain scores on a graph, but for improving patient satisfaction and reducing long-term healthcare dependency. For the professional physiotherapist, this evidence supports the use of DN to stabilize patient symptoms and prevent recurrence-seeking behaviors.
References
Hando, B. R., Rhon, D. I., Barker, D., Samson, J. Y., Anderson, D. N., Cleland, J. A., & Snodgrass, S. J. (2026). Dry Needling Plus Manual Therapy and Exercise for Subacromial Pain Syndrome: A Sham-Controlled Randomized Clinical Trial. The Journal of Orthopaedic and Sports Physical Therapy, 56(1), 50–63. https://pubmed.ncbi.nlm.nih.gov/41476428/
