Trigger Point Dry Needling to Reduce Pain and Improve Function and Postural Control in People With Ankle Sprain: A Systematic Review and Meta-Analysis

Objective

The purpose of this review was to evaluate the effectiveness of dry needling (DN) to improve function, proprioception, and balance and to reduce pain in individuals with chronic ankle instability (CAI).

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for this review. We searched PubMed, ISI Web of Knowledge, Scopus, Science Direct, Google Scholar, and ProQuest databases from inception until July 2022 using the PICO (population, intervention, comparison, outcome) method. Inclusion criteria were as follows: studies that (1) investigated individuals with CAI; (2) used DN as a main intervention; (3) compared DN with exercise therapy, shockwave therapy, and placebo DN; and (4) compared the effect of DN in CAI cases with healthy individuals. The risk of bias assessment was examined through the Downs and Black checklist. Where possible, a meta-analysis was performed using standardized mean difference (SMD; Cohen's d) and 95% CIs. A narrative analysis was conducted where data pooling was not feasible.

Results

Seven studies consisting of 169 individuals with a history of CAI in chronic phase (more than 12 months after the initial injury) were selected for final evaluation. Using DN in fibularis longus may positively have immediate, short-term (1 week), and medium-term (1 month) effects on pain (SMD: −1.31, 95% CI: −3.21 to 0.59), function, proprioception, and static and dynamic postural control compared with before intervention (P < .05). One study reported the superiority of DN over shockwave therapy to significantly improve range of motion of ankle (P < .05) but not for pain. Additionally, the results of 1 study were in favor of the superiority of DN intervention compared with placebo DN with regard to postural control and pre-activation variables. Moreover, spinal plus peripheral DN was not preferable to peripheral DN for improving patients’ outcomes (P > .05).

Conclusion

Although almost all of the reviewed articles showed some immediate, short-term, and medium-term benefits of DN for improving postural control, pain, and function for people with CAI, this review found that there was heterogeneity among included trials and many of them had a high risk of null findings due to insufficient power and inconsistent techniques, control groups, and outcome measures. Therefore, scientific evidence supporting the use of DN for ankle instability is premature, and the results of the current review should be interpreted with caution. This area may be worth exploring by conducting large-scale, placebo-controlled randomized trials.