Dry Needling Alone vs. Dry Needling with Electrical Stimulation
As dry needling continues to gain popularity among physical therapists and rehab professionals, questions about best clinical applications of dry needling are becoming more prevalent. Using electrical stimulation with dry needling, sometimes called Intramuscular Electrical Stimulation (IMES), is one such application. A recently published randomized controlled trial (RCT) by Hadizadeh et al. (2025) sheds light on the comparative effectiveness of dry needling and IMES for active TrPs in the upper trapezius.
In this post, we’ll break down the study’s findings, discuss practical implications for clinicians, and examine the strengths and limitations of the research. If you're a clinician currently using dry needling—or interested in learning—it’s essential to understand how these interventions stack up and how research like this can shape evidence-based practice.
Understanding the Study: Dry Needling vs. IMES
Study Design Overview:
Population: 30 patients with active upper trapezius trigger points.
Intervention: Participants were randomized to receive either dry needling or IMES over three treatment sessions.
Primary outcomes: Neck range of motion (ROM) and TrP circumference.
Secondary outcomes: Pain intensity (VAS), pressure pain threshold (PPT), disability, sonographic characteristics of TrPs, and muscle blood flow (vascular resistance index or RI).
Assessment points: Pre-treatment, immediately after the third session, and at one-month follow-up.
Key Findings and Clinical Significance
1. Range of Motion (ROM)
IMES led to significantly greater improvements in neck ROM compared to dry needling alone.
Clinical takeaway: For patients with mobility restrictions due to myofascial pain, IMES may offer a superior option.
2. Pain Pressure Threshold (PPT)
The IMES group demonstrated greater improvements in pain tolerance, as measured by PPT.
Clinical takeaway: IMES may have a stronger hypoalgesic effect, likely due to the enhanced neuromuscular stimulation.
3. Trigger Point Morphology
Ultrasound showed larger reductions in TrP size (circumference and longitudinal diameter) in the IMES group.
Clinical takeaway: Objective reductions in TrP size suggest that IMES may be more effective in altering tissue properties.
4. Pain Levels (VAS)
Both groups saw significant reductions in pain, with no major differences between them.
Clinical takeaway: Both interventions are effective for short-term pain relief.
5. Vascular Resistance Index (RI)
IMES led to a notable improvement in muscle blood flow, while DN alone did not show significant changes.
Clinical takeaway: Improved perfusion may aid in longer-term healing and tissue recovery.
How Does This Apply to Clinical Practice?
While dry needling remains a cornerstone of manual therapy for myofascial pain, this study suggests that adding or transitioning to IMES may enhance outcomes—particularly in cases with limited ROM or pronounced TrP morphology.
At Dry Needling Academy, we emphasize the integration of updated clinical applications. All of our courses incorporate electrical stimulation and functional circuits with e-stim, helping clinicians stay on the leading edge of neuromusculoskeletal care.
Commentary: Strengths and Limitations of the Study
While the study presents compelling evidence in favor of IMES, it's essential to examine both its strengths and its limitations to determine its real-world applicability.
🔍 Strengths
Use of Sonographic Imaging
Unlike many prior studies that rely solely on subjective measures, this RCT incorporated ultrasound imaging to assess changes in TrP size, stiffness, and vascularity. This provides a more objective basis for understanding treatment effects.Well-Designed RCT Framework
The trial used random allocation and blinded assessors—key features that help reduce bias and increase reliability.Clinically Relevant Outcomes
The outcomes—ROM, pain, TrP size—are directly relevant to daily practice, making the findings more translatable to patient care.
⚠️ Limitations
Narrow Focus on Trigger Points
The study is limited to localized effects on TrPs in the upper trapezius. While valuable, this does not account for global neuromusculoskeletal benefits that dry needling may offer—such as central sensitization reduction, autonomic effects, or systemic functional changes.Small Sample Size (n = 30)
With just 15 participants in each group, the study is statistically underpowered to detect subtle differences or assess long-term outcomes with confidence.Short Follow-Up Duration (1 month)
The limited follow-up period makes it difficult to draw conclusions about long-term efficacy, recurrence of symptoms, or sustained functional gains.Lack of Control for Placebo or Sham
A third control group receiving sham needling or no electrical stimulation could help clarify the specific vs. non-specific effects of IMES vs. DN.Focused on a Single Muscle (Upper Trapezius)
While the upper trapezius is a common TrP site, clinicians treat a wide range of musculoskeletal conditions. And to make dry needling most effective, a full accurate assessment is key. Treating trigger points to reduce pain without looking at (and treating!) the bigger picture is a very limited scope of the functionality and capabilities of dry needling.
The Bigger Picture: Integrating Evidence into Your Practice
The take-home message? Both dry needling alone and IMES are effective interventions for myofascial trigger points—but IMES may offer enhanced local effects in certain clinical scenarios.
However, when it comes to global treatment strategies, dry needling remains an essential skill for addressing neuromusculoskeletal dysfunction across the kinetic chain. Whether you're treating cervicogenic headaches, postural syndromes, or chronic pain, dry needling offers versatility, quick changes, and precision.
That’s why our curriculum at Dry Needling Academy is designed not just to teach technique—but to ensure you understand the “why” behind every needle. We cover:
Central and peripheral nervous system, as well as musculoskeletal effects of dry needling with and without electrical stimulation
Real-world clinical application and clinical reasoning
Ready to Deepen Your Skills?
Whether you’re new to dry needling or looking to advance your techniques, we offer comprehensive, hands-on courses led by experienced, approachable instructors.
🔹 Foundations in Dry Needling
Perfect for clinicians just getting started. Learn foundational skills, safety, and clinical application incorporating electrical stimulation.
🔹 Beyond Foundations in Dry Needling
Advanced techniques for the practitioner who has taken a previous dry needling course.
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Final Thoughts
This study contributes meaningful data to the ongoing exploration of dry needling and its evolving role in rehab medicine. While IMES shows promising localized benefits, dry needling remains a core modality with broad applications—and when taught correctly, it empowers clinicians to deliver precise, evidence-based care.
At Dry Needling Academy, our mission is simple: teach you how to needle smarter, treat better, and grow as a clinician.
References:
Hadizadeh, M., Rahimi, A., Velayati, M., Javaherian, M., Naderi, F., Keshtkar, A., & Dommerholt, J. (2025). A comparative study of sonographic and clinical parameters in patients with upper trapezius muscle trigger points following dry needling and intramuscular electrical stimulation: a randomized control trial. Chiropractic & Manual Therapies, 33(14). Read the Full Study
Other references on dry needling and electrical stimulation:
León-Hernández JV, Martín-Pintado-Zugasti A, Frutos LG, Alguacil-Diego IM, de la Llave-Rincón AI, Fernandez-Carnero J. Immediate and short-term effects of the combination of dry needling and percutaneous TENS on post-needling soreness in patients with chronic myofascial neck pain. Braz J Phys Ther. 2016;20(5):422-431. Published 2016 Jul 11. doi:10.1590/bjpt-rbf.2014.0176 Read it Here.
da Graca-Tarragó M, Lech M, Angoleri LDM, et al. Intramuscular electrical stimulus potentiates motor cortex modulation effects on pain and descending inhibitory systems in knee osteoarthritis: a randomized, factorial, sham-controlled study. J Pain Res. 2019;12:209-221. Published 2019 Jan 3. doi:10.2147/JPR.S181019 Read it Here.
Napadow V, Makris N, Liu J, Kettner NW, Kwong KK, Hui KK. Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI. Hum Brain Mapp. 2005;24(3):193-205. doi:10.1002/hbm.20081 Read it Here.
