Dry Needling and Knee Osteoarthritis: What Clinicians Need to Know in 2025
Knee osteoarthritis (OA) is one of the most common reasons people walk into physical therapy clinics—and one of the most common conditions clinicians struggle to treat effectively. With millions worldwide dealing with pain, mobility limitations, and functional decline, the search for meaningful interventions continues to grow. Fortunately, recent research from 2024–2025 is making it clear: dry needling, when used within a movement-based clinical reasoning framework, can significantly improve outcomes for people with knee OA.
If you've read our previous blog about dry needling making the “A-list” in treatment guidelines for hip osteoarthritis, you know the evidence base has been evolving quickly. Now, knee OA is getting the same high-quality attention, and the results are extremely promising.
No gimmicks.
No chasing pain.
And definitely no needle puns. Just evidence-based strategies that improve movement and function.
Why the Knee Isn't the Whole Story
Knee OA isn’t just a knee problem. It stems from changes in the neuromuscular system, inefficient loading patterns, altered sensory input, and compensations throughout the kinetic chain. Key muscles—quadriceps, hamstrings, gastrocnemius, adductor magnus, hip rotators, and the often overlooked popliteus—play a major role in how the knee accepts load. Let’s not forget the important role neurology plays in the overall region as well (hint - look at the spine!).
Manual therapy can only influence some of these structures. Dry needling allows clinicians to reach deeper muscles and modulate neuromuscular behavior in a way that enhances movement and supports a more efficient loading strategy. And, it allows for a ridiculously quick check to see if you are on the right path with your assessment.
What the 2024–2025 Research Shows
Recent studies—including randomized clinical trials, a multicenter investigation, and a systematic review—point to dry needling as an effective adjunct for knee OA.
1. Dry Needling + Exercise > Exercise Alone
A 2024 randomized clinical trial by Agost-González et al. found that adding dry needling to a strengthening program significantly improved pain, stiffness, mobility, strength, and walking capacity. These benefits lasted for at least 3 months.
This study highlights the importance of muscles like the popliteus, which influence tibial rotation and knee stability but are difficult to target manually.
2. Electrical Dry Needling Enhances Outcomes
A 2025 multicenter trial by Dunning et al. showed that periosteal and intraarticular electrical dry needling “booster” sessions reduced pain and disability and that dose spacing influenced outcomes. Electrical stimulation further amplified treatment effects. Though intraarticular electrical dry needling introduces an unnecessary risk for infection (in our opinion), the outcomes in this study are compelling.
3. Improved ROM and Function When Added to Physiotherapy
Morshedlou et al. (2025) demonstrated that adding neuromuscular-focused dry needling to a physiotherapy protocol improved pain, active knee range of motion, and functional ability more than physiotherapy alone.
Again, the findings reinforce the value of addressing muscular contributors to movement dysfunction—not simply needling trigger points.
4. Systematic Review Confirms Effectiveness
A 2025 systematic review by Kaye et al. found consistent improvements in pain and function with periosteal electrical dry needling. It also confirmed a strong safety profile, making it a reliable adjunct to loading-based rehab.
Clinical Meaning: Dry Needling Is an Accelerator, Not a Replacement
Dry needling works best when integrated with exercise, not instead of it. It can:
Improve neuromuscular activation
Reduce pain to allow more effective loading
Influence deeper muscles that are unreachable with other techniques and tools
Enhance gait and functional mobility
Reduce movement-related fear and improve confidence
Dry Needling Academy emphasizes using DN within a clinical reasoning model, not as a “find the painful spot and poke it” technique. We evaluate movement patterns, strength deficits, and neuromuscular control to determine which muscles are contributing to impaired loading.
A DNA-Style Knee OA Plan
Assessment:
Gait analysis, step-downs, tibial rotation control, quadriceps recruitment, hip strategy patterns, myotomes, and functional tests.
Potential Dry Needling Targets (individualized):
Popliteus, medial/lateral gastrocnemius, hamstrings, quadriceps, adductors, hip rotators and glutes, L3 circuits, and other contributors identified through assessment.
Considerations:
SINSS: Severity, Irritability, Nature (including predominant pain presentation- nociceptive, neuropathic, or nociplastic), Stability and Stage. This helps determine your dosing, targets (local or remote), e-stim parameters and progressions.
Does Dry Needling Help Knee OA?
Yes—when used appropriately and paired with exercise. The newest research shows:
Reduced pain
Improved function
Better mobility and walking ability
Improved strength
Reduced kinesiophobia and catastrophizing
Dry needling is not a cure. It’s a tool that enhances the effectiveness of movement-based rehab.
Ready to Apply This in Practice?
Dry Needling Academy teaches a movement-based approach grounded in biomechanics, neuromuscular science, and clinical reasoning. If you want to elevate your knee OA treatment strategies:
Register HERE for a Dry Needling Academy course today:
References:
Agost-González A, Escobio-Prieto I, Barrios-Quinta CJ, Cardero-Durán MLÁ, Espejo-Antúnez L, Albornoz-Cabello M. Analysis of Dry Needling Combined with an Exercise Program in the Treatment of Knee Osteoarthritis: A Randomized Clinical Trial. J Clin Med. 2024;13(23):7157.
Dunning J, Young I, Taylor N, et al. Effect of dose interval of periosteal and intraarticular electrical dry needling boosters on pain and disability in patients with knee osteoarthritis. Physiother Theory Pract. 2025.
Morshedlou M, Daghiani M, Negahban H, et al. Effectiveness of adding muscle dry needling to physiotherapy protocol on pain, active ROM, and function in knee osteoarthritis. Physiother Theory Pract. 2025.
Kaye AD, Mipro O, Tynes BE, et al. Periosteal Electrical Dry Needling Efficacy in Knee Osteoarthritis: A Systematic Review. Curr Pain Headache Rep. 2025;29(1):48.
