Comparison of dry needling, shockwave therapy and standard physiotherapy  in cervical myofascial pain syndrome

Blerton Hulaj; Daniela Shukova Stojmanovska; Georgi Georgiev; Serjoza Gontarev; George Sebastian Iacob; Bogdan Alexandu Antohe

doi:10.15391/prrht.2025-10(6).05

Authors

Blerton Hulaj Alma Mater Europaea Campus College “Rezonanca”, Pristina, Kosovo https://orcid.org/0000-0002-9804-5981
Daniela Shukova Stojmanovska Faculty of Physical Education, Sport and Health, University “Ss. Cyril and Methodius”, Skopje, North Macedonia https://orcid.org/0000-0003-0389-1972
Georgi Georgiev Faculty of Physical Education, Sport and Health, University “Ss. Cyril and Methodius”, Skopje, North Macedonia https://orcid.org/0000-0002-1748-9477
Serjoza Gontarev Faculty of Physical Education, Sport and Health, University “Ss. Cyril and Methodius”, Skopje, North Macedonia https://orcid.org/0000-0001-5873-2974
George Sebastian Iacob Department of Physical Therapy, Physiozentrum Däniken, 4658 Däniken, Switzerland https://orcid.org/0000-0003-3265-5063
Bogdan Alexandu Antohe Department of Physical Therapy and Ocupational Therapy, “Vasile Alecsandri” University of Bacău, Bacău, Romania https://orcid.org/0000-0001-5044-402X

DOI:

https://doi.org/10.15391/prrht.2025-10(6).05

Keywords:

Dry needling, shock wave, physiotherapy, myofascial pain, neck disability, range of motion

Abstract

Purpose. This study aimed to compare the effectiveness of dry needling (DN), shockwave therapy (SW), and conventional physiotherapy in managing trigger points (MTrP) related cervical pain.

Material & Methods. A randomized controlled trial included 99 patients (mean age 35.6±10.2 years) allocated to three intervention groups: (1) standard physiotherapy with DN, (2) standard physiotherapy alone, and (3) standard physiotherapy with shock wave (SW). Treatments were applied over 5 weeks (10 sessions). Outcomes measured pre- and post-treatment included the pain catastrophizing scale (PCS), neck disability index (NDI), neck flexor and extensor strength, and cervical ROM (flexion, extension, rotation, lateral flexion). Statistical analysis was performed using ANCOVA and MANCOVA.

Results. There were clear differences between treatments (Wilks' λ=0.09, F=17.54, p<0.001, η²=0.70). Dry needling reduced NDI scores the most (p=0.023 vs standard physiotherapy; p=0.036 vs SW) and improved lateral flexion to both sides (p<0.001). Shockwave therapy (SW) gave the biggest increase in neck flexor strength (79.75; p<0.001) and improved extension and rotation ROM, while standard physiotherapy had the highest extensor strength (95.28). PCS scores improved in all groups, with no significant differences.

Conclusions. All interventions reduced pain and improved function, with DN (Dry Needling) showing greater effects on reducing neck disability index and lateral flexion, and SW (shock wave) enhancing muscle strength and extension ROM.

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