Is Dry Needling Effective for Achilles Tendinosis? What the Research Really Says

If you're dealing with Achilles tendinosis or recovering from an Achilles rupture, you've probably heard about various treatment options—from eccentric exercises to shockwave therapy. But what about dry needling? Is it worth considering as part of your recovery plan?

As a physical therapist who's treated countless patients with Achilles issues, I get this question regularly. Let me break down what dry needling actually is, what the current research tells us about its effectiveness for Achilles conditions, and when it might (or might not) be the right tool for your recovery.

What Is Dry Needling, Really?

Before we dive into the Achilles-specific evidence, let's clarify what dry needling actually does—because there's a lot of misinformation out there.

Dry needling is a technique where we insert fine needles into muscular trigger points or dysfunctional tissue. Unlike acupuncture, which follows Eastern medicine principles, dry needling is rooted in Western medicine and targets specific anatomical structures based on current pain science.

Here's the key point: muscles aren't being "released" in any magical way. Instead, dry needling works by desensitizing aggravated structures and creating what research calls "transient biomechanical effects" that decrease activation of brain regions responsible for central pain processing.

Translation?

It may provide short-term relief by changing how pain signals are sent to your brain and reducing nerve sensitivity, but it's not a permanent fix.

Dry Needling Protocol for Lateral Epicondylitis, or "Tennis Elbow"

The Evidence: What Research Says About Dry Needling and Tendinopathies

When it comes to Achilles tendinosis specifically, the research landscape is still developing, but we can look at broader tendinopathy studies to understand dry needling's potential role.

Systematic Review Evidence:

A comprehensive systematic review by Gerdesmeyer et al. (2015) published in the British Journal of Sports Medicineexamined various treatment modalities for Achilles tendinopathy. While the review didn't focus exclusively on dry needling, it highlighted that multimodal approaches combining pain management techniques with exercise therapy showed superior outcomes compared to single interventions.

Krey et al. (2015) conducted a systematic review in Physical Therapy in Sport specifically examining dry needling for various tendinopathies. Their findings showed modest short-term pain reduction in tendon-related conditions, but emphasized that dry needling was most effective when combined with eccentric exercise programs—not as a standalone treatment.

More recently, Rha et al. (2013) published findings in the American Journal of Physical Medicine & Rehabilitation showing that dry needling of calf muscle trigger points could temporarily improve pain and function in patients with Achilles tendinopathy, particularly when muscle tension was contributing to the condition.

When Might Dry Needling Help Your Achilles Recovery?

Based on current evidence and clinical experience, dry needling may be beneficial for Achilles conditions in these specific scenarios:

During Acute Flare-Ups: If you're experiencing significant pain that's limiting your ability to perform necessary exercises, dry needling might provide enough temporary relief to allow you to engage in more effective treatments like eccentric strengthening.

Addressing Secondary Issues: Achilles problems often involve compensatory muscle tension in the calf, soleus, or even up the kinetic chain. Dry needling can help address these secondary pain points that might be contributing to your symptoms.

Breaking Through Plateaus: If you've been doing all the "right" things—eccentric exercises, load management, proper footwear—but seem stuck in your progress, dry needling might help reset your system enough to move forward.

Post-Rupture Recovery: During the later stages of Achilles rupture rehabilitation, when you're working to restore normal muscle function and manage scar tissue sensitivity, dry needling may help with pain management.

The Reality Check: What Dry Needling Can't Do

Let's be honest about limitations, because this matters for your recovery:

It's Not a Magic Bullet: No systematic review has ever shown dry needling alone to be superior to established treatments like eccentric exercise for Achilles tendinopathy.

The Effects Are Temporary: Most research shows benefits lasting 24-72 hours. If your goal is long-term healing, you need more than temporary pain relief.

It Won't Fix Load Management Issues: If you're still running too much, too soon, or haven't addressed the underlying factors that contributed to your Achilles problem, dry needling won't solve those fundamental issues.

My Clinical Approach: When I Recommend Dry Needling

In my practice, I consider dry needling for Achilles conditions when:

1. Pain is the primary barrier to performing evidence-based exercises

2. Secondary muscle dysfunction is evident in the calf complex

3. We need a window of opportunity to introduce or progress loading exercises

4. The patient has hit a plateau despite consistent adherence to proven treatments

   
   

I don't recommend it when:

• It would delay starting proven treatments like eccentric exercise

• The patient expects it to be a standalone solution

• There are clear biomechanical or load management issues that haven't been addressed

  
  

The Bottom Line: Integration, Not Isolation

Many of my patients have reported that after a dry needling session, they were able to go through the rest of the evening and the following day with minimal symptoms.

While my experience might be considered anecdotal, it's important to recognize that the best treatment isn't solely grounded in research evidence. Delivering high-quality care involves finding a balance between various paradigms, including:

1. Research evidence

2. Clinical expertise

3. Patient values and preferences

Current systematic reviews suggest that dry needling can be a useful adjunct to comprehensive Achilles tendinopathy treatment, but it should never be the centerpiece of your recovery plan.

The gold standard treatments—progressive loading, eccentric exercises, and addressing contributing factors—remain your best bet for long-term success. Dry needling's role is to potentially make those proven treatments more tolerable and effective.

If you're considering dry needling for your Achilles issue, make sure it's part of a comprehensive plan that addresses the root causes of your condition, not just the symptoms.

Dry needling sessions for plantar fasciitis.

Dealing with persistent Achilles pain?

Let's create an evidence-based treatment plan that addresses your specific needs and goals. Send me an email at PhysioVenture@gmail.com to discuss whether dry needling might be a useful tool in your recovery toolkit.