Effects of Dry Needling in Athletes With Subacromial Pain Syndrome

Effects of Dry Needling on Proprioception, Dynamic Stability, Strength, Pain Perception, and Disability in Athletes With Subacromial Pain Syndrome

The goal of this clinical trial is to evaluate whether dry needling combined with therapeutic exercise improves shoulder proprioception in amateur athletes with subacromial pain syndrome. The study will also assess its effects on dynamic stability, strength, pain, and functional disability.

The main questions this study aims to answer are:

Does dry needling improve shoulder proprioception compared with therapeutic exercise alone? Does dry needling improve dynamic shoulder stability and muscle strength? Does dry needling reduce pain and upper limb disability?

Researchers will compare a group receiving dry needling plus therapeutic exercise with a group performing therapeutic exercise alone to determine whether the combined intervention produces better outcomes.

Participants will:

Be randomly assigned to one of the two treatment groups. Perform a home-based therapeutic exercise program for 3 weeks. Complete assessments of proprioception, dynamic stability, strength, pain, and functional disability before and after the intervention.

Study Overview

• Status: Not yet recruiting
• Conditions: Subacromial Pain Syndrome
• Intervention / Treatment: Procedure: Dry needling; Behavioral: Therapeutic Exercise

Detailed Description

Subacromial pain syndrome (SAPS) is one of the most common causes of shoulder pain and dysfunction in both the general population and athletes involved in repetitive upper-limb activities. In sports requiring overhead movements, throwing actions, or repetitive shoulder loading, the increased mechanical demand placed on the glenohumeral joint may contribute to functional impairments, persistent pain, and reduced athletic performance.

Several studies have reported proprioceptive deficits and sensorimotor control alterations in individuals with SAPS. These impairments may affect joint position sense, muscular coordination, and dynamic shoulder stability, potentially contributing to symptom persistence and increasing the risk of recurrent injury. Previous research has also associated proprioceptive deficits with higher pain intensity, functional disability, and reduced neuromuscular control.

Proprioception plays a fundamental role in sensory integration and in the regulation of precise and coordinated shoulder movements. Altered afferent input from muscular and articular structures may impair dynamic stabilization mechanisms and compromise upper-limb function during sports activities.

Dry needling is a minimally invasive physiotherapy technique widely used for the treatment of myofascial trigger points. Previous studies have demonstrated positive effects of dry needling on pain and functional disability in individuals with subacromial pain syndrome. In addition, research conducted in other joints has suggested that dry needling may influence motor control, postural stability, and proprioceptive mechanisms.

Despite the growing clinical interest in this intervention, there is currently limited evidence regarding the effects of dry needling on shoulder proprioception and sensorimotor variables in individuals with SAPS, particularly in athletic populations. Therefore, further investigation is needed to determine whether adding dry needling to a therapeutic exercise program may provide additional benefits for neuromuscular control and shoulder function.

The primary aim of this clinical trial is to evaluate the effectiveness of dry needling combined with therapeutic exercise on shoulder proprioception in amateur athletes with subacromial pain syndrome. Additionally, the study will assess the potential effects of the intervention on dynamic stability, shoulder isometric strength, pain perception, and upper-limb functional disability.

A randomized controlled trial with two parallel groups will be conducted. Participants will be randomly assigned in a 1:1 ratio to:

an experimental group receiving dry needling combined with therapeutic exercise, or a control group receiving therapeutic exercise alone.

The intervention period will last 3 weeks. Participants in the experimental group will receive two dry needling sessions separated by a 10-day interval. The technique will be administered by an experienced physiotherapist with specialized training in dry needling, following a predefined protocol based on the available scientific literature.

The intervention will target myofascial trigger points located in scapulohumeral muscles commonly associated with shoulder pain and subacromial pain syndrome. Trigger points will be identified through standardized clinical examination procedures.

Both groups will perform a structured home-based therapeutic exercise program focused on muscular strengthening, neuromuscular control, and shoulder function. Participants will receive individualized instructions, and adherence to the exercise program will be monitored using follow-up records.

Outcome assessments will be performed by an evaluator blinded to group allocation in order to minimize measurement bias. Measurements will be collected at different time points throughout the study to evaluate changes in proprioception, dynamic stability, muscular strength, pain, and functional disability.

This study aims to provide clinical evidence regarding the potential role of dry needling as an adjunct to therapeutic exercise in the management of sensorimotor and functional impairments associated with subacromial pain syndrome in athletic populations. The findings may contribute to the development of more effective therapeutic strategies aimed at improving shoulder function and optimizing functional recovery in athletes with this condition.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Pablo Taberner Mortes, PT, MSc; Phone Number: +34 680869335; Email: pablo.taberner@universidadeuropea.es
• Study Contact Backup: Name: Alejandro Sendín Magdalena, PT, MSc, PhD; Phone Number: +34 652 53 43 10; Email: alejandro.sendin@universidadeuropea.es

Study Locations

• Spain
  • Valencia
    • Valencia, Valencia, Spain, 46006
      • Clínica Dr Villarón
      • Contact: Pablo Taberner Mortes, PT, MSc; Phone Number: +34 680869335; Email: pablo.taberner@universidadeuropea.es
      • Contact: Carlos A Villarón Casales, Clinical Director; Phone Number: + 34 611 68 62 26; Email: cvillaron@gmail.com
      • Principal Investigator: Carlos A Villarón Casales, PT, MSc, PhD
      • Sub-Investigator: Pablo Taberner Mortes, PT, MSc
      • Sub-Investigator: Alejandro Sendín Magdalena, PT, MSc, PhD
      • Sub-Investigator: Mathilde Conde Aparicio, PT, MSc
      • Sub-Investigator: Lucia Ortega Pérez de Villar, PT, MSc, PhD
      • Sub-Investigator: Javier Fenollar Cortes, PT, MSc, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Men and women aged between 18 and 40 years.
• Clinical diagnosis of subacromial pain syndrome (SAPS) according to the Dutch Orthopaedic Association criteria: presence of a painful arc and at least two positive tests among the following: Hawkins-Kennedy test, Neer sign, Jobe test, Drop Arm test, or Gerber test.
• Participation in sports involving predominant upper-limb activity between 2 and 4 hours per week.

Exclusion Criteria:

• Previous surgery involving the upper extremities.
• Diagnosis of specific shoulder pathologies other than SAPS at the time of the study.
• Receipt of medical or physiotherapy treatment within the month prior to the intervention.
• Needle phobia or refusal to receive dry needling treatment.
• Presence of vestibular disorders, balance impairments, or vascular alterations that could interfere with study measurements.
• Confirmed or suspected pregnancy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dry Needling + Therapeutic Exercise; Participants assigned to the experimental group will receive a combined intervention consisting of dry needling and a structured home-based therapeutic exercise program over a 3-week period. Dry needling will be applied to active myofascial trigger points identified in scapulohumeral muscles commonly associated with subacromial pain syndrome, including the supraspinatus, infraspinatus, subscapularis, teres minor, teres major, and anterior and middle deltoid muscles. Trigger points will be identified through standardized clinical examination based on the presence of a palpable taut band, a hypersensitive spot within the taut band, reproduction of the participant's recognizable pain, and local twitch response. The intervention will be performed by a physiotherapist with more than 10 years of clinical experience and certified training in dry needling techniques. A standardized dry needling protocol based on previously published methods will be used. After skin disinfection with chlorhe	Procedure: Dry needling; Dry needling will be applied to active myofascial trigger points identified in scapulohumeral muscles commonly associated with subacromial pain syndrome, including supraspinatus, infraspinatus, subscapularis, teres minor, teres major, and anterior and middle deltoid muscles. Trigger points will be identified through standardized clinical examination. The intervention will be performed by an experienced physiotherapist using sterile disposable needles and a standardized fast in-fast out technique. Participants will receive two dry needling sessions separated by a 10-day interval.; Behavioral: Therapeutic Exercise; Participants will perform a structured home-based therapeutic exercise program focused on shoulder strengthening, neuromuscular control, and sensorimotor function using elastic resistance bands. The exercise program will be performed three times per week for 3 weeks following a standardized protocol. Participants will receive individualized instruction, exercise materials, and adherence monitoring throughout the intervention period.
Active Comparator: Therapeutic Exercise; Participants assigned to the control group will receive a structured home-based therapeutic exercise program over a 3-week period without dry needling intervention. The exercise program will focus on shoulder strengthening, neuromuscular control, and sensorimotor function using elastic resistance bands. Participants will perform the exercises three times per week for 3 weeks following a standardized protocol. All participants will receive individualized in-person instruction from a physiotherapist to ensure correct exercise execution. Participants will also receive the necessary exercise materials and an adherence diary to record compliance throughout the intervention period. The therapeutic exercise program administered in the control group will be identical to the exercise intervention performed in the experimental group in terms of exercise type, frequency, duration, supervision, and home-based format. No invasive procedures or sham dry needling interventions will be performed i	Behavioral: Therapeutic Exercise; Participants will perform a structured home-based therapeutic exercise program focused on shoulder strengthening, neuromuscular control, and sensorimotor function using elastic resistance bands. The exercise program will be performed three times per week for 3 weeks following a standardized protocol. Participants will receive individualized instruction, exercise materials, and adherence monitoring throughout the intervention period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder Proprioception Assessed With the Joint Position Sense Tes	Shoulder proprioception will be evaluated using the Joint Position Sense (JPS) test. Participants will actively reproduce a predefined shoulder position, and the absolute angular repositioning error in degrees will be recorded using an inclinometer. Lower values indicate better proprioceptive accuracy.	Baseline, 10 days after the first intervention session, and 10 days after the second intervention session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dynamic Shoulder Stability Assessed With the Upper Quarter Y Balance Test	Dynamic shoulder stability will be assessed using the Upper Quarter Y Balance Test (YBT-UQ). Reach distances in the medial, inferolateral, and superolateral directions will be recorded in centimeters. Greater reach distance indicates better dynamic stability and sensorimotor performance.	Baseline, 10 days after the first intervention session, and 10 days after the second intervention session
Isometric Shoulder Strength Assessed With Handheld Dynamometry	Isometric strength of the shoulder abductors and rotator muscles will be measured using a handheld dynamometer during maximal voluntary isometric contractions. Higher force values indicate greater muscle strength.	Baseline, 10 days after the first intervention session, and 10 days after the second intervention session
Pain Intensity Assessed With the Numeric Rating Scale	Pain intensity will be assessed using the Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Lower scores indicate lower pain intensity.	Baseline, 10 days after the first intervention session, and 10 days after the second intervention session
Upper Limb Disability Assessed With the Disabilities of the Arm, Shoulder and Hand Questionnaire	Functional disability of the upper limb will be assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Higher scores indicate greater disability and functional impairment.	Baseline, 10 days after the first intervention session, and 10 days after the second intervention session

Collaborators and Investigators

• Sponsor: Universidad Europea de Valencia
• Investigators: Principal Investigator: Carlos A Villaron Casales, PT, MSc, PhD, Universidad Europea de Valencia

Publications and helpful links

General Publications

• Arias-Buria JL, Fernandez-de-Las-Penas C, Palacios-Cena M, Koppenhaver SL, Salom-Moreno J. Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial. J Pain. 2017 Jan;18(1):11-18. doi: 10.1016/j.jpain.2016.08.013. Epub 2016 Oct 5.
• Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sanchez-Mila Z, Fernandez-de-Las-Penas C, Alburquerque-Sendin F. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:790209. doi: 10.1155/2015/790209. Epub 2015 Apr 30.
• Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med. 2023 Feb 2;12(3):1205. doi: 10.3390/jcm12031205.
• Ager AL, Borms D, Deschepper L, Dhooghe R, Dijkhuis J, Roy JS, Cools A. Proprioception: How is it affected by shoulder pain? A systematic review. J Hand Ther. 2020 Oct-Dec;33(4):507-516. doi: 10.1016/j.jht.2019.06.002. Epub 2019 Aug 31.
• Gliga AC, Neagu NE, Voidazan S, Popoviciu HV, Bataga T. Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. Medicina (Kaunas). 2022 Sep 9;58(9):1248. doi: 10.3390/medicina58091248.
• Alfaya FF, Reddy RS, Alkhamis BA, Kandakurti PK, Mukherjee D. Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study. Diagnostics (Basel). 2023 Jun 17;13(12):2099. doi: 10.3390/diagnostics13122099.
• Blanco-Diaz M, Ruiz-Redondo R, Escobio-Prieto I, De la Fuente-Costa M, Albornoz-Cabello M, Casana J. A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome. Biology (Basel). 2022 Feb 4;11(2):243. doi: 10.3390/biology11020243.
• Para-Garcia G, Garcia-Munoz AM, Lopez-Gil JF, Ruiz-Cardenas JD, Garcia-Guillen AI, Lopez-Roman FJ, Perez-Pinero S, Abellan-Ruiz MS, Canovas F, Victoria-Montesinos D. Dry Needling Alone or in Combination with Exercise Therapy versus Other Interventions for Reducing Pain and Disability in Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Sep 2;19(17):10961. doi: 10.3390/ijerph191710961.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: May 27, 2026
• First Submitted That Met QC Criteria: May 27, 2026
• First Posted (Actual): June 2, 2026

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: May 27, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: dry needling; Shoulder pain; Shoulder proprioception; subacromial pain syndrome
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Joint Diseases; Arthralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Shoulder Pain; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Patient Care; Rehabilitation; Aftercare; Continuity of Patient Care; Exercise Therapy; Dry Needling
• Other Study ID Numbers: SDSA-PS-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Individual participant data may be shared in the future in anonymized form upon reasonable request and in accordance with ethical approval, participant consent, and applicable data protection regulations. A definitive data sharing plan has not yet been established.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No