Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial.

The study only followed patients for 3 months, so it is unknown if these benefits persist long-term. There was no placebo control group (e.g., sham needling or sham manipulation), so the effect of the specific techniques cannot be separated from the additional time and attention given to the experimental group. All therapists were trained in the same fellowship program, which may introduce bias in how the interventions were delivered. Patients and therapists could not be blinded to the treatment assignment.

Several authors are senior faculty or directors of the American Academy of Manipulative Therapy, which provides postgraduate training in the specific techniques used in the study (dry needling and manipulation). No external funding was received.

Do not assume that dry needling or thrust manipulation alone is responsible for the improvement. The experimental group received these techniques as an addition to a comprehensive multimodal program including exercise, manual therapy, and ultrasound. The study demonstrates the benefit of this combined package over the standard package, not the efficacy of the adjuncts in isolation.