Abstract
BACKGROUND: Dry needling (DN) is used in sports medicine for myofascial pain, injury and recovery, but athlete-specific effects over time are uncertain. Objective: To synthesize evidence on DN applied to cervical and related upper-quarter regions in athletes, distinguishing (i) symptomatic athlete trials from (ii) post-exertion recovery trials, and to summarize injury-related outcomes only when prospectively reported. DATA SOURCES: PubMed, Scopus, and Web of Science searched 11 Feb 2026. Study selection: Trials/prospective studies in athletes comparing DN (alone or add-on) with sham/no intervention or active comparators. METHODS: Two authors independently screened/extracted data and assessed risk of bias (RoB 2; ROBINS-I). RESULTS: Eight studies were included. In symptomatic overhead/throwing athletes, DN improved pain and shoulder ROM immediately versus no treatment in one trial, while several trials showed no differences versus active comparators or sham. Recovery trials showed inconsistent differences in hemodynamic indices and inflammatory markers, and their short follow-up and proxy endpoints limit inference about next-session performance, training continuity, or injury risk. CONCLUSION: DN may provide short-term symptom modulation in sport athletes. Evidence for consistent recovery/readiness enhancement, performance benefit, or injury prevention remains highly uncertain and is constrained by proxy outcome selection and short time windows. Registration: OSF osf.io/fsg6w (11 February 2026). SYSTEMATIC REVIEW REGISTRATION: OSF (Open Science Framework; ID: osf.io/fsg6w (11 February 2026).