Effectiveness of Dry Needling, Dynamic Cupping and Instrument-assisted Soft-tissue Mobilisation in Plantar Fasciitis: A Critical Narrative Review of Individual and Combined Use

Abstract

Plantar fasciitis, more broadly described as plantar heel pain or plantar fasciopathy, is commonly treated with exercise, stretching, education and load modification, yet clinicians frequently add dry needling, cupping or instrument-assisted soft-tissue mobilisation when symptoms persist. This critical narrative review evaluates the effectiveness, plausible mechanisms, safety and clinical positioning of dry needling, dynamic cupping and instrument-assisted soft-tissue mobilisation, with particular attention to whether dynamic cupping combined with instrument-assisted soft-tissue mobilisation can be considered an evidence-supported alternative to dry needling. Literature published from 2000 to 21 May 2026 was identified through live searches of PubMed/MEDLINE, PubMed Central, the Directory of Open Access Journals, ClinicalTrials.gov, DOI and official journal records, supplemented by backward and forward citation searching. Evidence was appraised according to design quality, comparator credibility, sample adequacy, intervention fidelity, clinical relevance, follow-up, adverse-event reporting and applicability to multimodal rehabilitation. Dry needling has the largest direct evidence base. Sham-controlled and add-on trials indicate possible reductions in pain and disability, but effect estimates vary with technique, comparator and co-intervention, and statistical improvements do not consistently reach clinically important thresholds. Evidence for cupping is limited to a small number of trials of static dry cupping; direct evidence for moving or dynamic cupping in plantar fasciitis was not identified within the search period. Instrument-assisted soft-tissue mobilisation has a small plantar-heel-specific evidence base, while broader reviews report inconsistent and generally low- or very-low-certainty effects. No eligible trial directly compared dry needling with dynamic cupping plus instrument-assisted soft-tissue mobilisation or tested whether the combined mechanical modalities provide additive benefit. These interventions should therefore be considered optional, preference-sensitive adjuncts rather than substitutes for diagnosis, education, progressive loading and plantar fascia-specific rehabilitation. Future trials require credible sham or attention controls, factorial designs, prespecified clinically important outcomes, longer follow-up and transparent reporting of treatment dose and harms.