Dry Needling for Relief of Spasticity in Patients with Chronic Stroke: An Evidence Synthesis
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Morgan Darner, SPT, Tristen Rush, SPT, Emily Wald, SPT, Christian Whitesell, SPT
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Morgan Darner, SPT, Tristen Rush, SPT, Emily Wald, SPT, Christian Whitesell, SPT
USD PT Research 
Question: I notice that the intervention protocol includes relatively short-term use of dry needling in these individuals. Do you think there may be different (better or worse) effects with longer-term dry needling bouts?
Question: I see that there are a variety of muscles treated with this dry needling technique for patients with chronic stroke. Has dry needling seen to be more effective in response to treating certain muscles/certain areas of the body versus others (upper body versus lower body)?
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Hey Tiegen, thanks for the questions! Research supports dry needling for both upper and lower extremities and there wasn’t significant differences between the upper and lower extremity muscles in the articles we covered. Evidence heavily supports dry needling for taut muscle bands in both upper and lower extremities. The long-term effects of dry needling are still lacking in current literature, and our project supports further research to specifically look at the potential long-term effects. I hope this helped!
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Hey guys! Nice job with your poster, it was very interesting to read! It seems like dry needling would be a great option to try for treating spasticity. I saw that you have a table at the bottom showing when DN was performed and what days the subjects were tested. It is mentioned that more research needs to be done for the practice guidelines for implementing this treatment but, in your group’s opinion, how often do you think that DN should be used for a patient with spasticity? And do you think if the patient is experiencing spasticity in muscles in both UE and LE, would it be too fatiguing to DN in all of the muscles they are experiencing spasticity in during one treatment session?
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Hey Sydney. Great questions!
As the world of PT goes, it depends. Each person is different and responds to dry needling differently, 1-2 times per week would be our initial idea, however, it is subject to change depending on the patient’s response to treatment.
To answer your second question, it also depends on the treatment and your patient. If dry needling is only performed one time a week or less frequently, dry needling may be performed in both UE and LE dry in one session. However, if dry needling is used more frequently, performing UE and LE dry needling may be more fatiguing for the patient. It also depends whether dry needling is being used as a sole intervention or as an adjunct treatment within the same session. But most importantly, it depends on the patient and their response to dry needling. Insurance may alter frequency depending on if it’s covered or the patient is paying out of pocket. Overall, dry needling frequency depends on the patient and how they respond to treatment.
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Hi Sydney, great question! In our research, none of the studies that we included discussed how the time between treatments would affect the outcome. We had a variety of treatment frequencies but our research did not look at what frequency is the most beneficial. As for treating all the muscles with spasticity in a single treatment session, none of the research articles included or discussed this method of treatment. They treated a handful of muscles but none of them indicated that they did all the muscles that were experiencing spasticity in a single treatment session. Research on amount and frequency of DN is still limited therefore more research needs to be done to determine if it would be beneficial for all the spastic muscle could be treated in a single treatment session.
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Hi everyone! Great job on your poster/research. I feel that dry needling has so much potential in the physical therapy realm especially with chronic post stroke patients! It makes me wonder how effective it would be for acute stroke patients in early Brunnstrom stages.
My question to you is this – Although it seems there are many different variables and outcome measures that your articles used, in your group’s opinion, what intervention type seemed to be the most beneficial to this specific population? (ie. Fast-in fast-out, time when DN a muscle, etc..) Thanks in advance for your insight!
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Hey Drew, thank you for your comments and question. I also wonder how effective dry needling would be in the acute stages of stroke, and it would be worth looking in to. As for your question, 9 of the 10 research articles that we used utilized the fast-in, fast-out technique, so right now, it seems as though that may be the technique to try first. Majority of the studies’ methods performed the dry needling for 1 minute or less. However, like everything in physical therapy, it depends on the patient. It is important to keep an open mind when working with a patient in order to find the best individual treatment for them. I hope this helped answer your question, thanks again for commenting!
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Hi! Thank you for presenting this information on the effectiveness of dry needling for relief of spasticity in patients with chronic stroke. This is a very interesting intervention that is definitely gaining popularity in the PT world, rightfully so if it is producing positive outcomes for our patients. I also think it is cool that more research is being presented on this topic outside of the sports setting. From the findings of your study, it seems to even be emerging as effective in the neurological setting as well.
I have a couple of questions for you.
1) I know you stated the patients in the study had experienced a chronic stroke, but how was ‘chronic’ defined? Was there any information provided on how long ago the patients experienced their stroke before receiving the dry needling intervention (i.e., 3 months post-stroke, 1 year post-stroke, etc.)? And if so, did this have an impact on the outcomes?
2) Were any adverse outcomes experienced by any of the patients in the studies you examined? I know dry needling tends to be very safe for most patients but was just curious if this was mentioned in the studies at all, especially due to the type of patient population.
Thank you!
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Great question Maddison!
To answer your first question, chronic was defined as 6 months. Our articles had a variety with length of time after stroke before the treatment. One study had a patient that was 13 years post stroke. Since most of the study we included were case reports so further research needs to be done to see if there is a specific time after a stroke this treatment would be best.
There were no adverse outcomes mentioned in the any of the research articles. All the articles that we included in this study reported good outcomes. One limitation of our research is that most of the research that is published report good outcomes. Whereas other articles that may have poor outcomes are less likely to get published. There is a possibility that a patient could have an adverse reaction to dry needling but none of the articles included any.
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Hey guys, great job with your poster presentation! I am curious to know if the studies that looked at dry needling as the sole intervention if it mentioned if the participants were also receiving physical therapy or if they were asked to stop standard rehab following a stroke? For the one study that compared standard rehabilitation to dry needling, was there a significant difference in post treatment spasticity outcomes between groups?
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Hey Cassandra, thanks for the questions! To answer your first question, the participants in the studies did not receive other physical therapy interventions other than the dry needling. For example, one study excluded participants that were receiving other treatment protocols. Also, many of the studies assessed the results from the dry needling on the same day, normally within an hour. Furthermore, if the participant were to show improvements, it would be, with almost no doubt, due to the dry needling.
For your next question, the Mendigutia-Gomez et al. study did not find a significant difference in spasticity between the groups. While there was not a significant difference in the spasticity, this does not mean it did not help with the spasticity, meaning it could still prove beneficial for our patients. In this study, the dry needling group did show significant differences when compared to the control group in shoulder range of motion and pressure sensitivity.
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Nice job guys! Dry needling is a relatively new intervention in the PT world, and I love to see all of this positive research. Your group mentioned that spasticity is most commonly treated pharmacologically. Were any of the patients in these studies on medication and attempting to seek relief from spasticity with DN or did they have to stop the medication to participate? If they were on medications, did that change results in any way?
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Hey Jordyn, great questions! For these studies, the participants were not on medication. Many of the studies would not let participants participate unless they were off medications or other spasticity treatments for 6 months prior to the study. The studies wanted to make sure the results were from the dry needling and not from other treatment protocols.
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Nice job analyzing previous studies that looked at using dry needling as a treatment for spasticity among patients with chronic stroke.
Did dry needling muscles of the LE seem to be more effective in reducing spasticity compared to dry needling muscles of the UE? Or vice versa? Or were treatments equally effective?
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Hi Jamie, thanks for the comment. For the articles we read and covered, there was not a significant difference between the UE and LE muscle groups and both extremities had supporting evidence for treating spasticity. I am also curious if there would be a significant difference between them, but our research did not support or refute that. Our presentation concluded that further research is required to determine the long term effects to see if the treatments were equally effective, or if one was favored more than the other. I hope this answered your question!
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Hi everyone! I thought you did an awesome job with the poster and explaining your findings. The topic was really interesting to me! I was wondering if there are any special considerations clinicians should be aware of when dry-needling this specific patient population? For instance, if a patient had reduced sensation or other impairments related to their stroke beyond spasticity, would that change how PTs go about performing dry-needling?
Thank you so much!
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Hi Andy, thanks for the question. From what we found in the articles, there weren’t any special considerations mentioned that clinicians should be aware of when dry-needling this specific population. However, when dry needling the muscles around the chest cavity, such as the pectoralis muscles, subscapularis, and upper traps, clinicians must be aware of the angle of the needle and the lungs to where they won’t be puncturing the patient’s lungs when performing dry-needling.
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Nice work guys! This is a really interesting topic that could help replace some current pharmacological treatments such as Botox. Did any of the studies compare dry needling to current pharmacological methods in regards to effectiveness or patient satisfaction? Also, regarding the Hernandez-Ortiz study, for how long were the benefits of a single dry-needling session able to be observed? Based on that, what would the optimal frequency be for dry needling sessions? I know it was mentioned above that you might start with 1-2x/week based on the patient. I am just wondering the justification or if this study aligns with that philosophy?
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Hey Austin, thanks for the questions! The studies did not directly compare pharmacological methods to the dry needling, but improvements in spasticity and other measures were observed without the adverse effects that are commonly experienced with medication. In the Hernandez-Ortiz study, there were improvements in spasticity, and they still observed effects from the dry needling at 6 weeks. Majority of the studies we included only did one session of treatment, and saw improvements in the outcome measures. We decided on 1-2x a week because this may be a common frequency to see patients. It may be beneficial for studies to look in to the frequency that the dry needling should be used to achieve the maximum benefit. If the patient first comes in with a large amount of spasticity, more dry needling sessions may be helpful. Once the spasticity starts to decrease, less dry needling may be needed. Like all treatments, it should be based on the individual and how they tolerate the treatment and if it improves their symptoms.
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Great job on the poster! I find dry needling very interesting and intriguing as a potential new intervention. You had mentioned that pharmacological interventions seem to benefit those with spasticity better than other interventions. I was wondering if time would be a factor within this study, meaning how long would it take to see long term results with dry needling when compared to medications? Would patient adherence be a conflicting factor as well?
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Hey Ali, good questions! Your first question is the same question we had as well, however we were unable to find any studies that looked at long-term results. This is definitely an area where the research is lacking. One study looked at the effects of dry needling after 6 weeks, and still found the spasticity to be reduced in the group that received the dry needling. Hopefully with more studies, we will be able to truly see how it compares to medication in the long run. Dry needling is definitely a treatment that should be tried, because although medications seem to work, they generally are associated with severe adverse effects which can negatively impact the patient.
To answer your second question: As with a majority, if not all, of our treatments, patient adherence is one of the most important factors. I do not believe this would be any different with dry needling as well. Patient adherence is crucial. Luckily, I think this treatment would have a high adherence rate, due to the improvements that have been seen with it with minimal to no side effects.
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Hey guys, great job on your poster! Dry needling seems to be successful for varying diagnoses I’m interested to see how it can be beneficial for other neurological cases besides chronic strokes!
I have two questions for you:
1. In regard to interventions, did research specify/give detail to “standard rehabilitation”? I was curious what was considered standard.
2. Looking at outcome measures, what was the average score on the MMAS? I was curious if the patient’s muscle tone scores correlated with successful outcomes of dry needling? (ex: the higher the MMAS score, the more difficult to treat spasticity).
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Hey Emma, thanks for the questions! For your first question, the studies did not go into detail as to what standard rehabilitation was. I am assuming standard rehabilitation would be treatment that focuses on the patients’ impairments. This could include strengthening what is weak, stretching what is tight, using techniques to decrease spasticity and tone, balance exercises, and functional exercises. As for your second question, when looking at the studies, several of the patients were at a grade II and grade III on the MMAS. Improvements were seen with these individuals. I am unsure if higher scores on the scale would be more difficult to treat, as many of the studies did not exceed a grade III. More research needs to be done in this area with more patients with grade IV spasticity.
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Nice job on your poster! It’s great that you guys chose to explore more about dry needling, as it has definitely shown promising outcomes for patients. Finding interventions other than pharmacological approaches that can effectively treat various conditions is very important for our profession. I just had one question: Did you by chance come across any literature that addresses the effectiveness of dry needling when comparing its use in upper vs. lower extremity musculature for spasticity?
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Hi Cody, Thanks for the question! From what we found in the research, we did not find any literature that compares upper and lower extremity musculature for spasticity. Research supports dry needling for both upper and lower extremities and did not show any significant differences between the upper and lower extremity muscles in the articles we covered. Currently, there is a lack of literature on the long-term effects of dry needling, and our project supports further research to specifically look at the potential long-term effects of dry needling on muscle spasticity.
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Very interesting poster! I have never seen dry needling performed on a patient who has experienced a stroke, so it would be interesting to see where the literature goes regarding this topic. I do think dry needling is a good technique so it would be awesome if it could be incorporated into treatment with this population. I know you guys were just looking at patients who had experienced a chronic stroke, but has dry needling been studied in any other neuro conditions that are associated with spasticity?
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Hi Bailey, thanks for the question. Our topic was conducted with a specific search engine that narrowed in chronic stroke patients but there is research currently being conducted, as well as already published, discussing the implications that dry needling has on other neurological conditions associated with spasticity. These mainly include multiple sclerosis and spinal cord injuries. I hope this answers your question!
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