Jo Murphy of The Murphey Saga has done dry needling and received benefits from it.
The Emergence of Dry Needling in Stroke Rehabilitation
Nirmal Surya1
, Guhan Ramamurthy2
Editorial
The management of stroke, acute revascularization and
rehabilitation techniques have taken a giant leap in the current
decade. The presence of neurological deficits, spasticity and
pain are the common limiting factors in post-stroke patients.
The various rehabilitation measures in stroke are focused on
improving the trio. Spasticity, in a post-stroke patient, is
disabling(Then why does Dr. William M. Landau consider it not worth treating?) and can be managed using oral pharmacological
agents, botulinum toxin, intrathecal baclofen. The use of needle
therapy, dry needling, which was commonly used in the
management of myofascial pain syndromes has emerged useful
in the management of spasticity. Further recent evidence has
shown it to be useful in the other dimensions of stroke
rehabilitation. Dry Needling is a skilled intervention, that is
performed by trained personnel using a filiform needle. It can
be performed superficially or deep. The speculative
mechanisms by which dry needling reduces spasticity include
inducing stretch in the muscle and afferent modulation of the
sensory information from the muscle. It improves blood flow
and oxygenation, reduces pain through central and peripheral
mechanisms. (1)
The use of dry needling in neurology has evolved from its use
in the management of myofascial pain to spasticity in spastic
tetra paresis and stroke rehabilitation. In post-stroke patients,
dry needling has been used in the management of post-stroke
spasticity, balance, post-stroke pain. In the management of
spasticity, dry needling using ‘pistoning technique’ in the
lower limbs (gastrocnemius, tibialis posterior) and upper limbs
(shoulder, elbow and wrist) revealed improved scores in
modified modified Ashworth scale (MMAS) that translated to
improved gait and range of upper limb motion respectively.
The dry needling was performed for 1 minute in each muscle
studied. However, the number of sessions varied from a single
session to 8-week therapy between studies. In the management
of balance, the dry needling of the involved tibialis posterior
muscle improved the balance as measured by single-leg stance,
balance component of Fugl-Meyer scale and dynamic
posturography. The improvement in the above measures is also
shown to improve the functional outcome of post-stroke
patients in Barthel index, 10-metre walk test, timed up and go
test. The dry needling is shown to reduce pain including poststroke shoulder pain by reducing the pain threshold. The above
effects of dry needling were also evident in ultrasound
assessment of the intervened gastrocnemius muscle that showed improved muscle length, reduced mean muscle
thickness and angle of pennation. (1-3)
The dry needling has also been studied in post-stroke
rehabilitation as a component of the multimodal approach. The
use of dry needling in conjunction with electrical stimulation
of the muscle is shown to produce persistent improvement in
the tone of the muscle. The adverse events noted following the
use of dry needling include post interventional muscle
soreness, bleeding, bruise and pain during the intervention.
Major side effects such as loss of consciousness are rare and
hence dry needling serves as a safe therapeutic option in the
rehabilitation of post-stroke patients. (1-3)
Hence dry needling is a safe, cost-effective technique that can
be used in the management of post-stroke spasticity, balance,
pain that translates to improved functional outcomes. However,
further evidence is required to establish the efficacy of this
promising technique in the management of post-stroke
rehabilitation.
Zengqiao Zhang
Wu Wang3†, 
Kunpeng Li