DRY NEEDLING AS A SUPERIOR PHYSIOTHERAPY INTERVENTION FOR POST- STROKE UPPER LIMB REHABILITATION: NEUROPHYSIOLOGICAL MECHANISMS, CLINICAL EVIDENCE, AND A PROPOSED TREATMENT FRAMEWORK

Abstract

Background: Post-stroke upper limb spasticity is a multi-dimensional issue that involves neural
hyperexcitability, myofascial trigger point development and secondary musculoskeletal remodelling.
Traditional stretching methods address mechanical, but not neurophysiological, causes of spasticity. Dry
needling is a mechanistically more comprehensive treatment that targets both neuromuscular, neurological,
and musculoskeletal issues.
Objective: To describe the mechanism of dry needling for the treatment of post-stroke upper limb
spasticity, summarise clinical evidence to support its superiority over stretching, and outline an evidence-
based phased treatment pathway utilising dry needling as a first-line treatment.
Study Design: A randomized comparative interventional study conducted for 4 weeks in 60 post-stroke
patients (Group A: Dry Needling, n = 30; Group B: Stretching, n = 30) at PMCH, Udaipur, was the source
for the primary clinical data.
Results : Dry needling significantly improved all six outcome measures: a significant reduction in MAS
(1.16 vs 0.57), reduction in VAS (3.46 vs 2.57), gain in shoulder ROM (26.8° vs 13.3°), elbow ROM
(32.3° vs 14.7°), wrist ROM (24.3° vs 12.2°), and FMA-UE (15.2 vs 8.8 points), all p<0.05.
Conclusion: Dry needling is a neurophysiologically, mechanistically and clinically more effective
treatment than stretching alone for reducing upper limb spasticity following stroke and can be used as the
main intervention in a structured, multimodal physiotherapy approach.