Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report

Abstract

Context: Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury. The aim of this case report was to study the immediate, short-term effects of dry needling treatment (10 weeks) on spasticity, dynamic stability, walking velocity, self-independence, and pain in a single patient with an incomplete spinal cord injury. Findings: The dry needling treatment resulted in immediate, short-time effects on basal spasticity in the upper (reduction from 2 to 0 point median) and lower (reduction from 2 to 0 point median) limbs, as measured by the modified Ashworth Scale. Dynamic-stability, assessed by trunk accelerometry, improved more than 50% (Root Mean Squared of acceleration, Root Mean Squared of Jerk and step variability), and gait speed improved by 24.7 s (i.e. time to walk 20 m). Self-independence and pain were respectively scored by the Spinal Cord Independence Measure (21 points improvement) and visual analog scale (4 points improvement). Conclusions: This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury.

Functional intermuscular reduction in spasticity for people with multiple sclerosis

“…Because we did not have literature to support our choice for an efficacious dose of IMES in people with MS, we used parameters based on clinical judgement and previous studies in other neurological populations. 7 , 12 – 15 Another limitation of the study was that we could not attribute changes we observed in spasticity to IMES, TM + FES, or a combination of these interventions. Additionally, this study might be subject to selection bias, as many of the participants were able to walk longer distances.…”

“…While other studies have investigated the short-term effects of dry needling/IMES for the treatment of spasticity in individuals with stroke and spinal cord injury, our study is novel in that it used a two-pronged approach to address spasticity and gait impairments in individuals with MS. 7,[12][13][14][15] Slowed gait speed has been associated with fall risk in people with MS, 28 and the T25FW is often used to measure gait speed in this population as it is highly correlated with falls. 29 Coleman and associates suggest a 20% decrease in time in the T25FW constitutes a minimal clinically important difference (MCID).…”

“…Researchers have previously used trigger point dry needling (TPDN) to reduce spasticity in persons with stroke and spinal cord injury. 7 , 11 – 15 These studies demonstrate that short-term decreases in muscle tone are possible, however tone modulation in connection with gait after a retention period was not assessed. 16 Functional electrical stimulation (FES) has had a positive orthotic effect on walking, but most research used stimulation to either the fibular nerve and/or the pre-tibial muscles, not focusing on the importance of the gastrocnemius/plantarflexor muscles.…”

“…5,6 In turn, these impairments are associated with slow gait speed, poor endurance, fatigue, and impaired function. 3,6 Furthermore, while studies have singularly addressed both spasticity 7 and gait training, [8][9][10] their combined potential influence on fatigue and function has largely been overlooked. 3 A central unresolved question is how to best manage spasticity, while improving walking speed and function for people with MS.…”

Rehabilitation Therapies in Spinal Cord Injury Patients

“…Dry needling is an invasive procedure that consists of reaching muscle myofascial trigger points (MTPs) with a needle [38]. MTPs are small, tense muscle nodules that cause pain, cause weakness, and limit range of motion [39].…”