Dry Needling For The Treatment Of Spasticity In Persons With Multiple Sclerosis

Abstract

Spasticity is a symptom commonly reported by person’s with multiple sclerosis (PwMS) which can make walking difficult thus increasing energy expenditure and exacerbating symptoms of fatigue. It has been proposed that dry needling, a common practice in orthopedics and sports medicine for treating pain, may decrease spasticity in PwMS. PURPOSE: To determine whether repeated sessions of dry needling with electrical stimulation followed by walking with functional electrical stimulation to the gastroc and tib anterior in PwMS resulted in a decreased level of spasticity as measured by the number of foot-taps and mean muscle EMG amplitude. METHODS: Sixteen PwMS (10 females and 6 males, mean age: 47.9 ± 10.0) were recruited and completed 4 separate sessions of dry needling of the gastrocnemius followed by functional electrical stimulation walking (FESW). Subjects went on to complete 8 more sessions with FESW only. Pre and post needling gastrocnemius EMG mean amplitude was assessed during a 5-second heel raise. EMG was furthermore assessed pre and post FESW. The number of foot-taps was assessed using the foot-tapping test (FTT). Results were compared using repeated measures ANOVA and paired samples t-tests. Of the original 16, only 11 subjects had a complete EMG dataset capable of being analyzed. RESULTS: No significant changes were seen in the mean EMG amplitude between pre and post needling tests in either the first (Pre: 43.4 ± 23.5 μV, Post: 41.2 ± 21.1 μV, p = 0.47) or last needling sessions (Pre: 50.8 ± 32.0 μV, Post: 50.5 ± 24.0 μV, p = 0.93) nor was the post needling EMG different between the first and last needling sessions (p = 0.18). Furthermore, no significant differences in amplitude were found post FESAW at any of the dry needling sessions or FESAW only sessions (all p > 0.05). Despite a non-significant difference in EMG amplitude, there was a significant increase in foot-taps from the first visit (24.1 ± 7.9 foot-taps) to the final visit (27.6 ± 6.5 foot-taps, p < 0.01). CONCLUSION: Neither dry needling nor FESAW sessions resulted any significant changes in mean EMG amplitude of the gastrocnemius during heel raises. Despite this, there was a significant increase in mean foot tapping ability between pre and post intervention which may lend some support to the efficacy of dry needling for the improvement of spasticity in PwMS.