Effects of Dry Needling on Spasticity and Gait in Multiple Sclerosis Patients: A Controlled Trial on the Gastrocnemius Muscle

Abstract

Background: Spasticity is a common and debilitating complication in patients with multiple sclerosis (pwMS), significantly affecting their mobility and quality of life. The gastrocnemius muscle often experiences increased spasticity, leading to challenges in gait and daily functioning. While current treatments include pharmacological and physical therapy interventions, there is a growing interest in alternative therapies such as dry needling (DN) to manage spasticity and improve functional outcomes.

Objective: The present study aimed to evaluate the clinical, biomechanical, and functional effects of dry needling on gastrocnemius muscle spasticity and gait in pwMS.

Methods: A single-blind randomized controlled experiment was undertaken at Lahore Institute of Professional Studies, Lahore, Pakistan. The intention was to recruit thirty-two individuals diagnosed with multiple sclerosis, aged between twenty and fifty. The participants were then allocated at random to either the DN group (n=16) or the control group (n=16). The criteria for participation in the study were a confirmed diagnosis of multiple sclerosis (MS), presence of gastrocnemius spasticity with a minimum score of 2 on the Modified Modified Ashworth Scale (MMAS), and the capability to walk without assistance or with the use of assistive devices. Individuals having contraindications to DN, recent changes in their spasticity treatment, or previous participation in interventional studies within the last six months were excluded from eligibility for the research. Unlike the control group, the DN group had a single two-minute intervention specifically aimed at the gastrocnemius muscle. The control group was not subjected to any kind of therapy. The outcome measures were evaluated at the commencement of the intervention, immediately after it, and one week subsequently. The three main outcome measurements were passive resistive torque (PRT), maximum voluntary isometric contraction (MMAS), and podography foot pressure distribution. The secondary outcome measures were the Timed Up-and-Go (TUG) test, as well as the active and passive ankle dorsiflexion range of motion (ROM). The data underwent analysis using SPSS version 25, which included descriptive statistics, paired t-tests for comparing groups within the same group, and estimated effect sizes.

Results: A total of 32 pwMS (mean age: 39.52 ± 7.24 years; mean MS duration: 166.86 ± 5.66 months) participated in the study. The DN group showed a significant decrease in MMAS spasticity from a median score of 3 to 2 immediately post-intervention and at one-week follow-up (p = 0.004). The PRT improved significantly in the DN group with an effect size of 0.65. Active and passive ankle ROM also improved significantly with effect sizes of 0.62 and 0.80, respectively. The TUG test showed a moderate improvement with an effect size of 0.49. There were no significant changes in foot pressure distribution metrics, but small effect sizes were observed for maximum plantar force (0.28) and maximum peak pressure at follow-up.

Conclusion: A single session of DN applied for 2 minutes was effective in reducing gastrocnemius spasticity and improving PRT, active and passive ankle ROM, and dynamic balance in pwMS. However, no meaningful improvements in gait were observed. These findings suggest that DN can be a beneficial adjunct therapy for managing spasticity in MS, although further research with larger sample sizes and longer follow-up periods is needed to fully understand its effects.