200 Section - Ultrasound-Guided Dry Needling in Early Post-Stroke Rehabilitation: Addressing Trigger Points, Spasticity, and Spinal Fluid Dynamics

Early post-stroke rehabilitation requires targeted strategies for motor recovery, spasticity management, and pain modulation. Ultrasound-guided dry needling (DN-US) is a precise intervention addressing myofascial dysfunction, neuromuscular reeducation, and central sensitization. This case report evaluates the effects of DN-US on motor function, spasticity, and spinal fluid dynamics.

Case Description:

A 31-year-old female (BMI 30) with post-ischemic stroke sequelae—including left-sided paresis, shoulder impingement (90° limitation), numbness, vertigo, headaches, and post-lumbar puncture low back pain—underwent three monthly DN-US sessions based on Bubnov RV’s methodology [https://doi.org/10.1186/1878-5085-3-13]. Targeted areas included:

• Left shoulder (mobility restriction)


• Right sacroiliac joint (pelvic stability)


• L2–L5 and thoracolumbar fascia (LBP)


• Left soleus (gait dysfunction)


• Suboccipital muscles (headaches/central modulation; treated in all sessions [https://doi.org/10.1177/03331024241280496#sec-206])

The patient also received moderate rehabilitation, but improvements were clearly associated with DN-US sessions.
After the first session, all symptoms—numbness, vertigo, pain, and weakness—began improving. Shoulder mobility increased to 180°, and spinal root micromovement frequency decreased from 200 Hz to 70 Hz. By the second session, nearly all symptoms had resolved. After the third session, the patient achieved full recovery, returned to work, and resumed cycling.

Discussions:

DN-US demonstrated consistent and rapid symptom relief, including:

• Trigger point inactivation


• Spasticity modulation


• Neuromuscular reeducation


• Central sensitization reduction, evidenced by spinal micromovement changes


• Vertigo and headache improvement, particularly via suboccipital DN

The observed improvements—both subjective and objective—were temporally and anatomically linked with DN-US, supporting its causative role distinct from general rehabilitation effects.

Conclusions:

Ultrasound-guided dry needling appears highly effective in addressing both myofascial and neurogenic symptoms in early post-stroke rehabilitation. It facilitated recovery of mobility, strength, and function, with measurable neuromodulatory effects. These findings warrant further clinical investigation into its role in modulating cerebrospinal fluid dynamics and enhancing neuroplasticity in stroke recovery.