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

Background: Post-stroke upper limb spasticity is a multi-dimensional issue that involves neuralhyperexcitability, myofascial trigger point development and secondary musculoskeletal remodelling.Traditional stretching methods address mechanical, but not neurophysiological, causes of spasticity. Dryneedling 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 limbspasticity, 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-strokepatients (Group A: Dry Needling, n = 30; Group B: Stretching, n = 30) at PMCH, Udaipur, was the sourcefor 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 effectivetreatment than stretching alone for reducing upper limb spasticity following stroke and can be used as themain intervention in a structured, multimodal physiotherapy approach.