---
title: "Post-stroke spasticity"
url: "https://acuiq.com/wiki/evidence/post-stroke-spasticity"
updated: 2026-10-21
last_verified: 2026-10-21
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-21"
reading_minutes: 9
sources: 19
---

# Post-stroke spasticity

_What reviews of sham-controlled and add-on trials, reviews of dry needling, three sham-controlled trials and two guidelines report on acupuncture, electroacupuncture and dry needling for spasticity after stroke._

Spasticity after stroke is raised muscle tone in the affected arm or leg, and the reviews on this page mostly score it on the Modified Ashworth Scale (MAS), an assessor's rating of muscle tone. Cochrane has not published a review of acupuncture, electroacupuncture or dry needling for spasticity after stroke. The reviews that exist split by comparison. A [2010 review of sham-controlled trials](https://doi.org/10.1503/cmaj.091113) by Kong, Ernst and colleagues found three chronic-stage trials that measured the MAS, and none showed a benefit; [Stroke recovery](/wiki/evidence/stroke-recovery) reports that finding. Later reviews pooled trials that added acupuncture to rehabilitation and compared it with rehabilitation alone, and they report lower MAS scores at low or moderate certainty. Reviews of dry needling of the spastic muscles report short-term reductions, some of them against a sham.

## What Cochrane reviews report

The nearest Cochrane review is the [2016 review of acupuncture for stroke rehabilitation](https://doi.org/10.1002/14651858.CD004131.pub3) by Ai Yang and colleagues, of 31 trials with 2,257 people in the subacute and chronic stages. Its abstract reports results for daily activities, neurological function, motor function, cognition, depression, swallowing and pain, and none for spasticity or muscle tone.

## Reviews of acupuncture and electroacupuncture

| Review | Trials and people | Comparison | What the authors report | Certainty |
| --- | --- | --- | --- | --- |
| [Park 2014](https://doi.org/10.1089/acm.2014.0097), Korea | 8 trials, 399 people | Controls without acupuncture | No effect on the MAS or on the H/M ratio, a nerve-conduction measure of reflex excitability, at the end of treatment; the H/M ratio fell immediately after the first session | Quality of all trials inadequate |
| [Lim 2015](https://doi.org/10.1155/2015/870398), Korea, searched to July 2013 | 5 trials | Usual care or placebo acupuncture | Lower spasticity at the wrist, knee and elbow; long-term studies needed | Not stated in the abstract |
| [Cai 2017](https://doi.org/10.1016/j.apmr.2017.03.023), searched to September 2016 | 22 trials, 1,425 people | Electroacupuncture added to drugs and rehabilitation, against those alone | Upper-limb MAS SMD −0.57; lower-limb MAS SMD −0.88, with high heterogeneity; no add-on effect on upper-limb motor function | Not stated in the abstract |
| [Xue 2022](https://doi.org/10.3389/fneur.2022.942597), Chengdu, searched to June 2022 | 88 trials, 6,431 people | Added to rehabilitation against rehabilitation; acupuncture against rehabilitation | MAS SMD −0.73 added to rehabilitation; −0.22 in place of it | Low (added); moderate (in place) |
| [Xing 2026](https://doi.org/10.3389/fneur.2026.1725618), Tianjin, network meta-analysis | 28 trials, 2,626 people | 14 acupuncture methods, each added to rehabilitation | Luan's three-needle technique with meridian sinew cluster needling ranked first on the MAS for the upper limb | Not graded in the abstract |
| [Xiong 2026](https://doi.org/10.3389/fneur.2026.1782831), Beijing, network meta-analysis, searched to December 2025 | 34 trials, 3,383 people | Rehabilitation, conventional treatment or sham | MAS and Clinic Spasticity Index SMD −1.03, I² 88%; warm needling and high-dose acupuncture ranked first | Moderate to low |

A standardised mean difference (SMD) expresses the gap between groups in units of the spread of scores; I² measures how much the trials disagree beyond chance. In Xue's review, most comparisons were open: two trials against sham, described rather than pooled, reported acupuncture more effective, and the authors rated the trials at high risk of bias or some concerns and asked for sham-controlled trials with objective measures. The points the 88 trials used most often were [`LI04`](/points/li04) (Hegu), [`LI15`](/points/li15) (Jianyu), [`LI11`](/points/li11) (Quchi), [`TB05`](/points/tb05) (Waiguan) and [`LI10`](/points/li10) (Shousanli) in the arm, and [`ST36`](/points/st36) (Zusanli), [`GB34`](/points/gb34) (Yanglingquan), [`SP06`](/points/sp06) (Sanyinjiao), [`LV03`](/points/lv03) (Taichong) and [`SP10`](/points/sp10) (Xuehai) in the leg.

All 34 trials in Xiong's review were run in China, 30 of them published in Chinese, and all reported positive results, which the authors flagged as a possible source of publication or language bias. They defined high dose as at least 9 points, at least two sessions a week for 8 weeks or more, and the needling sensation called deqi, and described their network analysis as exploratory. Xing and colleagues wrote that their rankings were not yet strong enough to change guidelines. A [2019 overview of systematic reviews](https://doi.org/10.1016/j.rehab.2017.10.001) by Khan and colleagues, of 18 reviews of non-drug treatments for spasticity, rated the evidence for acupuncture added to routine care after stroke as moderate. [Electroacupuncture](/wiki/techniques/electroacupuncture) and [Scalp acupuncture](/wiki/techniques/scalp-acupuncture) describe two of the methods these trials used.

## Reviews of dry needling

- **2020, narrative.** [Valencia-Chulián and colleagues](https://doi.org/10.1016/j.ctim.2020.102515) found 16 studies, 7 of them randomised, which generally reported less spasticity and pain and more range of movement; control groups, muscles and measures varied too much to pool, and the authors asked for sham dry needling as the control.
- **2020.** [Núñez-Cortés and colleagues](https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105236) included 6 randomised trials with 221 people and found less spasticity in most muscles tested, at low certainty, with every trial measuring only short-term effects.
- **2021.** [Fernández-de-las-Peñas and colleagues](https://doi.org/10.1093/pm/pnaa392) pooled 7 trials: spasticity SMD −1.01 at short-term follow-up, mainly in the leg (MAS mean difference −1.05), with no effect at 4 weeks and none on motor function. They rated the evidence for the leg as moderate, downgraded for imprecision.
- **2026.** [Yuan and colleagues](https://doi.org/10.1016/j.ctim.2026.103420), searching to April 2026, pooled 11 trials with 276 people: MAS mean difference −0.65 overall, −0.45 against sham and −0.76 when dry needling was added to rehabilitation, largest at the ankle plantar flexors (−1.05). They rated certainty moderate to low, for small samples and blinding.

[Dry needling](/wiki/techniques/dry-needling) describes the method.

## Sham-controlled trials

- **Leg, 2004.** [Fink and colleagues](https://doi.org/10.1016/j.apmr.2003.06.012), at Hannover Medical School in Germany, randomised 25 people about five years after stroke, with a stiff inturned foot, to acupuncture or a purpose-built placebo needle. After 4 weeks the ankle MAS averaged 3.3 in both groups. The H-reflex, a measure of spinal nerve excitability, rose with real needling.
- **Arm, 2005.** [Wayne and colleagues](https://doi.org/10.1016/j.apmr.2005.07.287), at the New England School of Acupuncture in Massachusetts, randomised 33 people with chronic arm weakness to traditional Chinese acupuncture, including electroacupuncture, or sham, for up to 20 sessions. The intention-to-treat analysis found no difference in any outcome, spasticity included; among participants who kept to the protocol, wrist spasticity improved more with real acupuncture, in a small, unadjusted post hoc analysis.
- **Dry needling, arm, 2024.** [Panahi and colleagues](https://doi.org/10.1080/09638288.2023.2190168), at Shiraz University of Medical Sciences in Iran, gave 24 people 12 sessions of neurorehabilitation with 4 sessions of dry needling or sham needling of the wrist and finger flexors. Both groups improved; dry needling did better on muscle thickness, reflex torque, motor function and dexterity, but not on spasticity.

[Kong 2010](https://doi.org/10.1503/cmaj.091113) counted three chronic-stage sham-controlled trials of spasticity, and all three found no benefit on the MAS. [Sham acupuncture](/wiki/research/sham-acupuncture) explains what such controls can and cannot show.

## What guidelines say

NICE's [guideline NG236 on stroke rehabilitation in adults](https://www.nice.org.uk/guidance/ng236), published in October 2023 and current, recommends stretching, splints and managing triggers for spasticity, botulinum toxin A for focal spasticity of the arm, a trial of electrical stimulation (NMES, FES or TENS) for focal spasticity, and oral baclofen for generalised spasticity. Its spasticity recommendations do not mention acupuncture or dry needling.

The [Brazilian practice guidelines for stroke rehabilitation, part II](https://doi.org/10.1055/s-0042-1757692), published in 2022, state that acupuncture and electroacupuncture combined with conventional care may be beneficial for spasticity, and recommend that acupuncture, electroacupuncture and functional bandaging should be considered (class IIa, level A); the same guideline rates acupuncture not useful for recovering gait (class III, level A). A [2025 review of 19 stroke rehabilitation guidelines](https://doi.org/10.1186/s12906-025-04916-9) by Zhu and colleagues, which [Stroke recovery](/wiki/evidence/stroke-recovery) also reports, counted the Brazilian Academy of Neurology's 2022 guideline as the one, of the 19, that strongly recommended acupuncture or electroacupuncture for spasticity. [Clinical guidelines](/wiki/evidence/clinical-guidelines) sets out other bodies' positions.

## What the reviews could not settle

The comparison with sham rests on a handful of trials of 25 to 33 people for acupuncture, which found no difference on the MAS, and on small dry needling trials whose pooled effect against sham Yuan rated moderate to low in certainty. The larger pooled results compare acupuncture added to rehabilitation with rehabilitation alone, where participants knew whether they were needled, so they cannot separate needling from extra treatment time and attention. Xue's review noted that the MAS is a subjective scale and that blinding of the assessors was often unclear. Xiong's review found too little long-term follow-up to judge lasting effects, and the dry needling reviews measured effects over days to weeks. [Difficulty swallowing](/wiki/evidence/dysphagia) covers another problem after stroke.

AcuiQ's pages on [post-stroke spasticity](/symptoms/spasticity-post-stroke), [upper-limb spasticity](/symptoms/spasticity-upper-limb), [lower-limb spasticity](/symptoms/spasticity-lower-limb), [spastic paralysis after stroke](/symptoms/paralysis-spastic-post-stroke) and [hemiplegia](/symptoms/hemiplegia) list the protocols individual studies prescribed, each with its citation.

### Sources

1. Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ, Acupuncture for stroke rehabilitation, Cochrane Database of Systematic Reviews 2016 — https://doi.org/10.1002/14651858.CD004131.pub3
2. Kong JC, Lee MS, Shin BC, Song YS, Ernst E, Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials, CMAJ 2010 — https://doi.org/10.1503/cmaj.091113
3. Park SW, Yi SH, Lee JA, Hwang PW, Yoo HC, Kang KS, Acupuncture for the treatment of spasticity after stroke: a meta-analysis of randomized controlled trials, Journal of Alternative and Complementary Medicine 2014 — https://doi.org/10.1089/acm.2014.0097
4. Lim SM, Yoo J, Lee E, et al., Acupuncture for spasticity after stroke: a systematic review and meta-analysis of randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2015 — https://doi.org/10.1155/2015/870398
5. Cai Y, Zhang CS, Liu S, et al., Electroacupuncture for poststroke spasticity: a systematic review and meta-analysis, Archives of Physical Medicine and Rehabilitation 2017 — https://doi.org/10.1016/j.apmr.2017.03.023
6. Khan F, Amatya B, Bensmail D, Yelnik A, Non-pharmacological interventions for spasticity in adults: an overview of systematic reviews, Annals of Physical and Rehabilitation Medicine 2019 — https://doi.org/10.1016/j.rehab.2017.10.001
7. Xue C, Jiang C, Zhu Y, et al., Effectiveness and safety of acupuncture for post-stroke spasticity: a systematic review and meta-analysis, Frontiers in Neurology 2022 — https://doi.org/10.3389/fneur.2022.942597
8. Xing F, Zhang R, Guo Y, et al., Network meta-analysis of different acupuncture methods for post-stroke upper-limb spasticity, Frontiers in Neurology 2026 — https://doi.org/10.3389/fneur.2026.1725618
9. Xiong Z, Dong J, Hua Y, et al., Acupuncture therapy for post-stroke spasticity: a systematic review and exploratory network meta-analysis of clinical efficacy and dose-response relationship, Frontiers in Neurology 2026 — https://doi.org/10.3389/fneur.2026.1782831
10. Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C, Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: a systematic review, Complementary Therapies in Medicine 2020 — https://doi.org/10.1016/j.ctim.2020.102515
11. Núñez-Cortés R, Cruz-Montecinos C, Latorre-García R, Pérez-Alenda S, Torres-Castro R, Effectiveness of dry needling in the management of spasticity in patients post stroke, Journal of Stroke and Cerebrovascular Diseases 2020 — https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105236
12. Fernández-de-las-Peñas C, Pérez-Bellmunt A, Llurda-Almuzara L, et al., Is dry needling effective for the management of spasticity, pain, and motor function in post-stroke patients? A systematic review and meta-analysis, Pain Medicine 2021 — https://doi.org/10.1093/pm/pnaa392
13. Yuan X, Wang Z, Zhang H, Li Y, Meng D, Efficacy of dry needling in reducing spasticity after stroke: a systematic review and meta-analysis, Complementary Therapies in Medicine 2026 — https://doi.org/10.1016/j.ctim.2026.103420
14. Fink M, Rollnik JD, Bijak M, et al., Needle acupuncture in chronic poststroke leg spasticity, Archives of Physical Medicine and Rehabilitation 2004 — https://doi.org/10.1016/j.apmr.2003.06.012
15. Wayne PM, Krebs DE, Macklin EA, et al., Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study, Archives of Physical Medicine and Rehabilitation 2005 — https://doi.org/10.1016/j.apmr.2005.07.287
16. Panahi F, Ebrahimi S, Rojhani-Shirazi Z, Shakibafard A, Hemmati L, Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial, Disability and Rehabilitation 2024 — https://doi.org/10.1080/09638288.2023.2190168
17. National Institute for Health and Care Excellence, Stroke rehabilitation in adults (NG236), 2023 — https://www.nice.org.uk/guidance/ng236
18. Minelli C, Luvizutto GJ, Cacho RO, et al., Brazilian practice guidelines for stroke rehabilitation: part II, Arquivos de Neuro-Psiquiatria 2022 — https://doi.org/10.1055/s-0042-1757692
19. Zhu RR, Wang JX, Pan B, et al., Evidence-based evaluation for stroke guidelines mentioning traditional and complementary medicine rehabilitation, BMC Complementary Medicine and Therapies 2025 — https://doi.org/10.1186/s12906-025-04916-9