Hi all,

I have a complicated patient with multiple medical and orthopedic problems.  Main problem currently is unsteadiness in gait with lower extremity weakness that began at least 5 years ago but may have been slowly declining since 2018.  Secondary issues are left great toe pain and left low back pain.  I know this patient well and have treated him for 5 years.  I will treat him in the spring and summer then he goes south for the winter and we have repeated each year for the past 5 years.  

Question related to dry needling: I did a first treatment last week with this patient: left Saphenous and tibial homeostatic points with ENS.  This went fine.  I attempted the left common peroneal homeostatic and he had a spasm of his left ankle dorsi flexors that did not reduce until I took the needle out.  Goal of dry needling was to reduce great toe pain and to use for neuromuscular re-education of his lower leg muscles.  Question: Thoughts on using dry needling for neuromuscular re-education in the lower leg?  With left Saphenous and tibial homeostatic points and ENS, I was able to get a strong ankle inversion contraction, better than I am able to get without DN.  I was a bit surprised with the the muscle spasm that he had with the common fibular homeostatic. We are doing a comprehensive PT program working on balance, gait proprioception, core strength, etc.  Trying to decide if dry needling has a place in his treatment plan for neuromuscular re-education or for pain modulation?  Is this sort of muscular spasm common with neurological disease? 

Brief background: Thoracic transverse myelitis diagnosed in 2005 (not much info here), L3-S1 lumbar fusion (2 day surgery, 2018), S/P treatment of squamous cell cancer of the scalp and resection of the latissimus dorsi for scalp reconstruction (2022) , Type two diabetes, low back pain.   Gait: right knee hyper extension due to plantar flexion weakness.  Past work ups by his orthopedic and neurology team ruled out other neurological conditions and diagnosed him with spinal myelopathy of unknown origin. 

Bilateral peroneal weakness (2/5) Bilateral tibialis anterior weakness (4-/5) Bilateral extensor digitorum weakness: (3+/5) Bilateral gastrocnemius weakness: (2+/5): unable to perform heel raise.

Any thoughts?  Thank you.

Anthony