Many non-pharmacological interventions have been proposed for spasticity modulation in spastic stroke subjects. To investigate the immediate effect of dry needling (DN), electrical stimulation (ES), and dry needling with intramuscular electrical stimulation (DN plus IMES) on H-reflex in post-stroke spasticity. Spastic subjects with stroke (n = 90) (55 to 85 years) were evaluated after 1 month of stroke onset using Modified Ashworth Scale (MAS) score >= 1. Subjects were randomly allocated to receive one session of DN - Soleus (n = 30), ES - posterior lateral side of the leg with 100 Hz and 250 Î?s pulse width (n = 30), or DN plus IMES - Soleus (n = 30). MAS, H-reflex, maximum latency, H-amplitude, M-amplitude and H/M ratio, were recorded before and after one session of intervention. Relationships for each variable within group or the difference among groups were calculated by effect size. Significant decrease in H/M ratio in Gastrocnemius and Soleus at post-treatment within DN group (p = 0.024 and p = 0.029, respectively), large effect size (d = 0.07 and 0.62, respectively); and DN plus IMES group (p = 0.042 and p = 0.001, respectively), large effect size (d = 0.69 and 0.71, respectively). No significant differences in all variables at pre-treatment and post-treatment was recorded among ES, DN, and DN plusIMES groups. Significant decrease in MAS was recorded at post-treatment compared to pre-treatment within ES group (p = 0.002), DN group (p = 0.0001), and DN plus IMES group (p = 0.0001), but not significant (p > 0.05) among three groups at pre-treatment (p = 0.194) and post-treatment (p = 0.485). Single session of DN, ES, and the DN plus IMES can significantly modulate post-stroke spasticity by possible bottom-up regulation mechanisms.

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