Dry needling therapy

The dry needling technique is widely used for treating the myofascial trigger points. Dry needling has advantage over other trigger point manual therapies by reducing the duration of treatment. But, dry needling is an invasive procedure and if it is done without following safety aspects, will bring adverse effects.

Equipments needed

• Acupuncture / Dry needles (various sizes)
• Pair of gloves
• Sterilium / Alcohol disfectant solution or spray
• Cottons
• Needle box (Disposing needles)
• Electroneedling: TENS and crocadile clips

Contraindication and precautions

Knowing contraindication is an important thing before applying any treatment procedures. As dry needling is an invasive procedure, Therapist should be cautious about contraindications. Following are some contraindications for dry needling procedure:

• Malignancy or tumour
• Open wounds or broken skin
• Aneurysm
• Osteoporosis
• Arteriosclerosis
• Hematomas
• Fractures / implants (chances of infection)
• Needle phobia or unwilling
• Not signing the consent form
• Needling over neurovascular structure and lymph nodes.

Risks

• Allergic reactions
• Neurovascular damage
• Visceral penetration e.g. Lungs
• Prosthetic or implant infection.

Pre-requesites

• Knowledge of surface anatomy and anatomical landmarks
• Clinical anatomy
• Trigger points and referral patterns

General guidelines

• Get the consent from the patients before applying dry needle.
• Wash the hands with soap.
• Wear single use gloves.
• Find the anatomical landmarks, identify the trigger points, apply alcohol disfectant spray over the treatment area.
• Apply the needle by the guiding tube and follow the type technique preferable for that area.
• Do not touch the needle shaft because of contamination.
• Dispose the needle in needle box after use.
• Apply ischemic compression immediately after removing the needle to prevent bleeding.
• Dispose the glove after the treatment session.
• Do not needle more than 5 muscles in single session. Treat proximal and medial muscles first.
• Always treat the patient in lying position than being seated. There is a chance of fainting during treatment in seated position.

Types of Dry needling

1. Superficial or shallow needling
2. Deep or trigger point needling
3. Functional dry needling
4. Periosteal pecking
5. Tendon needling
6. Electroneedling

Procedure

1. Patient position: supine, sidelying or prone with full comfort.
2. Therapist position: Therapist stand with treatment area should be easily accessible.
3. Palpation: palpate the muscle for trigger points.
4. Follow safety guidelines e.g. gloves, disinfect the skin etc...
5. Keep the guiding tube over the target muscle and insert the needle by firm tap. Then remove the tube and hold the handle.
6. Technique:
   • Slowly insert the needle inside the muscle. Do in and out motion for treating the trigger points.
   • Twisting / twirling the needle is used by many therapist for treating the fascia.
   • Superficial needling is inserted only upto dermis level. Shallow needling is used to prevent penetration over vulnerable structures.
   • Fuctional needling: Insert the needle over the trigger point and ask the patient to contract the muscle isometrically for 10 sec followed by rest for a min. procedure is repeated for 3 to 5 times.
   • Electroneedling can be applied through crocadile clip to the needles. TENS can be used for electroneedling procedure.

Techniques

1. Suboccipital muscles
2. Trapezius dry needling

1. John sharkey., The concise book of dry needling.
2. Giles gyer et al., Dry needling for manual therapists.
3. James Dunning, Raymond Butts, Firas Mourad, Ian Young, Sean Flannagan, and Thomas Perreault., Dry needling: a literature review with implications for clinical practice guidelines. →

Creator Details

Name	:	Deva senathipathi
Qualifications	:	Physiotherapist