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How to Perform Dry Needling

Physical Therapys Newest Method of Pain Management
Andrew Cardenas

Table of Contents

Table of Contents
The Method of Dry Needling .................................................... 5 What is Dry Needling................................................................ 5 Materials needed: the needle ................................................ 5 Avoiding Injury and Damage ................................................ 6 The Procedure ............................................................................. 11 Preparation ................................................................................ 11 Insertion ...................................................................................... 11 Pistoning ..................................................................................... 12 Cleaning/Post-procedure care .......................................... 13 Bleeding.................................................................................... 13 Cleaning .................................................................................... 13 Common Problems and Solutions ...................................... 17 Problem 1: Infection .............................................................. 17 Problem 2: Nerve Damage .................................................. 17 Problem 3: Muscle Damage ................................................ 17 Index ................................................................................................ 19

Introduction

The Method of Dry Needling

This manual ensures that the procedures of dry needling are stated clearly and precisely step by step. Despite proper training from certified physical therapists, the manual helps keep track of the procedures as well as the dangers of dry needling when needed by physical therapists. We encourage occasionally reading this manual to freshen your knowledge of the procedures of dry needling and maintain clean, safe hospital/clinic.

What is Dry Needling

Intramuscular stimulation, or better referred to as dry needling is a specific type of intramuscular manual therapy involving the insertion of a needling to stimulate trigger points to release tension on muscle myosin and actin proteins. When one experiences minor, moderate or severe muscle pain, usually contracted muscles are unable to be released. This causes knots and increases the chances of further muscle tears and tissue damage. By hitting trigger spots along the muscle tissue with a filament needle, the myosin and actin release and relieving stress on the muscle and instantly relieves pain. The methods simplicity along with its effectiveness gives it its reputation as the most efficient pain relief method.

Materials needed: the needle

Performing dry needling only requires one thing: the needle itself. Along with proper safety equipment such as gloves, alcohol wipes, the needle is the only tool required to hit trigger points and relieve pain. The needle itself contains three parts: The plastic covering tube The fibrotic needling The plastic handle

How to Perform Dry Needling To ensure the sanitation of every needle before being used, it is made within a plastic covering can only be taken off forcefully by cracking off a piece of plastic connected the needle and the covering. The needle varies in length from just 2 inches to 5 inches. The length depends on the area where the needle is inserted or the angle, which it needs to be inserted. The width of the needle is three times smaller than that of a syringe to decrease both pain upon insertion, changes of muscle and nerve damage, and more precision on hitting trigger points. The needle on one end has a thicker plastic covering, which is used as an effective way to piston the needle in and out of the tissue (see Pistoning). Gloves must be warn before breaking the covering off the needle and can only be taken off when the needle is disposed of. Alcohol is used to cover the area of insertion to prevent possible infection.

Avoiding Injury and Damage

Before beginning the procedure, it is vital to understand the risks and dangers of dry needling no matter how rare or safe the procedure might Insertion of any object into the human body allows bacteria or other pathogenic organisms into the skin to cause infection. Though infection is extremely rare due to the small size of the insertion, infection can be deadly if not cared for. To prevent infection, it is important to wear gloves as well as insert alcohol before and after the insertion to kill any possible harmful germs or pathogens. The second possible risk is damage to nerves. Nerves are sensitive bundles of neurons that send signals to the brain and to motor neurons to perform an action. Though unlikely, a needle may damage some of these neurons and affect the nerves in the area of insertion. This could affect the depolarization of these neurons and thus make an area feel numb and inhibit the possibility of action potential back to the brain. The best way to prevent this is to study the nervous system and insert the needle in places of low sensitivity where it can still hit the trigger points and relieve pain.

Introduction

Lastly, damage to the muscle tissue can also occur. When the needle is pistoned into the muscle tissue repeatedly, it can have a significant separation of muscle fibers. This type of damage is usually only caused when the needle is used improperly where if the needle is pistoned to fast or too much, this type of damage will occur.

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Chapter 1: The Procedure

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The Procedure
Dry needling involves a simple four-step process to relieve pain. Despite slight variation in steps one and four depending on the therapists, steps two and three will not be altered. Any variation in the method of these steps can be dangerous and lead to damage of tissue.

Preparation
Preparation requires the therapist to do three key tasks: Ask for consent AFTER explaining the method Prepare yourself by putting on gloves and gathering all necessary supplies Clean the area of insertion with alcohol to prevent infection

Asking for consent before explaining the procedure is unethical. Since the method is new and most patients are unaware of its existence, a therapist must explain it to them and then ask for their consent to relieve the pain. Gloves are worn before touching the patient or the needle to prevent any possible transmission of pathogens or foreign organisms on to the needle of skin. Gather the alcohol pads and the needle. After receiving consent, apply alcohol on to the area of insertion before picking out the needle. When choosing a needle, the needles length is determined on the area of pain. Areas such as the foot, hand, neck, etc. are treated with shorter needles while areas such as shoulder, back, leg, arm, etc., which have more tissue require a longer needle.

Insertion
After sanitizing the area of insertion, break the needle from its plastic casing. The needle and plastics connects through a thick piece of plastic between the casing and the needle handle. In order to break it, follow these instructions: 1. Hold the casing in your fingers (not your palm) 2. Place your thumb on the handle of the needle where the plastic connecting the casing and the needle is located 3. Apply force onto the needle to break the plastic 4. When broken, leave needle in the casing as it will be used in the next stage of insertion When broken, the needle is now loose in the casing. The casing now acts like a tube like structure, which is important for insertion of the needle. The next step in inserting the needle is to find the trigger point on the skin to insert the needle. Trigger points will usually appear as knots where muscle tissue has contracted. Physical therapists prefer

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How to Perform Dry Needling

different methods of insertion or finding the trigger points, but most look for knots in the area of discomfort. When the trigger point is found, insertion of the needle can begin: 1. Find the trigger point and place the bottom end of the tube (casing) while holding the needle. (The needle is facing down toward the skin) 2. Drop the needle onto the skin while holding the casing on the trigger point 3. Use your index finger while holding the casing and quickly press the needle at the top into the skin and remove the casing/tube The tube acts as a barrel to shoot the needle into the skin. Its support allows for the needle to penetrate quickly and deeply. As soon as the casing is removed, the needle will stand straight and ready to begin the stage that relieves the pain.

Pistoning
The key to dry needling is the pistoning motion of the needle inside the trigger point. While pistoning the trigger point, a therapist looks for a twitch reaction from the patient to signify the stimulation of a neuron action potential thus relieving stress on the trigger point. Pistoning does not massage muscles, but rather stimulates neurons on the muscle fibers. Pistoning is simple, but also must be taken with extreme care to prevent nerve damage: 1. Pinch the top of the needle handle with your thumb and index finger. 2. Lightly, push the needle in and pull out repeatedly (needle should go no further than half a centimeter) 3. Pull out needle in no reaction occurs, perform insertion procedure again on different area around the trigger point, and repeat steps above. The repositioning of the needle is necessary in case no twitch reaction occurs. The key is to search for a nerve ending that will stimulate depolarization of the muscle fiber thus relieving stress and the trigger point. After two or three twitches, the trigger point will expand and the procedure is now over.

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Cleaning/Post-procedure care
The last part of the procedure is cleaning and caring for the area of insertion.

Bleeding
In some cases, bleeding occurs in areas where the skin is thin such as the arm. To care for bleeding: 1. With gloves on, clean the blood with alcoholic wipes to sanitize the area 2. When blood is gone, place a bandage on the insertion to prevent any further bleeding.

Cleaning
If bleeding does not occur, simply wipe down the insertion with alcohol. When disposing of items, place the needle back into the tube and throw into the needle dispenser, and throw all wipes, bandages away in biohazard trashcans. Once all materials are disposed of, gloves can be removed and thrown away in the biohazard trashcans

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Chapter 2: Problems and Solutions

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Common Problems and Solutions

Problem 1: Infection
Despite the low chances of it happening, infection is a possibility with dry needling. The insertion of the needle creates a hole in the skin big enough for bacteria or pathogens to build up there and increase risk of infection. To prevent infection, follow cleaning procedures. Upon analysis, they are likely to either place the patient on antibiotics, or if the infection is severe schedule surgery to remove infection. Depending on the type of infection, this can result in negligence, the failure to perform ones job. It is vital to follow the cleaning procedure thoroughly to prevent infection.

Problem 2: Nerve Damage

Nerve damage has occurred with improper dry needling, which can result in paralysis, muscle atrophy, twitching, loss of strength, severe pain, numbness, burning, loss of autonomic function such as heart contractions and breathing. Nerve damage occurs when the needle is pistoned too much or too deep. For example, if a needle hits a nerve repeatedly where its dendrites are located, the needle could damage those dendrites and possible destroy the synapse in that region and kill the connection. One connection disrupted can influence these symptoms minor and severe.

Problem 3: Muscle Damage

Muscle damage results again from over use to the piston procedure. Muscle fibers are strong and can withstand pressure, but when pierced with a needle repeatedly, the fibers can be badly damaged. When the needle is inserted the needle breaks through muscle fibers and tears them; however, the extent at which the fibers are damaged depends on how the needle is pistoned. The needle should only be pistoned at one angle at a time. Attempting to change angles in the middle of insertion can damage more fibers and leave the muscle strained. Though muscle damage is not as severe as nerve damage, patients have the opportunity to attest to negligence if the pain continues for a few days. Limiting the damage caused by the needle is vital to ensuring easy appointments and pain relief.

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Index
Actin, 5 Action potential, 6, 12 Alcohol, 5, 6, 11, 13 Alcohol wipes, 5 Antibiotics, 17 Area of discomfort, 12 bacteria, 6, 17 bandage, 13 biohazard, 13 Bleeding, 13 Burning, 17 Casing, 11, 12 Certified physical therapists, 5 Consent, 11 Dendrites, 17 depolarization, 6, 12 Dry Needling, 5, 6, 12, 17 filament needle, 5 Gloves, 5, 6, 11, 13 Infection, 6, 11, 17 Insertion, 5, 6, 11, 12, 13, 17 Intramuscular stimulation, 5 Knots, 5, 11, 12 Loss of autonomic function, 17 Muscle atrophy, 17 Muscle damage, 17 Muscle fibers, 17 Muscle tears, 5 Muscles, 5, 12 Myosin, 5 Needle dispenser, 13 Negligence, 17 Nerve damage, 6, 12, 17 Nerves, 6 Neurons, 6, 12 Numbness, 17 Pain, 5, 6, 11, 12, 17 Paralysis, 17 Pathogenic organisms, 6 Pistoning, 6, 12 Preparation, 11 Procedures, 5, 17 Sanitation, 6 Stimulate, 5, 12 Synapse, 17 Tissue damage, 5 Trigger points, 5, 6, 12 tube, 5, 11, 12, 13 Twitch reaction, 12