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Dry Needling Advanced
WELCOME
Copyright*CPD*Health*Courses*2014.**
Safety in Advanced Dry Needling Practice!
Avoidance of Pneumothorax: Lung & Pleural Fields
A: Apex of Lung & Plura
Mc: Mid Clavicular
Ma: Mid Axillary
P: Posterior (Spinous Process-Lower Border)
L: Lung
P: Plura
A2.5-4!
Mc!
Ma!
P!
L!
6!
8!
10!
P!
8!
10!
12!
Eg: The Lung is at the level of the 8th rib on the Mid axillary line & the Plura is level with the lower border of the
12th Thoracic vertebrae posteriorly.
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ANTERIOR
VIEW
1
2
MSA
3
A
P
4
R
C
N
5
T
6
7
M
XP
P
S
8
9
10
Copyright*CPD*Health*Courses*2014.***
L
A!
!
2.5-4!
LATERAL VIEW
2
3
4
5
6
7
8
9
10
Copyright*CPD*Health*Courses*2014.***
Mc! Ma!
P!
L!
6!
8!
10!
P!
8!
10!
12!
POSTERIOR
VIEW
T
3
T
7
A!
!
2.5-4!
Mc! Ma!
P!
L!
6!
8!
10!
P!
8!
10!
12!
T10
T12
Copyright*CPD*Health*Courses*2014.***
Safety in Dry Needling Practice
Pneumothorax: Signs & Symptoms!
C-C-C-D-D-D-H-S-T-T
Copyright*CPD*Health*Courses*2014.**
AR13 - Dorsal Scapular (SI-14)
Ma’s Acu Reflex Points
In a tender depression on the superior border of the medial end of the scapular
spine.
AR7 - Greater Occipital (BL-10)
From the ventral ramus of C5, passing along the medial border of the scapula.
Supplies: Levator scapulae, rhomboid major & minor. Enters the Levator scapulae
approximately 1 cm superior to the base of the scapulae.
In a depression 1.5 cun lateral to the midline at the lateral edge of the trapezius
muscle.
Symptoms: Periscapular pain, rotator cuff injury & shoulder injuries.
The greater occipital nerve is formed from the dorsal rami of the C2 spinal nerve. It
emerges between C1 & C2, below the inferior oblique muscle. Supplies the skin of
the sub-occipital area & the posterior skull.
Needling Instructions: 0.25. Oblique medial insertion at a depth no greater than
25mm. Internal rotation of the arm moves the scapula away from the rib cage.
Symptoms: Headache, neck pain, neck stiffness, temporal headache
Caution: Deep perpendicular needling carries a substantial risk of injuring the
lung.
Needling Instructions: 0.22-0.25. Perpendicular insertion 10-20mm depth.
AR8 - Suprascapular - Infraspinatus (SI-11)
AR3 - Spinal Accessory (GB-21)
In a tender depression in the middle of the infra-scapular
fossa.
At the apex of the shoulder, midway between the midline & the
acromion process.
The suprascapular nerve innervates the infra & supraspinatus
muscles. Receiving fibres from C5 & C6 it enters the middle
of the infraspinous fossa.
This acureflex point contains both spinal (C1-C6) & cranial nerve
(XI) fibres. It also contains efferent (motor) & afferent (sensory)
nerve fibres.
Symptoms: Periscapular pain, rotator cuff injury & shoulder
injuries.
Symptoms: Neck pain & headache.
Needling Instructions: 0.25. Perpendicular or oblique
direction.
Needling Instructions: 0.25. Perpendicular insertion while
applying a pincer grip to pull the trapezius away from the apex of
the lung.
Caution: Deep perpendicular needling carries a substantial
risk of injuring the lung.
AR21- Posterior Cutaneous of T6
(BL-16)
Is at the crest of the erector spinae at the level of the lower border
of the T6 spinous process. 1.5 cun lateral to the mid-line.
From the cutaneous & medial branches of the post primary ramus
of the T6 spinal nerve.
Symptoms: Interscapular tension, periscapular pain & referred
anterior chest pain.
Needling Instructions: 0.25. Oblique direction towards the spine.
Caution: The apex of the lung lies 2.5-4 cms superior to the
clavicle.
AR20 - Spinous Process of T7 (DU-9)
In a depression just below the spinous process of T7. Level with the inferior angle of
the scapula.
From the posterior primary ramus of the seventh thoracic spinal nerve.
Symptoms: Interscapular tension, periscapular pain & referred anterior chest pain.
Needling Instructions: 0.25. Oblique insertion towards the interspinous ligament.
Caution: The spinal canal lies 20-35mm deep to the surface of the skin.
Caution: Deep perpendicular needling carries aCopyright*CPD*Health*Courses*2014.***
substantial risk of
injuring the lung.
AR2 - Greater Auricular (TE17)
AR18 - Iliotibial (GB-31)
Located in a depression behind the earlobe, between the mastoid
process & the ramus of the mandible.
Located at the point where the tip of the middle
finger lies if you were to ask your patient to
place their extended arm over the lateral thigh.
The point is located just anterior to the mastoid attachment of the
sternocleidomastoid muscle.
The sciatic nerve may send sensory branches to
innervate the iliotibial band.
The greater auricular nerve ascends over the sternocleidomastoid
over the earlobe angle of the mandible.
Symptoms: Lower back pain, lateral thigh pain,
ITB soreness & lateral knee pain.
It supplies the ares of skin over the inferior part of the ear, the
mandible & mastoid process.
Needling Instructions: 0.25. Perpendicular &
30-40mm to the bone.
Needling should be directed towards the opposite ear at a depth of
10-20 mm in order to avoid the external jugular vein.
AR24 - Common Fibular (Peroneal) (GB-34)
Symptoms: Headache, neck pain, ear ache & ear pain.
In a tender depression 1 cun inferior & 1 cun
anterior to the head of the fibula.
Needling Instructions: 0.18-.22. Directed towards the other ear
to a depth no greater than 10-15mm.
The common peroneal nerve, a branch of the
sciatic nerve (L4-S3 ventral rami) enters the
knee at the popliteal fossa along the medial
edge of the biceps femoris muscle.
Caution: External Jugular vein
AR4 - Saphenous (SP-9)
Located on the medial side of the knee at the angle formed by the
medial tibial condyle and the posterior shaft of the tibia.
It passes superficially over the lateral
gastrocnemius, posterior to the head of the
fibula & pierces the peroneus longus muscle,
where it divides into the superficial & deep
fibular nerves.
It is called the saphenous because the saphenous nerve emerges
exactly at this location.
The saphenous nerve is a sensory (cutaneous) branch of the
femoral nerve that descends inferiorly from the femoral triangle.
The area where it divides into superficial &
deep is where this point is located.
The skin of the antero-medial surface of the knee & leg up to &
including the medial malleolus is supplied by the saphenous nerve.
Symptoms: Lower back pain, lateral leg pain,
sciatic pain.
Symptoms: Needling Instructions: 0.25.
Perpendicular insertion & depth of 30-40mm.
Symptoms: Medial knee pain, groin pain & medial thigh pain.
Copyright*CPD*Health*Courses*2014.**
Needling Instructions: 0.25. Perpendicular & depth of 25-30mm
Occipitalis & Frontalis
Anatomy
Origin:
Occipitalis - Lateral 2/3 of superior nuchal line,
external occipital protuberance.
Frontalis – The area of skin that lies superiorly
above the eyebrows.
Insertion:
Galea aponeurosis. This is a thin sheet of
connective tissue that connects the Occipitalis
& Frontalis muscles.
Action:
Occipitalis - Assists the Frontalis muscle by
anchoring over the occiput & allowing the
Frontalis to retract against it.
Frontalis – Raises the eyebrows & wrinkles the
forehead.
Copyright CPD Health Courses 2014. Occipitalis
Surface Anatomy
Occipitalis is located by first finding the
superior nuchal line and sliding upwards
towards the vertex of the head.
There are two thin oval shaped muscles in
this area.
Frontalis is found over the forehead and is
engaged by asking the patient to wrinkle
their forehead.
Copyright CPD Health Courses 2014. Occipitalis
Caution
The posterior auricular nerve (Facial
nerve), Maxillary artery & Occipital artery
are located in the region of the Occipitalis
& Frontalis.
Superficial transverse needling is
recommended to avoid damaging
neurovascular structures.
Copyright CPD Health Courses 2014. Occipitalis
Needle Selection
Quantity: 1-2 per muscle
Size: 0.22-0.25 x 30mm
Direction: Transverse Oblique/Transverse
Depth : 20-25mm
Suggested patient position: Supine
Copyright CPD Health Courses 2013. Occipitalis
Trigger Point
The Occipitalis muscle trigger zone is in
the centre of the muscle & refers pain
over the ipsilateral parietal region and eye.
The Frontalis muscle trigger zone lies just
above the eyebrow & refers into the
ipsilateral supraorbital area.
Copyright CPD Health Courses 2014. Temporalis
Anatomy
Origin:
Temporal fossa & fascia above the ear.
Insertion:
Anteriorly into the ramus of the mandible
& the coronoid process below.
Action:
Elevation & retraction of the mandible.
Copyright CPD Health Courses 2014. Temporalis
Surface Anatomy
Temporalis is located over the side of the
head just anterior to the ear.
It is easily located and engaged by placing
the pads of your fingers over the muscle
and asking the patient to clench their
teeth.
Copyright CPD Health Courses 2014. Temporalis
Caution
The Facial nerve & Superficial Temporal
artery are located in the region of the
Temporalis muscle.
Superficial transverse needling is
recommended to avoid dging
neurovascular structures.
Copyright CPD Health Courses 2014. Temporalis
Needle Selection
Quantity: 1-2
Size: 0.22-0.25 x 30mm
Direction: Transverse Oblique/Transverse
Depth : 20-25mm
Suggested patient position: Supine
Copyright CPD Health Courses 2013. Temporalis
Trigger Point
TrZ1, an enthesis type trigger point zone located
over the anterior margin of the muscle just superior
to the upper border of the zygomatic arch. It refers to the incisors of the ipsilateral upper jaw
and eye. TrZ2 & TrZ3 are located immediately & numerically
behind TrZ1and are also enthesis type trigger point
zones. TrZ3 is the most commonly linked trigger point zone
with TMJ pain. TrZ2 & TrZ3 refer upwards over the superior
temporalis as well as the ipsilateral maxillary teeth on
the upper jaw. TrZ 4 is located at a point just superior to the tip of
the ear lobe. It refers postero-obliquely over the
muscle and the temporal bone. Copyright CPD Health Courses 2014.