Dry Needling Precautions And Why It Pays To Be A Curious Dry Needling Therapist

All therapists should take dry needling precautions when diagnosing and preparing a treatment regime for a new patient.

tell me more about dry needling precautionsThe next time a patient responds to a question about whether they’ve had previous Dry Needling treatment from another therapist, don’t take their word for it. You shouldn’t take their word for it, not because they could be trying to mislead you but because not all Dry Needling treatment is the same.

Just like when I ask my patients, “Have you ever had Spinal Manipulation?” The ones that think they’ve had spinal manipulation will tell you about it, they might then add that it was really helpful or that they would never allow anyone to manipulate them again!

Whether they say that it was helpful or it wasn’t, I’ll definitely want to know more about what it is that the other therapist did. I’m going to be curious.

Failing to be curious and take dry needling precautions can lead to missing a golden opportunity to replicate the same treatment that worked for them last time or, much worse, you ignore the lessons that can be learned about the previous therapy and how to avoid an adverse outcome.

Many patients think that Dry Needling is synonymous with Acupuncture, others, who may have a deeper understanding of the differences don’t realize that one Dry Needling therapist may work in a completely different way to the next but still call their treatment Dry Needling.

dry needling precautions recording patient case history

So, when it comes to Dry Needling precautions it’s exactly the same system that I follow with my history questions. I will always want to know exactly what type of needling the last therapist performed and how the patient responded. I’ll want to know the duration of the treatment, information about the placement of the needles, the needling technique that was used, the profession of the last therapist, and the outcome of the treatment. The more information I have, the better prepared I’ll be to try and help my patient.

So, we need to be more curious, and ask more questions about exactly what type of Dry Needling a patient has had in the past and not simply tick the box.

Having uncovered the details of the previous Dry Needling treatment, we must now decide on whether needling is an appropriate treatment choice on this occasion.

If we decide that needling is appropriate, we must now determine how much treatment to give to that patient. We must take dry needling precautions seriously and decide on a suitable treatment dosage.

Treatment dosage is something that can vary according to many factors just like a drug.


dry needling precautions getting the treatment dosage rightThere are many factors that can influence the Dry Needling dosage; these include needling intensity, number of needles, duration of treatment, number of regions/muscles treated, size (gauge/length), brand of needle, and the frequency of your treatments.

The needling intensity relates to the type of needling that is given to a patient. At our Dry Needling Courses we teach students about our 6 level intensity scale. The scale is used for two main reasons:

  • To enable the practitioner to accurately record the type of needling that was given to the patient and,
  • To assist the practitioner to adjust the intensity, and therefore the dosage of all future treatments based on the patient’s response.

The intensity scale that I developed was based on my desire to differentiate our courses and offer a Dry Needling treatment structure that could be used by all of our students.

The structure of the intensity scale was based on my clinical experience, I tweaked it a little over the past few years but it has remained pretty much the same for the past 4 years. It therefore came as a surprise recently when I came across a paper authored by Sudarshan Anandkumar and Murugavel Manivasagam published in the journal, Physiotherapy Theory and Practice (2017, VOL. 33, NO. 5, 420–428).

The title of the article is “Effect of fascia dry needling on non-specific thoracic pain – A proposed dry needling grading system”


dry needling precautions fascia dry needling

The title alone gave me a clue that someone else has the same idea about grading the type of needling they perform. Until now I had not heard or read of any other classification system other than my own.

The article describes how a 42 year old, female, secretary was helped using Dry Needling over the paraspinal region, home exercises, and posture advice over a 2-week period and a total of four treatments.

Prior to the Dry Needling therapy the patient had undergone 8 sessions of deep tissue massage and physiotherapy treatment, the treatment included thrust manipulation, non-thrust mobilization, ultrasound therapy, and a series of gym exercises) spread over 4 weeks.

In addition, the patient took (Naproxen, 275 mg twice daily) and applied hot/cold packs, which unfortunately did not change her symptoms.

The patient felt her pain status worsened after the massage sessions, gradually becoming more sensitive to touch in her upper and mid back.

The needling treatment that was given to the patient was described as fascial dry needling. “Six needles (three on the right side and three on the left side) were placed perpendicular in the thoracic paraspinal region which had fascial restriction.”dry needling precautions thoracic pain example

“The needles were placed between the spinous process of T2 and T3, T4 and T5, and T6 and T7, respectively. After each needle was inserted into the skin, it was rotated clockwise engaging the tissue bind. The needle rotation was done until resistance was felt and it locked on the tissue where no more rotation could be achieved.”

A Dry Needling Precautions Classification System Is Important

The following is the classification system that Anandkumar and Manivasagam proposed in the article. Although this classification system is more detailed than my own, it has the same objective, by differentiating and grading the needling techniques it allows therapists to record and modify their treatments more accurately.

The other important reason that a classification system like this is helpful is for comparison.

dry needling precautions do not compare apples with oranges

Very often apples are compared to oranges in published articles about Dry Needling therapy. The result is poor external validity, the results of the studies, whether positive, negative or ambivalent cannot be generalized to a population or similar presenting circumstances.

Unless we begin to classify the Dry Needling techniques that we use in our practices, teach at courses, and test in research papers we cannot gain the valuable information, knowledge and insight into the effects of this treatment or the optimal ways in which we can take dry needling precautions and use it to help our patients.

Congratulations to Anandkumar and Manivasagam for making this important contribution in defining Dry Needling therapy.

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