3 Most Important Dry Needling Skills

What would you say are the three most important considerations when Dry Needling?


These are my 3 Top Tips in order of most important to least important:

  1. Patient Positioning
  2. Your Positioning
  3. Anatomy Knowledge

Yes, none of these have anything to do with the actual dry needling technique. That’s because if you can’t get the first three right, don’t needle!

1. Patient Positioning


Patient positioning is really important for all treatment preparation, not just dry needling. I see too many practitioners allowing their patients to randomly position themselves on the treatment tables and ready themselves for what the the therapist wants to do next. Who’s in charge?

There’s either too much of a gap between the therapist and patient, usually when there’s a side-lying technique about to be used, or the therapist is too head on (square-on) to the patient. This results in poor technique because the therapist has to compromise in allowing for wherever the patients ends up. It’s almost like we throw a pack of cards up in the air and wait for them to drop. Wherever they end up we’ll work around them.

Try and get the patient set up correctly to suit you as much as possible, before you even start thinking about your position in relation to them. My other “pet hate” is when practitioners leave the patient hanging. This happens when the therapist hasn’t given the patient clear instructions about what they would like the patient to do next. Invariably, it’s because the therapist hasn’t thought about the optimal position for the next technique ahead of time. The time for thinking and deciding on this is towards the end of the previous technique. Don’t allow your patient to wander around looking for your next instruction, the treatment room choreography should be a series of seamless transitions from one act to another.

2. Your Positioning


Your positioning is the next most important consideration. If your patient is in the right spot, that will certainly help you achieve a great operator position. However, it doesn’t always follow that because your patient is set up correctly, you’ll just get it right too.

There are some key principles about your positioning.

  1. Avoid over supination or over pronation of your wrists
  2. Try to position yourself so you can needle towards yourself
  3. Maintain a T position of your feet

Avoiding over supination or over pronation of your wrists


By avoiding these positions you allow your operating and palpation hands full freedom to move, swivel, bend and adapt to the type of grip that you’ll be using. Try it and see. Place your wrists in full pronation or supination and see how limiting it is. The magic happens by not trying to fix up your wrist position but actually by moving your feet and body.

Try to position yourself so you can needle towards yourself


Limiting your ability to move freely always makes for discomfort, for you and your patient, and no one wants that. If you try and needle towards yourself rather than away from yourself you create a much more ergonomically efficient positioning which fits in with your hand and wrist position.

Maintain a T position of your feet


This is the final “step” If you’ve got the last two key points right, this one is the last piece of the jigsaw. By creating a T position with your feet you create an open posture towards your patient rather than cramping yourself into a square on position.

So, as you see it’s not about the actual needling. Think about this analogy:

If you were a Pro-Golfer, you’d line up to the ball at the tee, launch it into an elliptical flight path with grace, poise and ease. The ball lands softly on a patch of bent grass barely the size of the pocket on your jeans, ready for you to birdie putt with the same masterful & confident stroke.

So, how does that happen?

The work is done before the ball connects with the club face. The ball just happens to be in the way of the swing. It’s almost irrelevant to the final goal.

Just like the needle is to you as a Dry Needling therapist. If the hard work is done before you insert the needle the rest is as beautiful & effortless to watch as the ball landing on the green. It’s not about how hard you hit the ball, it’s the preparation, the placement of your hands on the grip, the patient positioning & your positioning. Try it and see.

3. Anatomy Knowledge


There’s no other manual therapy technique that requires a more thorough knowledge of anatomy than Dry Needling. Why? Well, there’s no other invasive techniques that we, as manual therapists perform on our patients. The need for accuracy is very important when needling because of two main reasons, unrelated adverse events following needling and accurate record keeping.

Let’s say that you treat a patient today for a lateral elbow pain. The patient returns the following week and explains how his lateral elbow pain has improved but he now has new symptoms over the ulnar aspect of his forearm, wrist and hand. If you cannot be certain of exactly which muscles you needled and the course of the ulnar nerve, you can’t be certain that you did not cause those new symptoms.

By knowing your anatomy you’re able to explain & understand the safest needling direction to needle. As an example, when needling the Quadratus Lumborum you will be able to explain, in your own mind why it’s important not to direct your needling towards a cephalad direction. You will also be able to understand why a maximum of 20 degree needling direction is recommended.

In summary, try and do the preparation first before you think about needling. Everything will fall into place once you do the hard work before you even insert the needle, that’s the easy bit!

>>Did you know that CPD Health Courses has a Free Dry Needling Video Training App? Download it HERE

>>Watch all the Video Training direct from our Dry Needling Courses HERE.

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