This video describes how to control a bendy needle in thick or tight muscle tissue.
Hi. Welcome to the Twitch Dry Needling video training series where I’ll show you a fantastic dry needling technique followed by a manual therapy technique to get great results for your patients every time.
These Dry Needling Techniques should only be applied by trained therapists who have completed an accredited course.
Now, a question from one of our members about needling the ITB and TFL. Now, often with that type of muscle, it’s really tight, like many muscles that are compressed, tensioned, loaded, a lot of trigger points in there. Particularly this one here. It’s very hard to get a longer needle in, like a 50 or a 40. What do we do? What are the techniques that we can use to get through that tissue and achieve either a twitch or getting some ache or referral to simulate a familiar pattern for that patient? Well, I’ve got a few tips and tricks here for you.
I’m going to have a look at this very nice muscle right here. Of course, to turn this muscle on, we could have the patient in this position here. It comes off the ASIS and that front part of the iliac crest here and goes into the ITB. Now, how we turn this muscle on is medial rotation, of course, of the hip. So push up against me there, just against with your foot up that way. That’s it. That is perfect.
Now, it’s important to understand what this muscle should actually feel like. So if you’ll just keep pushing against me here. So it’s actually a very interesting muscle in terms of its shape. It’s like a spindle right here. It’s a long, thin muscle which is tapered at one end and tapered at the other. The bulk of it is sitting right here. To palpate this muscle, what we need to do is put our three fingers just below the ASIS, because it’s going to come just above here. This is going to be the tendinous part here. The meat, the belly, the bit that you want to get onto is right there. So just three fingers there. That will pretty much span the bit that you want. Come back, and we’re going to feel it right there. Now, just even push, lift your foot up for me, and it’s right there. You can feel it.
So now there’s a time to actually really orientate yourself, because the leg is like this, and the muscle … Just keep doing that for us. There you go. It’s a bit like going to the gym this, isn’t it? It’s actually sitting just like that. It’s coming at an angle. So if I was to get this needle here, it’s actually sitting just like that here. It’s important to remember the orientation of that muscle.
Now, once we’ve got that spot, we put our three fingers right over it. It’s always the middle finger that’s worse, right there. When we find that spot here, we’re going to spread with the fingers here. Important to remember this, because if we don’t do this, if we just have this and we’re feeling like a lot of people do like this, we could end up anywhere. Even if you started here and then you just feel with this finger, that finger is over here now. You’re going to needle there. You’ve got a nice big bulge there. That’s a problem already.
What we need to do is keep our fingers together and palpate as a group like this. So there’s my spot. There’s my spot right there. Now we’re going to spread and we’re going to move that finger away from this one. What we do is we spread like that. What that does here is there’s no bulge here, so you’re actually closer to the muscle tissue and you stretch the skin. When I tap that needle in between these two fingers, the needle will stay in situ and not touch your glove. That’s important.
Let me show you the first thing that we need to do with a 40/50 mm needle. So I put my glove on and show what we do next. We’ve already done the alcohol rub, so let’s see. Here we are. Push up again for me. There it is. Then I find my spot here. I spread.
Now, let’s say that we’re having trouble getting it. See that? Bolt upright. Not going to go anywhere. So as we move that needle in, let’s say that needle starts wobbling. We’ve got it like this and it starts wobbling like this. Problem with that is that you’re now at 90 degrees to the handle. That means half of your force is going through the handle and then the shaft, the rest of it isn’t. What you can do is get closer to the handle here and rest this finger right here and only have these two fingers here at the bottom of the handle. Once you do that, then we can go straight in, no problem.
Now, let’s say that that didn’t work. It’s pretty tough. It’s not in this particular one. A very fit and young patient here, so we’re not going to find a problem. But let’s say that that didn’t work for you. Resting here is the first tip or trick that I would suggest to get that needle in.
Second thing is make sure … And also, hold down further on the handle, especially with the Hwato needles. They’ve got a longer handle. Get closer to the tip that way. The closer you are here to the tip … Not on the shaft, of course … the more control you have.
This one is a really good one. This one here. So we’re now in a position where you’ve got those two fingers and that thumb holding that shaft and we’re going straight down. Now there’s not a 90 degree vector across here. It’s straight down. So here, as we do that, then we can go straight in. That’s really straightforward. That can give you great results in your level six, level one to five or whatever result you want to look for. So the straight down manoeuvre is straight down like this when you’ve got two fingers here, the thumb there, going straight down. That’s going to be great.
Now, if that still doesn’t work for you, what you need to do is … Let’s take that out … is use a shorter needle. Of course, we can use the 30 mm needle either in a Seirin or the Hwato That is going to be able to give you much more control, because you can hold further down the handle here. So we can go like that. That’s very straightforward. Or, of course, if you’re still having problems, you can go straight in like this. That’s going to be … That drive, that one, is going to be great for getting great results for your patient every time.
So there’s a few tips and tricks there. Let me review those for you. We get the hand here so that we’re nice and close to our needle. We’re resting on here so it’s not wobbling everywhere. Second thing is the drive straight down with the two fingers and the thumb. Use a shorter needle. That’s going to be your last tip and trick to get that sorted for you.
I hope that really helps with the needling for the TFL, ITB, any type muscle like that. Even works really well on the multifidi as well. Speak to you soon. Bye for now.
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