Needling technique Flashcards
position, grip/technique, needle
Infraspinatus
s/l or prone
flat - down to scapula
40-50 size
deltoid
prone, supine, or s/l
flat (but don’t go too medially)
40-50mm
Biceps
supine
pincer - and needle lateral to medial
40-50mm
brachialis
supine
Flat - lateral to medial (Do not pass mid line)
40-50mm
Triceps
prone, can do s/l or supine too
Pincer - lat/long head
flat - Medial head (lat to med direction)
40-50mm
Upper Trap
prone, sidelying, or supine
pincer grip
30-40mm
SCM
upper - prone
Most of it - supine
Upper - toward occiput in btwn mastoid and occiput
OR – small window in s/l off mastoid process
Supine - with pincer with findings vessels
Needle 30mm
Lat
Prone for trunk portion
Supine, s/l, prone for axillary
Trunk = rib lock
Axillary - Pincer
Trunk 40mm
Pec Major
Supine
Clavicular - flat lateral clavicle create window and tangential parallel with clavicle
Axillary - pincer
Sternal - rib block with whole hand flat
Subscapularis
Axillary - Supine
Medial - prone
Axillary 90deg abd ER and go perp into scapular
Medial - hammerlock position with shelf mm and go into scapular area. Do not use support in front of shoulder**
Medial 50mm needle
Wrist extensors
Supine in slight flex
Flat - tangential tech
Pincer - Extensor longus/brevis
Flat - digitorum/ulnaris
For ulnaris come from the side to stay more horizontal
Needle 30mm
Brachioradialis
supine with slight flexion
Pincer grip
Needle 30-50mm
Supinator
Supine
Flat -start at radius and only fan inf/sup direction. needle radius towards ulna
Go off radius and below radial head towards ulna
Needle 40mm
Anconeus
Prone - forearm flexed ~45deg
Flat (thin muscle so insert just prox to TrP and hit bone)
Needle 30mm
QL
sidelying / prone
Flat - need to open up QL (Pillow under, arm overhead), find mid line and go just posterior to mid line.
Posterior approach - L3 middle, up and over past p/s and slight ankle to belly button.
Psoas major
side lying, supine, prone
Flat palpation -
Lateral approach - like QL but 10-30deg ant to belly button. (Avoid abdominal cavity)
Posterior - same as QL but deeper
Supine - Iliopsoas approach - lateral to femoral canal (flat)
75mm
50mm if anterior?
Glute max
prone or s/l
flat
60-75mm
Glute med
sidelying
flat
50-60mm
Glute min
prone or s/l
flat
50-60mm
Adductor longus/brevis
Gracilis
Adductor magnus
supine :
with leg out to the side in ER - pincer/OK grip
Magnus - flat palpation (if you needle magnus you typically go through gracilis)
sidelying - pincer (longus/brevis)
*stay away from big groove (adductor canal)
Needle - 50-60mm
Pectineus
supine - slight ER
Flat -Femoral Triangle (inguinal ligament, sartorius, adductor longus) locate artery. Middle finger on it. Other rest down for nerve (lateral), vein Medial). Needle AP only
Needle 50-60mm. Only down about an inch.
Rectus femoris
supine
Flat
40mm fine. Longer for deeper quad.
Vastus lateralis
supine or sidelying
Flat - do AP or PA. Painful to go to fascia/ITB.
big muscle need to do both sides.
50-60mm
Vastus medialis
supine
flat - lower 2/3rd of femur under rectus and goes medial. Keep in mind adductor canal (have them quad set)
Needle 50-60mm.
Vastus intermedius
supine
Flat AP - need a longer needle. Go anywhere
50-60mm
Genu articularis
supine
flat - 1-2 inch above patella and go 45-60deg from aponeurosis. Angle towards femur and *Need to hit femur. Nothing else is there.
Needle 40-50mm
Hamstrings
prone
flat - do not go mid line (sciatic)
- biceps femoris - cannot separate short/long head. Needle away from mid line. Very easy to treat besides upper 1/3. Pillow under feet.
50-60mm needle
Gastroc
Prone
Flat - Prox - stay very superficial and needle away from mid line.
- lower - pincer palpation.
- Medial head typically more TrPs.
Needle 50 should be fine.
Soleus
If someone has TrPs and you have them do eccentric work it will flare up the TrPs**(tendonitis rehab)
Prone or s/l
Flat - fingers on tibia, come posterior to tibia. Stop before mid line with needle. Lower 1/4 wouldn’t do. Can do straight AP 1/4 to 1/2in but you don’t know what is under in mid/low section.
Teres Major
Prone with slight abd, or sidelying
pincer - needle ventral lateral (no precautions)
Needle 30-50mm
Teres Minor
Prone arm abd 90. or in s/l. Resist ER to make it pop.
Pincer - needle ventral lateral (no precautions)
Needle 30-50mm
Coracobrachialis
Supine with Abd and ER. Sit superior to the arm and next to the person.
Flat - find biceps first (make a muscle) and drop off. Then have them adduct Needling into bone only about 1 cm. Do not go posterior due to neurovascular bundle** Muscle will contract. If it does not, then don’t needle it!
Needle - 30 typically good. 40 for more space.
Pronator teres
supine with forearm supinated and arm slight flex (pronator comes about halfway down radius)
Flat - Needle directed to med epicondyl or the radius. (Do not needle mid belly straight down. Median nerve runs between the two heads)
Needle - 30-40mm.
Wrist flexors
Supine
From Ulna -> radius (Med -> Lat) FDP, FCU, FDS, palarmis, FCR, pronator teres
Flat - tangential techniques towards hand (up to elbow to stability hand) (Do not go medially for median nerve)
For Profundus - supine with larger needle (40-50). Elbow bent, prox 2/3. Pincer with thumb on radius and come between ulna and median nerve heading to radius. Palpate ulna and go just off it. Don’t hit radius (too far)
Needle 30-40mm
Pec minor
supine with arm up in abd or “fainting position”
pincer and needle medial to lateral. Do the “hover over the ribs.” When you do the minor you also do the major.
Do not use smaller needles. Need 50-60 for flexible needle.
Levator scap
Prone (lower), sidelying (upper or lower)
Prone - hammerlock position. Towel under. Rock climb grip. Flat into the scap (don’t have to)
Sidelying - C5/6 area posterior to the SCM. Thumb on spinous process, fold. Will also get neck mm. Pincer to thumb.
Needle 30-40 (C5/6 area)
Supraspinatus
Prone, or sidelying with towel under shoulder
Rock climber grip - needle goes post/lat direction into fossa (deeper than you think)
Needle 40mm
splenius capitus / cervicis
Cap - prone
Cervicis - sidelying (clump with semispinalis cap and cerv)
Cap - Flat
Cerv - Pincer/ fold technique. Have them lift head and go posterior to SCM and near spinous process. DO not go above C2.
Cap - 30mm
Cerv - 30-40mm.
Semispinalis Capitus
s/l
Pincer - done together with semi cap, cerv, and splenius cerv.
Not above C2**
Needle 40mm.
Oblique capitus inferior
prone (do not needle lat/cranially) -
Sit above the person (easier) or to the side.
Medial portion of muscle is all you can do. Lateral off limits due to artery
Palpate C1 transverse tubercle and C2 spinous process. Draw a line between. 1 finger SP C2 other half way. Only needle the medial half.
***Deep muscle. Go towards opposite eye. DO not go up to occiput.
50mm
Multifidi (C, T, L-spine)
Technique is the same throughout.
**Scoliosis - T-spine off limits.
Fusions are fine. Laminectomy absolutely not. Discectomy ok.
Rule 1 - Lamina used to protect spine
Rule 2 - ALWAYS - caudal/medial
Rule 3 - 1 finger width off spinous process
Prone
Needle 40 C-spine prob ok.
50 T-spine
50-60 L-spine
Longissimus Thoracis
Prone arm at side.
Flat palpation (sometimes can pincer). Shallow, deeper caudal/medial. We are outside of our safety window. *Do not do a rib lock.
Needle 40mm.
Iliocostalis Thoracis
Prone
RIB LOCK. Tangential. Do not move hand at all once satisfied you have the rib locked all the way down into the webbing of the hand.
Shallow, deeper
Needle 40mm.
Iliocostalis Lumborum
Prone
Shelf - anywhere below the ribs. Reach across the body. Hook and pull. Needle straight across.
Needle 40mm.
Iliacus (Prox and distal portion)
**Precautions. Viscera prox. Distal femoral artery, nerve.
Prox - Quarter roll with pillow under. Hook it, needle in to iliac fossa. Do not go medial. Needle 40-50mm
Distal (do with psoas just like pectineus) - Supine. Flat palpation. Find pulse, block artery medially, nerve laterally, other finger lat up to ASIS. Needle straight down (Do not go superior due to pelvic floor)
TFL
supine or in sidelying with pillow between legs.
Flat
40-50mm
(No precautions)
Obturator internus
Part of pelvic floor
(Medial side) Sidelying, Bottom leg straight, top leg up and over. Pull shorts up.
Find ischial tub, curl up and over. Needle flat palpation only within fingers. Go in about 1-1.5 cm towards fossa.
Lateral side - Prone all greater troch like other deep rotators.
Obturator Externus,
Gemelli sup and inf.
Quadratus femoris
Prone
Find superior edge of greater troc to find the top. Stay away from mid section to avoid sciatic. Straight down into femur. Fan up/down.
Needle depends - 50-60 prob fine.
Piriformis
Prone or sidelying (can treat anywhere in piriformis except for going straight down)
Find triangle - PSIS, greater troc, ischial tub.
Needle slightly towards troc or sacrum
*Can do tendon off the greater troc (40mm like cork board)
Abdominal
abs, pyramidalis, obliques
Supine. Always lateral->medial.
Shelf palpation, 40mm shallow. Horz only
Obliques - Grab with pincer on same side. Have them lift head. Fan along your grip. 40mm
Prymidalis - Find pubic rami. Put towel over their privates. Need to be on the side and shelf into the bone 40mm
Serratus anterior
Sidelying, their arm resting in front. Stand behind them. Have them hold their elbows. Protract to kick on SA. Start low and feel ribs 8-9th ribs.
RIB LOCK!
Shallow, deep, deeper - parallel to rib.
40mm.
Lower trap
Prone 40mm, very superficial.
*if you can pick it up, pincer grip.
If not, RIB LOCK!! Same as iliocostalis (you go through low trap to get to those)
Mid trap
Prone
50-60mm needle (MUST use bigger needle)
Flat palpation. Sit overhead, apex and “waterfall down” towards head. Tangential shallow, deep, deeper
*Also gets rhomboids and Serratus posterior superior.
Serratus posterior superior (SPS)
Same as mid trap. Waterfall from apex to the head.
MUST use bigger needle 50-60mm.
Flat
Depth = mid trap, then rhomboids, SPS and the SPS sits over the erector spinae.
Rhomboids
Same as mid trap. Waterfall from apex to the head.
MUST use bigger needle 50-60mm.
Flat
Depth = mid trap, then rhomboids, SPS and the SPS sits over the erector spinae.
