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Grading & Recording Your Dry Needling Treatment

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Grading & Recording Your Dry Needling Treatment

After years of implementing dry needling into different practices, two questions arise. How do I quantify the needling treatment, and how do I succinctly record the needling treatment in my notes?

First, let's quantify your needling treatment in this Clinical Kit. An intervention aims to use the minimum input to achieve your treatment goals. Whether you are a superficial, fascia, or deep muscle needler, you are using dry needling techniques that evoke chemical reactions in your client’s body.

Like reactions to bee stings or drinking alcohol, the result varies from person to person, and we don’t unnecessarily want to provoke an excessive response. Mann 1992, says about 10% of clients are strong reactors, while adverse response research related to the aggravation of pain and doziness indicates around 4-6%. Regardless, the potential for strong reactions is present. So how can we minimise these events, especially if you work in a multi-practitioner practice and share clients?

We have been teaching a grading system ranging from I to V for the past 15 years and found that it suits most practitioners’ styles. The progressions are based on time and degree of stimulation. Clinically, you start with a Grade II and, depending upon the effect, change your grade accordingly.

Grade II (Up to 1 minute)

Insert your needle and leave for up to 1 minute. Initially, I wouldn’t additionally stimulate a point at all. After removing the needle, I manually re-tested the point for the pain pressure threshold. If not 50-75% reduced, I reintroduce a needle and proceed to Grade III.

Grade I (Insert and Remove)

Use this grade if after the initial treatment (Grade II), the client returns and describes an excessive reaction (aggravation of pain, feeling washed out).

Grade III (Up to 5 Minutes)

Progression from a grade II, using some gentle manual stimulation. e.g. fanning, twisting, flicking.

Grade IV (Up to 10 Minutes)

For progression from grade III, use gentler manual stimulation. e.g. fanning, twisting, flicking.

Grade V (Up to 20 - 30 minutes)

Not commonly required, but occasionally with chronic pain clients or those that have low opioid-producing systems, I progress to electro-acupuncture stimulation for 20 -30 minutes.

Considerations

During the initial treatment, it is better to under-stimulate rather than over-stimulate
In conditions that have been present for more than 3 months, likewise minimise the stimulation as these clients tend to have a larger post-treatment flare
10% of the adult population and most children are ‘strong reactors’, meaning they only require transient insertion for pain relief
The number of points treated depends upon the client's comfort and intensity of presenting trigger points
Points should be palpated before and after treatment to assess pain pressure threshold and other objective signs reassessed