Trigger Point Dry Needling Consent Form

Trigger Point Dry Needling Consent Form

Trigger Point Dry Needling Consent Form

Dry Needling is a therapeutic treatment procedure that involves multiple advances of a monofilament needle into a skeletal muscle which produces pain and typically contains a ‘trigger point’. In medicine, trigger points are defined as hyper-irritable spots in skeletal muscle that are associated with hyper-sensitive nodules in taut bands.

  • There is no injectable solution used and typically the needle which is used is very thin. Most people will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the feeling of discomfort can vary drastically from person to person.
  • Usually a healthy muscle feels very little discomfort with insertion of the monofilament needle; however, if the muscle is sensitive and shortened or has active trigger points within it, you may feel a sensation much like a muscle cramp—which is often referred to as a ‘twitch response’. The twitch response also has a biochemical characteristic to it which likely affects the reaction of the muscle, symptoms, and response of the tissue.
  • Along with the health of the tissue, the expertise of the practitioner can also attribute to the variation of outcome and/or discomfort. You may feel the cramping sensation locally or a referral of pain or similar symptoms for which you are seeking treatment. With the needle insertion, a reproduction of your pain can be a helpful diagnostic indicator. People receiving dry needling treatments soon learn to recognize and even welcome
    this sensation as it results in deactivating the trigger point, thereby reducing pain and restoring normal length and function of the involved muscle.
  • Typically, positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, your overall health, and experience level of the practitioner.
  • Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This treatment can be effective in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.
  • IMT/TDN involves placing a small needle into the muscle at the trigger point which is typically in an area which the muscle is tight and may be tender with the intent of causing the muscle to contract and then release, improving the flexibility of the muscle and therefore decreasing the symptoms. The intent of this treatment is to treat skeletal muscle, not Chinese medicine acupuncture points. I will not stimulate any distal (fingertips or toes) or
    auricular (on the ear) points during the dry needling treatment. Typically, 3-4 muscles, which share a common spinal nerve root innervation, are stimulated by advancing a monofilament needle multiple times at each location (this is termed “pistoning”).
  • IMT/TDN is a valuable treatment for musculoskeletal related pain such as soft tissue and joint pain, as well as to increase muscle performance. Like any treatment there are possible complications. While these complications are rare in occurrence, it is recommended you read through the possible risks prior to giving consent for treatment.

Risks of the procedure:
Though unlikely there are risks associated with this treatment. The most serious risk associated with TDN is accidental puncture of a lung (pneumothorax). If this were to occur, it may likely only require a chest x-ray and no further treatment as it can resolve on its own. The symptoms of pain and shortness of breath may last for several days to weeks. A more severe lung puncture can require hospitalization and re- inflation of the lung. This is a rare complication and in skilled hands should not be a concern. If you feel any related symptoms, immediately contact your IMT/TDN provider. If a pneumothorax is suspected you should seek medical attention from your physician, or if necessary, go to the emergency room.

Other risks may include bruising, infection, and nerve injury. I will always clean the area of skin being treated with alcohol and use hand sanitizer immediately prior to treatment. The needles are sterile and not re-used. Please notify me if you have any conditions that can be transferred by blood, require blood anticoagulants or any other conditions that may have an adverse effect to needle punctures. Bruising is a common occurrence and should not be a concern unless you are taking a blood thinner. As the needles are very small and do not have a cutting edge, the likelihood of any significant tissue trauma from IMT/TDN is unlikely.

Contraindications for Dry Needling Clinic:

*Fear of Needles *Metal allergy
*Cancer *Pregnant patients
*Fever *Children under the age of 18 (Need parental consent and need to be present)
*Systemic Disease (impaired immune function) *Taking anti-coagulants or unstable INR
*Hypothyroidism (impaired immune function) *In area of joint replacement (infection)
*Infection *Have a bleeding disorder (Hemophilia)
*Impaired immune system *Heart valve replacement (increased risk of infection)
*Injuries to skin above dry needling area *Unstable epilepsy
*Recent surgery (risk of infection)  

Do you have any known disease or infection that can be transmitted through bodily fluids? If yes, please notify your clinician at your initial evaluation.

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“Early treatment is the key to maximizing movement, managing chronic pain and recovering from surgery and injuries.”

Dr. Jennifer Jeschke PT, DPT, CMPT, MFDc

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