Grading & Recording Your Dry Needling Treatment

AAP Education


Grading & Recording Your Dry Needling Treatment

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

First lets look at quantifying your needling treatment in this Clinical Kit. The aim of an intervention is to use the minimum amount of input to achieve your treatment goals. Whether you are a superficial needler, a fascia needler 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 upon time and degree of stimulation. Clinically, you start with a Grade II and depending upon effect change 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. On removal of the needle, I then manually re-test the point for 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 when 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)

Progression from a grade III, use more gentle 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.


  • During the initial treatment, it is better to under stimulate rather than over stimulate
  • In conditions that have been present for greater than 3 months, likewise minimise the stimulation as these clients tend to 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 client comfort and intensity of presenting trigger points
  • Points should be palpated before and after treatment, to access pain pressure threshold and other objective signs reassessed


Mann F. Acupuncture: Cure of Many Disease. Oxford: Butterworth Heinemann, 1992.

All the best,

Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education

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