Increasing Your Stiffness
Nope, not talking about my increasing age or the AM rise men supposably have. This topic came up during our last Level 1 Dry Needling course when penetration of infraspinatus was proving difficult for some participants. I have listed a range of suggestions that depend on technique, tools and patient factors.
Let's start in reverse. If your patient has tight fascia (infraspinatus is a good example), through positioning and support of their arm, the fascia can be loosened and made softer before needle insertion. Also if their body is supported and they are mentally relaxed, this will make it easier.
Enter your text hereIt helps to start with a high quality needle like a Seirin of the correct length and gauge. The longer the length, the more floppy and less penetration power you have. The same goes for thinner needles. Think pole vaulting. As the pros jump higher, they choose less 'bendy', think thicker/stiffer poles.
If you have already inserted the needle (quality, gage and length options now limited), you could slide your finger tips down off the handle and onto the shaft. This artificially shortens the needle shaft, making it relatively 'stiffer'. Of course, you would not touch any portion of the shaft that would be entering your patient's skin.
'Tap with authority'. While watching a needle insertion, I often see that when the therapist removes the guide tube the needle flops over, rather than staying perpendicular. If they lift and drop the needle handle a couple of times, the needle tip gets 'caught' in the superficial layers, making complete insertion difficult. It is important to tap the needle handle with appropriate authority to pierce the superficial layer succinctly. Slow and complete insertion can then follow.
So you have a relaxed patient, inserted the needle with authority but can't get it through the fascial interface. You are sweating a bit and your fingers can't grip your needle shaft. Another technique tip to stiffen the needle is to slide a smaller guide tube over the handle and needle. This limits the needle's shaft from flexing side to side and encourages the needle down, rather than side to side.
Final technique that is sometimes required on specific tissues/muscles is a type of pecking action, to relax the fascial boundary sufficient to enter into the muscle. An example would be the superior lateral pole of the patella where the VL attaches.
If you have other tips on how to stiffen up, would love to hear them in the comments section.