From time to time there is media attention given to a story about a patient who suffered a pneumothorax after receiving acupuncture or dry needling treatment.
A situation such as this has recently been reported in New Zealand, which highlights the importance of many aspects of dry needling, including patient education and consent, needling technique and post needling advice and follow up.
Whilst many aspects of these are taught on the GEMt course, I wanted to re-iterate and remind GEMt course participants of these important messages.
There are several things to consider here. Firstly, patient consent. It is important to adequately explain dry needling to your patient and obtain their consent, this can be both in verbal and/or written form. In addition, it is important to explain to your patient what you are doing and why and continue to explain your reasoning throughout the treatment process, so as to keep them informed in real-time.
- In terms of the assessment process for the spine, bear the following points in mind:
- Assess the spinal curves – if a patient is hyper-lordotic, consider placing a pillow under their lumbar spine to flatten their spine
- If a patient has a mild scoliosis/rotation, needle cautiously and adjust for this as appropriate when directing your needle towards lamina
- If a patient has a significant rotation, or you are not confident of your bony landmarks or technique, consider needling a peripheral region instead or use a non-invasive spinal technique
- Remember when needling the spinal regions to always stay within ½-1 finger breadth of the spinous process when needling down towards lamina
- If a patient is travelling immediately after treatment consider using another spinal technique as an extra safeguard
- When needling Upper Trapezius, always direct the needle caudally (away from lung field)
Having said all that, a pneumothorax can be induced by needling other regions too, such as Supraspinatus, Levator Scapula, Pec Minor, Serratus Muscles and QL. It is for these reasons these muscles are taught on our Advanced courses only and should only be practiced once GEMt participants have completed the Advanced Courses.
In terms of the post needling advice, always educate your patient on what is reasonable to expect following treatment which might include things such as minor treatment soreness/tenderness and fatigue.
Remember the main signs of pneumothorax, which includes:
- Chest pain that can radiate straight through the chest wall
- The feeling of a bubble
- Likely (but not always) shortness of breath
- Symptoms may not develop immediately
If a pneumothorax is suspected, a patient must be instructed to present immediately to hospital as a chest X-Ray is always needed to confirm the diagnosis.
With adequate screening, education, consent, technique and post care advice, these situations can and should be avoided.