Summary
Dr. Jim Shepherd from the Institute of Clinical Excellence shares practical techniques for advancing dry needles through tough, resistant tissues. Using an apple to demonstrate (as opposed to the typical banana used in courses), he walks through the common problem of needle "bowing" when encountering dense fascia or thick subcutaneous tissue that acts like body armor between the skin and the target muscle. Jim presents five specific strategies to overcome needle bowing: the "kickstand" technique (stabilizing your hand against the tissue for more directed force), "twist and advance" (rotating the needle head like a screwdriver), "peck peck push" (using quick, short-amplitude taps followed by a push), maintaining compression and tension with the palpating hand throughout insertion, and zooming out to check and correct the needle angle. He emphasizes that the palpating hand is just as critical as the needling hand, and that students often lose their tissue compression when shifting focus to needle advancement.
Key Points
- Needle "bowing" is a common challenge when encountering dense fascia or thick subcutaneous tissue during dry needling
- The "kickstand" technique: use your ring or pinky finger against the tissue to direct force straight down into the insertion area
- "Twist and advance": rotate the needle head clockwise or counterclockwise while pushing down, like a screwdriver
- "Peck peck push": use quick, short-amplitude taps followed by a forceful push to break through tough tissue layers
- The palpating hand must maintain compression and tension throughout the entire insertion, not just at the start
- Bracketing technique: splay fingers to compress and tension tissue, creating a clear insertion zone between fingers
- When all else fails, zoom out and check your needle angle; small angle misalignments often cause bowing
- Practice these techniques on a firm apple rather than a banana to simulate resistant tissue
Key Moments
The kickstand technique for needle insertion
Dr. Jim Shepherd demonstrates the kickstand technique where you place your ring finger or pinky against the tissue to direct force more accurately straight down into the insertion area, preventing the needle from bowing.
"We like to create this thing called a kickstand when you're inserting, all right? And what does that kickstand look like? It usually means that you're taking some other part of the hand that you're needling or advancing the needle with and placing it on the tissue, right? So I like to use my ring finger or my pinky finger"
Twist and advance like a screwdriver
When the kickstand isn't enough, rotating the needle head clockwise or counterclockwise while pushing down, like turning a screwdriver, can help advance through resistant tissue.
"Oftentimes you can take that needle head and twist it either clockwise or counterclockwise. Sometimes I'm asked which one's better, Jim. It doesn't matter just as long as you're creating a twist action and you are twisting and forcing the needle downward, right? So we like to call this a twist and advance."
Peck peck push through body armor
For the toughest tissue layers, the "peck peck push" technique uses quick short-amplitude taps followed by a forceful push to break through dense fascia or subcutaneous tissue.
"Peck peck push, right? So it's this tiny little fast amplitude and then down in right peck peck push Okay so if there's like a very tough layer of what I lovingly like to call a bit of body armor between the skin and the muscle a Peck peck push might be a really good strategy to try to get that needle through versus a smooth steady mapping stroke Alright, so now you have three you have a kickstand a"
Maintain compression and tension with the palpating hand
The palpating hand is just as critical as the needling hand. Students often lose their tissue compression when shifting focus to needle advancement, which increases resistance and causes bowing.
"What I observe many times is students are, they're doing a great job, they compress tension, they get that needle placed in to the tissue, and as soon as they let their focus shift from this hand to the needling hand, the compression and tension leave, right?"
