Table 4.

Dry needling intervention algorithm for treatment selection.

Assessment	Treatment
Trigger point assessment performed on the trapezius	Patient in prone, therapist identifies the hypersensitive spot in the trapezius
	The overlying skin will be cleansed with alcohol
	Once the needle has been inserted manually into the trigger point, the needle will be pistoned in an up-and-down fashion so that 2- to 3-mm vertical motions occur (ie, fast-in and fast-out technique as described by Hong) at approximately 1 Hz for 25-30 seconds, with the aim of eliciting local twitch responses
	After needle is removed, pressure with a cotton ball will be maintained to prevent excessive bleeding
	The number of sites and specific muscles treated will be recorded by the therapist
Trigger point assessment performed on the levator scapulae	Patient in prone, therapist identifies the hypersensitive spot in the levator scapulae
	The overlying skin will be cleansed with alcohol
	Once the needle has been inserted manually into the trigger point, the needle will be pistoned in an up-and-down fashion so that 2- to 3-mm vertical motions occur (ie, fast-in and fast-out technique as described by Hong) at approximately 1 Hz for 25-30 seconds, with the aim of eliciting local twitch responses
	After needle is removed, pressure with a cotton ball will be maintained to prevent excessive bleeding
	The number of sites and specific muscles treated will be recorded by the therapist
Trigger point assessment performed on the splenius capitis, semispinalis, spinalis capitis, and multifidi	Patient in prone, therapist identifies the hypersensitive spot in the splenius capitis, semispinalis, spinalis capitis, or multifidi
	The overlying skin will be cleansed with alcohol
	Once the needle has been inserted manually into the trigger point, the needle will be pistoned in an up-and-down fashion so that 2- to 3-mm vertical motions occur (ie, fast-in and fast-out technique as described by Hong) at approximately 1 Hz for 25-30 seconds, with the aim of eliciting local twitch responses
	After needle is removed, pressure with a cotton ball will be maintained to prevent excessive bleeding
	The number of sites and specific muscles treated will be recorded by the therapist
Trigger point assessment performed on the suboccipital muscles	Patient in prone, therapist identifies the hypersensitive spot in the suboccipital muscles
	The overlying skin will be cleansed with alcohol
	Once the needle has been inserted manually into the trigger point, the needle will be pistoned in an up-and-down fashion so that 2- to 3-mm vertical motions occur (ie, fast-in and fast-out technique as described by Hong) at approximately 1 Hz for 25-30 seconds, with the aim of eliciting local twitch responses
	After needle is removed, pressure with a cotton ball will be maintained to prevent excessive bleeding
	The number of sites and specific muscles treated will be recorded by the therapist