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Functional Dry Needling and
Cupping Consent Form
Functional Dry Needling:is a very successful medical treatment which uses very thin needles without any medication (a dry
needle) to achieve its aim.
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How to fill out functional dry needling and

How to fill out functional dry needling and
01
To fill out functional dry needling, follow these steps:
02
Start by gathering all the necessary information about the patient, including their medical history, current symptoms, and any previous treatments they have undergone.
03
Conduct a thorough assessment of the patient's musculoskeletal system to identify any trigger points or areas of tension that may benefit from dry needling.
04
Prepare the patient by explaining the procedure and obtaining their informed consent.
05
Cleanse the skin with an alcohol swab and make sure all necessary equipment, such as sterile needles and gloves, is readily available.
06
Insert the sterile needle into the targeted trigger point using a quick and precise motion.
07
Once the needle is inserted, manipulate it to elicit a twitch response or a local twitch response (LTR) from the muscle, which indicates successful stimulation of the trigger point.
08
Leave the needle in place for a specific amount of time, usually around 10-15 minutes, depending on the patient's response.
09
After the designated time, carefully remove the needle and dispose of it properly.
10
Provide the patient with post-treatment instructions, including any recommended stretches or exercises, and schedule any necessary follow-up appointments.
11
Document the procedure thoroughly in the patient's records, noting the location of the trigger points targeted and any notable reactions or changes observed during the treatment.
Who needs functional dry needling and?
01
Functional dry needling can be beneficial for individuals who are experiencing musculoskeletal pain or dysfunction.
02
Some specific groups of people who may benefit from functional dry needling include:
03
- Athletes or active individuals who have sports-related injuries or overuse injuries.
04
- Individuals with chronic pain conditions, such as fibromyalgia or myofascial pain syndrome.
05
- People recovering from surgeries or injuries that have resulted in muscle imbalances or limited mobility.
06
- Patients with postural abnormalities or muscle imbalances that contribute to their pain or dysfunction.
07
- Individuals seeking alternative or adjunctive treatments for pain management.
08
However, it is important to note that functional dry needling should only be performed by qualified healthcare professionals who have received proper training in the technique.
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What is functional dry needling?
Functional dry needling is a treatment technique used by physical therapists to relieve pain and improve muscle function by inserting thin needles into trigger points in muscles.
Who is required to file functional dry needling?
Physical therapists who are trained and certified in functional dry needling are required to file for this treatment technique.
How to fill out functional dry needling?
To fill out functional dry needling, physical therapists must document the treatment session including the location of trigger points and the number of needles used.
What is the purpose of functional dry needling?
The purpose of functional dry needling is to relieve pain, improve muscle function, and promote healing in the affected area.
What information must be reported on functional dry needling?
Information such as the date of treatment, location of trigger points, number of needles used, and patient's response to treatment must be reported on functional dry needling.
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