title: PERTINENT DRY NEEDLING CONSIDERATIONS FOR MINIMIZING ADVERSE EFFECTS - PART TWO.
abstract: BACKGROUND
  Dry needling (DN) is an evidence based treatment technique that is accepted and used by physical therapists in the United States. This clinical commentary is the second in a two-part series outlining some of the pertinent anatomy and other issues that are needed for optimal utilization of this treatment modality. Part one was an overview of the thorax with a summary of reported adverse effects (AEs) and the underlying anatomy that could be used to minimize patient risk. As is the case with any intervention, the technique of dry needling has some inherent patient risk. The incidence of AEs with this procedure is typically low, ranging from zero to approximately 10 percent. Knowledge of the underlying anatomy can be a key factor associated with decreasing the likelihood of an AE.
  
  
  OBJECTIVE
  The second part of this clinical commentary goes beyond the thorax, to explore the anatomy associated with dry needling the abdomen, pelvis, and back. In the abdomen, pelvis and back, dry needling can penetrate the peritoneal cavity or adjacent organs, resulting in AEs. A physiological reaction that is an AE secondary to a needle insertion, pain or fear, is an autonomic vasovagal response. Additionally, suggestions for dealing with the fearful patient, the obese patient, universal precautions, and other clinical considerations, are discussed. The purpose of parts one and part two of this clinical commentary is to minimize the risk of a dry needling AE.
  
  
  CONCLUSIONS
  Dry needling is an effective adjunctive treatment procedure that is within the recognized scope of practice of the physical therapist. An evidence-based implementation of the procedure must be based on a thorough understanding of the underlying anatomy and the potential risks, with risks communicated to patients via informed consent.
  
  
  METHODS
  Level 5.
authors.affiliation: Belmont University, Nashville, TN, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Halle
authors.affiliation: US Army-Baylor University Post-Professional Sports Medicine, Physical Therapy Doctoral Fellowship, Keller Army Community Hospital, West Point, NY, USA.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Halle
keywords: Adverse effect; anatomy; dry needling; informed consent; pneumothorax; vasovagal response