Dry Needling and Muscle testing
Do you do manual muscle testing on your patients before needling?
We all evaluate our patients; hopefully on the table as well as observation while weight bearing. Here is some food for thought...
When your patient or client is lying on the table (or wherever you are evaluating them), do you pay attention to where their head is in space (ie the position of their head)? Why should you care?
Remember about facilitation? That has something to do with it.
Here is the short story. Make sure the head is neutral and midline (lined up between the shoulders), there is good preservation of the cervical curve , with a small pillow supporting the neck, but not altering it’s angle.
The long story involves the vestibular system. It is a part of the nervous system that lives between your ears (literally) and monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration. 
The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles.
So, what do you think happens if we facilitate (or defaciltate) a neuronal pool? We alter outcomes and don’t see a clear picture.
Notice the lateral semicicular canals are 30 degrees to the horizontal? If you are lying flat, they are now at 60 degrees. If the head is resting on a pillow and flexed forward 30 degrees, the canals are vertical and rendered inoperable, defacilitating the extensors (like the traps, splenius, semispinalis, etc). This could be good (or bad) depending on what muscle groups you are testing.
...So if we defacilitate the extensors, what happens to the flexors? Remember reciprocal inhibition? According to the law of reciprocal innervation, the flexors will be MORE FACILITATED. Sounds like those neck flexors may be a little more lit up than they actually are. Hmmm. Make you really think about needling the SCM doesn't it? Or even the head position when needling the trapezius.
Yes, there are many factors to consider when needling, and head/body position is just one of them!
Keep on Needling
Dr Ivo
