Fourth installment of our "No Mess Up Mondays" series on Facebook. You can check it out here or (facebook.com/msdryneedling). To spread out content, I've decided to reduce the frequency to every other week. Remember, one of the best ways to stay safe and smart when you are performing dry needling is knowing exactly what lies under the surface of the skin before you insert a needle! That ESPECIALLY holds true when you are needling in the vicinity of the abdomen. I purposely avoid teaching dry needling of the psoas or iliacus in course one or course two for the reasons I'll explain below. I've been to courses that teach this to entry level dry needling students and it makes me cringe. Lets have a look at the anatomy and then we'll see what the researchers say about this area
Below, you'll find a deeper look into the abdominal region above the inguinal canal that comes from our new Pelvic Floor Dry Need Course. Click here to learn more about that! I'll launch that course early next year as soon as I can get off of this deployment. There are two pictures because each side of the abdomen is different. On the left side is the descending and sigmoid colon. On the right side is the cecum. For my previous students, you haven't seen this yet so have a look!
Needling Above the Inguinal Ligament
It is sort of scary when you take a look at how close the viscera is above the inguinal ligament. But don't just take my word for it. Halle and Halle (2016) conducted cadaver dissection to determine pertinent dry needling considerations specifically in this area. You can find their article here. It really is a good read and I encourage you to check it out if you can find some time. Halle and Halle state "when needling in the region above the inguinal ligament, the needle will, by necessity, pass into and puncture the peritoneal cavity and the needle has the potential to pass into a portion of the bowel" (2016, p.814). Excuse me?? Ok, that makes me pump the brakes a little. So, your dry needling instructor told you you can safely perform dry needling to iliacus above the inguinal ligament if you have the patient lay on their side because this will cause the intestines to "fall out of the way" or you can simply mobilize or move them out of the way before you needle. I've heard this in courses before as well. Halle and Halle (2016) would disagree. "The anatomical layout of this region of the abdomen and pelvis argues against such a possibility. Structurally, it is not advantageous for the contents of the abdomen to be freely moveable, since this could lead to a twisted gastrointestinal tract" (Halle and Halle, 2016, p.814). Lastly, some dry needling courses teach to only use a needle once in this region "in case a bowel is punctured and the needle gets contaminated you won't spread contamination." Oh my...how about you just don't needle in an area where you could PUNCTURE A BOWEL! Although there apparently aren't any reported cases of dry needling causing a bowel puncture and peritonitis, the risk is there and the risk is real. You don't want to be the first documented case! That's the kind of thing that doesn't wash off...
This photo really kicks it up a notch from what you've seen in the dry needling courses you have attended with us and probably with other folks as well. It will be vitally important in our Pelvic Floor Dry Needling Course to have a thorough understanding of the viscera above the inguinal ligament because we will be addressing iliacus; however, we will address iliacus BELOW the inguinal ligament because the risk of bowel puncture simply is not worth it for me. For some, it may have been a while since you attended a dry needling course. Spend a moment remembering the anatomy. It is easy to get complacent when you needle several people a day! Use this moment as a good reminder of what lies beneath and maybe think twice before the needle the iliacus above the inguinal ligament! Is it really worth it??
Reference:
Halle, J. S., & Halle, R. J. (2016) Pertinent dry needling considerations for minimizing adverse effects: Part two. Int J Sports Phys Ther, 11(5), 810-819