I. DRY NEEDLING
Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissuesfor the management of neuromuscular/ musculoskeletal pain and movement impairments. Dry needling is a technique used to treat dysfunctions in skeletal muscle, fascia, and connective tissue, and, diminish persistent peripheral nociceptive input, and reduce or restore impairments of body structure and function leading to improved activity and participation. It is important to understand that dry needling is not acupuncture.
II. POTENTIAL BENEFITS/RISKS OF DRY NEEDLING
There are many benefits to dry needling. Such benefits include: decreased muscle pain, decreased muscle tension, increased range of motion, increased muscle flexibility and improved blood flow. However, there are also potential adverse effects of dry needling which include, but are not limited to: post-treatment soreness, bruising, minor bleeding, fainting, infection, autonomic responses (i.e., sweating), and a pneumothorax (if muscles treated are located on the thorax).
III. PHYSICAL THERAPIST’S QUALIFICATIONS
Micah Wells, PT, DPT, CMTPT is a licensed Physical Therapist and has completed the required training in dry needling to be recognized as a certified myofascial trigger point therapist (CMTPT).
IV. ADDITIONAL QUESTIONS
Please carefully read and answer the following questions. If you need any clarification, please ask your physical therapist:
I, ________________________, certify that I have read and fully understand the information outlined in sections I-III. I further certify that my physical therapist, Micah Wells, and I have discussed his training, the potential risks and benefits of the procedure. I have directed all of my questions to my physical therapist and those questions were answered, to my satisfaction. Moreover, I confirm that I have answered the questions in section IV to the best of my knowledge.
I understand that no guarantees or assurances have been made regarding the results of the procedure. I also recognize that multiple functional dry needling sessions may be required. Additionally, I understand that dry needling is completely a voluntary treatment option, and that I may refuse this treatment at any time. Finally, I acknowledge that this dry needling is not acupuncture, and that I am not receiving acupuncture.
By providing my signature below, I consent to the performance of this procedure.
