The document discusses superficial dry needling (SDN), a technique developed by Peter Baldry as a safer alternative to deep dry needling (DDN). SDN involves inserting needles just under the skin (5-10mm) over trigger points, rather than deeper into muscles. This stimulates A-delta nerve fibers in the skin to achieve a therapeutic effect without risks of DDN like puncturing internal structures. Patients are categorized as strong, average, or weak responders based on how long needles must be left in place. SDN is recommended when treating pain, sensitive areas, or as a precautionary measure.

1. DR. SUBHANJAN DAS, PT
Subhanjan_82@yahoo.com
+91 8967549104
Dry Needling Instructor
MPT (Musculoskeletal & Sports)
Assoc. Prof., BIMLS, Burdwan

2. Also in the series
 http://www.slideshare.net/SubhanjanDas/introduction-to-dry-needling
 http://www.slideshare.net/SubhanjanDas/2-brief-hisory-of-needling
 http://www.slideshare.net/SubhanjanDas/3-superficial-dry-needling
 http://www.slideshare.net/SubhanjanDas/4-indications-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/6-dangers-of-dry-needling
 http://www.slideshare.net/SubhanjanDas/7-physiologic-background-of-dry-
needling
 http://www.slideshare.net/SubhanjanDas/8-dn-vs-acupuncture
 http://www.slideshare.net/SubhanjanDas/9-electroacupuncture
 http://www.slideshare.net/SubhanjanDas/10-legalities-involved-in-dry-needling

3. Although it is certainly essential to locate each TrP
accurately, experience has led me to believe that it is
not necessary to employ deep needling but easier, safer
and just as effective to insert the needle into the
superficial tissues overlying a TrP
-Peter Baldry

4. SDN
SDN has been started by Peter Baldry in 1980’s.
Baldry was treating a trigger point in the scalaneus
anterior muscle when to prevent accidental damage to
pleura he inserted the needle just a few millimeters
into the skin.
He found this to be as effective as DDN

5. Rationale
 A lot of effects of dry needling is achieved via
stimulation of A delta nerve ending.
 Majority of the A-d sensory afferents are present in the
skin and just beneath it.

6. Development
 With the success of scalanae Baldry developed a
system of SDN for trigger points all over the body, even
with the deep muscles.
 In SDN the needle is inserted in the skin overlying the
trigger points to a depth of 5-10mm
 LTR phenomenon will not be present
 The needle is kept inserted for 30 seconds to 3
minutes, depending on the type of responders.

7. Type of responders
 Depending on the responsiveness of the patient to
needling, they are divided into 3 types:
1. strong responders
2. Average responders
3. Weak responders

8. strong responders
 A strong responder will achieve needling effects with
minimal stimulation. The needle should be withdrawn
within seconds of insertion.
 Overstimulation will increase patients symptoms.
 They constitute about 10% of all individuals.
 This may be related to the phenomenon of opioid
induced hyperalgesia. Higher levels of CCK may play a
role.

9. Average responders
They need stimulation of seconds to about a minutes to
get optimal needling effect

10. Weak responders
 They need prolonged needling to achieve effects.

11. When to use SDN
 When treating pain, when release of opioids are
primary therapeutic goal.
 When treating areas with sensitive underlying
structures.
 When dermatomes and myotomes coincide.
 When in doubt about safety! 