Informed Consent for Dry Needling
DESCRITION OF TECHNIQUE:
Dry Needling is a valuable and effective addition to standard therapy for musculoskeletal pain. It is a technique used to reduce muscle tension, promote healing and stimulate activation. The technique is invasive and involves placing a fine filiform needle into a muscle (or muscles) in order to release shortened muscle bands and decrease trigger point activity. No medications are injected. Dr. Sara Ziegele, PT has advanced training in functional dry needling. Clients are monitored throughout the procedure and appropriate infection control procedures are in place. Dry needling as used in physical therapy is not acupuncture and should not be confused with acupuncture treatment performed by a licensed acupuncturist.
POTENTIAL RISKS AND COMPLICATIONS:
Dry needling is generally a safe treatment technique, but as with any medical procedure there are possible complications. Complications related to dry needling are rare and do not usually require additional medical treatment. Minor, common side effects include bruising, numbness or tingling, temporary worsening of symptoms, dizziness, sweating, or fainting. Rare side effects can include nerve damage, organ or lung puncture or infection.
Precautions/Contraindications for the use of dry needling include: pregnancy (near abdomen), malignant tumors, bleeding/clotting disorders, use of blood thinners (ie: Coumadin, Warfarin, Heparin), unstable blood pressure, internal organ disease, local skin lesions, lymphedema, local or systemic infection, allergies to materials used in needles (nickel, chromium), immune system compromise, varicose veins or vascular disease, significant fear of needles, or recent local surgery (< 6 weeks).
CONSENT AND RELEASE OF LIABILITY:
By signing below, I am indicating that I have read, or have had read to me, and understand this consent to dry needling treatment. I have had the opportunity to ask questions and to discuss the precautions and contraindications outlined above. I consent to and voluntarily assume the risks of my participation in dry needling. I understand that no guarantee or assurance has been made as to the results of this procedure. I agree to indemnify, defend and hold harmless, Dr. Sara Ziegele, PT and Preempt Physical Therapy LLC from and against any liability, suits, losses, costs, expenses, or other claim of damage whatsoever, caused by or as a result of dry needling treatment. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment. I understand that my consent can be withdrawn at any time.