1. Use more needles rather than less to treat as much pathologic tissue as possible. The only too many needles is if the patient becomes overly sympathetically stimulated, leading to a vasovagal response.

2. Needle bilateral (I don’t treat the unaffected side as thoroughly).

3. Leave the needles in for 20-30 minutes (this allows the ANS to go through the cycle of initial sympathetic autonomic elevation followed by sympathetic depression with concomitant parasympathetic elevation, resulting in parasympathetic dominance compared to baseline. This is key, since our patients present with sympathetic hyperactivity and dominance. More time with the needles in the body under parasympathetic dominance, to a point, increases treatment efficacy).

4. Connect the right spine to the left extremity and vice versa. I have not seen any research on this, but I believe it increases the neuroplastic effect of needling.

5. Connect the spinal level (through the multifidus to the laminar periosteum) of the nerve root or roots innervating the distal area of pathology. This increases neuroplasticity.

6. Target the PANS with your first needles, then needle whatever else you are going to treat. This limits the amplitude and duration of the initial sympathetic autonomic spike, which, per research, lasts about 15 minutes, on average. Target the ear for the auricular branch of the vagus nerve (Concha, cymba concha, inside of the tragus), the sacral plexus periosteum (S2-S4), & the suboccipital / C2 spinous process periosteum. Connect these areas to each other with 1 Hz microcurrent. Also use this frequency between the other needles. 1-5 Hz is the best frequency to induce endogenous opioid, beta endorphin, release from the hypothalamic-pituitary-adrenal (HPA) axis. This helps reduce pain and depress sympathetic activity via numerous known and unknown mechanisms. I like 1Hz because it is the closest to the, we think, desired heart beat.

7. Following needle treatment, manipulate any deviated joints to neutral. Joints don’t move themselves and they cannot move without moving muscles. Treating only one or the other is only addressing half the battle.

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