Hi Michelle,

Perineural needling is often categorized as a specific needling technique, similar to other methods such as superficial needling, basic manipulation, rotation, tenting and pistoning. In our courses, we emphasize a diverse array of techniques to address the complexity of human anatomy and physiology. However, the precise definition of “perineural needling” warrants clarification, as it raises important conceptual and clinical questions.

Every needle placement inherently interacts with sensory or motor nerves due to the integrated nature of anatomical structures. By this logic, all forms of needling could be considered “close to a nerve.” For instance, the integrated theory of myofascial trigger points suggests that spontaneous electrical activity (SEA) of the nerve increases in these foci, and needling them induces a nerve-mediated response (e.g., a twitch response), facilitating muscle release. If this constitutes perineural "close to a nerve" needling, would it imply that myofascial trigger points cannot be addressed using pistoning techniques?

This illustrates the challenge of isolating the effects of needling to a single structure or system, as its mechanisms influence muscles, nerves, blood vessels, and lymphatic tissues collectively. A more precise and operational definition of perineural needling is therefore essential, particularly to clarify its scope and delineate specific practices or outcomes that clinicians should either pursue or avoid.

Unfortunately that does not answer your question,  in fact creates a more relevant one that needs to be answered by the board to provide the clarity. A clear and consistent definition would enhance understanding and ensure alignment across clinical practices and educational approaches, particularly in relation to the multifaceted effects of dry needling.

Frank