Great question and these patients can be difficult to treat as there are a lot of factors to consider. Is the patient coming for a certain condition? I can’t speak to the particular condition they are there for if there is one, but would suggest you can still treat locally to reduce peripheral sensitization of their chief complaint but then beyond that consider the homeostatic points to get a stronger central effect. Thoracic paravertebrals are really important in my opinion for patients with CS and I will try to needle a number of thoracic levels using the 1:1 rule. I would also advise to add needle rotations 10-15 minutes at those levels for a comfortable neurol-sensory effect. I try to minimize aggressive pistoning especially early on as I have found they their soreness can be exacerbated. Hope this helps! Let us know if this helps.
Dave Griswold, PhD, DPT, CIDN
Faculty Instructor for IDN