I’ve had quite a few older patients that want DN for their neck pain. Many of these patients have a severe forward head posture, significant thoracic kyphosis, and are overweight. They also require needling in sidelying and don’t have the easiest bony landmarks. It’s almost like all their spinous processes exist within 2 inches total. It seems there’s not an option to needle many different levels. Are there any modifications you guys make for this population regarding safety or effectiveness?
I like the sidelying option or head rested on arms in sitting ( will create a little bit of cervical flexion for you if sidelying doesn’t work. I find it much easier to needle whichever side is up in the cervical region in sidelying. Make sure you stay posterior to the Transverse processes and that will keep you safe.
Always Hedge towards safer rules anytime you are uncomfortable with your ability to palpate, so at the transition zones c7-T1 and around c2, T12-L1 go towards safety with direction and needle length.