1. Myofascial Dry Needling Head and Neck

2. Overview Neurovascular Anatomy of the Head and Neck
MDN of muscles in the Head and Neck:
Levator Scapulae
Splenii (Cervicis & Capitis)
Sternocleidomastoid
Scalenes
Masseter
Temporalis
Occipitalis
Frontalis

3. Nerves: Head
Basmajian, J. V. (1982)

4. Nerves: Neck
Basmajian, J. V. (1982)

5. Arteries: Head & Neck
Basmajian, J. V. (1982)

6. Levator Scapulae
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

7. Levator Scapulae
MDN
Patient in a side lying position with the head supported by a pillow
The superior TrP (generally needled first) is held against the transverse processes and needled from the posterior on a perpendicular/slightly oblique angle away from the lung
The inferior TrP is needled obliquely/transversely (parallel to the rib cage) to avoid pneumothorax
Consider using SDN protocol (5mm max depth)

8. Splenius Capitis
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

9. Splenius Cervicus
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

10. Splenii (Cervicis & Capitis)
MDN
Patient in a side lying position
The splenius capitisTrP should be needled just inferior to the level of C1 spinous process on an oblique caudal angle to avoid the exposed portion of the vertebral artery
The splenius cervicis Trp is needled on an oblique angle from lateral to medial
The tip of the needle must be kept superficial to the ribs to avoid pneumothorax

11. Sternocleidomastoid
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

12. Sternocleidomastoid MDN Supine positioning
Position head in slight degree of flexion and rotate head approx 45° to the contralateral side so (bring the ear towards the origin)
Secure TrP/ taut band with a pincer hold and pull away from the underlying vessels
The jugular vein can be identified by occluding it just above the clavicle in order to avoid it
Ensure the needle is follows an oblique path in an inferior direction
Consider using SDN protocol (5mm max depth)

13. Scalenes
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

14. Scalenes
MDN
Patient in supine position with head supported by a pillow and turned to the opposite side
Care should be taken when needling scalenus anterior not to puncture the external jugular vein, or to damage the brachial plexus
Scalenus posterior may be difficult to palpate
SDN protocol (5mm max depth) should be used when needling the scalenes.

15. Masseter
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

16. Masseter
MDN
The patient is in a supine position with the head resting on a pillow and the mouth slightly open to take up slack in the muscle fibres
The TrPs are palpated and held between the index and middle finger
Alternatively the taut bands may be held in a pincer grip between the thumb and finger (finger of the gloved hand inside the mouth)
The needle is inserted on an oblique/transverse angle directed superiorly and slightly medially
The needles should be guided in slowly as the parotid gland and facial nerve lie superficial to the muscle
Deactivation of TrPs in Upper Trapezius and SCM first will often help resolve masticatory muscle TrPs

17. Temporalis
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

18. Temporalis
MDN
The patient is in a supine position with the head resting on a pillow
The mouth may be held slightly open to aid palpation of the taut bands/TrPs
The temporal artery must be identified and a finger placed lightly over it to avoid penetration
The needle is inserted on an oblique/transverse angle directed superiorly and away from the temporal artery
Deactivation of TrPs in the Masseter must be done first, as tightness of this muscle will restrict venous drainage and may cause an ecchymosis
Deactivation of TrPs in Upper Trapezius and SCM first will often help resolve masticatory muscle TrPs

19. Occipitalis
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

20. Occipitalis
MDN
The patient is in a prone position with the head resting in the face hole of the table
The TrP/taut band is located with the flat palpation method and is held between two fingers
The needle is inserted obliquely/transversely along the subcutaneous muscle

21. Frontalis
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999)

22. Frontalis
MDN
The patient is in a supine position with the head resting on a pillow
The TrP/taut band is located with the flat palpation method
The skin may be gathered up and the TrP/taut band held between two fingers
The needle is inserted transversely along the subcutaneous muscle

23. Bibliography
Travell, J. G., Simons, D. G., & Cummings, B. D. (1983). Myofascial pain and dysfunction : the trigger point manual (Vol. 2). Baltimore: Williams and Wilkins
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999). Travell & Simons' myofascial pain and dysfunction : the trigger point manual (2nd ed. Vol. 1). Baltimore: Williams & Wilkins
Basmajian, J. V. (1982). Primary anatomy (8th ed.). Baltimore: Williams & Wilkins

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