Contraindications and Precautions for Acupuncture and Dry Needling

Prohibited Areas for Needling

• Nipples
• Umbilicus
• External genitalia
• Scalp areas in infants before the frontanelles have closed

Dangerous or Vulnerable Points

The following are useful points but should not be needled until appropriate training has been undertaken:

• GB21 (trapezius); BL 11; Lu 1; any other point in the thorax due to the relative risk of pneumothorax. Needling should be shallow and/or away from long tissue and/or over bone
• Orbit of the eye points (BL1, ST1, Ex Pt qiuhou) are generally considered contraindications for physiotherapists
• Neck points CV 22 (anterior neck), LI 18 (lateral neck over the major vessels), SI 17 (lateral neck over the baroreceptors), GV 15 (over the spinal cord), GV 16 (over the brain stem).
• ST 21 which lies over the gallbladder on the right should be needled superficially and/or obliquely.
• CV 17 (sternum) and SI 11 (infrascapular fossa) should be needled superficially and/or obliquely due to congenital foramen (holes) in these bony structures which are evident in a percentage of the population.
• Ah Shi (tender) points close to vulnerable structures
• Avoid needling into vulnerable pathological sites including varicose veins, acutely inflamed areas, areas of unhealthy tissue or infected tissue.
• Avoid needling into a limb affected by lymphodema or needling directly into breast tissue.

Pregnancy

• LI 4, SP 6, BL 60, BL 67, LV 3
• Points over abdomen
• Ear points for endocrine & genito-urinary system
• Scalp points for genital & foot motor sensory areas
• GB 21 with caution
• Upper lumbar region with caution
• Strong electro-acupuncture or over stimulation of points should be avoided

Note: Strongly recommended to seek written as well as verbal consent as 1 in 4-5 pregnancies naturally abort in 1st trimester

Diabetes

• Relative risk of peripheral needling due to poor circulation

Pacemakers

• No electro-acupuncture

Confused patients

• Patients must be able to consent to treatment, if they are confused or disorientated acupuncture treatment is not advisable.

Children

• Parental consent must be obtained for those under 16 years of age.

Bleeding Disorders

• Naturally occurring hemorrhagic diseases are relative contraindications. This clinic officially advises against needling these individuals.

Anti-coagulants

• Patients on high levels of blood thinning medication (e.g. Plavix, Warfrin) may not be suitable for acupuncture
• Care should be taken with these patients using finger gauge needles and apply pressure to site of insertion after withdrawing
• Needling into joints is contraindicated due to the risk of hema-arthrosis.

Cancer

• Due to the immunicological risk extra care should be taken

Blood Borne Diseases

• Patients may be questioned as to their awareness of having a blood borne disease
• Care should be taken when needling nay patient in reference to their likelihood of having a blood borne disease
• Gloving may be appropriate
• Physiotherapists to consider current legislation of local, state or federal governing bodies which may have guidelines concerning the use of gloves when practicing acupuncture.

Acute Immune Disorders

• Patients with acute immunological disorders (i.e. acute states of RA or SLE) have increased risk of infection therefore should be considered as a relative precaution and care should be taken when needling such patients.

Incompetent Heart Valve or Valve Replacement

• Patients with incompetent heart valve or valve replacement have an increased risk of infection and therefore should be considered a relative precaution and should be needled with care
• May be pertinent to seek advice (in terms of consent / antibiotics) from the patient’s general practitioner or cardiac specialist.

Allergy to Metals

• Patients with known allergy to metal may react to acupuncture needles and relative risks should be discussed prior to treatment.

Unstable Epilepsy

• Patients with epilepsy (especially unstable) should be needled with care
• The number of needles, strong points, stimulation of needles and length of time that the patient is needled should be considered when needling such patients

Frail Patients

• Patients in frail or weakened health or those who have prolonged chronic illness may not tolerate acupuncture
• Minimal treatment should be considered (i.e. reduced number of needles, reduced treatment times, finer needles, minimal stimulation of needles)

Medications

• Due to the effect on the autonomic system patients may have reactions that effect their current medication – as a result of homeostatic action of needling an over correction of patient’s medical condition may occur
• This is particularly pertinent for patients on blood pressure or diabetic medication
• Advisable for the physiotherapist to consider this possibility and discuss this with the patient.

Treatment External to Clinical Rooms

• No needling to be provided as a representative of this clinic external to established treatment rooms (i.e. clinic and on-site clinical rooms)
• Unauthorized needling outside of the established treatment rooms will be the sole liability of the physiotherapist and will be considered a breach of procedures.

Additional Contraindications and Precautions for Electroacupuncture (EA)

• Patients with heart pacemakers should not receive EA
• All contraindications and precautions of manual acupuncture should be observed
• Extra care must be taken if patients have bleeding disorder or are on anti-coagulant therapy as the muscle contraction and movement of the needle may create a significant bleed.
• It is recommended that EA is not applied across the spinal cord
• Use a biphasic stimulator, designed for EA. Direct current (DC) must be avoided to prevent polarization of the needles due to electrolysis. The unit must be battery operated.
• Do not use needles with a plastic hilt/handle.

Additional Contraindications and Precautions for Moxibustion

• Essential to check sensitivity to heat prior to commencing
• Use with great caution in hair covered areas of the body
• Do not use on broken / damaged skin
• Use with care with children and frail patients
• Where possible shield the skin with a protective guard to protect against burns.

Additional Contraindications & Precautions for Cupping & Spooning / Gua Sha

• Not to be used in hair covered areas of the body
• It is not usual for bruising due to prolonged or strong cupping to occur. Blistering due to prolonged strong cupping may occur. It is advisable to draw patient’s attention to any bruising which has occurred – use a mirror if necessary so that they are not surprised when they get home.
• Essential to check skin state prior to commencing – do not use on broken or damaged skin or inflamed tissue
• Use with care with children and frail patients
• Avoid the sacral and abdomen areas of pregnant women
• Avoid using in patients who have bleeding disorders or are on anti-coagulant therapy

Additional Contraindications and Precautions for Auricular Needles; Press Needles and Beads

• All contraindications and precautions of manual acupuncture should be observed
• Clean the ear with an alcohol swab to remove dead cells/wax
• In the case of press needles/beads sterilize the skin with a 2% solution of iodine in 70% alcohol
• In the case of press needles/beads, after applying a sterile disposable press needle/bead, apply 2% iodine in flexible colleden solution, or a 2% iodine and cover with “op-site”. This seals the press needle/bead and reduces the risk of infection.
• These needles/beads may remain in-situ for 7-10 days. In humid conditions this time should be shortened.
• At the time of removing the press needles check the tissue and assess whether an antiseptic ointment or antibiotic ointment is required to be applied to the needle site
• Extra precautions must be taken with all ear acupuncture because the cartilage has a very poor blood supply. Therefore, if this becomes infected, it is difficult for the body to mount an immune response to the invading bacteria. Do not use press needles if there are obvious lesions on the ear or the patient has an immune deficiency disease.