| A | B | C | D | E | F | G | H | I | J | K | |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Master Dry Needling Live Level 1 | ||||||||||
2 | NAME | NOTES: | |||||||||
3 | Credentials: (i.e. PT, ATC, DC, DO, MD, RN, PA, OT etc.) | ||||||||||
4 | Date of Seminar: | ||||||||||
5 | Location: | ||||||||||
6 | Instructor: (circle) Ken, Lisa, Mitch, Pete, Jared) | ||||||||||
7 | Full Body Scan - Describe Functional Deficits | SCORE | Scoring: Low 10-30; Med 40-60; High 70-100 | Video/Pic Taken? (Y/N) | OTHER SYMPTOMS | ||||||
8 | UE | 1 | |||||||||
9 | Trunk | 2 | |||||||||
10 | LE | 3 | |||||||||
11 | 4. QUICKSCAN LOCATION(S): | ||||||||||
12 | Muscles/Tissues Completed: | Needle Size | Page in Manual | Video Lesson # | Pic of Needle Insert Y/N | NEW Deficit 1 Score | NEW Deficit 2 Score | NEW Deficit 3 Score | NEW Quickscan Score | Video/Pic Taken If Big Change? (Y/N) | |
13 | DAY 1 | TISSUE TYPES | (T=Tissue) | ||||||||
14 | 1 | Muscle Belly (on self): Quad CLOCKFACE EXERCISE) | .25x40 | (video) | T1 | ||||||
15 | 2 | Muscle Belly (on lab partner): Middle Deltoid Belly | .30x50 | (video) | T2 | ||||||
16 | 3 | Musculotendinous Junction (MTJ): Gastrocs | .30x50 | 12 | T3 | ||||||
17 | 4 | Tendon (non-sheathed): Achilles + Quad | .18x15 | 13 | T4 | ||||||
18 | 5 | Tenoperiosteal Junction (TPJ) & Periosteum: Deltoid insertion | .25x40 | 14 | T5 | ||||||
19 | 6 | Ligament: Posterior Sacroiliac | .30x50 | 15 | T6 | ||||||
20 | 7 | Scars (List region treated): | .18x15 | 16 | T7,T8 | ||||||
21 | 8 | ||||||||||
22 | DAY 2 | AM: UPPER EXTREMITIES (alphabetical order) | (U=Upper) | ||||||||
23 | 9 | Biceps | .25x40 | 63 | U1 | ||||||
24 | 10 | Brachialis | .25x40 | 73 | U2 | ||||||
25 | 11 | Brachioradialis | .25x40 | 74 | U3 | ||||||
26 | 12 | Common Extensor Origin & Supinator (A) & Common Flexor Origin (B) | .25x40 | 75-80 | U4, U5 | ||||||
27 | 13 | Infraspinatus & Teres Minor | .25x40 | 65 | U6 | ||||||
28 | 14 | Latissimus, proximal & Teres Major supine | .25x40 | 66 | U7 | ||||||
29 | 15 | Levator Scap (AFTER watching "Maximizing Winging of Scapula") | .25x40 | 47 | U8 | ||||||
30 | 16 | Pectoralis Major | .25x40 | 49 | U9 | ||||||
31 | 17 | Pectoralis Minor | .25x40 | 50 | U10 | ||||||
32 | 18 | Rhomboid, Side-lying (AFTER watching "Maximizing Winging of Scap") | .25x40 | 52 | U11 | ||||||
33 | 20 | Subscapularis | .25x40 | 67 | U12 | ||||||
34 | 19 | Supraspinatus | .25x40 | 68 | U13 | ||||||
35 | 21 | Trapezius | .25x40 | 69 | U15 | ||||||
36 | 22 | Triceps | .25x40 | 70 | U14 | ||||||
37 | 23 | ||||||||||
38 | DAY2 | PM: LOWER EXTREMITIES (alphabetical order) | (L=Lower) | ||||||||
39 | 24 | Adductors (Longus (A), Magnus (B) | .25x40 | 32 | L1, L2 | ||||||
40 | 25 | Gastrocs (A), Hamstrings. (B) | .30x.50 | 33 | L3, L5 | ||||||
41 | 26 | Glute Medius, Minimus & TFL | .35x75 | 34 | L4 | ||||||
42 | 27 | Iliacus, distal | .30x50 | 35 | L6 | ||||||
43 | 28 | Ischial Tuberosity, Side-lying | .30x50 | 36 | L7 | ||||||
44 | 29 | Peroneals/Fibularis | .25x40 | 23 | L8 | ||||||
45 | 30 | Piriformis, Prone | .35x75 | 37 | L9 | ||||||
46 | 31 | Quads: Rectus & Intermedius, V Lateralis, V Medialis | .30x50 | 38-39 | L10, 11.12 | ||||||
47 | 32 | TFL (and ITB) Side-lying | .25x40 | 40 | L13 | ||||||
48 | 33 | Tibialis Anterior (Supine) & Tibialis Posterior (Side-lying) | .25x40 | 24-25 | L14,L15 | ||||||
49 | DAY 3 | SPINE | (S=Spine) | ||||||||
50 | 33 | Multifidus (C3-4, T6-7, L4-5) | .25x40 | 48,56 | Sp 1,2,3 | ||||||
51 | 34 | Occipital TPJ's | .25x40 | 57 | Sp 4 | ||||||
52 | 35 | Paraspinals & Other Muscles in the Lung/Kidney Fields | .25x40 | 46 | Sp 5 | ||||||
53 | 36 | Quadratus Lumborum (superficial fibers), prone | .30x50 | Sp 6 | |||||||
54 | 37 | Iliocostalis Lumborum (ICL), Right, prone | .25x40 | (video) | 7 | ||||||
55 | 38 | ||||||||||
56 | Day 2 Combos (**IF DESIRED) | ||||||||||
57 | PRONE | SIDE LYING | SUPINE | ||||||||
58 | Infraspinatus/Teres Minor/Supraspinatus (U6, U13) | Levator-Rhomboid (U8, U11) | Biceps-Brachialis-Triceps (U1, U2, U14) | ||||||||
59 | Rhomboids and Middle Trap (U 11, Sp 5) | Adductor Magnus (L2) | Brachioradialis-Comm Flex (U2, U5) | ||||||||
60 | Upper trap (U15) | Ischial Tuberosity (L7) | Pec Maj-Minor (U9, U10) | ||||||||
61 | Glute Med-Min-TFL (L4) | Peroneals/Fibularis (L8) | Adductor Longus (L1) | ||||||||
62 | Hams-Gastrocs (L3, L5) | TFL-ITB (L13) | Ant Tibialis (L14) | ||||||||
63 | Piriformis (L9) | Post Tib (L15) | Iliacus, distal (L6) | ||||||||
64 | Quads (L10, 11, 12) | ||||||||||
65 | To Get Certicate | ||||||||||
66 | Go to masterdryneedling.com, Member Login, Forms for All Seminar Days. Must complete Day 1 and Day 3 | At the end of the seminar, take pictures of these 2 forms: | PLEASE: Like us on Facebook | ||||||||
67 | Complete Day 3 Forms (easiest way is ON YOUR PHONE) | (1) Post Course Knowledge Exam | Follow us on Instagram | ||||||||
68 | After entering Day 3 Password from instructor, follow prompts. | (2) Worksheet | Make a post & TAG US | ||||||||
69 | |||||||||||
70 | |||||||||||
71 | |||||||||||
72 | |||||||||||
73 | |||||||||||
74 | |||||||||||
75 | |||||||||||
76 | |||||||||||
77 | |||||||||||
78 | |||||||||||
79 | |||||||||||
80 | |||||||||||
81 | |||||||||||
82 | |||||||||||
83 | |||||||||||
84 | |||||||||||
85 | |||||||||||
86 | |||||||||||
87 | |||||||||||
88 | |||||||||||
89 | |||||||||||
90 | |||||||||||
91 | |||||||||||
92 | |||||||||||
93 | |||||||||||
94 | |||||||||||
95 | |||||||||||
96 | |||||||||||
97 | |||||||||||
98 | |||||||||||
99 | |||||||||||
100 | |||||||||||