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Frequently Asked Questions about Dry Needling

Have questions about dry needling? You might find the answers in this Bethesda Physiocare Dry Needling FAQ (pdf) publication.

Myopain Seminars Graduate Featured in Online Health Article

Read the December 2011 article that features Myopain Seminars graduate and physical therapist, Ben Grotenhuis, at NapervilleSun online: “Men’s Health: Dry needling targets myofascial pain”

Testimonial: Ehlers Danlos Syndrome and Dry Needling

APTA Publishes a Dry Needling Resource Guide

In 2011, the American Physical Therapy Association (APTA) invited Dr. Jan Dommerholt to participate in the APTA Dry Needling Workgroup along with several other physical therapists representing legislators, educators, insurance specialists, clinicians, and the APTA administrative staff. In January 2012, the APTA released
Physical Therapists & the Performance of Dry Needling: An Educational Resource Paper (pdf).

AAOMPT logoAAOMPT Executive Committee Rules for Dry Needling

June 4, 2009—Following a request from an AAOMPT member, the AAOMPT Executive Committee charged the Practice Affairs Committee to investigate the basis of “dry needling” within physical therapist practice. Following an extensive review of the literature and discussions among the committee members the Practice Affairs Committee brought forth the following position for the Executive Committee to review:

Statement

POSITION: It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist practice.

SUPPORT STATEMENT: Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.

Update: During the October 2009 Annual Meeting, the AAOMPT Membership voted in favor of the position statement and agreed that intramuscular manual therapy/dry needling is indeed within the scope of physical therapy practice.

Rulings about IMT (Dry Needling) by U.S. State Boards

Map of USA Dry Needlings Rulings, August 2011At this point in time, dry needling is formally within the scope of physical therapy practice in the District of Columbia and in twenty-one states, including Alabama, Colorado, Georgia, Illinois, Kentucky, Louisiana, Maryland, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and Wyoming.

  • In 1989, the Maryland Board of Physical Therapy Examiners was the first physical therapy board that approved dry needling by physical therapists. Several years later, the Maryland board approved trigger point injections by physical therapists. Maryland remains the only jurisdiction in the US allowing this procedure to be performed by physical therapists.
  • In 1992, the New York Board of Education concluded that dry needling would not be allowed by physical therapists.
  • In 1999, the New Mexico Physical Therapy determined that dry needling is within the scope of physical therapy practice. In March 2000, the Board reiterated its position following an inquiry by the New Mexico Board of Medicine.
  • In 2001 and 2002, state boards of Tennessee and North Carolina ruled that dry needling was not in the scope of physical therapy practice.
  • In March 2002, the New Hampshire Physical Therapy Governing Board determined that dry needling is within the scope of physical therapy practice.
  • In April 2002, the Virginia Board of Physical Therapy started issuing statements that dry needling appeared to be within the scope of physical therapy practice.
  • In October 2004, the Georgia State Board of Physical Therapy suggested that dry needling would be within the scope of physical therapy practice.
  • In October 2004, the South Carolina Board of Physical Therapy Examiners determined that dry needling is within the scope of physical therapy practice.
  • In December 2004, the Kentucky State Board of Physical Therapy determined that dry needling is within the scope of physical therapy practice.
  • In July 2005, the Director of the Colorado Board of Regulations determined that dry needling is within the scope of physical therapy practice.
  • In January 2007, the Ohio Occupational Therapy, Physical Therapy and Athletics Trainers Board determined that dry needling is within the scope of physical therapy practice.
  • In March 2007, the Virginia Board of Physical Therapy determined that dry needling is within the scope of physical therapy practice, after having been challenged by the Virginia Acupuncture Society in August 2006. Jan Dommerholt, president of Myopain Seminars, testified in favor of dry needling during the Board’s meeting in October 2006.
  • In January 2008, the Texas Board of Physical Therapy Examiners determined that dry needling is within the scope of physical therapy practice.
  • In May 2008, the Alabama Board of Physical Therapy determined that dry needling is within the scope of physical therapy practice.
  • In 2008, the Georgia Composite Medical Board, which oversees the practice of acupuncture rewrote their practice act. After the Acupuncture Statutes were modified in 2009 by including a sentence that “dry needling is a technique of acupuncture,” the Georgia Attorney General ruled that dry needling would therefore no longer be allowed by physical therapists. Myopain Seminars faculty member Dr. Joseph Donnelly was very instrumental in effectively addressing this issue. In July 2010 the Georgia State Board of Physical Therapy met with the Georgia Composite Medical Board and both boards agreed to collaborate to resolve the dry needling problem. In December 2010, a meeting was conducted with Georgia Representative Edward Lindsey (Republican Whip), which was followed by a meeting with Representative Sharon Cooper, Chair of the Health and Human Services Committee and Chief Sponsor of the re-write of the Medical Practice Act. Representatives Cooper and Lindsey introduced legislation (House Bill 145) stating that dry needling is also an intervention used by physical therapists. In February 2011, the Bill passed the House of Representatives and was moved to the Senate, which approved the Bill in April 2011. On May 12, 2011 the Governor of Georgia signed the Bill into law effective July 1, 2011. Georgia is the only state in the United States where dry needling is part of the Physical Therapy Statutes.
  • In 2008, The Nevada Board of Physical Therapy Examiners concluded that dry needing is not within the scope of physical therapy practice.
  • In 2008, the Maryland Board of Chiropractic approved dry needling for Maryland chiropractic physicians.
  • In July 2009, the Oregon Board of Physical Therapy approved dry needling, but was immediately challenged by the Medical Board of Oregon and its Acupuncture Committee, “who voted that dry needling is the practice of acupuncture.” In response, the PT Board issued a statement that “upon further discussion and consideration, the Physical Therapy Licensing Board believes that the dry needling of trigger points is likely within the physical therapist scope of practice (excluding PTAs). The Board acknowledges that the dry needling of trigger points is an advanced intervention requiring post physical therapy graduate training and education.” The PT Board concluded its statement with “in the interest of public safety, until specific training and education parameters can be determined, the Board strongly advises its licensees to not perform dry needling of trigger points at this time.”
  • In July 2009, the Wisconsin Physical Therapy Affiliated Credentialing Board determined trigger point dry needling as within the scope of practice of physical therapy provided that the licensed physical therapist is properly educated and trained.
  • In August 2009, the Wyoming Board of Physical Therapy announced that the Physical Therapy Practice Act does not preclude dry needling with the proper credentials.
  • In August 2009, the Board of Idaho did not approve dry needling, “based upon the fact that trigger point dry needling is an invasive procedure, and invasive procedures are not within the physical therapy scope of practice,” even though invasive electromyography and nerve conduction studies can be performed by Idaho physical therapists.
  • In September 2009, the New Jersey State Board of Physical Therapy Examiners determined that dry needling is within the scope of physical therapy practice.
  • In October 2009, the Delaware Board of Physical Therapy elected not to issue an opinion about dry needling.
  • In November 2009, the District of Columbia Board of Physical Therapy approved intramuscular manual therapy to be within the scope of physical therapy practice. The American Association of Acupuncture and Oriental Medicine (AAAOM) prepared a letter to the District of Columbia Medical Board objecting to dry needling by physical therapists.  The DC Board of Physical therapy issued a “Policy Statement: Guidance On Dry Needling In The Practice Of Physical Therapy” on May 17, 2010.
  • In August 2010, dry needling by physical therapists was approved in Illinois. In June 2011, the Illinois Acupuncture Federation issued a position statement opposing dry needling by physical therapists.
  • Dr. Dommerholt addresses the APTA State Governments Forum in Portland, OR (September 2010)
    Dr. Dommerholt addresses the APTA State Governments Forum in Portland, OR (Sept 2010)
    In September 2010, the North Carolina Board of Physical Therapy Examiners reversed its 2002 decision and determined that dry needling is within the scope of physical therapy. The Board frequently consulted with Dr. Jan Dommerholt throughout the process. In December 2011, the ruling was finalized. The Board decided that “Intramuscular manual therapy is an advanced skill that requires additional training beyond entry-level education and should only be performed by physical therapists who have demonstrated knowledge, skill, ability, and competence, in one of the following two ways: (1) Completion of an Intramuscular Manual Therapy course of study at a program approved by the Board with a minimum of 54 hours of classroom education, an additional forty hours of clinical instruction under an experienced Intramuscular Manual Therapy practitioner and two years of practice as a licensed physical therapist prior to using Intramuscular Manual Therapy; or (2) Evidence of practice experience in the use of intramuscular manual therapy techniques (‘experienced intramuscular manual therapy practitioner’) which consists of using the technique for at least 100 hours per year for a period of 2 years. Since Intramuscular Manual Therapy requires ongoing re-evaluation and reassessment, it is not in the scope of work for physical therapist assistants or physical therapy aides.” To date, Myopain Seminars is the only dry needling course program in the US that meets the requirements of the NC Board.
  • In September 2010, the the South Dakota Board of Medical and Osteopathic Examiners voted against dry needling, however, in December 2010, the Board agreed to develop an Advisory Position on Dry Needling.
  • In January 2011, the Utah Division of Occupational and Professional Licensing concluded that “the performance of trigger point dry needling is outside the scope of practice of a physical therapist in the State of Utah.” The Bureau Manager continued with “Utah Code 5B-24b-102 (11)(b) prohibits physical therapists from performing acupuncture. The Division’s research regarding the practice of trigger point dry needling confirms that it is the practice of acupuncture. Therefore, the Division finds that it is outside the scope of practice of physical therapists in Utah.” On February 1, 2011 we submitted a reply (pdf) to the Utah Division of Occupational and Professional Licensing.
  • In May 2011, the Montana Board of Physical Therapy determined that dry needling is within the scope of physical therapy practice.
  • In May 2011, the Oregon Board of Chiropractic Examiners approved dry needling for Oregon chiropractic physicians. In July 2011, the Oregon Association of Acupuncture and Oriental Medicine filed a Petition for a Judicial Review with the Court of Appeals in Oregon, which lead to the decision of the Oregon Appeals Court Commissioner to stay the dry needling rule. The Oregon Chiropractic Board shared that “Chiropractic physicians who have been certified (by the OBCE) should cease all practice of dry needling. The OBCE may not certify any new chiropractic physicians during the period of the Stay. […..] The OBCE’s dry needling rule is no longer in effect pending a full proceeding and argument before the Oregon Court of Appeals. This could be a lengthy process that could take up to a year.”
  • In May 2011, the Louisiana Board of Physical Therapy issued standards of practice for the utilization of dry needling techniques, which formally established dry needling as a physical therapy treatment.
  • In June 2011, the Nebraska Board of Physical Therapy decided that “a Nebraska licensed physical therapist may perform dry needling as long as he/she can competently perform such a procedure. This does not include physical therapy assistants.”
  • In August 2011, the Tennessee Board of Physical Therapy reversed its 2002 decision and approved dry needling by physical therapists.

Most physical therapy statutes do not prohibit dry needling by physical therapists. Only the physical therapy statutes of Hawaii do not allow physical therapists to penetrate the skin. Reportedly, state boards of Arizona and Pennsylvania are legally not allowed to issue interpretations of the Physical Therapy Statutes, but did not restrict the use of dry needling.

The Florida Physical Therapy Statutes are rather confusing on the issue of dry needling and include language that physical therapists are allowed to practice acupuncture as long as they do not penetrate the skin. The Florida statutes do not offer any suggestions how to accomplish this. Whether this language applies to physical therapists using intramuscular manual therapy has not been considered.

Commentary on Scope of Practice

From our perspective, medical boards should adhere to the guidelines of their own Federation of State Medical Boards (FSMB), which in 2006 published a joint report together with the Association of Social Work Boards (ASWB), the Federation of State Boards of Physical Therapy (FSBPT), the National Board for Certification in Occupational Therapy (NBCOT), the National Council of State Boards of Nursing (NCSBN), and the National Association of Boards of Pharmacy (NABP®) on changes in healthcare professions scope of practice.

According to these federations of state boards, since most professions today share some skills or procedures with another profession, it is no longer reasonable to expect each profession to have a completely unique scope of practice, exclusive of all others. Yet, it is quite common that “one profession may perceive another profession as “encroaching” into their area of practice. The profession may be economically or otherwise threatened and therefore oppose the other profession’s legislative effort to change scope of practice.” There are clear indications that some acupuncture societies and associations in the United States may feel threatened by increasing numbers of physical therapists, who are using dry needling techniques within their scope of physical therapy practice, even though few entry level physical therapy schools include dry needling in their curricula. As the joint report of the US regulatory boards indicated, it is common that new skills are initially performed as advanced skills by only a select number of professionals. Once a sufficient cohort of practitioners is utilizing the skills, they are likely to become entry-level skills and subsequently will be taught in entry-level curricula. The regulatory agencies concluded, that “it is not realistic to require a skill or activity to be taught in an entry-level program before it becomes part of a profession’s scope of practice. If this were the standard, there would be few, if any, increases in scope of practice.”

“No one profession actually owns a skill or activity in and of itself. One activity does not define a profession but it is the entire scope of activities within the practice that makes any particular profession unique. Simply because a skill or activity is within one profession’s skill set does not mean another profession cannot and should not include it in its own scope of practice.”

Although acupuncture boards did not participate in preparing this joint report on scope of practice, it is our recommendation that acupuncturists, acupuncture societies and associations, and acupuncture boards adopt the conclusions of their colleagues on other boards and realize that no one owns the exclusive right to a solid filament needle, irrespective of discipline. One discipline cannot and should not determine the scope of practice of any other discipline.

“Conquering Chronic Pain”
Bethesda Physiocare on NBC4 DC News, “News For Your Health”

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