Finding an Effective Treatment
When you hear patients say things like “I didn’t know I didn’t have to live with that pain,” “I have never felt better,” and “I feel like I have my life back,” you know you are offering treatments that work. I chose to become an occupational therapist (OT), so I could help people. Yet, when I first began to practice in an outpatient clinic, I was not getting the outcomes I wanted. I would often feel frustrated that the traditional modalities were not working. It wasn’t until I completed dry needling training with Myopain Seminars that I began to feel confident I could help patients, even difficult chronic pain patients. After adding dry needling to my treatment plans, I see improved patient outcomes, and I am more successful with treating patients with persistent pain. I now have more effective modalities, and my patients can see results on the first visit.
After introducing dry needling to my Northern Minnesota community, I became inundated with new patients as news of the successes with dry needling spread quickly. I continue to struggle to keep up with referrals as it is evident to the community that dry needling greatly benefits many patients. They often refer to their family members and friends, keeping me busy and saving me advertising costs. Adding dry needling as a treatment modality has changed the way I practice, and it allows me the opportunity to help my patients in ways I have only dreamed of.
My Dry Needling Certification
The purpose of this blog is to share the benefits of dry needling as an occupational therapy treatment modality, review dry needling regulations and research for occupational therapy, and share how regulations are defined within the national and state legislative boards.
But first, I want to take a minute to share how I personally benefited from the dry needling in the courses. I took my first Myopain Seminars dry needling course in 2017, and I was astounded by the healing I experienced and witnessed. During the courses, therapists and instructors are demonstrating and practicing the dry needling techniques on each other. While practicing dry needling techniques, students taking the courses frequently get dry needled for existing pain and dysfunction. I was dealing with headaches and shoulder pain at that time, and after treatment in that course, I had complete resolution of symptoms of shoulder pain and a dramatic decrease in my daily headaches. Because I experienced such considerable changes in my own pain, I was motivated to learn more about it and share dry needling with my patients. I continue to see consistent and immediate changes among patients from dry needling treatments. Dry Needling and Occupational Therapy Scope of Practice
There are far fewer occupational therapists offering dry needling than physical therapists; however, dry needling is picking up momentum among occupational therapists. Occupational therapists really can make a difference using dry needling. Course programs are starting to market-specific training for occupational therapy. For example, Myopain Seminars is now offering Occupational Therapy Dry Needling Certification courses. At this time, the guidance for occupational therapists using DN is limited. As more occupational therapists witness the benefits of dry needling, we look to our boards for more guidance. Each state has a unique practice act that defines the scope of practice for occupational therapists in that state. This can make it difficult to determine your state’s opinion on dry needling. Some states have not produced a statement on dry needling, some are for it, and some states say that dry needling is not allowed. It may take some research, and you may have to reach out to your state board for further information about your state’s practice act. Since most written rules about dry needling are defined for and by physical therapists, we must also consider physical therapy state acts for guidance on the legality of dry needling.
So as an occupational therapist, it is essential to review and follow both the physical therapy and occupational therapy state practice acts to determine your state requirements and regulations on dry needling. The lack of specificity and difference among states can make dry needling regulations challenging to navigate.
The Occupational Therapy Dry Needling Task Force
The AOTA dry needling task force met to identify and define how dry needling fits into the occupational therapy scope of practice. At the May 2021 Representative Assembly (RA) meeting, the task force presented its early findings and strongly supported dry needling within the OT scope of practice. However, as I mentioned earlier, they also identified limitations in the 2017 research articles used to support the 2017 statement, making that statement invalid. The task force also confirmed current limitations in the number of studies, methodology, and use of outcome measurements. However, they did identify evidence that dry needling has a positive impact on occupational performance. Therefore, it appears that at a minimum, the COP will retract the 2017 statement on dry needling, if not update it in support of dry needling. We can only hope that positive changes will be forthcoming. AOTA members can read the Report of the AOTA Representative Assembly Dry Needling Task Force.
Scientific Review and Evidence
A recent high-quality systemic review, published in the American Journal of Occupational Therapy, concluded that dry needling might positively impact occupational performance compared with other interventions in treating individuals with spasticity. Byrum and colleagues (2021) concluded that dry needling is an effective physical agent modality to decrease spasticity and increase range of motion. Ten articles were identified, which were grouped by outcome measures. Changes in function were assessed with the Modified Ashworth Scale. Of the ten studies, four demonstrated a significant decrease in spasticity, and seven showed a significant increase in range of motion after dry needling. Of the five studies evaluating spasticity, only one study did not show a significant improvement. Although the decrease in spasticity was not statistically significant, participants did experience a statistically significant improvement in range of motion. Of the nine articles that addressed range of motion, two did not show significant improvement. This is one of the systemic reviews the task force cited in support of occupational therapists and dry needling in its presentation to the AOTA. Once the AOTA supports dry needling within the occupational therapy scope of practice, more occupational therapists could conduct research and use dry needling in clinical practice. In addition, state legislators would be more likely to update the practice acts to include dry needling.
National and State Guidelines on Dry Needling
The American Society of Hand Therapists (ASHT) is the only professional society to confirm the use of dry needling by occupational therapists. In a position statement, the ASHT was unable to reach a conclusion on the use of dry needling but acknowledged that dry needling is used by occupational therapists and physical therapists. This statement recognizes that dry needling is within the scope of occupational therapy, yet the state practice acts still dictate regulation for dry needling.
As occupational therapists, we look to the AOTA to guide the occupational therapy scope of practice and dry needling. The AOTA currently has not published an official statement on dry needling. They are in the process of revisiting their previous findings of dry needling issued in 2017, which stated:
Currently, no available evidence exists in the occupational therapy literature investigating the use of dry needling. Available literature in other health care professions has reported mixed outcomes in general and as related to function (2017).
This statement from the AOTA on dry needling and the lack of support by the AOTA’s Commission on Practice (COP) may explain why many states are indifferent to using dry needling or don’t support dry needling. It may also be why there is a lack of research for dry needling within the practice of occupational therapy. If the AOTA does not officially consider dry needling to be a part of the occupational therapy scope of practice, research will be challenging to obtain and reference. The majority of state practice acts follow what is happening at the national level. States may have some apprehension about adding a statement to the practice act about dry needling without formal support from the AOTA. However, there is some reason for optimism: in 2020, the AOTA created an occupational therapy dry needling task force. The task force presented its findings to the AOTA and change has been set in motion. Most importantly, the task force invalidated AOTA’s 2017 statement.
Right now, 36 states, plus the District of Columbia allow physical therapists to use dry needling:
|1. Alabama||10. Illinois||19. Montana||28. South Carolina|
|2. Alaska||11. Indiana||20. Nebraska||29. South Dakota|
|3. Arizona||12. Iowa||21. Nevada||30. Tennessee|
|4. Arkansas||13. Kansas||22. New Hamshire||31. Texas|
|5. Colorado||14. Kentucky||23. New Mexico||32. Utah|
|6. Delaware||15. Louisana||24. North Carolina||33. Vermont|
|7. Florida||16. Maine||25. North Dakota||34. Virginia|
|8. Georgia||17. Maryland||26. Ohio||35. West Virginia|
|9. Idaho||18. Mississippi||27. Rhode Island||36. Wyoming|
There are six states where dry needling is prohibited:
Eight states have no formal opinion or regulations (see Dry Needling State Laws | APTA):
|1. Connecticut||5. Missouri|
|2. Massaschusetts||6. Oklahoma|
|3. Michigan||7. Pennsylvania|
|4. Minnesota||8. Wisconsin|
State laws or regulations allowing occupational therapists to use dry needling are not as easy to find. In some states, the occupational therapy profession appears to follow the provisions in place for physical therapists, such as in Wisconsin. In a few other states, there are OT-specific rules in place:
In Ohio, the Occupational Therapy Section on dry needling concluded that:
In accordance with section 4755.04 (A)(3) of the Ohio Revised Code, it is the position of the Occupational Therapy Section that occupational therapy practitioners may use physical agent modalities, such as dry needling in the provision of occupational therapy services provided that the occupational therapy practitioner demonstrates and documents competency in the modality, in accordance with rule 4755-7-08 of the Administrative Code, and is practicing within the occupational therapy scope of practice.
The Maryland Board of Occupational Therapy intends to develop regulations specific to dry needling in the near future. There will be an opportunity for public comment when the laws are proposed. Once rules are adopted, licensed occupational therapy practitioners will be authorized to utilize dry needling.
The New Hampshire Occupational Therapy Governing Board used to have a statement on its website supporting dry needling by OTs, but following a recent revision of the site, that statement was no longer available.
The Wyoming Board of Occupational Therapy concluded that:
After reviewing our statutes, the Board has determined that the Board of Occupational Therapy’s Practice Act/Statute DOES support that Wyoming licensed Occupational Therapists who are properly trained can use dry needling techniques in their practice.
The Wyoming Board of Occupational Therapy recommends using the following guidelines when engaging in dry needling:
- Licensees will need to have evidence of competence before they can begin using dry needling techniques in their practice.
- Licensed occupational therapists shall be able to demonstrate upon the Board’s request that they have received training in dry needling that meet the Board’s requirements.
- Training shall include, but not be limited, to training in indications, contraindications, potential risks, proper hygiene, proper use and disposal of needles, and appropriate selection of clients.
- Training shall include a minimum of twenty-seven (27) hours of live face-to-face instruction. Online courses are not appropriate training in dry needling.
- Dry needling may not be performed by an occupational therapy assistant or any other supportive personnel.
- The occupational therapist shall supply written documentation, upon request by the Board, that substantiates appropriate training as required by this rule. Failure to provide written documentation may result in disciplinary action taken by the Board.
Many states have no defined opinion, such as:
The Future of Dry Needling Is Bright
In conclusion, dry needling has proven to be an effective modality for treating patients within the occupational therapy scope of practice. Dry needling is gaining momentum in occupational therapy; the ASHT and AOTA are beginning to recognize dry needling as an evidence-based treatment for occupational performance. The future as an OT in dry needling is exciting and I’m looking forward to seeing more OTs using it in their practices.
“Don’t be the same, BE BETTER.” – Unknown author
Bynum, R., Garcia, O., Herbst, E., Kossa, M., Liou, K., Cowan, A., & Hilton, C. (2021). Effects of dry needling on spasticity and range of motion: A systematic review. American Journal of Occupational Therapy, 75, 7501205030. https://doi.org/10.5014/ajot.2021.041798
State Laws and Regulations Governing Dry Needling Performed by Physical Therapist in the U.S. APTA 2020 https://www.apta.org/patient-care/interventions/dry-needling/laws-by-state)
Uygar, E., Aktas, B., Ozkut, A., Erinc, S., & Yilmazoglu, E. G. (2017). Dry needling in lateral epicondylitis: a prospective controlled study. International Orthopaedics, 41, 2321-2325. doi:10.1007/s00264-017-3604-1
American Occupational Therapy Association. (2017). Vision 2025. American Journal of Occupational Therapy. doi:10.5014/ajot.2017.703002