Occupational Therapy and Dry Needling – An Update

In a previous blog, we reviewed what was known about dry needling and occupational therapy at that time. In May 2021, a dry needling task force of the American Occupational Therapy Association (AOTA) presented its early findings in strong support of dry needling within the OT scope of practice. Fast forward to April 2023, when the AOTA released “Policy E.18: Interventions to Support Occupations.

AOTA asserts that interventions to support occupations including but not limited to physical agent modalities (PAMs), dry needling, and other techniques may be used in preparation for, or concurrently with occupations and activities or interventions that ultimately enhance a client’s engagement in occupation.

When the American Physical Therapy Association (APTA) endorsed dry needling, many state boards of Physical Therapy approved it as a treatment option within the scope of physical therapy. Most state practice acts follow what is happening at the national level, and going forward, occupational therapy state boards may consider approving dry needling. The APTA published two dry-needling guidelines in 2012 and 2013.

Dry Needling Regulations By State

Jan Dommerholt joined the OT students at their DN poster.

State laws or regulations allowing occupational therapists to use dry needling are not easy to find. In some states, the occupational therapy profession appears to follow the provisions for physical therapists, such as in Wisconsin. In only a few states, OT-specific rules are in place. During the AOTA Inspire 2024 Conference & Expo in Orlando, FL, OT students Alexander Hatter, Hayley Medsker, Seth Murphy, Madison O’Daniel, Katherine Peters, Benjamin Snodyans, and Dr. Prya Bakshi presented their poster about “The Practice of Dry Needling for Management of Lateral Elbow Tendinopathy in Occupational Therapy,” which possibly was the first accepted DN presentation at the conference. The students presented an up-to-date map of state boards as part of their presentation.

From Hatter et al. (2024), “The Practice of Dry Needling for Management of Lateral Elbow Tendinopathy in Occupational Therapy” (reproduced with permission)

Combining Myopain Seminars knowledge with Hatter et al., we provide a current list (in alphabetical order):

  • According to the Alabama State Board of Occupational Therapy, dry needling is within the scope of occupational therapy in Alabama as long as the clinician has received appropriate training or education to render such service.
  • On June 13, 2022, the Occupational Therapy Examining Committee of the Arkansas State Medical Board, Arkansas Department of Health shared with Myopain Seminars that  “the Occupational Therapy Examining Committee previously voted that a statutory change to the Occupational Therapy Practice Act would need to be made to include dry needling in the occupational therapy scope of practice. The Committee met on July 11, 2022, and discussed dry needling.  The vote was to continue to research the procedure. According to Hatter et al., the Committee has not yet taken a stance on dry needling.
  • When Myopain Seminars approached the Georgia State Board of Occupational Therapy (June 2022), we were informed that the Board “may not provide what is considered legal advice regarding scope of practice to any third party due to any potential and unforeseen legal ramifications for providing such advice.”
  • According to the Illinois Occupational Therapy Licensure Board, dry needling is within the scope of occupational therapy and may also be performed by occupational therapy assistants possessing advanced training, skill, and competency. The Illinois Compiled Statutes, Section 225 ILCS 75/2 (from Ch. 111, par 3702,  include […]
    • (7) “Occupational therapy services” means services that may be provided to individuals, groups, and populations, when provided to treat an occupational therapy need, including the following: […]
    • (e) for the occupational therapist or occupational therapy assistant possessing advanced training, skill, and competency as demonstrated through criteria that shall be determined by the Department applying physical agent modalities, including dry needling, as an adjunct to or in preparation for engagement in occupations
      • The Maryland Board of Occupational Therapy Practice has developed regulations specific to dry needling, which the Maryland Secretary of Health proposed to adopt as Regulations .01—.04 under a new chapter, COMAR 10.46.09 Dry Needling, following public meetings held on May 19, 2023, and November 6, 2023, by the Maryland Board of Occupational Therapy Practice. Surprisingly, only occupational therapists who are also Certified Hand Therapists (CHT) are being considered now. A public comment period ended on February 26, 2024. Next, a public hearing will likely be scheduled. Please be aware that at least one course provider maintains erroneously that dry needling is within Maryland’s scope of OT practice.
      • Once upon a time, the New Hampshire Occupational Therapy Governing Board had a statement on its website supporting dry needling by OTs; however, after a site update, that statement was no longer available. According to Hatter et al., the New Hampshire Occupational Therapy Governing Board has not decided on dry needling, which does not necessarily imply that it is not permissible. Following an email inquiry on March 24, 2024, Myopain Seminars was informed that “Board staff are not authorized to provide any legal advice but are able to refer you to the statutes/rules.  You should seek advice regarding its applicability to your specific situation from your personal or corporate legal counsel.” According to Occ 102.03, (b), Occupational therapy services include, but are not limited to: […] (5)  Application of physical agent modalities as an adjunct to, or in preparation for, engagement in purposeful activities and occupations. 
      • According to the North Carolina Board of Occupational Therapy,physical agent modalities (PAMs) and the use of specific therapeutic procedures to enhance performance skills are allowed in OT practice. However, it is the opinion of the NC Board that an OT may use PAMs in the course of their occupational therapy practice, so long as they are trained and competent to do so AND their competency has been demonstrated and documented, provided they are billing for OT services. It is also the opinion of the Board that an OTA may use PAMs in the course of their occupational therapy practice, so long as they AND their supervising OT are trained and competent to do so AND their competency has been demonstrated and documented, provided they are billing for OT services. The burden is on the occupational therapy practitioners to prove that they are competent to provide the treatment.” Although Hatter et al. indicated that dry needling would not be within the scope of OT practice, Myopain Seminars maintains that dry needling is within the scope of OT practice in North Carolina.
      • The Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board 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.
      • According to the Tennessee Board of Occupational Therapy, occupational therapists are allowed to use dry needling of the upper limb, with proper training and certification. The Tenn. Code Ann. § 63-13-103, 63-13-103. Chapter definitions, 10 (D) states that “Occupational therapy practice includes specialized services provided by occupational therapists or occupational therapy assistants who are certified or trained in areas of specialization that include, but are not limited to, hand therapy, neurodevelopmental treatment, dry needling of the upper limb, sensory integration, pediatrics, geriatrics and neurorehabilitation, through programs approved by AOTA or other nationally recognized organizations.”
      • According to the Texas Board of Occupational Therapy Examiners:
        • According to §362.1(29)(C)(xiii) of the OT Rules, occupational therapy interventions and procedures that promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation include the application of physical agent modalities, and use of a range of specific therapeutic procedures (such as wound care management; techniques to enhance sensory, perceptual, and cognitive processing; manual therapy techniques) to enhance performance skills.
        • The Texas Board of Occupational Therapy Examiners does not dictate the specific modalities, techniques, or procedures that may be incorporated into the occupational therapy plan of care.  However, at all times, it is the responsibility of occupational therapy practitioners (OTs and OTAs licensed by this board) to demonstrate competency in all modalities, techniques, and procedures used for treatment.
        • The occupational therapy practitioners must know how to perform and demonstrate proficiency in, as noted, any modalities, techniques, or procedures performed; however, please note that the Board does not specify certifications they must hold for specific modalities, etc.  The occupational therapy practitioners are responsible for all of the modalities, techniques, or procedures that are used and the use of such must comply with the OT Act and Rules.
        • 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.

        The American Society of Hand Therapists and Dry Needling

        The American Society of Hand Therapists (ASHT) does not yet have a formal position on dry needling. According to the ASHT, “the current body of evidence neither supports nor refutes the use of dry needling in the practice management of the hand and upper extremity.”

        Important Note

        We recommend that occupational therapists practicing in a state that has not decided on dry needling contact their professional liability (malpractice) insurance company and request that coverage for dry needling be included as a specific clause in their insurance policy.

        Jan Dommerholt, PT, DPT, President, Myopain Seminars

        (Photo by Randy Tarampi on Unsplash)

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