In June 2024, the North Carolina Board of Physical Therapy Examiners issued a “position statement on dry needling,” in which the Board addressed several questions. In preparation for the position statement, the Board consulted with several dry needling specialists, including Jan Dommerholt, president of Myopain Seminars. In addition, the Board reviewed documents by the Federation of State Boards of Physical Therapy (FSBPT), the American Physical Therapy Association (APTA), and dry needling certification requirements from various course providers. This position statement is an update of a previously issued statement on December 11, 2019.
In North Carolina, dry needling is defined as “a treatment that uses physical or rehabilitative procedures, with assistive devices, for the purpose of correcting or alleviating myofascial pain, a physical disability.” The Board emphasized that “any utilization of dry needling techniques that satisfy the foregoing language is within the scope of physical therapy practice in NC.” On March 9, 2024, the Board concluded that perineural dry needling is not within the scope of physical therapy in North Carolina.
Furthermore, the Board “strongly encourages” to satisfy the following principles:
- Prior to introducing dry needling into a personal scope of practice, the physical therapist should attest to having attained the knowledge, skill, ability, and competence to perform dry needling.
- Prior to administering dry needling, the physical therapist should communicate the plan of care and obtain informed consent from the patient/client or their legally authorized representative.
- All physical therapists engaging in the practice of dry needling should acquire the appropriate “advanced training” as defined below.
- All physical therapists engaging in the practice of dry needling should retain documentation as proof of successful completion of “advanced training.”
- A physical therapist should not delegate any portion of the dry needling treatment/intervention to a physical therapist assistant or physical therapy aide.
- Student physical therapists do not meet the Board’s definition of “advanced training” therefore should not engage in the practice of dry needling, regardless of the level of supervision from the supervising physical therapist.
It is noteworthy that the Board does not require any of these stipulations. Instead, the Board “strongly encourages” physical therapists to follow these principles, which raises questions about the legal ramifications for a physical therapist who does not satisfy the recommended principles. For example, could a North Carolina physical therapist allow a physical therapy assistant or even a physical therapy aide in their clinic to perform dry needling without any Board action? The Virginia PT Board is much more committed:
- Dry needling shall only be performed by a physical therapist trained pursuant to subsection A of this section and shall not be delegated to a physical therapist assistant or other support personnel (Statutory Authority § 54.1-2400 of the Code of Virginia).
In North Carolina, the “recommended” Advanced Training should consist of
- Completion of at least 1 year of licensed practice as a physical therapist.
- Completion of a formalized course of study on the topic of dry needling from an approved provider in accordance with 21 NCAC 48G .0105-.0112.
- The course of study should include:
- A minimum of 50 hours of in-person (not online) instruction which includes at least 50% of the course study spent on practical, clinical application.
- Certification of completion of all program requirements.
- The course of study should include:
Again, “recommend” and “encourage” suggest that the Board has no real power to enforce any of the clauses presented in the updated position statement. What would happen if a new graduate starts dry needling in the clinic during their first year of practice? Or what would happen if a physical therapist starts needling after attending one 27-hour course?
Based on the position statement, neither appears to be illegal, but to be sure, legal advice would be recommended. Generally speaking, it is probably wise to follow the suggested rules by a state board, but in this case, there seems to be much room for interpretation.
Jan Dommerholt | President, Myopain Seminars
