Dry Needling Rulings

North Carolina

Is Dry Needling Legal in North Carolina?
Attorney General Opinion 1 – North Carolina
Attorney General Opinion 2 – North Carolina
Supreme Court Decision
Settlement Agreement
  • On May 26, 2022, the Board's website shows: [A physical therapist] would need to assess [their competence after obtaining advanced training prior to performing dry needling on patients. More specifically certification is not currently required by the Board; however, if a certification is o]btained, it is very useful to keep on file as part of documentation of competence related to the personal practice of dry needling. If a licensee has not obtained advanced training for a technique they would not be considered to meet the requirements noted above. Dry needling courses are currently approved per the Continuing Competence rules in 12 NCAC 48G .0105 - .0112.
  • On December 11, 2019, the NC PT Board determined that as noted in the North Carolina Supreme Court decision issued on December 7, 2018, in the case brought by the Acupuncture Board, “dry needling is a treatment that uses physical or rehabilitative procedures, with assistive devices, for the purpose of correcting or alleviating myofascial pain…” Therefore, any utilization of dry needling techniques that satisfy the foregoing language is within the scope of physical therapy practice in North Carolina. As the Board has previously noted, dry needling is an advanced skill for which training beyond entry level education is required. It is incumbent upon the licensee to obtain the appropriate training, education and be competent to perform dry needling.
  • On March 1, 2019, a Settlement and Agreement stipulated that the North Carolina Acupuncture Licensing Board had to pay the plaintiffs the sum of $130,000 and had to stop sending cease and desist letters to physical therapists stating that they are prohibited from offering dry needling.
  • On December 7, 2018, the North Carolina Supreme Court upheld the Physical Therapy Board’s declaratory ruling affirming that dry needling constitutes physical therapy and falls within the scope of physical therapy in North Carolina. After the decision the parties jointly entered in mediation. On February 11, 2019, the parties reached a settlement and resolved the issues between them.
  • On April 18, 2018, the North Carolina Supreme Court heard oral arguments in the case.
  • On August 2, 2017, Louis A. Bledsoe, III, Special Superior Court Judge for Complex Business Cases of the North Carolina General Court of Justice, Superior Court Division, ruled that physical therapists may perform dry needling. The Court’s ruling affirms a decision by the North Carolina Board of Physical Therapy Examiners that reached the following conclusions: 1) The scope of physical therapy under North Carolina law includes dry needling. 2) Dry needling is distinct from acupuncture. 3) The Acupuncture Board “fails to recognize that health professions are allowed to have overlapping scope of practice”. 4) North Carolina public policy favors patient choice in health care.
  • On January 30, 2017, the United States District Court for the Middle District of North Carolina issued its Opinion and Order in the case of Henry et al. v. the North Carolina Acupuncture Licensing Board et al. Henry et al. v. the North Carolina Acupuncture Licensing Board et al, is an antitrust lawsuit arguing that the North Carolina Acupuncture Licensing Board (NCALB) is violating antitrust law and due process rights in its actions to prevent PTs from practicing the skilled intervention of dry needling. The court ruled “that Plaintiffs have satisfied their obligation, at this stage, to plausibly allege an impact on interstate commerce”. Furthermore, the court ruled “that Plaintiffs have sufficiently alleged injury in fact” and the court agreed “with Plaintiffs and finds that the Amended Complaint adequately alleges “the type of injuries the antitrust laws were intended to prevent”. The court also found evidence of conspiracy by the North Carolina Acupuncture Licensing Board and the North Carolina Association of Acupuncture and Oriental Medicine. As far as we know, this is the first Federal ruling in favor of dry needling by physical therapists in the United States, which could have far-reaching implications for acupuncturists in other states who are still attempting to stop the practice of dry needling by physical therapists.
  • On April 26, 2016, Louis A. Bledsoe, III, Special Superior Court Judge for Complex Business Cases in the State of North Carolina dismissed all of the Acupuncture Board’s claims against the Physical Therapy Board and several NCPTA members. Days after its lawsuit was dismissed in full, the Acupuncture Board started more legal proceedings against the Physical Therapy Board. The new proceedings have the same purpose as the dismissed lawsuit: trying to prevent North Carolina patients from receiving the safe, effective treatment that those patients choose.
  • On December 8, 2015, the NC Acupuncture Board filed an “Amended Verified Complaint for Declaratory Judgment and for Permanent Injunction” against the NC Board of Physical Therapy Examiners and against three NC licensed physical therapists and a physical therapy practice.
  • On October 7, 2015, attorneys for the North Carolina chapter of the APTA (NCPTA) filed a federal antitrust lawsuit (Henry v. NC Acupuncture Licensure Board) against the North Carolina Acupuncture Licensure Board (NCALB). The landmark lawsuit asserts federal antitrust and due process claims against the NCALB and its members. It seeks an injunction blocking the NC Acupuncture Board from taking action against physical therapists, recovery of three times the physical therapists’ lost profits, and payment of attorneys’ fees, The plaintiffs in the case are four licensed physical therapists. Two of the four PT plaintiffs received cease & desist letters from the NCALB in 2013; the other two PT plaintiffs do not currently perform dry needling and want to be able to do so in the future, but are afraid of entering the market due to fear of the NCALB taking action against them. In addition there are two patient plaintiffs who currently receive and are benefitting from dry needling treatment performed by their NC physical therapists. The Henry lawsuit has legal support in a 2015 decision by the US Supreme Court holding that state licensing boards controlled by market participants, such as the NCALB, are not exempt from antitrust claims unless their conduct is actively supervised by the state. The NCPTA lawsuit is the first in the country to bring this type of antitrust violation claim on behalf of PTs since the Supreme Court decision.
  • On September 2, 2015, the North Carolina Acupuncture Licensing Board filed a lawsuit in Wake County Superior Court against the North Carolina Board of Physical Therapy Examiners to “protect the public from the unlicensed practice of acupuncture by physical therapists offering “dry needling”. The complaint seeks judicial confirmation that the practice known commonly as “dry needling” is acupuncture.
  • On January 15, 2015, the North Carolina Rules Review Commission objected to Rule 21 NCAC 48C 0104 which is the Physical Therapy Board’s proposed rule on dry needling due to a “lack of statutory authority”. According to the North Carolina Board of Physical Therapy Examiners, “…. the Board’s Position Statement on Intramuscular Manual Therapy and Dry Needling is not considered to be a rule, and physical therapists must therefore comply with 21 NCAC 48C .0101(a)”. Furthermore, the NC PT Board issued a statement that “….. based on an Advisory Letter from the Attorney General’s Office submitted to the Acupuncture Licensing Board in 2011, and the opinion of the RRC Staff Counsel reviewing the NCBPTE rules for statutory compliance, dry needling is within the scope of practice of physical therapy”. In summary, this means that while dry needling is legally within the scope of physical therapy practice, any previously issued rules regarding minimal educational requirements are no longer valid. In other words, there are no regulations anymore to set the specific requirements for engaging in dry needling. The Board believes that physical therapists can continue to perform dry needling so long as they possess the requisite education and training required by N.C.G.S. § 90-270.24(4).
  • In August 2013, the North Carolina Board of Acupuncture issued Cease & Desist letters to a number of physical therapists in that state who use dry needling techniques, even though the acupuncture board has no jurisdiction over physical therapists and physical therapy practice.
  • In May 2012, the NC Board of Physical Therapy Examiners lowered the requirements for dry needling to 54 hours of education.
  • In December 2011, an initial ruling was finalized.
  • In September 2010, the NC Board of Physical Therapy Examiners reversed its 2002 decision and determined that dry needling is within the scope of physical therapy.
  • In 2002, the North Carolina Board of Physical Therapy Examiners ruled that dry needling was not in the scope of physical therapy practice.