a note on "dry needling"
Dry needling is the use of a basic acupuncture technique, often after a couple of weekends of training.
A number of patients have come to me confused about the term "dry needling," which is the insertion of needles into myofascial trigger points. This service was ruled out of scope for Physical Therapists in 2016 and a subsequent attempt to expand their scope to include it (with just 54 hours of training) failed. It is currently illegal for physical therapists to perform this procedure in our state.
A number of patients have come to me confused about the term "dry needling," which is the insertion of needles into myofascial trigger points. This service was ruled out of scope for Physical Therapists in 2016 and a subsequent attempt to expand their scope to include it (with just 54 hours of training) failed. It is currently illegal for physical therapists to perform this procedure in our state.
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What is dry needling?
"Dry needling" is another term for a specific acupuncture technique found in acupuncture texts dating back more than 2000 years. The most significant practical difference between acupuncture and "dry needling" performed by physical therapists is that acupuncturists have 3-4 years of training in needling and physical therapists have somewhere between 27-54 hours (yes, that is just a two-weekend class). Physical therapy organizations promoting "dry needling" attempt to differentiate it from acupuncture by saying it is based in "modern scientific reasoning" without acknowledging that the practice of modern acupuncture incorporates that same reasoning within the greater theoretical framework by which acupuncture has worked for thousands of years. They refuse to acknowledge the extensive biomedical training required to practice acupuncture and present acupuncture and acupuncturists as archaic and uneducated in modern science. |
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"Dry needling" is essentially trigger point acupuncture with a different name. We sometimes call it "ashi" acupuncture, as "ashi" translate as "ah, yes," as in "there it is," the "it" being a hyperirritable location in muscle or other connective tissue. In modern terms, that's a trigger point. When performed by an acupuncturist, trigger point needling addresses the whole patient rather than simply treating symptomatically. Acupuncturists have been thoroughly trained in the how needling these points works within the multi-systemic effects of acupuncture.
Acupuncturists have been performing trigger point needling for millennia but in recent years, some western medical professionals (mostly physical therapists) have recognized the efficacy and value of acupuncture and tried to rebrand it as something new. By attempting to skirt existing laws surrounding the practice of acupuncture, and some physical therapists seek to needle patients with only the most rudimentary understanding of therapeutic needling.
As stated in a recent British Medical Journal article, "...dry needling is a subcategory of Western medical acupuncture. Taken literally, the term acupuncture includes both Western medical and traditional acupuncture, and thus obviously covers dry needling." (Fan, He, Dec. 2015).
Is dry needling by physical therapists legal in the state of Washington?
In Washington, PTs performing dry needling were declared to be practicing outside their scope of practice by both the Attorney General in 2016 and, previously in 2014, by a superior court judge. An attempt to clarify dry needling as within scope failed to even make it out of the Senate Health Care Committee. These decisions left PTs with one avenue: a formal scope expansion process called a Sunrise Review. In December 2016, the Department of Health released a report denying the scope expansion.
Bottom line: dry needling is acupuncture (with far less training) and it is illegal for physical therapists to practice it in Washington state, where the attempt to legalize it via a Sunrise Review (scope expansion process) failed all three Sunrise criteria: that it be effective, cost-effective, and safe.
What kind of training do physical therapists have in dry needling?
While many PTs are indeed well-trained in anatomy, that is only a small part of the knowledge required for the safe and skilled practice of acupuncture. The random determination of the proposed 54 hours of training was determined by the for-profit training companies who conceived of it (some companies even certify a PT in dry needling after just a single weekend). There is no substantiation behind any proposed number of hours of training in "dry needling."
"Dry needling" requires:
The American Medical Association has concluded, “Dry needling is indistinguishable from acupuncture.” AMA Policy on Dry Needling is:
The fact is that an expansion of scope dramatically increases medico-legal risk to referring physicians, and also the medico-legal dangers of physical therapy. Even for physicians (MDs) who possess seven years of advanced training and extensive performance of invasive procedures, 300 hours of training in medical acupuncture is considered the baseline industry norm, which includes the theoretical foundation essential for the practice of needling.
The needle experts--including licensed acupuncturists, acupuncture associations, the members of the American Academy of Medical Acupuncture (MDs trained in acupuncture) and the American Academy of Physical Medicine and Rehabilitation--all agree that the practice of dry needling by physical therapists is an unsafe, unreasonable and problematic self-proclaimed expansion of scope of practice by Physical Therapists. Here in Washington, the actions against the unlawful practice of acupuncture is summarized as follows:
Acupuncturists have been performing trigger point needling for millennia but in recent years, some western medical professionals (mostly physical therapists) have recognized the efficacy and value of acupuncture and tried to rebrand it as something new. By attempting to skirt existing laws surrounding the practice of acupuncture, and some physical therapists seek to needle patients with only the most rudimentary understanding of therapeutic needling.
As stated in a recent British Medical Journal article, "...dry needling is a subcategory of Western medical acupuncture. Taken literally, the term acupuncture includes both Western medical and traditional acupuncture, and thus obviously covers dry needling." (Fan, He, Dec. 2015).
Is dry needling by physical therapists legal in the state of Washington?
In Washington, PTs performing dry needling were declared to be practicing outside their scope of practice by both the Attorney General in 2016 and, previously in 2014, by a superior court judge. An attempt to clarify dry needling as within scope failed to even make it out of the Senate Health Care Committee. These decisions left PTs with one avenue: a formal scope expansion process called a Sunrise Review. In December 2016, the Department of Health released a report denying the scope expansion.
Bottom line: dry needling is acupuncture (with far less training) and it is illegal for physical therapists to practice it in Washington state, where the attempt to legalize it via a Sunrise Review (scope expansion process) failed all three Sunrise criteria: that it be effective, cost-effective, and safe.
What kind of training do physical therapists have in dry needling?
While many PTs are indeed well-trained in anatomy, that is only a small part of the knowledge required for the safe and skilled practice of acupuncture. The random determination of the proposed 54 hours of training was determined by the for-profit training companies who conceived of it (some companies even certify a PT in dry needling after just a single weekend). There is no substantiation behind any proposed number of hours of training in "dry needling."
"Dry needling" requires:
- no oversight or consistency to training programs
- no national standard or certification route
- no requirement of even a single supervised patient encounter included in order to be "certified"
The American Medical Association has concluded, “Dry needling is indistinguishable from acupuncture.” AMA Policy on Dry Needling is:
- "Our AMA recognizes dry needling as an invasive procedure and maintains that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists."
The fact is that an expansion of scope dramatically increases medico-legal risk to referring physicians, and also the medico-legal dangers of physical therapy. Even for physicians (MDs) who possess seven years of advanced training and extensive performance of invasive procedures, 300 hours of training in medical acupuncture is considered the baseline industry norm, which includes the theoretical foundation essential for the practice of needling.
The needle experts--including licensed acupuncturists, acupuncture associations, the members of the American Academy of Medical Acupuncture (MDs trained in acupuncture) and the American Academy of Physical Medicine and Rehabilitation--all agree that the practice of dry needling by physical therapists is an unsafe, unreasonable and problematic self-proclaimed expansion of scope of practice by Physical Therapists. Here in Washington, the actions against the unlawful practice of acupuncture is summarized as follows:
- A court injunction was issued in 2014 against physical therapists offering this service, citing that it is practicing medicine without a license.
- A February 2016 bill that would allow PTs to begin dry needling failed to pass the Senate Health Care Committee in Washington State.
- In April, 2016, the Washington State attorney general ruled that dry needling is out of scope for physical therapists.
- The Department of Health denied a request to expand the scope of physical therapy to include dry needling (December 2016).