Five Important Dry Needling Developments

Yes, more on dry needling.  More about education will have to wait.

Five things to know —

  1. The Oregon Ruling did not (despite the Acupuncture Today headline) determine that “Dry Needling is Acupuncture.”  For a full exploration of the case, read this post. In summary, the ruling of the court was that Dry Needling is not physiotherapy.
  2. On April 1st Utah Governor Gary Herbert signed HB 367, legislatively adding Dry Needling to the scope of Physical Therapists.
  3. On April 24th Arizona Governor Jan Brewer signed SB 1154, legislatively adding Dry Needling to the scope of Physical Therapists.*
  4. On March 25th Massachusetts HB 3972 advanced. This redraft of acupuncture bills HB 2051 and SB 1107 was necessary because the bill could not advance with the language that “dry needling is acupuncture.”
  5. At the end of April the Illinois Department of Professional Regulation issued an informal ruling that dry needling was not within the scope of practice for Physical Therapists “as the acts are currently written.”  That last phrase is important. From what I can tell there are about 550 LAcs in IL and over 9,000 PT’s.  The PT’s aren’t ready to call it quits. Time will tell if the victory for the LAcs is a lasting one. The PT’s could well look to Arizona and Utah and work for a legislative change.

(A colleague practicing in Delaware recently told me of the urgent phone calls and emails she’s been receiving — she must get involved in the fight against PT Dry Needling! Delaware is a state in which a few LAcs on the Advisory Board refuse to grant licenses to qualified acupuncturists. There are so few LAcs (less than 40) that they can’t maintain an association and citizens are far more likely to get acupuncture from a DC or an MD than an LAc. Now the profession wants to take on the PT’s? If there’s an urgent need for action from the LAcs of DE, perhaps it should be action to bring LAcs to the state?)

For those who insist we must do something about this serious risk to our profession, here are some suggestions. They would do far more to benefit our profession than this ongoing battle with the PT’s.

* One of the acupuncture profession’s strategies from the start of the Dry Needling issue was to argue, as the AAAOM wrote in their 2013 position paper,– “the addition of TPDN to physical therapy practice is being determined by physical therapy regulatory boards, deleteriously circumventing transparency and public health safety protections provided by standard legislative process.”  This was a mistake. Given the relative political strength of the PT profession and their MD supporters legislative victories are likely. Had we been willing to work with our health-care colleagues in the regulatory arena we might well have had input and influence in the use of this procedure.


Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

8 thoughts on “Five Important Dry Needling Developments

  1. The argument in Illinois was not that PT’s could never do acupuncture, just that it is improper to add that to their scope of practice with no training. There are standards available, and they may be perfectly appropriate. I would like to have seen the PT association say, “we would like to add this to our scope of practice and this is how we think we can safely do that”. For example, # of training hours, supervised treatments, clean needle technique, continuing education, etc. The original, informal verbal opinion of the IL DPR required none of that. And it wasn’t the PT’s who asked for it, it was a continuing ed outfit that wanted to “certify” PT’s in dry needling with a weekend course. The original opinion implied that a weekend course was not even necessary. PT’s do have political power and may well be able to get dry needling inserted into their practice act, but they will need to require some degree of training and oversight.

    • Thanks for your comments, Jason. As our profession has been addressing the dry needling issue, I think we’d have done much better if we’d had the sort of conversation you refer to. Hey, we’ve got some concerns, can you tell us more about your training in X, Y, and Z, and, oh, we think it would be great if you could include A, B, and C. I suspect we’ve poisoned the well with some of our diatribes. And I’ve also noticed we’ve been quick to label certain educational programs with some very loaded terms — often without much knowledge of how a weekend class adds on to previous training.

      I’ve asked the acupuncture community about what an “appropriate” training program would look like, considering it would come after full PT training. I’ve had answers like “we studied 2000 hours, so they should have at least 400” but I haven’t had anyone actually explain what they’d do with all those hours. Assuming that we want the PT’s to stick to releasing trigger points (which they can already find) it’s hard for me to come up with more than 20 hours of class time to learn this technique, but I continue to be open to hearing what others have to say.

      I think a strategy of expressing concerns and offering to help identify important items to include in an educational program would have been a good way to address this issue.

  2. It is really revealing to read the AAAOM position paper, released March 2013, claiming “No standards of education have been validly determined to assure that physical therapists using TPDN are able to provide the public with a safe and effective procedure.” and citing the CAPTE Accreditation Handbook of 2011. Contrast this with the 140 page APTA position paper on dry needling. It lists the Irish Draft guidelines as a standard. These are so well thought out and comprehensive, covering clean needle technique and safety thoroughly, that I am going to use them on my own clinic. I wonder how many acupuncturists have read these guidelines, let alone know they exist. And you are right, the PT’s in Illinois will not back down and I would wager a $100 donation to (the unfortunately named) NCASI that they will not miss a day of dry-needling between now and when they win victory legislatively.

    • With the legislative wins in AZ and UT I think we should be able to see the writing on the wall. I can’t think of more than a handful of states in which the LAcs have any hope of stopping a legislative push from the PT’s.

      I’m certain the AAAOM did not know of the Irish standards and did not make the slightest attempt to educate themselves about what PT’s learn as part of their regular training. I’ve had LAcs throw out all sorts of number for additional training they’d want PT’s to have — 200 hours, 500 hours, etc. — all based on well, we had X numbers so they should have at least Y. When I ask how they’d spend all those hours — long silence.

      • I meant to say that the APTA paper was released in 2012, a year later than the paper they referenced. It’s possible they didn’t know, but it shows a willful lack of diligence in formulating their position if they didn’t. I found it in less than 5 minutes. The guidelines include clean needle technique, avoiding pneumothorax and internal organs, as well as the interesting provision that if needles are left in situ the practitioner should stay in audible range of the patient. I wonder how many’s follow that precaution?

  3. I just recently got an update from the NCAAOM in North Carolina and that is what they are talking about. They want to create equal opportunity for all practitioners to have the same access to insurance. I personally don’t think that will happen because it hash’t happened in the 16 years I have been practicing. I don’t know what the answer is for the profession. They have made such a mess of things in the pass few years it is hard to predict. I see the economy moving in bad directions and I am concerned for those practitioners that do not accept insurance. Not necessarily now but within the next ten years. Only the wealthy are in the stock market so that is not a good tool to predict. Poverty is increasing in this country. Twenty-five percent of children live in poverty today. That was not the case when I got out of acupuncture school. Things have changed and they will continue to change. That is my concern and has been since 2008.

    • I am actually more concerned for those practitioners who depend on insurance reimbursements — they are at the mercy of the insurance companies who can reduce payments at any time. I know there are states like North Carolina where practitioners are fighting to have acupuncture be considered an essential health benefit, but there seem to be plenty of practitioners in the states where acupuncture already is an EHB who aren’t too happy about the changes it is having on their practices.

  4. Seems to me that fear is creating a strategy for the profession of once again fighting against something, instead of for something. There are many professions that do similar work to what we do. MD’s inject lidocaine into points behind the head to treat headaches. In many states Naturopaths and Chiropractors do acupuncture. Lots of other professions included dietary and lifestyle “counsel” as part of their modality. What acupuncturists are afraid of is that if PT’s can “needle” then they will lose business, so we have to “prevent” that. The threat is that if PT’s dry needle and PT is almost always covered by insurance, then its a threat to our economic viability. While i am not an insurance practitioner, seems to me that the playing field needs to be level. Anyone that uses an needle should have equal access to insurance coverage, so that consumers can choose which modality best suits them. Therefore instead of fighting against everyone trying to “take our stuff”, perhaps the focus should be on fighting for something… Insurance Parity.. Giving the consumer equal access to treatment options then creates the need for our profession to concentrate on what we offer and what we do, instead of concentrating on how to prevent others for “stepping on our toes”.

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