Dear Sirs and Madams,

I am submitting my comment in opposition to “Dry Needling” being added to the scope of practice for Physical Therapists, for the following reasons:

1. NO MINIMUM TRAINING STANDARD ENDANGERS THE PUBLIC.

   1. The proposed regulations do not require any training or clinical supervision for PTs to safely practice dry needling.

   2. In contrast, Medical Doctors are required to complete minimums of 300 hours of training, including direct clinical supervision by experienced practitioners. Licensed/certified Acupuncturists are required to have even more training in Virginia and other states, typically ranging from 1,000-3,000 hours of didactic education and supervised practice. Such training standards, including training in the 275-page Clean Needle Technique Manual (CCAOM 7th ed., 2016), as well as precautions and contraindications to needling are necessary to prevent the poor outcomes and well-documented serious harm, including permanent disability and death, that can occur from untrained and unsupervised needle insertion, including organ puncture, asphyxiation from pneumothorax, and nerve, spinal cord and brain injuries.

   3. The largest company insuring physical therapists recently called dry needling “an emerging area of risk” and documented numerous dry needling injuries. Such documentation of a rising number of serious dry needling injuries has lead the American Medical Association to adopt a policy critical of dry needling: “Lax regulation and nonexistent standards surround this invasive practice … For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”

2. NO AUTHORITY TO EXPAND THE SCOPE OF PRACTICE.

   1. Dry Needling is outside the current physical therapy scope of practice. When the Virginia Legislature adopted the legal definition of physical therapy it had no intent to allow physical therapists to insert acupuncture needles and no authority for any similarly invasive procedures are allowed in statute. The Board of Physical Therapy lacks the legal authority to expand the physical therapy scope of practice to include dry needling. Any attempt to do so would plainly violate state law and the intention of the Virginia Legislature.

3. NO PUBLIC NECESSITY TO ADD DRY NEEDLING TO THE PHYSICAL THERAPY SCOPE.

   1. There is no convincing rationale that “dry needling” represents a unique modality that must be provided only by physical therapists for public health. The techniques of dry needling are a sub-set of the acupuncture training of licensed/certified acupuncturists and physicians who are already trained and competent to high standards to provide needle therapy. Physical Therapists who wish to add the use of needles to their practice currently have the option of applying to enroll in established training and education programs and become licensed/certified as acupuncturists and/or physicians.

   2. In the absence of any documented public necessity, adding dry needling to the scope of physical therapy without any training requirements would appear to be an attempt to subvert the intentions of the Virginia Legislature for the sole purpose of profitability, at the expense of the health, safety and well-being of the public.

I make this statement as a Licensed Acupuncturist (CA) with 15 years of clinical experience, and 10 years of experience as a Clinic Supervisor and Assistant Professor in the Masters’ Program at the Five Branches University of Traditional Chinese Medicine, and also as a Doctorate Instructor at the Academy of Chinese Culture and Health Sciences, and as Continuing Education Provider approved by the California Acupuncture Board. I am also national board-certified as a specialist in Acupuncture Orthopedics, and a Fellow of the American Academy of Pain Management. I have also served as an expert witness to the California Acupuncture Board and in civil litigation resulting from alleged harm from needling injuries. In these capacities, I am well-qualified to state unequivocally that “dry needling” without training represents a serious and unconscionable threat to public health and safety, and must be prevented.

Thank you for your consideration of my comments.

Sincerely,

Anthony Von der Muhll, L.Ac., DNBAO, FAAPM