I oppose the Virginia Board of Physical Therapy’s proposed dry needling regulation for the following reasons:

Dry needling is outside the physical therapy scope of practice. Dry needling is an invasive procedure. The use of an acupuncture needle for the purposes of dry needling is an incisive procedure which raises the issue whether the proposed regulation is consistent with Virginia statute §54.1-3473 which prohibits physical therapists from using “surgical purposes.”

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 and any attempt to do so would plainly violate state law.

Dry Needling is not safe. Dry needling involves the insertion of FDA-regulated acupuncture needles as deep as 4” into patients by physical therapists that can have as little as a weekend of training and no prior experience in the safe use of needles. The draft regulations in fact provide NO MINIMUM training standard whatsoever. Dry needling injuries across the country including serious bruising, nerve damage, and pneumothorax have already been reported. In fact, the American Medical Association recently adopted a policy critical of dry needling stating, “Lax regulation and nonexistent standards surround this invasive practice … For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.” Even the largest company insuring physical therapists recently called dry needling “an emerging area of risk” and documented numerous dry needling injuries.

Dry needling presents a threat to public safety when performed without adequate education, supervised clinical training, and independent competency examination. In the state of Virginia, acupuncturists are required to have at least 1,365 hours of acupuncture specific training including 660 hours of supervised clinical training. Medical doctors already properly trained in the use of invasive medical devices are required to have a minimum of 300 hours of acupuncture training (100 hours of which must be clinical training) to satisfy the minimum competency standards from the American Board of Medical Acupuncture.

Dry needling is not distinct from acupuncture. Acupuncture is a system of medicine that utilizes needles to achieve therapeutic effect. The language used to describe and understand this effect can be articulated in both traditional and modern scientific terms. Claims that “dry needling” was an invention distinct from acupuncture because it is not based on “meridians” or “energy flows” reflects a gross misunderstanding of acupuncture and are not factually credible. National acupuncture accreditation and certification bodies require the study of biomedicine, evidenced-informed practice, and bioscience courses such as anatomy and physiology as part of standard training for modern acupuncture practice. In addition, the national certification agency for the profession (NCCAOM) provides a national certification examination in biomedicine. The idea that acupuncturists use energetic language that is different from the biomedical terminology used by physical therapists, and that for this reason dry needling is not acupuncture, is false and has no correlation to actual standards of practice and education in the acupuncture field.

In 2003, the National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) completed a job task analysis that documented the treatment of trigger points or motor points with acupuncture needles by practicing acupuncturists and found that 82% of acupuncturists used needling of trigger points in patients presenting with pain. These findings show that acupuncturists are well trained to use and have consistent historical usage of trigger and motor point “dry needling” treatment.