These are my opinions as a Virginia resident and licensed acupuncturist for the past 15 years. I represent no other entity with my comments that follow. 

The mandate for the Virginia Board of Physical Therapy is to protect the public. The primary duty to carry out that mandate is the promulgation of regulations that would uphold a measurable standard of care; “measurable” meaning that it would outline specific training and certification standards that can be easily referenced to ensure a reasonable measure of safety for the public. The patient, who walks into the physical therapy practice, or for that matter into the licensed acupuncturist’s practice, is unlikely to be an expert in the training and certification standards of their practitioner.  Thus it is up to regulatory Boards and legislators to ensure the public safety. This regulation, as it is written, abjectly fails at achieving that goal.

Having been personally involved with this process for roughly a decade, nationally as well as here in Virginia, I am familiar with the timeline of events leading to the revision of this document. While I sincerely appreciate the time that the PT Board has taken to revise it over the course of the last 5 years, as written it does a disservice to the PT profession and endangers patients being served.

No one is denying that the dry needling style of acupuncture is an effective modality. Additionally, this is not a competition between two professions. The dry needling style of acupuncture is undeniably well within the scope of practice for licensed acupuncturists. That is not the point. As it is written, this regulation does not protect the public or the practitioner.  

Why was the language in this regulation crafted to be so lacking in specificity? Two reasons come to mind. The first is that if you start defining dry needling in a regulation or scope of practice, you inevitably cross paths with acupuncture. Even a cursory search would identify that the origins of the modality originated with Janet Travell (and others’) research into acupuncture treatment methods in light of myofascial trigger points. It is blatantly insulting to insist that “dry needling” is something that physical therapists recently invented on their own and that other practitioners, specifically licensed acupuncturists, are mysteriously wrapped up in modes of treatment that are not biomedical in origin. 

Following this line of thinking, you would then have to grapple with the fact that there are already national acupuncture training and certification standards that have been on the books for decades. By failing to define dry needling in this regulation, the PT Board could skip all of that, circumventing the legislative process to change the PT scope, and instead craft a regulation, which is much less complicated and costly. Defining an invasive procedure that employs a deeply inserted acupuncture needle and only identifying it as an “advanced procedure that requires additional training” is hardly descriptive or sufficient.

The second reason, in my opinion, is that the current training offered for dry needling is by for-profit companies, such as Myopian Seminars, Integrative Dry Needling (note that this particular company was started by a licensed acupuncturist), and others. These companies are engaged in predatory marketing practices while competing for revenue from PTs, athletic trainers, and yes, --licensed acupuncturists, among others. The Federation of State Boards of Physical Therapy (FSBPT), referenced in the supporting documents for this regulation respective to a study regarding competencies for dry needling, has not defined what constitutes the advantage of one of these programs over another. This leaves it up to the practitioner to choose one, and then to decide afterward if they are competent.

Because these for-profit companies are competing with each other, they offer a very wide-ranging level of training, with no standard among them. Humans, being what they are, will obviously gravitate to the choice that costs the least amount of time and money. So, if this regulation remains as written, your newly licensed PT can take an online course over the weekend, and then “practice” on the unwitting patient on Monday. Since there is no standard of training, competency, supervision or third party certification with these for-profit companies, both the patient and the practitioner are at risk.

What this proposed regulation DOES do is allow the PT Board to take action against the practitioner if they injure a patient, something that could not have been done via the guidance document that preceded it. This is appropriate, and what regulations are supposed to do. However, It is doubtful that most physical therapists are aware of what that means.

I have knowledge of multiple documented instances, reported to the Virginia PT Board during the last five years, of serious patient injury, including those patients being hospitalized. With only a guidance document in place, these complaints were virtually ignored. This is the reason that Governor McAuliffe required the Board of Physical Therapy to create regulations to replace the guidance document in 2015, after receiving a letter from the American Academy of Medical Acupuncture.

I have heard countless stories from my patients of sub-optimal outcomes as a result of dry needling from physical therapists as well as from chiropractors. Some examples are nerve damage, worsening of symptoms, and more than one story about a physical therapist insisting that they can help with symptoms that are clearly originating from internal medicine issues rather than musculoskeletal, as well as physical therapists advertising "dry needing for migraines", "facial dry needling" etc.

All styles of acupuncture, including dry needling, have very real risks, no matter who the practitioner is. This style of acupuncture, aka myofascial trigger point acupuncture, motor point needling, etc., is performed by licensed acupuncturists across the country, all of whom are aware of these risks and that this particular style, with a focus on needling that is designed to initiate deeper muscle fasciculation, potentially increases these risks. We all share the same risks by use of the acupuncture modality.

Despite repeated input along these lines since the inception of this regulatory process, this Board has ignored constructive input from my profession, medical acupuncturists, the American Medical Association and the American Association for Physical Medicine and Rehabilitation. This Board has instead opted to circumvent legislative procedure and national acupuncture licensure and certification standards in favor of proposing a regulation that essentially protects only the Board by giving it legal authority to hold practitioners accountable, should they injure a patient. None of this protects the public.

In the interest of public safety, I urge the Virginia Physical Therapy Board to amend this proposed regulation with language that clearly identifies specific training, specific third party measurements of competency, and proper regulatory language regarding safety standards in order to protect the citizens of Virginia.