RE: Regulation changes proposed by The Virginia Board of Physical Therapy to allow dry needling in the scope of practice of physical therapists

DATE: 12/16/15

As Academic Dean and a professor at Kings Park University, a private institution delivering masters degrees in Oriental Medicine, I am responsible for both overseeing the content of, as well as teaching, classes in acupuncture needling including:

--The medical theory of acupuncture needling

-- How needling affects patient health by impacting various disease processes ,

-- The location of and how to accurately locate acupuncture points,

-- How to properly insert the needles according to the location of the point, the health of the patient, & the disease process presenting.

-- What points are contraindicated for needling during certain times and in certain diseases (for example, specific points during pregnancy, during severe cough, for sciatic nerve pain etc.),

-- And finally, how to handle any needle accidents (an inserted needle breaks off at the root, a needle is trapped in the muscle fibers and cannot be withdrawn, a hematoma has occurred etc).

These classes consist of a total of 350+ hours, and an additional 350 workshop/self-study hours.

Three and a half years of masters degree study for Chinese medicine culminates in 500 hours of closely supervised clinical practice in diagnosis and treatment that includes the close supervision of the needling acumen of medical interns. 

This amount of attention put on needling is hardly excessive.  What is accomplished by the current training in needling, at an accredited medical school, is that when done according to theory, done properly, done accurately, with a learned ability to avoid pitfalls and potential problems, acupuncture application of needles has been clinically proven to be a powerful positive impact on patients’ health, with a low risk level.

Currently, the state of Virginia licenses acupuncturists only after the masters degree level of study, successful graduation from an accredited institution and successful passing of a national exam. 

All the exams needed to become a licensed acupuncturist include questions regarding the history, technique, location of points, contraindications, and disease diagnosis’ that guide all needle techniques from choice of needle to manipulation, to style of insertion.

This intense amount of teaching, hands-on training, testing and licensing requirements assures the highest level of competency, the highest level of safety, and the highest level of positive health results from any medical intervention, and it certainly has been demonstrated to be the case with acupuncture needling, which by any other name, is still acupuncture.

The physical therapy board would like to call it "dry needling" in order to distinguish it from acupuncture, with the goal of circumventing the need for a high level of competency & reducing the training to 50+ hours. If allowed under their scope of practice, under the regulations they propose, this treatment will be taken completely out of the context in which is known, in which it has a basis in theory, and in which it is effective as a non-drug and non-surgical intervention for the pain experienced by so many patients seeking relief from our medical system.

As you can see, competency in the medical technique unique to Chinese medicine, called acupuncture needling is much, much more than the 50+ hours of training being proposed by the VA Board of Physical Therapy. 

I believe that because of our extensive training, we keep our patients safe and we are using a needling technique that is optimally effective for return of a healthy and pain free life for our patients with no “by guess and by golly”, no “maybe if we stick a needle here it will help this muscle”, and certainly no aggressive manipulation in a painful point (a report I hear from my patients).

Additionally, I have been in clinical practice for 15 years during which time I have treated patients who have told me of their very painful experience with a physical therapist doing “dry needling.” Many times, these patients report no results from “dry needling” but a lot of pain associated with it.

Sometimes, these patients report relief from the needling, but they report that the pain inflicted was not worth it.  In switching to needling being done in an acupuncture treatment, no pain is inflicted and the patient gets pain relief.

Licensed through the VA Board of Medicine, held to high standards, and respected throughout the medical community we already have a full medical system, Chinese Medicine, that includes a well-developed program of excellent training that results in medical providers who get successful clinical results from a needling technique. 

As responsible, professional, health care providers we are called on to protect the integrity of needling as a medical treatment worthy of the full training that is currently required at an institution of higher education for Chinese Medicine.  

It would make more sense for physical therapists to refer their clients to an acupuncturist instead of trying to train themselves in the manual application, at a minimum level, in a medical intervention that they have no background in, but they believe will work to relieve myofascial pain.

Indeed, referral is the mechanism that's in place for all medical practitioners when they feel there is an effective therapy for their patient, but they are not educated, trained or skilled in it. 

Short of referring, they can always go to one of the three acupuncture schools in VA, or a close acupuncture school in MD, and become licensed in acupuncture.

Thank you,

Kathe Ana, DAS, L.Ac, NCCAOM