Dear Virginia State Board:

I am a resident of Washington State, where we also face the Physical Therapists lobby to enact rule changes allowing Dry Needling practice under PT scope of practice.

I have worked in rehabilitation medicine for nearly 20 years, and I have watched as the Physical Therapist license has expanded both in education and in scope.  I have also seen an evolution of change in how patients are treated.

I believe deeply that rehabilitative medicine is essential to the welfare of many, if not most people, in recovery from injury.  Physical Therapy can dramatically improve many facets of physical function, and should be utilized far more than is currently done.

I have observed the ambitions of PTs to further expand that scope.  Despite the very full scope in which PTs practice, and the wide field of therapeutic, neurological and manual therapies at their command, they remain ever seeking new procedures to call their own.  I have observed plans to incorporate forceful manipulation (chiropractic), dry needling (acupuncture) and prescribing of medication (physician) to their practice acts.

No single PT can possibly fulfill all of the general and specialized therapies within the current scope of Physical Therapy.  The patient will not benefit from adding additional skills which are currently practiced and easily accessible from other highly skilled providers.  There is no need to the patient to provide these services at the PT office.  And again, no individual PT would be able to competently provide all of these therapeutic practices – so there is no reason to direct a patient to pursue an already accessible modality through a PT versus referral to an existing skilled provider.

Dry Needling by any name is a highly skilled technique, which merits far more than a few dozen hours of education.  Needling the human body does not belong as an ancillary skill, to be applied with little more training than athletic or Kinesiology taping. 

Physical Therapists are highly educated in regards to the structure of the human body.  Many PTs who have pursued manual therapy training have learned the location and treatment of Trigger Points.  However, the insertion of a needle into a trigger point involves a great deal more than that level of knowledge.  Certification as a Manual Therapist would be an excellent basis from which to build the necessary skill level.

If the Virginia State board, in its wisdom, does see fit to consider Dry Needling as a PT or OT practice, I would like to emphasize a more involved course of training than that which is currently proposed.  In particular, thorough knowledge of all deep and superficial vasculature and neurology, as well as completion of Clean Needle Technique through Phlebotomy or Acupuncture. 

I would also suggest thorough education re: the limitations of Dry Needling of Trigger Points, vs the practice of Acupuncture.  To my understanding, Dry Needling of Trigger Points is limited to needling of the points of the musculature as prescribed by Janet Travell, M.D., in  the texts “Myofascial Pain and Dysfunction: The Trigger Point Manual” [books 1 and 2].

Further, Dry Needling by definition is limited in application, exclusively for the purpose of muscle spasm or dysfunction.  Any other use of Dry Needling would in fact be the practice of Acupuncture.  Relaxation of spasm of specific musculature is not equivalent to needling for general relaxation or wellness.  And anything further, i.e. treating general headaches as opposed to specific muscle tension, would be Acupuncture as opposed to Dry Needling; needling for health, for rejuvenation, and for internal ailments would all be outside the scope of the description of Dry Needling.

While I work in Rehabilitative medicine and will continue to do so, I am also a graduate of Middleway Acupuncture Institute, and a candidate with NCCAOM in pursuit of licensure as an acupuncurist.  I believe I have a balanced and informed perspective of this issue, and I offer my opinion in good faith.

Respectfully,

Vickie Koran