AcuWorks                                 Brigitte A. Fox, L.Ac., RN

362 McLaws Circle Suite 2                                                  Licensed Acupuncturist, NCCAOM

Williamsburg, VA 23185                                                                                              Tax ID# 13-43576115

Phone 757-565-9611

Public Comment re: Proposed Dry Needeling Rules

Dear Board of Physical Therapy,

As the Board of Physical Therapy is considering proposed rule 18 VAC112-20-121 one must first consider what is dry needling? Dry needling is the insertion of needles through the skin in order to relieve pain. While some call it “dry needling” and others call it “aggressive trigger point therapy” others would call it acupuncture. If a person were blind-folded and a practitioner performed dry needling on one arm and acupuncture on the other arm the subjective experience of the patient on both arms would be the same. If we asked the person: which arm received “dry needling” and which arm received “acupuncture” the patient would say “it was the same on both arms”. So dry needling is acupuncture, or at least appears to the patient as acupuncture. I would say it is a type of “guerilla acupuncture”.

Who should do “dry needling”.

It was not long ago (approx. 23 years in Virginia) that acupuncture was only allowed to be performed by physicians. Arguments varied widely from “it’s a dangerous invasive procedure” to “it doesn’t work” “it’s placebo” to “acupuncturists are untrained persons who risk transmission of infectious diseases” etc.

In 1994 the Virginia Board of Medicine passed rulings that required a person to perform acupuncture to have a valid license, thus legalizing the practice of acupuncture in Virginia. At present the Virginia Board of Medicine requires an acupuncturist to be NCCAOM certified, and in order to obtain a license to perform acupuncture in Virginia, the applicant is required to have not less than 1905 hours of training, not less than 1155 hours of didactic instruction, not less than 660 hours of clinical instruction, and a minimum of 3 academic years of training (90 semester credits or 135 quarter credits).

Why should anyone need a license to perform acupuncture or dry needling?

As humanity developed from Cave-man to modern existence, we gradually embarked on persons becoming experts in their trade. Some persons became skilled to work metal and became black-smiths, some persons became skilled to bake bread and became bakers, some persons learned the art of healing and became physicians. In the last 100 years this type of professionalization took on even more depth as we developed specialization within professions: lawyers specialized into family law, criminal law, tax law. Medical Doctors specialized into Cardiologists, Pediatricians, Pulmonologists, Neonatologists. Physical Therapy itself was born out of the need to re-hab patients with musculoskeletal concerns: frozen shoulders, Sciatica, post-rotator-cuff-repair re-habilitation. Gait re-training. Piriformis stretches. This is where physical therapists are experts. This is your domain because you are very, very good at it. And you have spent years learning about it.

Acupuncturists spend years learning about Acupuncture. My own training involved 3000 hours of didactic training and 1200 clinical hours (4 years of schooling).

The reason for professionalization is that the consumer, the patient receives professional services. We would all agree that an ENT doctor should not perform a C-section. Nobody in their right mind would walk into divorce court with a tax lawyer. I would not go to a podiatrist to get a new prescription for eye glasses. If I need cataract surgery I would definitely want an experienced Ophthalmologist. Even if I want a ceiling fan installed into my home I would call an electrician rather than hook up the wire myself.

If “dry needling” is so easy that anybody can do it, why not just sell the needles on Amazon and then post a few U-Tube tutorials.

THE REASON for acupuncture licensing is PATIENT SAFETY.

Dry Needeling/Acupuncture is an invasive procedure. Needles are inserted into the flesh through the skin. This procedure requires

1.) The practitioner to set up a sterile field.

2.) Disposal of Sharps according to BioHazard/Medical Waste Regulations.

3.) In-depth knowledge of anatomy (which Physical Therapists certainly posess).

4.) The complete presence of the practitioner to the procedure, as well as clear intention as to the desired outcome.

5.) In order to really be successful it requires an understanding of not only the physical body (trigger points and muscles), but it also an understanding of the bio-electric energy flow through the body and around the body (the flow of QI through the meridians). If you’re only sticking needles into flesh (trigger points), then you’re doing a type of “guerilla acupuncture” and while I believe that occasionally there are some physical therapists who do posess an intuitive perception about the body, mostly the puncturing of flesh will result in more harm than good. An occasional patient will say that dry needling helped, but overall the impression will be that dry needling is invasive and painful. Any professional Acupuncturist must see the practice of dry needling as an area of grave concern that will result in more harm than good.

The proposed rule 18VA112-20-121 on the practice of dry needling is not only haphazard, as it has no minimum training requirements (even MD’s are required a minimum of 300 hours of training in order to perform acupuncture). I believe that it is in fact illegal for the Board of Physical Therapy to essentially give itself permission to perform dry needling.

Keep in Mind that the State of Oregon in 2014 outlawed the practice of dry needling as well as the practice of Chiropractors performing Acupuncture.

The State of Washington outlawed dry needling in 2014. The State of Tennessee also has outlawed dry needling. There are lawsuits pending in Iowa, North Carolina and Texas. Maryland is preparing to file a similar suit.

In conclusion I strongly protest the practice of dry needling for physical therapists. I believe this is a patient safety issue and Physical Therapists are currently practicing OUTSIDE their license.

Before I close I would like to say that there is no doubt whatsoever that Physical Therapists are thoroughly educated in the area of Neuromuscular Therapy. And there is also no doubt that a good Physical Therapist is worth his or her weight in gold when a patient needs that type of intervention/education/training.

Physical Therapy and Acupuncture work very well (and in many instances better than surgery) when used in conjunction by the same patient.

Here is what I suggest: when a patient needs Physical Therapy I am happy to recommend them to one of our local Williamsburg PT offices. Great things happen when the right physical therapist works with the patient in the correct way. When a patient needs Acupuncture, let’s refer them to a local acupuncturist. Great things happen when a patient receives good acupuncture. When a patient needs surgery or nerve blocks, or trigger point injections or spinal injections the let’s refer them to the appropriate MD. This is how we best serve patients. When we all do our best, work within our field of expertise and encourage the patients to the appropriate referrals,  then we all win.

Thank you for your time and your thoughtful consideration,

Sincerely

Brigitte A. Fox, RN, LAc., MAcOM

362 McLaws Circle, Suite 2

Williamsburg, VA 23185