Virginia Regulatory Town Hall
Agency
Department of Health Professions
 
Board
Board of Physical Therapy
 
chapter
Regulations Governing the Practice of Physical Therapy [18 VAC 112 ‑ 20]
Action Practice of dry needling
Stage Proposed
Comment Period Ended on 2/24/2017
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2/24/17  3:27 pm
Commenter: Jaime Chaves

"Dry Needling" is a technique used in Acupuncture
 

First and foremost I have the utmost respect for PT's and work alongside many of them.

Regarding the issue at hand, "Dry Needling" is a method of acupuncture evidenced by the instrument (acupuncture needle), the technique (lift and thrust AKA "pistoning" or "fanning/coning"), the point locations, and the purpose.

"Dry Needling" is in reference to hypodermic needles. Using an acupuncture (solid filiform) needle to perform such a technique contradicts the name of the technique.

The technique of lifting and thrusting needles to obtain fasciculation’s is well documented in acupuncture literature. There is a popular analogy that circulates among the acupuncture profession comparing acupuncture to fishing which was first discussed in the late Jin Dynasty (265-420 CE) text Guide to Acupuncture and Moxibustion (Zhen Jiu Zhi Nan). When the needle is inserted at the proper location a twitch/fasciculation can be observed objectively and subjectively confirming the correct needle location. This is indeed what PT's are attempting to reproduce with "dry needling" by searching out the twitch response confirmation of needle placement.

The point locations fall under the umbrella of acupuncture.  Melzack et al. found there to be a 71% correlation between the trigger points and acupuncture points (Melzack et al. Trigger points and Acupuncture Points for Pain: Correlations and Implications. Pain, 1977; 3:3-23.). A later study by Dorsher et al, found that of the 255 TrP’s listed by Travell and Simons, 234 (92%) had anatomic correspondence with classical, miscellaneous, or new acupuncture points listed in Deadman & the Shanghai College of Traditional Medicine text. Of these points, 79.5% had a corresponding clinical indications and 76% had referred pain patterns corresponding with the channels of acupuncture (Dorsher PT. Trigger points and acupuncture points: anatomic and clinical correlations. Medical Acupuncture. 2006;17(3):20-23). Many acupuncture points are derived from "ashi" points which literally translate to "oh yes, you found it" in reference to the reproduction of the patient's pain by palpation which is analogous to trigger point palpation of pain concordance and pain referral.

The purpose for "dry needling" is to break the viscous cycle of hyperirritable bands of skeletal muscle with a needle to promote blood circulation and oxygenation of ischemic tissue to promote a healing response. Acupuncturist call this "promoting Qi circulation and removing blood stasis" in which Qi can be viewed as oxygen and blood stasis is confirmed by fixed firm nodules on palpation (AKA trigger points) which decrease local tissue oxygenation perpetuating the ischemic effect.

As you can see, renaming a technique used for thousands of years, does not make it a "new" technique. It is a way to get around regulatory boards and increase scope of practice. As a profession, we are already observing PT's advertising "Dry Needling for Insomnia, Dry Needling for Infertility, etc.” There is no limit to how far this aberrant disregard to regulatory boards can go unless it is acknowledged now. If this technique is truly accepted as being part of a PT scope of practice, it should be included in their core curriculum and training which it is not.

 

CommentID: 58099