I am opposed to physical therapists practicing the invasive procedure called “dry needling.” I recognize that the intent of the Board of Physical Therapy is to proceed with regulating this procedure, which I believe to be the practice of acupuncture.

I believe that this procedure falls under the scope practice of licensed acupuncturists as defined in Virginia statute pursuant to § 54.1-2900. It states that the "Practice of acupuncture" means the stimulation of certain points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain ailments or conditions of the body. It has not been demonstrated how “dry needling” does not fit under such definition and why a physical therapist or any other practitioner not licensed by the Board of Medicine can lawfully practice this procedure, given that “dry needling” is based on the insertion of needles to normalize physiological function.

The proposed regulation identifies “dry needling” as “an advanced procedure that requires additional training” but does not recommend or require any specific post-graduate training hours. According to the American Physical Therapy Association’s website, “dry needling” is a “skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments.”

As practiced by physical therapists, “dry needling” involves the insertion of FDA-regulated acupuncture needles as deep as 5” into patients by physical therapists that can have as little as a weekend of training, provided by for-profit companies, with no standard of clinical supervision, certification, assessment of skill, continuing education requirements, and no prior experience in the safe use of needles. The draft regulations provides no minimum training standard whatsover.  

There have been a number of serious “dry needling” injuries across the country, ranging from lung punctures to nerve damage.  Not surprisingly, the American Medical Association recently explained in adopting a policy critical of “dry needling,“ that “Lax regulation and nonexistent standards surround this invasive practice … For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”  The largest company insuring physical therapists recently called dry needling “an emerging area of risk” and documented numerous “dry needling” injuries. No provision in these regulations provide adequate requirements or protections to protect patient safety.

Most “dry needling” courses involve only one or two weekends of training without any of the supervised clinical training that has been critical to providing the real world experience that has been key to acupuncture’s strong national reputation for safety and effectiveness.  By comparison, licensed acupuncturists in Virginia are required to have at least 1,365 hours of acupuncture-specific training including 705 hours of acupuncture-specific didactic material and 660 hours of supervised clinical training. Even medical doctors with extensive training in the use of invasive medical devices, such as acupuncture needles, need to have 300 hours of training in acupuncture (including 100 hours of supervised clinical training) to satisfy standards for certification from the American Board of Medical Acupuncture (ABMA).  

There is also no difference in training requirements for physical therapists with a doctorate level degree, compared to entry level PTs with less than 2 years of training. Other states considering this issue have included additional requirements based on these significant differences in education.

The Virginia Deptartment of Planning and Budget Economic Impact Analysis of this proposed regulationd states that “54 hours of post professional training is required under the [existing] guidance while the proposed regulation does not state a specific number of training hours [and that] this provision is not being added because it is understood that all physical therapy educational programs now cover the practice of dry needling.” This assertion is false. The text of this proposed regulation even states that dry needling is an advanced procedure. Historically it has not been a part of standard physical therapy educational curriculums, has not been included in scope of practice for physical therapists, and is only taught by numerous for-profit training programs, which vary widely in the length and type of training offered. Thus, the DPB statement is not factual.

Furthermore, the DPB economic impact statement does not take into consideration the financial effect on any other professions that are affected by the  proposed regulation, including licensed acupuncturists, medical acupuncturists, or chiropractors.

The proposed regulation has no provisions for ongoing monitoring of the practice of this procedure. No requirements for proof of competency, no requirement to submit certifications or completion of courses or additional CEUs. There is no regulatory process to provide for accountability of who can safely practice this procedure. The public will not know training requirements and who has been trained based on this very lax and dangerous regulation.

The informed consent requirement includes a statement that the patient receiving “dry needling” is not receiving an acupuncture treatment. This is confusing to patients who may not be able to discern the difference between the technique of “dry needling” and the treatment modality of acupuncture. Unfortunately, this seems to be a strategy advanced by the Board of Physical Therapy to circumvent the requirement of more rigorous training standards that meet the standards required of licensed acupuncturists and physicians.

I have recently heard from three different friends who have received “dry needling” treatments. Of the three, two of them did not know that there was a difference between the dry needling treatment that they received and acupuncture. They used the term interchangeably. The third person, who did know there was a difference in “dry needling” and acupuncture, was unable to explain how the treatments were different, aside from receiving more needles in other parts of their body during their acupuncture treatment. These examples help illustrate the public confusion of the different between acupuncture and “dry needling.”

There is no statute that provides legal authority for physical therapists or any other health practitioner to expand their scopes of practice via regulation to include “dry needling” or any other invasive procedure. I believe that the actions by the Board of Physical Therapy to promulgate these regulations are in clear violation of state law.  I request that the Board seriously acknowledge the danger and risk in this invasive procedure and that additional safeguards, such as supervised training and certification requirements are added to the regulation in the interest of public safety.