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News
The following news is listed in reverse chronological order.
APTA Supports Dry Needling by Physical Therapists
Dr. Scott Ward, PT, PhD, president of the American Physical Therapy Association (APTA) has formally expressed that the APTA supports the use of intramuscular manual therapy/dry needling by physical therapists. The APTA was represented at the November 2009 meeting of the Board of Physical Therapy of the District of Columbia to speak in favor of intramuscular manual therapy by physical therapists.
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AAOMPT Executive Committee Rules for Dry Needling
June 4, 2009—Following a request from an AAOMPT member, the AAOMPT Executive Committee charged the Practice Affairs Committee to investigate the basis of “dry needling” within physical therapist practice. Following an extensive review of the literature and discussions among the committee members the Practice Affairs Committee brought forth the following position for the Executive Committee to review:
Statement
POSITION: It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist practice.
SUPPORT STATEMENT: Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.
Update: During the October 2009 Annual Meeting, the AAOMPT Membership voted in favor of the position statement and agreed that intramuscular manual therapy/dry needling is indeed within the scope of physical therapy practice.
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Rulings about IMT (Dry Needling) by U.S. State Boards
At this point in time, dry needling is formally within the scope of physical therapy practice in the District of Columbia and in fifteen states, including Alabama, Colorado, Georgia, Kentucky, Louisiana, Maryland, New Hampshire, New Jersey, New Mexico, Ohio, Oregon, South Carolina, Texas, Virginia, and Wyoming.
- In 1989, the Maryland Board of Physical Therapy Examiners was the first physical therapy board that approved dry needling by physical therapists. Several years later, the Maryland board approved trigger point injections by physical therapists. Maryland remains the only jurisdiction in the US allowing this procedure to be performed by physical therapists.
- In 1992, the New York Board of Education concluded that dry needling would not be allowed by physical therapists.
- In 2001 and 2002, state boards of Tennessee and North Carolina ruled that dry needling was not in the scope of physical therapy practice.
- In 2008, The Nevada Board of Physical Therapy Examiners concluded that dry needing is not within the scope of physical therapy practice.
- In 2008, the Maryland Board of Chiropractic approved dry needling for Maryland chiropractic physicians.
- In July 2009, the Oregon Board of Physical Therapy approved dry needling, but was immediately challenged by the Medical Board of Oregon and its Acupuncture Committee, “who voted that dry needling is the practice of acupuncture.” In response, the PT Board issued a statement that “upon further discussion and consideration, the Physical Therapy Licensing Board believes that the dry needling of trigger points is likely within the physical therapist scope of practice (excluding PTAs). The Board acknowledges that the dry needling of trigger points is an advanced intervention requiring post physical therapy graduate training and education.” The PT Board concluded its statement with “in the interest of public safety, until specific training and education parameters can be determined, the Board strongly advises its licensees to not perform dry needling of trigger points at this time.”
- In August 2009, the Board of Idaho did not approve dry needling, “based upon the fact that trigger point dry needling is an invasive procedure, and invasive procedures are not within the physical therapy scope of practice,” even though invasive electromyography and nerve conduction studies can be performed by Idaho physical therapists.
- In October 2009, the Delaware Board of Physical Therapy elected not to issue an opinion about dry needling.
- In November 2009, the District of Columbia Board of Physical Therapy approved intramuscular manual therapy to be within the scope of physical therapy practice.
Most physical therapy statutes do not prohibit dry needling by physical therapists. Only the physical therapy statutes of Hawaii do not allow physical therapists to penetrate the skin. Reportedly, state boards of Arizona and Pennsylvania are legally not allowed to issue interpretations of the Physical Therapy Statutes, but did not restrict the use of dry needling.
The Florida Physical Therapy Statutes are rather confusing on the issue of dry needling and include language that physical therapists are allowed to practice acupuncture as long as they do not penetrate the skin. The Florida statutes do not offer any suggestions how to accomplish this. Whether this language applies to physical therapists using intramuscular manual therapy has not been considered.
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Commentary on Scope of Practice
From our perspective, medical boards should adhere to the guidelines of their own Federation of State Medical Boards (FSMB), which in 2006 published a joint report together with the Association of Social Work Boards (ASWB), the Federation of State Boards of Physical Therapy (FSBPT), the National Board for Certification in Occupational Therapy (NBCOT), the National Council of State Boards of Nursing (NCSBN), and the National Association of Boards of Pharmacy (NABP®) on changes in healthcare professions scope of practice.
According to these federations of state boards, since most professions today share some skills or procedures with another profession, it is no longer reasonable to expect each profession to have a completely unique scope of practice, exclusive of all others. Yet, it is quite common that “one profession may perceive another profession as “encroaching” into their area of practice. The profession may be economically or otherwise threatened and therefore oppose the other profession’s legislative effort to change scope of practice.” There are clear indications that some acupuncture societies and associations in the United States may feel threatened by increasing numbers of physical therapists, who are using dry needling techniques within their scope of physical therapy practice, even though few entry level physical therapy schools include dry needling in their curricula. As the joint report of the US regulatory boards indicated, it is common that new skills are initially performed as advanced skills by only a select number of professionals. Once a sufficient cohort of practitioners is utilizing the skills, they are likely to become entry-level skills and subsequently will be taught in entry-level curricula. The regulatory agencies concluded, that “it is not realistic to require a skill or activity to be taught in an entry-level program before it becomes part of a profession’s scope of practice. If this were the standard, there would be few, if any, increases in scope of practice.”
“No one profession actually owns a skill or activity in and of itself. One activity does not define a profession but it is the entire scope of activities within the practice that makes any particular profession unique. Simply because a skill or activity is within one profession’s skill set does not mean another profession cannot and should not include it in its own scope of practice.”
Although acupuncture boards did not participate in preparing this joint report on scope of practice, it is our recommendation that acupuncturists, acupuncture societies and associations, and acupuncture boards adopt the conclusions of their colleagues on other boards and realize that no one owns the exclusive right to a solid filament needle, irrespective of discipline. One discipline cannot and should not determine the scope of practice of any other discipline.
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AAOMPT Executive Committee Rules for Dry Needling
