Caution! Beware of "Dry Needling"

While we deeply respect our colleagues in various interventions and modalities such as physical therapy and chiropractic care, there is a disturbing trend of many unqualified practitioners offering "dry needling" as a therapeutic intervention. Over the past several years, there have been more and more incidents of patient injury reported to various professional boards after receiving a therapy called "dry needling".


"Dry needling" is a term used by physical therapists and chiropractors in an attempt to differentiate the insertion of solid filament (acupuncture) needles into the body for therapeutic effect, from acupuncture, and to circumvent the state requirements for educational and proficiency standards for licensed acupuncturists and medical doctors providing acupuncture.


But "dry needling" is not a different therapy. IT IS ACUPUNCTURE. However, unliked state regulated acupuncture, "dry needling", as practiced by physical therapists and chiropractors has no current legislative standards for education, clinical skills or proficiency testing in the state of Maryland. Rather, chiropractors and physical therapists look to their respective boards for “guidelines” for educational and proficiency standards, rather than to the State Legislature which issues regulations for these standards for other licensed professional fields.


In fact, a typical "dry needling" course is a weekend event consisting of approximately 30 hours. Even medical doctors are currently state mandated to receive 200 educational hours in order to apply to their board to register to perform "medical acupuncture." By contrast, Acupuncturists typically receive at least 3000 hours of training , followed by approximately one to two years of clinical experience, and mandatory education testing in order to qualify for state licensure. In Spring of 2018, the Maryland Chiropractic Board was asked by the Secretary of the Department of Health to submit regulations specifying the hours of education and training that their licensees would have to complete in order to be registered and perform "dry needling,” This request has gone unanswered to the present day.


Currently no CPT code exists for “dry needling” so many physical therapists and chiropractors bill insurances under codes such as 97140 Manual Therapy or 97799 Unlisted Physical Medicine/rehabilitative procedure”. Many insurers are not aware that chiropractors and physical therapists are billing for “dry needling.”


This issue is not only concerning with regard to scope of practice and the rendering of an invasive therapy by practitioners without training or licensure to perform such a therapy, but has also become a grave public health and safety hazard.


Below please find some useful and pertinent links on this subject including recent rulings, malpractice coverage denial for dry needling, AMA policy statements and AAMA policy statements. Please don’t hesitate to contact me should you have any questions or require any further information regarding this very pertinent issue.


Dr. Bella Fooksman, D.Ac., L.Ac.



Here is an excellent link regarding this topic from an Acupuncture perspective:

http://www.liveoakacupuncture.com/dry-needling


Below is a link to a letter from the National Chiropractic Council, which provides malpractice insurance to chiropractors and physical therapists, and they have refused to provide malpractice insurance for this practice for chiropractors and physical therapists.

http://www.liveoakacupuncture.com/wp-content/uploads/2015/05/National-Chiropractic-Council.pdf


Below is a link to a recent win by the Florida State Oriental Medical Association vs. (Florida) Board of Physical Therapy Practice wherein the proposed inclusion of dry needling being within the scope of the practice of physical therapists by the Board of Physical Therapy Practice was ruled to be invalid.

https://www.dropbox.com/s/pynijzxk2onbo0w/2019-1-28-Dry-Needle-Ruling18002508.pdf?dl=0


A June 2016 policy statement from the American Medical Association stating that "physical therapists and other non-physicians practicing dry needling should — at a minimum — have standards that are similar to the ones for training, certification and continuing education that exist for acupuncture. Lax regulation and nonexistent standards surround this invasive practice. For patients' safety, practitioners should meet standards required for licensed acupuncturists and physicians."

https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policies-final-day-annual-meeting


Below is a link to a February 2016 policy statement by the American Academy of Medical Acupuncture stating that " for the health and safety of the public, this procedure should be performed only by practitioners with extensive training and familiarity with routine use of needles in their practice and who are duly licensed to perform these procedures, such as licensed medical physicians or licensed acupuncturists. In our experience and medical opinion, it is inadvisable legally to expand the scope of physical therapists to include dry needling as part of their practice."

https://www.nccaom.org/about-us/press/press-releases/aama-policy-on-dry-needling