Dry needling makes gains, often pitting physical therapists against acupuncturists

Photo Cred: Antonika Chanel/Unsplash

By Judy Packer-Tursman

Amid a controversy that heated up several years ago in the United States and shows no signs of abating, physical therapists contend their use of a therapeutic technique called “dry needling” is not the same as acupuncture and falls within their scope of practice. Acupuncturists counter that it is essentially part of the same treatment modality, and physical therapists performing dry needling are trying to skirt acupuncture regulations that call for extensive education and training.

Currently, many states ─ 36 in all ─ expressly permit physical therapists to perform dry needling, in which thin needles are briefly inserted into tight bands of muscles or even painful scar tissue, that is “growing in use and popularity,” according to Daniel Markels, state affairs manager for the American Physical Therapy Association (APTA).

He points to the 2021 practice analysis by the Federation of State Boards of Physical Therapy (FSBPT) indicating 10 states where more than 50 percent of physical therapists reported performing dry needling: Arizona, Colorado, Connecticut, Indiana, Kentucky, North Carolina, South Carolina, Tennessee, Texas and Wisconsin.

Eight states are silent on the issue, and six states prohibit the practice: California, Hawaii, New Jersey, New York, Oregon and Washington state.

After barring dry needling by physical therapists in 2017, New Jersey’s state senate passed a bill  (S. 867) on November 29 that would allow physical therapists to resume dry needling after taking 40 hours of academic instruction and 40 hours of hands-on training in the technique.

Acupuncturists in New Jersey are lobbying against these efforts by pointing to their 2,500 hours of training; and potential growth in dry needling is not sitting well with many of their colleagues across the U.S.

“Behind closed doors, if you mention dry needling in a room of acupuncturists, it’s incendiary,” said Bill Reddy, LAc, DiplAc, director of the Integrative Health Policy Consortium. “If I could learn the top three adjustments in chiropractic in a weekend and started doing adjustments, the whole chiropractic community would hit the ceiling.”

Afua Bromley, LAc, a practicing acupuncturist in St. Louis, Missouri and a board commissioner for the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), said she has “no interest in ‘turf wars’…We’re looking at competency and patient safety.”

Yet, a different picture is painted by Jan Dommerholt, PT, DPT, MPS, a Dutch-trained physical therapist who has studied dry needling techniques in Europe and Canada, as well as the U.S. He has testified on behalf of physical therapists at various state hearings on the issue.

Dommerholt, president and owner of Bethesda Physiocare, a physical therapy clinic in Bethesda, Md., is recognized as a specialized practitioner of dry needling by the Maryland Board of Physical Therapy Examiners. In 1984, Maryland became the first state to allow physical therapists to perform the technique, before the state had established a state acupuncture board.

Dry needling “really fits the physical therapist’s scope of practice and is probably the fastest way I know to get somebody out of pain ─ usually five to eight treatments and the migraines are gone,” said Dommerholt.

Dommerholt cites a growing body of scientific evidence validating the use of dry needling as an effective treatment, especially when combined with other therapeutic options.

But some researchers recently found no evidence that dry needling is better than other physical therapies or provides long-term benefit for musculoskeletal pain, others have questioned its efficacy for neck and shoulder pain over time and many have highlighted the need for further investigation.

Meanwhile, NCCAOM and other acupuncture groups in the U.S. underscore the extensive education and clinical training requirements for applicants seeking to become board-certified acupuncturists, asserting physical therapists have no similar standards to perform dry needling.

NCCAOM endorsed a policy adopted by the American Medical Association in 2016 stating that physical therapists and other non-physicians practicing dry needling at a minimum should have standards similar to those for training, certification, and continuing education in acupuncture.

In British Columbia, Melissa Carr, Dr. TCM, said she has worked with integrative healthcare clinics where dry needling, more commonly called “intramuscular stimulation” in Canada, is performed by physiotherapists. She conceded there are “a lot of feelings on both sides about defensive scope of practice,” but said that only allowing acupuncturists to perform needling is akin to only allowing naturopaths to use dietary supplements.

“In British Columbia, we’re aiming to be able to do more injections [as acupuncturists], so I feel we can’t hold dry needling hostage,” she said. “I just think we [i.e., acupuncturists] are better because we have more training and we do it more.”

Carr views teamwork as key. “A lot of naturopaths do acupuncture and refer to me, knowing I can take it further…and I can recommend some exercises, but then send patients to a physio,” she said. “So, my approach is, if you’re an acupuncturist and you don’t want physios to take over acupuncture, just be a better acupuncturist ─ and referrals back and forth create a much better outcome for the patient and better collaboration among practices.”