Name: Katherine Koch
Undergrad: The Ohio State University
Hometown: Cleveland, OH
Fun Fact: Last summer, I climbed six 14ers
Dry needling: not a type of craft that your grandmother does. This type of treatment uses thin filiform needles inserted by a physical therapist into myofascial trigger points, or a tight band of muscle that might be causing pain (1). Dry needling is based on physiological evidence supported by research that is usually part of a broader treatment plan (2). If this needling sounds familiar to you, you’re not alone. Acupuncturists use the same type of needle to adjust the flow of energy, or chi, throughout meridians in the body. Acupuncture is an ancient Chinese medicine and operates based on the belief that these thin needles can relieve tension, stress, and pain when inserted by an acupuncturist (3). While you won’t be getting an itchy sweater from this treatment, it can lead to pain relief for many people.
However, there is still confusion and debate among physical therapists and acupuncturists concerning the rights and responsibilities of physical therapists in performing dry needling on their patients. This debate of dry needling by physical therapists was recently taken to a Denver district court when the Acupuncture Association of Colorado (AAC) challenged the Colorado State Physical Therapy Board (Board). The AAC claimed that physical therapists had not undergone enough training to perform dry needling and requested the Board reverse the rule that allows physical therapists to practice this method of treatment. The AAC argued that physical therapists only perform 46 hours of training to be certified to practice dry needling, while acupuncturists train for almost 2,000 hours. The association claimed this made dry needling by physical therapists an “unsafe practice of acupuncture” (4). However, this statement is strongly misleading due to the additional 3,400 hours of doctorate level schooling that physical therapists already have behind them before they complete those 46 hours specific to dry needling training. Physical therapists spend three years in graduate school learning how the human body works, what can go wrong with it, and how to fix it within the realm of physical therapy. Additionally, doctors of physical therapy are required to take continuing education courses throughout their careers.
Additionally, the AAC made the claim that dry needling is just a misnomer for acupuncture, while the two are fundamentally different practices. They may look similar to the untrained recipient, but physical therapists and acupuncturists perform their respective treatments with fundamental ideological differences between the two. This is not to say that one is better than the other, and patients may make the informed autonomous decision to receive either or both treatments. However, as the Denver District Court decided, there is no need to prevent members of one profession from performing treatments all together. In December 2017, the court recognized that physical therapists are acting within the Colorado Physical Therapy Practice Act when they perform dry needling.
As the Colorado Chapter of the APTA President Cameron MacDonald put so eloquently,
“this legal debate was brought forth by those who wished to restrict the practice of another profession from their own. This debate could have been about any intervention utilized by physical therapists, and not just dry needling. It is imperative to consider this legal challenge and the lawsuits brought against the Colorado PT Board through the lens of the Colorado consumer of healthcare. Consumers in Colorado are provided access to health care providers which have a defined scope of practice under which to deliver patient care. Health care professionals are expected to provide the best care they can, and to practice under a scope flexible enough to both protect the consumer and not limit the development of practice by health care providers.”
When physical therapists perform dry needling, they are practicing within their professional scope. When acupuncturists perform acupuncture, they are practicing within their professional scope. Both professions can live harmoniously alongside each other while helping patients within their respective realms.
Why does any of this matter? First, any judicial ruling or legislative rule concerning a profession as a whole likely has implications that affect many of its members. In this case, physical therapists that perform dry needling in Colorado were in danger of losing their legal right to treat patients in this way. Further, patients were in danger of losing out on a treatment that can benefit them. To be effective health care providers, it is imperative that physical therapists are informed practitioners in order to best advocate for their profession and best treat their patients. Denying to inform themselves and take positive action does a disservice to future physical therapists and patients who will benefit from the work done to advance the profession today. In order to practice as autonomous providers, physical therapists must continue to advocate for their profession and understand the issues surrounding it. It also stands to reason that since the American Physical Therapy Association participated in this case as an amicus party and presented information that no doubt helped sway the case, physical therapists should support and be members of the organization that advocates for them on this broad level.
This debate is not in Colorado alone; lawsuits in three states have gone the opposite way and the state boards have been forced to remove dry needling provisions from their practice acts.4 Since each state has their own physical therapy act, it is important that the Colorado practice act, which will be revised next year, continues to maintain its inclusive language that provides “for new developments in physical therapy practice, which includes dry needling” (Caplan and Earnest, LLC, personal communication, January 9, 2018). For the good of physical therapists, patients, and the future of physical therapy as a profession, this particular case is closed.
If you are a student physical therapist, like myself, who hopes to perform dry needling as a professional one day or if you simply would like to learn more about its practice, please refer to the references below.
- Dry Needling by a Physical Therapist: What You Should Know. American Physical Therapy Association. http://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should. Published December 25, 2017. Accessed January 28, 2018.
- Gattie E, Cleland JA, Snodgrass S. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017;:1-41.
- Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
- Migoya D. Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft. The Denver Post. https://www.denverpost.com/2017/04/05/acupuncturists-sue-board/. Published April 7, 2017. Accessed January 28, 2018.
Regis University - School of Physical Therapy 
Katherine.
Very well constructed post. This issue is ongoing. An appeal has been entered on this case by the acupuncturist associations. It would be better that all these resources were directed into advancing patient care across provider groups, but that would require an intentional focus to collaboration which unfortunately is not currently present.
At this time, active involvement in our professional association and continuing provision of excellent patient care are the primary paths forward as we seek to protect our scope and ability to provide optimal patient care in Colorado.
CWM