Dry Needling…Not a Type of Craft that Your Grandmother Does

Name: Katherine Koch

Undergrad: The Ohio State University

Hometown: Cleveland, OH

Fun Fact: Last summer, I climbed six 14ers

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Dry needlingnot 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.

  1. 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.
  2. 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.
  3. Miller J. Physio Works – Physiotherapy Brisbane. Acupuncture and Dry Needling. https://physioworks.com.au/treatments-1/acupuncture-and-dry-needling. Accessed January 28, 2018.
  4. 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.

Coming to PT School From Another Career

 

Quite a few of our classmates came to physical therapy school after 1, 2, or even 3 previous careers! Laura and Tara are academic all-stars, wonderful additions to our Class of 2018 cohort, and have some of the coolest past experiences out there.  

Name: Laura Baker, Class of 2018
Undergrad: University of New Hampshire, Durham
Hometown: Seville, Ohio
Fun Fact: During college, I studied abroad in Tamil Nadu, India!

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Name: Tara Businski, Class of 2018
Undergrad: Bates College
Hometown: East Lansing, MI
Fun Fact: I have swum in 4 of the world’s 5 oceans.

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First off, tell me about yourself. 

Laura: I grew up on a small farm in Ohio. My father raised hogs and grew crops while my mom operated a strawberry business. Much to the delight of the unsuspecting customers, chaos ensued when piglets escaped from their pens and ran straight for the berry patch.

I chose UNH for my undergraduate degree because of their intriguing curriculum and to chase after the ocean and mountains. I received a resource economics degree that laid the foundation for my natural resource conservation career. After graduation, I spent a year in Queensland, Australia as an intern studying resource economics of tropical rainforest re-forestation. I chose my next job as a forest conservation activist based on running: the people of Ketchikan, Alaska informed me that there were miles of trails (and black bears and wolves were rarely problematic). So there I went–Alaska or bust! I spent the next 11 years working various conservation jobs in Alaska with the majority of my time being spent at The Nature Conservancy (TNC) in Juneau.

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Laura doing some plant surveying for TNC

Tara: I grew up in Michigan, went to college in Maine, then moved to Newfoundland to study biological oceanography. After 4 years of graduate school, I joined the Marine Corps to be a helicopter pilot. I stayed in that job for almost 9 years, then resigned to come to PT school.

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Tara’s Christmas in Afghanistan

When did PT first catch your eye as a future career? 

Laura: I’ve had a number of encounters with physical therapists, most resulting from mundane, physics-gone-wrong scenarios: a torn ACL here, a nagging hamstring injury there, a helluva whiplash and concussion situation, etc.

After I turned 30, I felt like I had lost the passion for working in the natural resource field; I quit my job and travelled for a year. Several months into drinking wine and picking olives in Italy, I found myself unhappy with my state of uncertainty.  I knew that physical therapy was a profession with attributes that aligned well with my values and goals: a specific and defined skill set, available work in remote areas of Alaska, and getting to support others’ well-being in a tangible way. It seemed like the perfect next step!

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Laura on the job in AK

Tara: When I was considering post-military careers, I was looking for an intellectual challenge and a consistent schedule. I had a biology degree, a Pilates teaching certificate, and a little medical background from my time as an EMT and as a search and rescue volunteer. Physical therapy seemed like a logical extension of these experiences. I’m excited about the new challenges, variety at work, and job prospects.

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Talk about a cool past career! 

Describe how you went from thinking about PT as a career and getting into PT school.

Laura: I came back to Alaska to work odd jobs and sent myself back to school for the basic sciences. I shadowed physical therapists in various settings in Anchorage and Juneau and gave myself 2 years to get accepted into PT school. If, within that time frame, I was not accepted to a program, I figured it was not meant to be and that I would return to the conservation world with new goals and intentions.

Tara: I observed in an outpatient clinic on the base where I was stationed for a handful of hours, but was unable to get very many hours due to work demands. I also took anatomy and physiology at the local community college in the evenings. After I decided on Regis for PT school, I was able to get more observation time at the naval hospital in San Diego. That experience was invaluable and has had a major impact on my interests within the PT profession.

What is an unexpected challenge in PT school?

Laura: I could not have anticipated how much I miss the relationships I had built during my time in Alaska. Also, I’m giving up years of income and will be facing a level of financial instability that makes me squeamish. However, I am completely energized by my motivated classmates, committed faculty, and opportunities that I could not have otherwise imagined!

Tara: Group work across generations. I didn’t even have dial-up internet until high school! While I am proficient with technology, messaging and social media are not as natural to me as for many of my classmates. I like meeting face-to-face much more than messaging…And how many different messaging apps do I really need, anyway? Can’t all my different groups just use the same one? Modes of communication that appear effortless to others take extra time and energy for me to work with

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Tara and Laura take a study break on their bikes

What’s an unexpected awesome part of PT school?

Laura: I am thrilled about the professional and leadership development offered within the curriculum at Regis.

Tara: Being on the puppy raising team!

 

Where do you see yourself in 5 years?

Laura: My plan is to practice in southeast Alaska where towns are located among the islands. I cannot say if I will be in a specific clinic, providing tele-medicine, or traveling on the ferry or floatplane to treat people in remote areas. I can say that I am looking forward to settling back into life in Alaska where everyone moves just a little slower than in the big city and where patients compete to bring you their finest smoked salmon.

Tara: Denver–I don’t want to move any more! I’m interested in working with patients with neurologic health conditions so I’d like to be in a rehab center or hospital.

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Tara and Laura sip some cocktails and study for a neuro test

What pieces of advice do you have to incoming students (particularly those coming from another field)?

 

Laura: My advice to incoming “career-changer” DPT students is to practice patience with yourself and others and to recognize that your skills and experience from previous work add significant value to this field.

Tara: Beware of hubris. You bring life experience and maturity to your new profession but you’re still a novice. On the flip side, don’t sell yourself short. You may be new to PT, but have confidence in your new skills and use your life experience to improve communication with your patients and to manage time.

Also, homework sucks. However, when you think nostalgically about being able to leave work behind at the end of the day, remind yourself that school work is helping you become good at your new job. Also, it lasts less than 3 years, so you’ll get back to the real world soon (or so I believe)!

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Questions for the bloggers? Email Tara at tbusinski@regis.edu or Laura at lbaker@regis.edu.

My Immersion Trip in Ethiopia: A Reminder About the Importance of Communication

Name: Matt Gervais, Class of 2017
Hometown: Medford, OR
Undergrad: University of Portland
Fun Fact: I actually enjoy wearing ties.
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Matt Gervais, disguised as a bottle of Sriracha sauce, ran the Move Forward 5K/10K with his classmates in the fall

Every year, the Regis University School of Physical Therapy puts on a series of immersion trips around the world as part of students’ 3rd or 4th clinical rotation. Through an application process, around 25 students in each class get selected to participate in 1 of 4 immersion experiences. This year, the options were Ethiopia (available in Fall and Spring), Peru (Fall), and Nicaragua (Spring). I applied for and was fortunately selected to go on the Fall Ethiopia trip. The experience did not disappoint!
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Regis DPT students on the Ethiopia immersion trip (from left to right): Brent Ingelman, Alexander William, Matt Gervais, Elizabeth Heckmuller, Morgan Pearson, and Amanda Morrow

Six of us students and three faculty members took part in the trip.  We students worked in several different hospitals around Addis Ababa, the capital city of Ethiopia.  One other classmate and I worked in an outpatient clinic at Yekatit Twelve Hospital, a government-run hospital near the center of the city.  In Ethiopia, inpatient physical therapy and initial mobility work is far less common than it is in the US, so most PT is outpatient PT.  The Yekatit 12 clinic sees a huge variety of patients: post-stroke, spinal cord injury, low back pain, post-fracture contracture, post-burn contracture, Guillaine-Barré syndrome, and many others.  Several things jumped out to me about the clinic: the small space available (coupled with a ton of patients), the lack of clinic resources, and the positive mindsets of the patients.

img_3531The small clinic was very crowded from the time we arrived at work in the morning until the time we left the clinic at noon. Because physical therapy is not the most lucrative career in Ethiopia, many PTs only work 3-4 hours per day in the morning and work other jobs in the evening. As such, every patient with a prescription for physical therapy would come to the clinic early in the morning and wait—sometimes up to 2-3 hours—to be seen. Naturally, this meant we had very limited space to use for treatment in the clinic.

Also, the clinic lacked many resources that we take for granted in outpatient clinics in the US; we learn to expect high-low tables/mat tables, exercise equipment, private rooms, a large selection of weights, and space to do a variety of PT interventions. I believe every student on the trip learned to be significantly more creative through the process.  For example, several times we used a makeshift combination of theraband, a dumbbell, and an ankle cable attachment cuff to create a forefoot weight, along with many other techniques that can only be described as “winging it.”

In any event, we made the small space and relative lack of resources work. And, despite the shortage of space and equipment, patients managed to maintain a very positive attitude and constantly work towards their goals. These attributes, coupled with an unwavering respect for healthcare practitioners, undoubtedly contributed to improving their outcomes.

Because of our short clinic hours during the mornings, we worked with many Non-Government Organizations in the afternoons. Our work included teaching basic nutrition, basic first aid, and performing PT at several different aid organizations. We also collaborated with students from the Regis-sponsored DPT program at Addis Ababa University—the first program of its kind in the country. Between our work and simply exploring the city, it was an incredibly busy and transformative trip.

Ultimately, my greatest takeaway from our trip to Ethiopia was the importance of communication. I started the trip assuming that many of our patients would understand English, at least to some extent. My first day in the clinic disproved that assumption, though, and I had to rapidly scramble to learn basic Amharic words so I could create some form of communication with my patients. In the end, I was not very successful during my short trip, but I learned to lean more on teaching through demonstration. I was reminded that, even in patients that do speak English, you can never underestimate the value of demonstrating a task to help a patient learn.

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Beyond all else, my immersion trip to Ethiopia reminded me that communication is paramount. As PT students and future healthcare professionals, we often are focused entirely on providing the most optimal care as efficiently as possible. However, without effective communication and rapport, that optimal care will likely never be delivered effectively. This program was a tangible reminder that sometimes strong communication can trump every piece of optimal practice that research can provide. I believe I can speak for every student and faculty member on my trip in saying that the Ethiopia immersion trip was a fantastic and informative experience. I highly recommend it to anyone in the program—even if you don’t necessarily have an interest in travel. Each trip is an invaluable experience to work with populations you rarely get to work with and is a unique opportunity to hone your clinical skills, communication skills, and intercultural awareness.