2019 APTA Federal Advocacy Forum – “Day on the Hill”

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Colorado members at the Forum representing and advocating for the #ChoosePT campaign.

Last week,  the APTA Federal Forum in Washington D.C. took place to advocate for important topics to physical therapists. The Forum brought together APTA members, speakers from the field, and stakeholders on the discussion of regulatory affairs and federal priorities that impact the physical therapy profession and its patients, as well as on learning about new information that comes with a new Congress. Attendees had the opportunity to speak with their representatives in person about issues facing their state and the profession as a whole. Among those in attendance were our very own Regis DPT students and faculty members. Second-year DPT student Hannah Clark reflects on her experience on the Hill and why it is crucial to not only advocate for our profession, but to be involved as a student, in her following essay:

“Issues Discussed at the Capital”

Hannah Clark, SPT – Regis University

To fundamentally agree with the policy positions held by the APTA is an exceptional feeling. As a DPT student who is hoping to delve headfirst into pain management and advocacy for marginalized communities in healthcare upon graduation, my decision to pursue this profession has been deeply validated by attending the Federal Advocacy Forum (FAF). Witnessing leaders within the APTA address topics related to population health, patient choice and access, value-based care and practice, and research and innovation helped me to fully recognize the crucial role the APTA has in influencing the policies that impact our ability to serve society. For these reasons, it felt important for me to join the GAC team advocating at the capital and I was deeply honored to be selected.

Due to the recent success regarding the removal of the Medicare cap, we were able to spend more time becoming educated and advocating for the field of physical therapy in a broader sense. On Monday, we spent the entire day learning about the current political climate in congress from Nation Gonzalez at CNN, the societal impact of healthcare policy from Sarah Kliff at Vox, and attended breakout sessions that detailed information regarding federal policy, payment, the ACA, Medicaid, and IDEA. One of the most emphasized topics throughout the day involved the #ChoosePT campaign. The APTA reminded those attending the FAF of the real impact physical therapists can have on the opioid epidemic through offering vulnerable populations access to non-pharmacological pain management. Clear objectives were presented that tackled this issue in addition to intra-professional issues such as student loan repayment. Several policy priorities were presented for every state to choose from when planning their congressional meetings.

The following topics were addressed by the Colorado GAC team when meeting with legislative assistants:

  • Our geriatric specialists spoke to the vital role in we play in exercise promotion and fall risk reduction in the community. Conversations were also had in the valuable perspective physical therapists can bring to park and recreational center design.
  • Our pediatric specialists asked congresspeople to consider expanding the budget for IDEA as they have witnessed the impact this program has on the lives of children.
  • Our outpatient clinicians provided examples of how they have successfully treated patients experiencing chronic pain and assisted them in weaning off opioids. These individuals also spoke to the measurable reduction in opioid use they have made in their local hospital system by implementing early access to physical therapy services.
  • Our students asked our congresspeople to cosponsor SB970 (and eventually the same bill when it is brought to the house) that would add physical therapists to the National Health Service Corps. This would allow graduates to serve rural populations, often most impacted by opioid addiction, and would offer student loan repayment as an incentive.
  • Our long-time advocates requested that physical therapists be added as community health center providers, as we are a vital element of the primary care team.

In addition to the invaluable time spent at the FAF learning about how physical therapists can impact healthcare quality and access in the U.S., one of the most important aspects of the weekend for my professional growth was getting to know the GAC members I accompanied. The people I spent time with exemplified everything I love and respect about our profession. They spoke with genuine care for their patients, integrity in leadership opportunities, intelligence in considering the complexity of pain, passion for their interventions, and commitment to social responsibility. Our conversations had a large impact on my personal development.

I returned to class following the Federal Advocacy Forum with a fresh perspective. I felt focused and calm as I approached coursework and simulation labs. Attending FAF granted me the opportunity to further shape who I aspire to be as a professional and world citizen. I am beyond grateful for this opportunity and truly believe that if any student were to have the chance to participate in this event, they would foster a deeper appreciation for the APTA and for healthcare advocacy at large.

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Hannah (pictured second from right) was all smiles with fellow members of the Forum at the 2019 APTA Federal Forum in Washington D.C. 

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.

Lessons Learned During the First Clinical Experience

Name: Kelsie Jordan, Class of 2019
Hometown: Portland, OR
Undergrad: Oregon State University
Fun Fact: I spent the summer of 2014 studying in Salamanca, Spain.
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When I tell people I was in California for my first clinical rotation, everyone’s minds seem to jump to the flashy big cities like Los Angeles, San Diego, or San Francisco. Sorry guys, I wasn’t lying on the beach or treating the movie stars; I was working more in the realm of Middle of Nowhere, CA in a small town called Orland. If you’ve ever driven to or from Oregon along I-5, you’ve probably driven right past it without ever even knowing it existed, as I actually have multiple times. I have lived in or near major cities all my life, so I had no idea what to expect from working in a rural setting. I was worried I was going to be bored, and that being away from everyone I know would make me lonely. But Orland, with its farmers, high school football, and Dollar General stores, turned out to be the best place I could have been for my first clinical.
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Welcome to Orland!

Here are just a few things I learned along the way:

Work schedules > school schedules

I’m not going to lie, clinicals are exhausting. Being on my feet all day, both literally and figuratively, drained the life out of me, especially in that first week. The good news is, I immediately discovered how great it is to come home at the end of a long, demanding day and have nothing–and I mean nothing–to worry about. After a year straight of exams, projects, and endless studying, I forgot how nice it was to have a mellow evening without feeling guilty about procrastinating. My clinical instructor (CI) once asked me what I generally do after work and I had to laugh; my nightly routine was pretty much eat dinner, drink an occasional glass of wine, and re-watch early episodes of Game of Thrones. Call me lazy, but I look at it as taking advantage of the free time I never get to have during school.

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Wine tasting in Sonoma!

It’s never easy, but it gets better

As barely a second year student going into this rotation, I was pretty much inexperienced in every sense of being a physical therapist. Even the skills I was most familiar with had a different feel to them when working with real patients instead of practicing on healthy classmates. Luckily, my CI was an amazing teacher. He did a great job of layering on responsibilities for me so I always felt challenged but never felt thrown into the deep end. After an observation-heavy first week, I was tasked with doing the subjective interview portion of every evaluation and taking over the exercises for a couple patients. At the time, that honestly made me nervous and it felt like a lot of independence. But fast forward to my final week: I had somewhere around 10 patients all to myself, I was flying solo on pretty much every lower extremity and back evaluation, I was completing all documentation, and I had discharged three of my patients. We had a packed 8-5 schedule and it was never easy because my CI always gave me more to do before I got fully comfortable. It was demanding, I made a lot of mistakes, and being challenged every day sometimes made me feel like I wasn’t improving or I shouldn’t still be struggling. But looking back at what was difficult for me in that very first week compared to what I was able to do by the end, it’s easy to see how much I learned and improved!

Confidence takes practice

I have always struggled with my outward displays of confidence in patient interactions because I get nervous and tend to doubt myself. I’ve always been told, “Fake it ‘til you make it,” but that’s a lot easier said than done; I guess I just don’t know how to fake confidence. Instead, my confidence builds gradually as I experience success and overcome challenges. And that’s exactly what happened during my clinical. From prescribing and teaching exercises on my own to completing several full evaluations in Spanish, I was definitely challenged, but I was also successful. Sure, I felt like I didn’t quite know what I was doing half the time, but I learned to not dwell on mistakes and to push myself out of my comfort zone. Most importantly, I gained confidence in my own knowledge and abilities, and I now feel more prepared to take on the rest of PT school. If there’s anything I learned from my clinical, it’s that I am capable of doing far more than I ever thought I was.

Solo adventures are good for the soul

I’m usually go go go from one thing to the next for fear of missing out on any fun, so being alone in a rural area was definitely a change of pace.  Although I was lucky enough to reunite with some college friends during trips to San Francisco and Lake Tahoe, I actually probably spent more time alone over the six weeks of clinicals than I did throughout the entire first year of PT school. It allowed a lot of time for self-reflection I didn’t even realize I needed. I was itching to get out and explore, and my weekend adventures were definitely worth all the miles I put on my car: I took my first solo camping trip, discovered a National Park I had never even heard of, and hiked upwards of 35 miles by myself. Of course I missed my friends and my normal crew of camping/hiking buddies, but I learned how to embrace time alone without being lonely.

I enjoyed the opportunity to appreciate silence and just be.

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Support systems are necessary

As a class, we spend so much of our lives together throughout the year that, I have to admit, it was oddly nice to be away from everyone. No, I’m not saying I was sick of my classmates, but those 6+ weeks apart allowed me to actually miss my friends. And, although I already said I enjoyed my time alone, man did I miss them. When you go from sharing all of your time together to none of it, all while you’re being thrown into a new situation, there’s a lot to catch up on after just one day! I did my best to reach out to my friends here and there to see how their clinicals were going, and sometimes those check-ins turned into 2-hour phone conversations. Shout out to the two friends who kept up a group text with me every single day–we practically shared a play-by-play of our clinical experiences, from funny patient stories to weekend plans. Knowing everyone else was having similar challenges was reassuring, and receiving daily encouragement and sharing my accomplishments kept me excited to keep learning.


In a rural setting, a physical therapist needs to be a jack-of-all-trades and a master of none, as my CI once told me. As a result, I got to see a little bit of everything. Sure, there were quite a few back, shoulder, and knee injuries, but I also did some detective work with more neural issues, and I got to observe several vertigo treatments as well. I absolutely loved being in Orland, not only for the varied learning experiences, but also for the people and the small town charm. I found out the correct way to pronounce almond is “am-end” (according to Northern California farmers), and I even joined in on the tradition of wearing blue on Fridays in support of the high school football team.

“You are enough!”

That’s what we were told in our final pre-clinical prep session over the summer, and it turns out it’s true! At first it was easy to think,“I’m just a student” and feel as though I had to run every thought and decision by my CI. However, as he let me become more independent, I realized even as a student, I really did have enough knowledge and skill to make a difference in patients’ lives all on my own. Now, when people ask me how my clinical went, I have nothing but good things to say. I was pushed into recognizing how much I was capable of, and humbled into realizing how much more I still have to learn. Although it was a short period of time, those six weeks were like a refresh button to help me overcome the burnout I had experienced after a year in the classroom, and allowed me to come back to Regis ready to keep expanding my knowledge base before I head back into the real world again.