Why is Dry Needling Illegal? Common Misconceptions & Legal History (2024)
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Table of Contents:
Introduction
Dry needling, a technique used by physical therapists (and not acupuncturists) to treat muscle pain, has become a subject of debate across the United States. Despite its popularity, dry needling faces legal challenges in several states. This blog explores why dry needling is illegal in some states and covers the perspectives of physical therapists, acupuncturists, regulators, and patients.
The video below is a quick overview on the basics of dry needling and how it differs from acupuncture.
What is the difference between Dry Needling and Acupuncture?
Dry needling and acupuncture, while both involve the insertion of needles, stem from vastly different traditions. Acupuncture is an ancient practice central to Traditional Chinese Medicine, aimed at balancing the body's qi (energy) by stimulating specific points along energy pathways known as “meridians.”
In more modern day terms, we can see meridians as useful points in our nervous system. In contrast, dry needling is a modern technique from Western medicine, targeting muscular tension and pain by inserting needles directly into muscle knots or trigger points. One could say these practices are siblings, close family members with slightly different interests.
Image Source: hjphysicaltherapy.com
The training for each practice differs significantly; acupuncturists undergo extensive training in a broad array of Traditional Chinese Medicine techniques, while physical therapists may receive focused, short-term training on dry needling as part of their medical education.
Trick question! They use the same needles, just are placed in different spots.
Source: PrecisionRehab.com
This distinction in training reflects in the legal landscape, with acupuncture being recognized as a licensed healthcare profession requiring rigorous certification, whereas dry needling's legal status varies, often seen as a optional component of physical therapy practice.
Why Do Physical Therapists Want to Dry Needle?
Physical therapists advocate for dry needling in their scope of practice primarily due to its effectiveness in treating muscle- or bone-related conditions. Dry needling provides a direct method for addressing myofascial trigger points—tight knots within the muscle that contribute to pain, stiffness, and decreased function.
By inserting thin needles into these points, physical therapists can elicit a twitch response, leading to the relaxation of the muscle knot and alleviation of pain.
Many physical therapists view dry needling as a natural extension of their skills in manual therapy and argue that it complements other therapeutic interventions such as exercise, manual manipulation, and electrical stimulation. The technique is seen as a vital tool in a comprehensive approach to pain management, particularly for chronic conditions that do not respond well to conventional treatments. Moreover, as professionals who are extensively trained in the anatomy and neuromuscular systems, physical therapists claim they are well-equipped to perform dry needling safely and effectively.
Concerns from Acupuncturists and Regulators
Acupuncturists and some state regulators express significant concerns regarding physical therapists performing dry needling, primarily focusing on the depth of training and the nature of the practice. Acupuncturists argue that dry needling is fundamentally an acupuncture technique, rooted in the insertion of needles into the body to manipulate physiological processes. Given this perspective, they contend that physical therapists lack the extensive training in needling techniques that acupuncturists receive, which typically encompasses thousands of hours of education.
Regulators echo these concerns, emphasizing patient safety and the risk of serious complications such as infections and nerve damage when needles are handled improperly. They worry that short courses, sometimes only a weekend long, are insufficient for physical therapists to acquire the necessary skills to perform dry needling safely. This discrepancy in training levels has led some states to prohibit physical therapists from practicing dry needling, categorizing it as outside their scope of practice without more rigorous certification.
Dry Needling Legality across the United States
The legality of dry needling by physical therapists varies significantly from state to state, reflecting a complex patchwork of laws and regulations. In some states, dry needling is explicitly recognized and regulated within the physical therapy practice acts, allowing therapists who have undergone specific postgraduate training to perform the procedure legally. These states require physical therapists to complete a set number of hours in dry needling courses and, sometimes, to pass a competency examination to ensure they meet the safety standards needed for practice.
Source: IntegrativeDryNeedling.com
Legal States: The states where dry needling is explicitly permitted for physical therapists, provided they meet certain training and certification requirements, include: Arizona, Colorado, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maryland, Mississippi, Missouri, Montana, North Carolina, North Dakota, Ohio, Oregon, South Carolina, Tennessee, Utah, Virginia, Washington, Wisconsin, Wyoming.
Conversely, there are states where dry needling is explicitly illegal for physical therapists. These states often align with acupuncturists' views that dry needling is indistinguishable from acupuncture and should therefore be performed only by licensed acupuncturists who have undergone extensive training.
Illegal States: The states where dry needling is prohibited for physical therapists are: California, Hawaii, New York, Oregon, Washington.
Additionally, in a large number of states, the legal status of dry needling remains ambiguous. These states have neither specifically authorized nor prohibited the practice, leaving it open to interpretation whether it falls within the scope of physical therapy. This ambiguity can lead to inconsistencies in enforcement and uncertainty among practitioners about what is permissible.
Ambiguous or No Specific Provisions: These states either have unclear regulations or have not explicitly addressed the legality of dry needling for physical therapists: Alabama, Alaska, Arkansas, Connecticut, Delaware, Florida, Kansas, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Vermont, West Virginia.
Important Case Study
In California, the legality of dry needling by physical therapists is explicitly prohibited. This prohibition stems from a clear delineation within both the Physical Therapy Practice Act and the Acupuncture Licensure Act. The Physical Therapy Board of California interprets dry needling as falling outside the scope of practice for physical therapists because it involves procedures that are considered invasive and akin to acupuncture, which requires specific licensure.
The Acupuncture Licensure Act in California broadly defines acupuncture as the stimulation of certain points on the surface of the body by insertion of needles to prevent or modify the perception of pain, or to normalize physiological functions. This definition is intentionally broad to encompass various needling techniques, including those used in dry needling.
The state's stance is that because dry needling involves the insertion of needles—a practice central to acupuncture—it should only be performed by individuals who have met the stringent training and licensure requirements set for acupuncturists. After all, patients should always receive this utmost safety. This includes extensive education in Eastern medicine and traditional needling techniques, which are not covered in the typical education and training of a physical therapist.
Perspectives on Dry Needling
The debate over the legality and appropriateness of dry needling encompasses a variety of viewpoints from different stakeholders, each bringing unique concerns and perspectives to the table.
Physical Therapists: Many physical therapists argue that dry needling is a valuable addition to their therapeutic toolkit, enabling them to provide comprehensive care that addresses neuromuscular dysfunction directly. They emphasize their understanding of human anatomy and physiological function, arguing that with adequate training, they can safely perform dry needling to benefit patient outcomes.
Acupuncturists: Acupuncturists maintain that dry needling is fundamentally an acupuncture technique, requiring extensive understanding of the body’s energy meridians, which they argue can only be gained through rigorous and lengthy training specific to acupuncture. They express concerns about safety and efficacy when practitioners with less comprehensive training in these techniques perform needling.
Regulators and Legislators: Regulatory bodies and legislators are caught between ensuring public safety and responding to evolving healthcare practices. They must navigate the conflicting interests of different professional groups, the demands of public health policy, and the complexities of medical and therapeutic advancements.
Patients: From the patient's perspective, there is often a desire for effective and timely treatment options. Patients may advocate for access to dry needling by physical therapists, especially in regions where it might be more readily available and potentially cost-effective compared to traditional acupuncture treatments.
Conclusion
The legality of dry needling for physical therapists varies by state due to complex healthcare regulations and professional disagreements. Most states allow dry needling, but five states do not. And as you can imagine, typically the states with the most acupuncture has restrictions on dry needling. Generally speaking, physical therapists support dry needling as an effective treatment, while acupuncturists have concerns about safety.
Relevant Law
California Business and Professions Code Section 2620.5:
In California, this code explicitly excludes dry needling from the physical therapy scope of practice, primarily due to concerns about adequate training and safety. This restriction is supported by the California Board of Acupuncture and other professional bodies advocating for stringent standards (Kaman Law).
Colorado Physical Therapy Practice Act (Title 12, Article 41):
In Colorado, dry needling is permitted for physical therapists who have completed specific education and training requirements. The Colorado Physical Therapy Practice Act outlines the necessary qualifications and continuing education needed to perform dry needling safely (World Population Review).
North Carolina General Statutes Chapter 90, Article 18B:
North Carolina allows physical therapists to perform dry needling under specific regulations. This statute defines the necessary training, including the number of hours of instruction and clinical practice required. It aims to ensure that physical therapists are adequately prepared to perform the technique safely and effectively (Kaman Law).
Oregon Revised Statutes (ORS) 688.010 to 688.995:
Oregon has debated the inclusion of dry needling within the physical therapy scope of practice. Currently, the Oregon Physical Therapy Licensing Board has established regulations that allow dry needling, provided the practitioner meets specified educational standards. However, this practice is still contentious and subject to ongoing review and potential legal challenges (World Population Review).
Further Research
Systematic Review on Dry Needling vs. Acupuncture for Scar Treatment:
This review focuses on the efficacy of dry needling and acupuncture in treating scars. It analyzes various studies and evaluates their methodological quality using tools like the Physiotherapy Evidence Database (PEDro) scale. The review finds that both techniques can be effective for scar treatment, though more high-quality research is needed to draw definitive conclusions (BioMed Central).
Systematic Review and Meta-Analysis on Dry Needling and Acupuncture for Fibromyalgia:
This paper reviews the efficacy of dry needling and acupuncture in managing symptoms of fibromyalgia, such as pain, fatigue, and sleep disturbances. Both treatments showed positive effects on these symptoms, although direct comparisons between the two were not included in the studies analyzed. The review suggests both treatments can be beneficial, but calls for more research to directly compare their effectiveness over the long term (MDPI).
FAQ Section
Why is dry needling illegal?
Dry needling is illegal in some states due to concerns about safety, training, and scope of practice. Regulatory bodies in these states argue that without standardized training, there is a higher risk of complications, such as nerve damage or infections. Additionally, there are professional conflicts between physical therapists and acupuncturists over who should be allowed to perform the procedure.
Is dry needling the same as acupuncture?
No, dry needling is not the same as acupuncture. Dry needling focuses on releasing muscle trigger points and is based on Western anatomical and neurophysiological principles. In contrast, acupuncture is rooted in traditional Chinese medicine and aims to balance the body's energy flow by targeting specific points along meridians.
What is the difference between dry needling and acupuncture?
The primary difference lies in their philosophies and techniques. Dry needling targets muscle trigger points to relieve pain and improve function, using a Western medical approach. Acupuncture, on the other hand, is based on traditional Chinese medicine principles, aiming to restore energy balance by inserting needles into specific points along the body's meridians.
How much does dry needling cost?
The cost of dry needling varies widely, typically ranging from $50 to $100 per session. Prices depend on factors such as the practitioner's experience, geographic location, and the length of the session.
Is dry needling covered by insurance?
Insurance coverage for dry needling varies. Some insurance plans may cover it if it is performed as part of physical therapy treatment, while others may not. It’s essential to check with your insurance provider to understand your specific coverage details.
What not to do after dry needling?
After dry needling, avoid strenuous activities and intense exercise for at least 24 hours. It's also recommended to stay hydrated and avoid consuming alcohol, as it can interfere with the healing process.
Can I take ibuprofen after dry needling?
Yes, you can take ibuprofen after dry needling to help manage pain and inflammation. However, it is always best to follow the advice of your healthcare provider regarding post-treatment care.
How long does dry needling last?
The effects of dry needling can last from a few days to several weeks, depending on the individual's condition and response to treatment. Multiple sessions may be needed for optimal results.
How long should you rest after dry needling?
It is recommended to rest for at least 24 hours after dry needling. This allows your muscles to recover and reduces the risk of adverse effects.
Does insurance cover dry needling?
Insurance coverage for dry needling can vary. Some insurance plans may cover it if it's part of a broader physical therapy treatment plan, but it's best to check with your insurance provider for specific details.
What to do after dry needling?
After dry needling, it's important to stay hydrated, avoid strenuous activities, and gently stretch the treated muscles. Applying ice to the treated area can also help reduce any soreness or inflammation.
Can dry needling cause nerve damage?
While rare, nerve damage can occur if dry needling is not performed correctly. Ensuring the procedure is done by a qualified and trained professional minimizes this risk.
