My Dry Needling Blog: Respect and Coexist............Someday?
Why wouldn't you think that physical therapists are dangerous and that having dry needling done by a physical therapist is akin to having surgery that will leave you permanently damaged or dead? This is what the U.S. acupuncture community (and others around the globe) would like you to believe. They would also like you to believe that physical therapists have not had one shred of education, except, of course, those wild, cowboy-like weekend excursions we go on to learn how to learn how to throw our darts. They have been working these angles and publicizing them for at least the last ten years. I live in a state where we have been allowed to dry needle since 2005. The term should be commonplace, not novel. But we physical therapists obviously are not good at promoting what we do and we have feared backlash and criticism from acupuncturists through the years. Everyday, I meet people who have not heard of dry needling for pain relief. Good job acupuncturists, you have tried and succeeded at keeping the merits of dry needling under wraps. You let the world know how dangerous dry needling is and how uneducated physical therapists are. You have also let the world know that dry needling is really acupuncture and not the trigger point work we think we are doing.
Dry needling, the insertion of acupuncture needles into trigger points for neuromuscular pain control, by physical therapists was first approved in Maryland in 1984. Admittedly, there was no hullaballoo about dry needling early on. The 80's and 90's remained fairly silent on the dry needling front, except that in 1992 New York declared that it would not allow dry needling by physical therapists. In 2002 Tennessee and North Carolina also ruled against the practice. From 2003-2012 the number of states where dry needling became within physical therapy scope of practice grew from 3 to 28. So, by the early 2010's the numbers of physical therapists practicing dry needling started to alarm acupuncturists and pushed their associations into fight mode, thus beginning the onslaught of turf wars and smear campaigns.
Let's keep in mind that the profession of acupuncture in the U.S. was still fairly young and slowly finding it's path. In 1985 there were only about 4500 licensed acupuncturists with over 60% in practicing in California. By 2000, there were 14,228 with over 53% practicing in CA, NY, and FL. These proportions have remained the same with the growth acupuncture. In 2015 there were 34,481 still with 51% practicing in CA, NY, and FL. The years of 1980-2000, acupuncturists and PTs with dry needling skills were all fairly low numbers. Probably nearing equal. All exploring an infancy of their techniques. It does not matter that Oriental Medicine dates back 3000 years, it was new in the U.S. in the early 80's. I have heard estimates that today (2018) somewhere between 25,000-45,000 PTs practice dry needling in the U.S. Again, similar to numbers of licensed acupuncturists. Our timelines and numbers of providers are fairly similar. Our theories of treatment are different. Acupuncture is an overall medical paradigm based on treatment with needles along meridian pathways to promote healing, relief of tobacco addiction, relief of asthma, relief of allergies, relief of depression, relief of PMS, aiding infertility, resolving organ dysfunction, resolving neuromuscular pain, and many other ailments. Physical Therapy is a medical profession that uses varied techniques aimed at improving a person's physical functional level with pain relieving, strengthening, and educational strategies. Dry needling is a technique of inserting thin needles into tender trigger point regions to help resolve neuromuscular pain. Ah, the overlap, neuromuscular pain, the source of conflict!
So neuromuscular pain seems to be the issue. We can't all possibly treat pain. There will not be enough work for all of us. There will not be enough people with back pain, neck pain, arthritis pain, headaches, whiplash, tendonitis, scoliosis, sciatica, tmj, sports injuries, and chronic pain for us all to find our niche and effective treatment. Last year, nearly 50,000 people died of opioid overdoses in the United States. No, there clearly is not enough pain to go around. The acupuncturists can handle all of the pain across the country as well as all of the other ailments they manage as long as the people who need pain relief reside in California, New York, Florida, Colorado, Washington, Oregon, Texas, Massachusetts, or Maryland. That's where 75% of the licensed acupuncturists practice. Coincidence that many of those states are the ones where the acupuncture associations have fought hardest to take away the rights of PT's to practice dry needling? It's not about them being superior at handling pain. It's not about safety and protecting the public from physical therapists. It's not about acupuncturists being smarter or having more education. It's clearly a turf war and anti-competitive behavior has ensued over the past ten years.
Georgia and North Carolina were two of the earlier states to wage war against physical therapists. In 2008-2009, Georgia modified its Acupuncture Statutes declaring "dry needling is a technique of acupuncture" and the PTs would no longer be allowed to practice dry needling. By 2011, through productive negotiation, PTs were once again able to practice dry needling.
North Carolina acupuncturists took the battle further. In 2010 they began their quest to drive PTs out of the market. They began to write articles discouraging dry needling done by any non-acupuncture providers. In 2012 the North Carolina Acupuncture Licensing Board (NCALB) wrote a position paper in which "NCALB defines dry needling as acupuncture and dry needling is the unauthorized practice of acupuncture." Also in 2012, a member of the NCALB had "done some editing to the Wikipedia page for dry needling" and included a statement that "dry needling would appear to be closest to the use of what are called ashi points in acupuncture." Then in 2013 the NCALB issued cease-and-desist letters with the intent to intimidate PTs in North Carolina who advertised dry needling and to deter PTs who intended to enter this market. By 2015, the acupuncture association was sending out letters to its members declaring that they needed funding now, to stop dry needling. They were also declaring and that PTs were endangering the public. They linked their own publications into the Wikipedia site and on other social media trying to persuade consumers not to seek dry needling by PTs. They were actively seeking information about dry needling injuries and weaponizing against PT's. In 2015 several PTs lodged a lawsuit against NCALB over these anti competitive anti-trust issues. The verdict is not yet in for the anti-trust suit, but in December 2018, the N.C. Business Court affirmed that dry needling is within the scope of physical therapy. Similar lawsuits have been happening all over the nation over the past 10 years.
So PTs and acupuncturists each do their own version of dry needling. So what. The turf wars have spent nonsense amounts of dollars on court cases and legal fees. PTs are still filling up dry needling courses around the globe. More and more states are adopting dry needling into the physical therapy scope of practice. Acupuncturists and their Associations are still telling people that they take their lives in their hands if they visit a PT for dry needling. In fact, they continue to seek 'dry needling gone bad' stories through a website called www.acupuncturesafety.org. The general public still does not even know what dry needling is probably because PTs are pretty poor at marketing and have been fearful of the acupuncture community. PTs that don't dry needle are fed up and frustrated that dry needling is a buzzword in the field. Non dry needling PTs are in abundance on Twitter and other social media dismissing any effectiveness of dry needling.
From this physical therapist with nearly ten years experience dry needling, I still perform dry needling everyday. It is the most useful tool I have to quickly start helping people with back pain, headaches, strains and sprains, whiplash, chronic pain, tendonitis, shoulder/hip/knee/ankle pain, acute pain, sports injuries, and general neuromuscular pain. I help people stay active with their everyday activities without the use of pain medications, cortisone injections, and surgery.
I look forward to mentoring new providers of dry needling so that they can review safety and quickly become effective with the tool. I look forward to ALL U.S. states adding dry needling to physical therapy scopes of practice, someday, fingers crossed! I look forward to the day when the term is just commonplace and I don't have to explain it to every new patient. I look forward to the day that we can coexist with the acupuncture community and all be productive in reducing pain no matter what our theories are. I look forward to seeing more research about the effectiveness of dry needling. I look forward to physical therapists, acupuncturists, chiropractors, osteopaths, MDs, athletic trainers, massage therapists (and anyone else who is allowed to learn dry needling) really making a significant difference in pain relief and in improving the function of those with more severe neuromuscular impairments like spasticity from stroke, cerebral palsy, and parkinson's disease.
Coexistence and respect............Someday?