My Dry Needling Blog: Please Forgive Me, I Dry Needle

It's presently known as the most controversial therapy technique and it has been causing acupuncturists to wage war on physical therapists for the last 10-15 years. Dry Needling. I entered this controversial practice after taking my first dry needling course in 2009. Yes, forgive me, I am a physical therapist who dry needles. In states all across the U.S. we are proclaimed bad, bad people. We became physical therapists with the goal of helping people feel better and function better. Within our careers, in addition to taking many other continuing education courses, we took dry needling courses that enable us to insert thin needles into muscles & trigger points for the purpose of decreasing pain and improving function. Now, because we perform this technique with skill and success, we get bastardized daily by the acupuncture community. The turf war is rampant. The turf war is ugly. The turf war is nonproductive. The turf war is costly.

According to the American Physical Therapy Association (APTA) dry needling is 'a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissue for the management of pain and movement impairments.'

According to the American Association of Acupuncture and Oriental Medicine (AAAOM) 'dry needling or any other method by which a needle is inserted to effect therapeutic change, is, by definition, the practice of acupuncture.' The stance is that physical therapists using needles is matter of public safety because our overall musculoskeletal education and specific training with needles are subpar compared to an acupuncture education. These are the thoughts fed to acupuncturists from the top. I see venomous statements written by acupuncturists every day about how educated they are, how uneducated we are, how the needles belong to them, and how dangerous we are. Seriously? At least in Colorado, we've had PT's dry needling since 2005. 13 years! Are we really that dumb and dangerous????

I read blogs posts, Instagram posts, and Facebook posts daily with references to dry needling. The comments from acupuncturists usually include such remarks as "Dry needling is acupuncture done by people who learned it over a weekend. PT's are unsafe and terrifying. I'd rather have a licensed acupuncturist that has 3700 hours of training, not a PT that takes a needling course." Or "Leave the needles to the acupuncturists." Or "PT's only do exercise." Or "PT's have the shortest and easiest doctorate in medicine." Or "PT's are out there impaling arteries, nerves, and lungs." Yep, I am very used to the acupuncture slant, talking points, and criticism. Needless to say, the rift runs deep between the professions. It does not look like we will be collaborating any time soon.

I'm not sure of the exact number of states that allow physical therapists to dry needle. The count has changed frequently over the past several years. My head is spinning after trying to review all of the legal battles nationwide over the past ten years. States initially allowing dry needling by physical therapists, only to be challenged by the state's board of acupuncture to deny dry needling by PT's. I am horrified thinking about all of the legal costs involved, all of the disruptions in client care as a result of halting services, and the lack of the research and development of treatment protocols that could have been happening within the whole dry needling community (chiropractors, acupuncturists, MD's, and physical therapists) if we didn't have to be arguing over scope of practice. To the best of my knowledge only Washington, Oregon, California, Hawaii, South Dakota, and New York specifically do not allow dry needling by physical therapists. Until recently, New Jersey, Florida, and Idaho were on that list but they are making strides for adoption of dry needling into their practice acts.

Maryland was the first state to adopt dry needling by physical therapists in 1984. This corresponds nicely with Dr. Janet Travell's published trigger point book, Myofascial Pain Dysfunction: The Trigger Point Manual, 1983. Other early adopters of the technique include New Mexico (1999), New Hampshire and Virginia (2002), Georgia, South Carolina, and Kentucky (2004), Colorado (2005), and Ohio and Virginia (2007). Many other states followed closely behind in the instruction and adoption of dry needling by physical therapists. Many legal battles have ensued by the acupuncture associations attempting to block or overturn dry needling decisions. It has been a true battleground and it continues today.

California does not allow for dry needling by physical therapists. California has the highest percentage (32%) of licensed acupuncturists nationwide. I read this description of dry needling on one California acupuncture website: "While dry needling and acupuncture use the same implements—extremely fine needles—the development of dry needling was not influenced by acupuncture; the practices are independent of one another, employing different theories and techniques. In short, dry needling is focused on restoring healthy anatomy and physiology through stimulation of injured local muscle tissue, while acupuncture seeks to normalize the flow along meridians. Many sites for dry needling overlap with acupuncture points (while many do not), but the criteria that define point locations and the needle techniques are very different between the two practices. At this practice, we are experts in both acupuncture and dry needling, and we are supportive of both practices, often combining them to maximum effect."

I read this excerpt from an acupuncture blog: "I think basic needle insertion technique is easy, and that anatomy training in other fields like [physical therapy] is probably satisfactory. However, for political reasons, and to try and ensure the permanence of the acupuncture profession, I think the use of acupuncture needles should should be restricted to licensed acupuncturists only. At least until acupuncturists properly define our own scope of practice such that we don’t risk particular rights, and shift public perception of acupuncture from that of pain relief to comprehensive, conservative healthcare."

Let's talk briefly about where the prevalence of where acupuncturists go to school and hold their practices. Coastal regions. California has 32%, New York has 11%, and Florida has 7% of U.S. licensed practicing acupuncturists. If in fact, dry needling is as great as we think it is (otherwise, why the turf war?) and that it can help reduce the opioid epidemic, need for steroid injections, and surgery, this leaves a huge void for the rest of the country in terms of access to dry needling, if the acupuncturists have their way (no PTs with needles). Given the numbers of roughly 35,000 licensed acupuncturists and 240,000 licensed physical therapists in the U.S.....How can we possibly leave neuromuscular pain in the hands of such a small number of acupuncturists that predominantly practice on the coasts? Do you really believe that PT's are really so uneducated with neuromuscular issues and have utter incompetence with insertion of needles that they should be taken out of the equation? Do we really want MD's making all of the profitable decisions (injections, pharmaceuticals, surgery) regarding pain?

What if the turf war did not exist? What if the acupuncture and physical therapy associations come to terms that we both use dry needling? Does that not broaden how effective we all can be? We know through our own patient testimonials that dry needling works. We know we have a powerful tool & technique for pain relief. We could go so much further without the attacks to our profession. We could promote each other's techniques. We could collaborate. We could do more research to prove our effectiveness. We could dive further into treating neuromuscular conditions like Parkinson's disease, strokes, and potentially cerebral palsy to improve function. What if we could decrease the prevalence of pediatric tendon lengthening surgeries because we had protocols in place using dry needling? Just some thoughts from this dumb and dangerous physical therapist. Please forgive me, I am a physical therapist and I dry needle.

Julie Schumann, PT, MSPT (Mercy College, January 2000), Kinetacore: Advanced Functional Dry Needling Level 3 and Functional Therapeutics.