No More Dry Needling by Physical Therapists in TN
The following is an OpEd recently submitted by Affinity Acupuncture to The Tennessean and other local press.
Affinity Acupuncture would like to commend the state Attorneys General for ruling that Intramuscular Manual Therapy (“IMT”), also known as Trigger-Point Dry Needling, does not fall within the scope of practice of physical therapy as defined by the Occupational and Physical Therapy Act, Tenn. Code Ann. §§ 63-13-101 to -318.
While this topic has not received much media attention, it is very important to state licensed acupuncturists.
Acupuncture and Trigger-Point Dry Needling, often referred to as Dry Needling, have many similarities. In fact, the ruling states that “while there are no doubt distinctions to be drawn between the two, dry needling’s obvious similarity to acupuncture cannot be ignored, and physical therapists may not perform acupuncture, which is a branch of medicine.” A 2008 Mayo Clinic study found a 93.3% anatomic correspondence with classic acupuncture points. The World Health Organization (WHO) lists Trigger Points as a subset of the catalog of acupuncture points. Our office considers dry needling to be a form of acupuncture.
Acupuncture is considered a branch of medicine. While it is growing in popularity, acupuncture is still a fairly controversial practice in the US. Most Americans are more comfortable with conventional Western techniques, or even Eastern techniques performed by Western practitioners. For this reason, some opt for dry needling from Physical Therapists or Doctors of Chiropractic Medicine. The reason this concerns acupuncturists does not reflect their confidence in Chiropractors or Occupational or Physical Therapists. Acupuncture, Chiropractic, and Occupational and Physical Therapy are all effective Complimentary and Alternative Medicines (CAM). They can have tremendous positive impact on the body with or without the compliment of Western medicine. Our office often refers individuals to Physical and Occupational Therapists, as well as Chiropractors, when we believe they can benefit from the services that are clearly outlined in their scopes of practice.
With a well-trained practitioner of Acupuncture, Physical Therapy, or Chiropractic, the methods used are generally regarded as safe. The concern of Occupational and Physical Therapists, and even Chiropractors, performing Dry Needling lies in the level of training specific to the application of applying needles to the body. There is currently no uniform requirement for education of Dry Needling technique, which is disconcerting. It is not included in entry-level education for Physical Therapists, but additional training is available.
There are two main programs for training, neither of which require more than 104 hours of study for individuals who have not had previous training on the insertion of a surgical needle into the human body. The state of Tennessee requires that Licensed Acupuncturists (L.Ac.) complete a minimum of 1490 hours of training in Acupuncture, 660 hours of which are clinical hours supervised by a Licensed Acupuncturist. Acupuncturists are also required to complete Clean Needle exams through the Council of Colleges of Acupuncture and Oriental Medicine. This is significantly more training than Physical Therapists and Chiropractors receive; many states only require 200-300 hours of approved training for licensed MDs.
It is in the best interest of the public that training meets certain standards. Without uniform levels of competency and safety, there are serious risks involved. If the required hours of training for Occupational and Physical Therapists, Chiropractors, and even MDs are not increased, the hours required for acupuncturists should be reduced so that everyone performing the techniques is educated on the same level.
Once again, Physical Therapy and Chiropractic work are highly regarded by our office. That being said, we do applaud the recent opinion by the state Attorneys General, that Dry Needling is similar enough to a branch of medicine, acupuncture, that cannot be performed by Physical Therapists.