Dry Needling and Direct Access Update

On Feb. 25, 2020, Senator Scavello's office sent a memo requesting co-sponsorship for a potential bill to explicitly state the ability of physical therapists to perform dry needling as part of their physical therapy session. The timing was difficult as shortly after this memo, concerns and issues surrounding the pandemic came to the forefront.

In order to move the language and get a bill number, the Senator has asked us to assist with obtaining commitments for at least seven state senators to cosponsor this bill.

PPTA is asking our members to contact their state senators and ask for support and to become a cosponsor. This bill will allow for explicit language of dry needling in our Practice Act as well as provide greater patient/client access with direct access revisions.

PPTA has a templated letter, talking points for calls and a map for all states using dry needling. You may send these resources to your state senators to assist with the conversation and email contact. The letter is in word format so that you can customize this letter with your story about dry needling.

FACTS about Physical Therapists & Dry Needling

Who are Physical Therapists?
Physical therapists are licensed health care professionals who maintain, restore, and improve movement, activity, and health enabling individuals of all ages to have optimal functioning and quality of life. Physical therapists provide care to people who have functional problems resulting from, for example, back and neck injuries, sprains/strains and fractures, arthritis, burns, amputations, stroke, multiple sclerosis, cerebral palsy, and other conditions.

What is Dry Needling?
Dry needling (DN) is a skilled intervention used by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Preliminary research supports that dry needling improves pain control, reduces muscle tension, and facilitates an accelerated return to active rehabilitation.

Do Physical Therapists perform Dry Needling?
Yes. Dry needling is recognized by the American Physical Therapy Association (APTA) as being part of the physical therapist scope of practice. Currently a majority of U.S. jurisdictions have explicitly recognized dry needling as being part of the legal scope of practice. Patients in Massachusetts have benefitted from dry needling provided by physical therapists for years.

Do Physical Therapists have the education & training to perform Dry Needling safely?
Yes. The current minimum educational requirement to become a physical therapist is a post-baccalaureate from an educational program accredited by the Commission on Accreditation of Physical Therapy Education (CAPTE). The doctor of physical therapy degree (DPT) from a CAPTE accredited program is the required degree for all entry-level physical therapist education programs. The education of physical therapists includes anatomy, histology, physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, clinical sciences, clinical interventions, clinical applications, and screening. Much of the basic anatomical, physiological, and biomechanical knowledge that dry needling uses is taught as part of the core physical therapist education; the specific dry needling skills are supplemental to that knowledge. Many of the current DPT programs are (at a minimum) including an introduction of the concepts of dry needling in their programs. This is similar to how many other advanced skills may be introduced in school but not physically taught.

Are there safety concerns with Physical Therapist who perform Dry Needling?
No. Claims that the performance of dry needling by physical therapists is a threat to public safety are without merit. In fact CNA, the underwriting company for the physical therapy professional liability insurance plan offered HPSO, the leading malpractice insurance carrier for physical therapists in the U.S, reported in a May 2016 letter that there are no trends relative to dry needling identified that would indicate this procedure presents a significant risk factor, nor does CNA foresee the practice of dry needling as having any immediate claim or rate impact.

Furthermore, the Federation of State Boards of Physical Therapy – the national organization representing state physical therapy licensing boards – reported in a May 2016 letter that during the period 2010-2015, only 4 instances of disciplinary actions related to dry needling against PTs by state licensing boards were reported in FSBPT’s Examination, Licensure, and Disciplinary Database (ELDD).

How is Dry Needling different from Acupuncture?
The practice of acupuncture by acupuncturists and the performance of dry needling by physical therapists differ. The performance of modern dry needling by physical therapists is based on western neuroanatomy and modern scientific study of the musculoskeletal and nervous system. Physical therapists that perform dry needling do not use traditional acupuncture theories or acupuncture terminology. It is not advertised as acupuncture nor is it tied to the roots of the practice of acupuncture.

Is Dry Needling exclusive to Acupuncturists?
No. Dry needling is an intervention performed by a number of health care providers, including physicians, chiropractors, physical therapists, and acupuncturists. Health care education and practice have developed in such a way that most professions today share some procedures, tools, or interventions with other regulated professions. It is unreasonable to expect a profession to have exclusive domain over an intervention, tool, or modality. One activity, whether it is dry needling, therapeutic exercise, or manual therapy, does not define a profession but it is the entire scope of activities within the practice that makes any particular profession unique. Simply because a skill or activity is within one profession’s skill set does not mean another profession cannot and should not include it in its own scope of practice.