Recently the Governor signed a draft of regulations to govern the use of dry needling by physical therapists. The regulations are in a period of public comment. I would like to put forth my support of these regulations as currently written. The practice of dry needling is of great clinical utility and physical therapists are uniquely well suited to be able to incoprorate this practice into their clinical paradigm. Physical therapists work to help people move better and dry needling can provide great relief of musculoskeletal deficits that limit moving well. I work under the federal scope of practice in a military setting and use dry needling on a daily basis. Since being trained in this skill I have found it to be an important part of my toolset to help my patients move better and feel better. My patients consistently ask for this treatment and recognize the dramatic positive effect that it can have. 

Physical therapists have been utilizing dry needling in Virginia since 2003.  It is a valuable technique that is used in addition to other physical therapy treatments.  The consumer has the freedom to choose this as a possible treatment.  

Please continue supporting physical therapists advance skill to dry needle with multiple benefit on the musculoskeletal and nervous systems.  Thank you

I have been practicing dry needling for about 2.5 years. I use dry needling to inactivate muscular trigger points. I believe that dry needling is a very effective way to release muscles especially in more chronic patients. I have taken my courses with myo pain seminars which was very comprehensive and required more than 100 hours of education. Also, I had to study a lot to be able to get the certification and safely practice dry needling, I have been working on trigger points for a long time and I have translated the main texct book of tirgger point by Janet Travell to Farsi , my home language. I found dry needling as one of the most effective ways to work on trigger points. I believe physical therapies have great knowledge of anatomy that helps a lot in mastering dry needling techniques and practicing safely.   

As a clinician that dry needles and sees the immediate effect, I do not feel that a doctor who knows nothing about dry needling should have the power to determine if we should be allowed to use a technique we have been formally trained to use. At what point is our profession going to stop letting others dictate how and when we do our jobs. This training for dry needling was extensive and expensive and I use it daily in my practice and often just because the guidelines require a doctors "say so" my clinicians and I take the necessary measures to implement this modality. The next step is making sure we are properly reimbursed as most patients pay out of pocket for this highly effective treatment.

I am fully in favor of Physical Therapists in Virginia maintaining the privledge of utilizing Dry Needling in our practice. Graudating with a Doctor of Physical Therapy degree already provides a very strong framework in anatomy, physiology, body systems, neuro, pain and standard precautions/safety/contraindications. Then, the coursework required above and beyond the DPT degree MORE than prepares a PT to utilize Dry Needling. It is a helpful procedure to use for pain control, muscle length/strengthening, neuromuscular re-education and most importantly to help our patients return to their full function and restore quality of life. Dry Neddling is distinctly different from Accupuncture in that we focus on hyperirritable loci in the muscle tissue to elicit a physiological response in the muscle tissue to enhance and progress treatments performed by the PTs.  Dry Needling has greatly enhanced the field of PT and the well-being of the population who receives it during their course of treatment. 

Please give practitioners of physical therapy the legal regulatory option to employ trigger point dry needling when treating their patients. I speak from personal experience. I have received dry needling from two physical therapists in the Richmond area and it expedited my treatment immeasurably. I know that I would not be as mobile or flexible as I am today, with as little pain as I experience, if dry needling had not been an option for me. It is safe when a delivered in a therapeutic environment by a properly trained practitioner. I support the use of dry needling in the state of Virginia wholeheartedly.

 I am a practicing Physical Therapist in private practive in Virginia. I am not credentialed to perform Dry Needling. A few of my associates in our practice have been incorporating Dry Needling in their practice. They have found this modality to be a valuable adjunct with certain patients who have not responded well to conventional modalities.I have referred several of my patients for this procedure with excellent outcomes. Physical Therapist have the proper educational background and training with Clinical anatomy for evaluation and modality treatment interventions including manual therapy to perform Dry Needling. I agree that additional continuing education and certification should be a requirement for the PT to incorpaorate this into their practice. Dry Needling should continue to be an adjunct modality offered  by these Physical Therapist to treat pain and dysfunction.  

Physical therapists utilize dry needling as another important treatment technique to help patients progress toward regaining optimal function and movement patterns. Our background in anatomy and physiology, neuromuscular re-education, soft tissue dysfunction, and pain management provides us with an excellent understanding in addition to extensive continuing education dry needling coursework of how to utilize dry needling effectively.

As a clinician myself, I have seen how effective dry needling can be in treating chronic pain and dysfunction in patients that had lost hope in finding relief. Eliminating pain, muscle weakness, and range of motion restrictions allows the patient to finally make progress toward recovery, insted of cycling through ongoing pain. I have greatly benefited from receiving dry needling treatment myself to address chronic myofascial pain and dysfunction, allowing me to continue practicing as a physical therapist. 

I am in full support of the Dry Needling Regulations as proposed. Physical Therapists have exceptional understanding of Neuromusculoskeletal anatomy as part of our core training. This is further accentuated with training specific to trigger point dry needling (TDN). TDN is noted to be definitively distinct and seperate from accupressure. TDN is a safe treatment that is economically viable to the patient and the current regulations do not alter this viability or add additional costs to the State of Virginia. 

Thank you to the Board of Physical Therapy for allowing a public comment period. 

I have benefitted from dry needling done by a physical therapist. It should continue tobe offered in Virginia and should be covered by insurance.

Having researched and published in this area of Pain Medicine over the last 25 years, I can say with complete confidence that there is no rational sceintifc reason for therapists (or medical practitioners) to practice "dry needling". The existence of trigger points as primary sources of pain has never been confirmed and the relevant literature fails to reveal benefit to patients over and above that of placebo therapy. 

In support of my position, I attach this list of references:

Quintner JL, Cohen ML. Referred pain of peripheral neural origin: an alternative to the "Myofascial Pain" construct. Clin J Pain  1994; 10: 243-251.

Cohen ML, Quintner JL. The horse is dead: let myofascial pain syndrome rest in peace [letter]. Pain Medicine 2008; 9: 464-465.

Quintner J, Bove G, Cohen M. A critical evaluation of the “trigger point” phenomenon. Rheumatology 2015; 54: 392-399.

Quintner JL, Cohen ML. Myofascial pain: a bogus construct. In: Hutson M, Ward A, eds. Oxford Textbook of Musculoskeletal Medicine, 2nd ed. 2015.

Quintner J, Bove G, Cohen M [letter to the Editor (matters arising)]. Comment on: A critical evaluation of the trigger point phenomenon: reply. Rheumatology 2015: doi:10.1093rheumatology/kev095.

Quintner JL, Bove GM, Cohen ML. Response to Dommerholt and Gerwin: Did we miss the point? J Bodyw Mov Ther 2015; 19: 394-395.

Trigger point dry needling is an extension of what therapists already do via manual stimulation of restricted soft tissue (Trigger points). It allows the therapist to specifically focus stimulation of trigger points. It is especially beneficial regarding recalcitrant areas that do not respond to traditional manual intervention.

Therapists use dry needling as an adjunct to traditional therapy and it is an invaluable tool. It is especially helpful in situations where pain from restricted trigger points is limiting progress (function, ROM, strength).

Dry needling is different from accupuncture in clinical reasoning, technique, and goal of treatment. Trigger point dry needling specifically addresses hyperirrable loci in the muscle tissue to elicit a physiological response in the muscle tissue. It has been been an invaluable addition to my practice  regarding my patients's outcomes. As a patient, it has allowed me to continue practicing as a manual therapist when I have had muscoloskeletal issues.

Lastly, Physical Therapists are highly educated in clinical anatomy and physiology. Most therapists have doctoral degrees, as that is the required standard of the APTA. In addition, we undergo rigorous continuing education to meet the requirements necessary to perform dry needling safely and effectively.

Because of dry needling to my neck and shoulder, I am able to live a most normal life without taking prescription drugs on a daily basis.  Due to car wreck injuries from 14 years ago, dry needling has helped maintain a low daily pain level and allowed me to function fairly normally raising children and being active.  Dry needling is most helpful with chronic pain like I have.

I support the PT's right to perform Dry Needling.I have seen several referrals for DN & have talked to individual's that have received this beneficial treatment.PT's definitely have the necessary base in anatomy & physiology.

Sirs/Mesdames:

I write as both a Physical Therapist and as a patient, in support of the TDN (Trigger Point Dry Needling) legislation that is pending.  As a PT and Assistant Professor in a Physical Therapist Assistant program, I can attest to the stringent educational standards that are basic to PT education.  The continuing education required for potential practitioners of dry needling is extensive and exhaustive, in order to, first and foremost, protect the patient from harm.  As a patient who has experienced TDN as administered by a qualified PT, I can also report that its effects are remarkable, and serve to decrease muscle tension, making ongoing related PT treatment more effective.  Regarding the comparison to acupuncture, I have experienced both (though for different conditions), and the sensations felt very different.

I wholeheartedly support the passage of this legislation, so that qualified and well-trained Physical Therapists can continue to provide this valuable treatment.

Thank you.

Laurie Z. Daigle, PT, MA

As a physical therapy patient in Richmond, Virginia dry needling has been part of my treatment plan. When administered by a certified physical therapist, I have found dry needling to provide relief when nothing else has. Lidocaine injections in diagnosed trigger points were the first line of treatment in my doctor's office. Unfortunately, I experienced an allergic reaction to the medication. Dry needling has allowed my physical therapist to access trigger points without the use of drugs, and enhanced their ability to treat my muscle and joint pain. I have experienced an definite increase in range of motion after needling sessions as well as shortened healing time as I am able to better perform prescribed exercises. As a health care consumer in the Commonwealth of Virginia, I believe it is very important that I continue to have access to physical therapists who are specifically trained and certified in dry needling techniques. Thank you.

I hold a PhD in neurobiology and human anatomy, and am primarily a biomedical reaearcher.  I learned trigger point therapy in 1984+, and practiced a form of it for a number of years.  Trigger point therapy never really worked for me; this is probably because it does not make sense physiologically.  Using needles to stick "trigger points" has no scientific basis, and the literature supports that it, like its cousin acupuncture, does not work beyond contextual effects.  The content of the training courses for dry needling is primarily review of anatomy, and seems predatory.  The practice of dry needling promulgates unscientific practice, and as such should not be licensed or practiced by anyone.

I am a patient of a therapist who gives uses dry needling and it helps me.  I am in full support of Virgina therapists being able to continue to do dry needling!  

I fully support Dry needling by Physical Therapist. Physical Therapists are highly educated and trained healthcare professionals who specialize in treating the neurological, muscular and skeletal movement systems via many modalities and dry needling is one such modality.  Physical Therapists possess the anatomical, physiological and clinical knowledge to perform trigger point dry needling safely and effectively.

Dry needling is an effective form of therapy. There may not be much scientific research geared towards this practice, but that is not to the fault of the results produced from the practice. We utilize this in our clinic from a highly trained DPT, and it works in very specific instances.  

I fully support Physical Therapists performing Dry Needling.  It is very well known that Physical Therapists are highly educated healthcare practitioners that have all of the needed neuromuscular and musculoskeletal anatomy knowledge required to be able to use this intervention as an extension of their skill sets.

I have severe neck injuries which result in both neck and shoulder pain.

I have tried Chiropractic, Massage, Tens Unit, Therapy Cane, Medi Cupping, Cervical Traction and even Salves and Creams. None of those provided long term relief.

One year ago I started Dry Needling by my Physical Therapist. Dry Needling has been the only modality that has provided me with any relief.

My PT has been trained and certified in Dry Needling.I feel that I am in great hands.

The ability to perform Dry Needling should be left with trained and certified PT's.

Sincerely

Carl Smith

540-580-4010

As a physical therapist and trained in dry needling, I feel that a physical therapist that has completed the required training for dry needling should be able to perform the skill in the clinical setting.  Physical therapist are trained at a doctoral level and have all the knowledge (and beyond) to be able to safely and properly perform this technique in order to improve patients pain levels and quality of life.  Taking this skill away from Physical Therapist would be depriving patients that find relief in our treatment, proper care.  Dry needling is in no way acupunture and we are not performing acupunture in any way.  We are not trying to clain we are acupunturist at all. Please allow Physical Therapist to continue to treat patients with dry needling. 

I am a licensed practicing PT in the state of Va . and that had done specific dry needling continuing education to be certified for level 1 dry needlling for muscle trigger points.

I agree with the proposed regulations below Regarding dry needling for theses reason.

1. Physical Therapists are highly educated and trained healthcare professionals who specialize in treating the neurological, muscular and skeletal movement systems via many modalities and dry needling is one such modality.  Physical Therapists possess the anatomical, physiological and clinical knowledge to perform trigger point dry needling safely and effectively. 

2.Trigger point dry needling is distinctly different from acupuncture as the treatment goal and method is different.  While both practices may use a similar implement or device, the clinical reasoning, technique, and goal of the treatment are different.  Accupunturist are not dry needling into a muscle trigger point so the affect the physical therapist do with the accupuncture needle for dry needling into a muscle trigger point give a different muscular physiological effect , that also enhances their exercise ability during that treatment session and with their home exercise program afterwards and can many time reduce the total # of treatment sessions needed to complete their rehab with meeting their PT plan of care goals .

3)I have been certified for level 1 dry needling with 2 continuing education  over 6 total days(  3 consecutive days at at time )and meeting the edcational hours for the state of  VA at this point required to dry needle patients in a PT clinic.My training included extensive review of muscle/nerve/trigger point anatomy/evaluation and physiological affect of t\dry needling and appropriate reloading exercises post needling for each muscle/body region to promote improvement in their daily function. and training for clean technique and emergency preparedness and contraindications/ precautions

4)Since I became certified ,I  am getting better muscle relaxation/pain reduction /immediate increase in range of motion of the body part to improve a patient's functional mobility than with just doing other PT modalities alone. It would be a shame not to offer this as part of physical therapy in the state of Virginia

In summary ,I feel confident that in our facility, I am  meeting all the elements of the proposed bill below in That : We are already in our facilties of inova obtaining a written referral that specifies dry needling procedure for each of our pt's ( A of the below proposed regulation ) and my training /ceritfication level included all the elements listed in B of the below proposal , and our written conscent form uses contains all the items in part C of the proposal below , an thus strongly encourage passage of the  the proposal for continuing dry needling in the PT practice act of Virginia

18VAC112-20-121. Practice of dry needling.

A. Dry needling is an invasive procedure that requires referral and direction in accordance with § 54.1-3482 of the Code of Virginia. Referral should be in writing; if the initial referral is received orally, it shall be followed up with a written referral.

B. Dry needling is not an entry level skill but an advanced procedure that requires additional training. The training shall be specific to dry needling and shall include emergency preparedness and response, contraindications and precautions, secondary effects or complications, palpation and needle techniques, and physiological responses.

C. Prior to the performance of dry needling, the physical therapist shall obtain informed consent from the patient or his representative. The informed consent shall include the risks and benefits of the technique and shall clearly state that the patient is not receiving an acupuncture treatment. The informed consent form shall be maintained in the patient record.  

I have been a licensed physical therapist practicing full time since 1984.  My extensive professional training in anatomy and physiology, as well as clinical experience, has enabled me to successfully treat a wide variety of diagnoses and client populations.  These include individuals presenting with problems stemming from and impacting the muscular, neurological, skeletal, fascial, integumentary, cardiovascular, and internal organ systems and functions.  My skills, much like most physical therapists, do not depend on imaging or laboratory tests, but instead stem from obtaining a thorough medical history, performing a comprehensive examination emphasizing movement in all body segments, palpation to identify faulty tissues, and synthesis of these findings to determine an appropriate plan of care. 

In 32 years of practice I have also pursued hundreds of hours of advanced study and training pertinent to more successfully managing clients in an outpatient setting.  This has included joint manipulation, exercise, fascial manipulation, Myofascial trigger point therapy, and dry needling. Obtaining certification to perform dry needling in 2009 has enabled me to offer one additional and very effective modality for resolving pain, restoring mobility, and optimizing function.  Physical therapists are well positioned to successfully use this modality by virtue of professional training. This has been confirmed by the Federation of State Boards of Physical Therapy, as well as published research determining a 0.04% incidence of adverse effects associated with physical therapists performing dry needling.  This is lower than the adverse effects associated with taking ibuprofen. 

Not being formerly trained in acupuncture precludes me from definitively comparing the two interventions.  But having received both as a patient, I can attest to how very different these two interventions are in terms of rationale determining sites to be treated, depth of needle penetration, scientific basis, and treatment goals.  Additionally, being employed by a continuing education provider that teaches dry needling to multiple health care disciplines including acupuncturists affords me an interesting perspective.  One comment I very often hear from the acupuncturists participating in these courses is how different dry needling is from acupuncture. 

In light of these points I would ask that the proposed regulations concerning dry needling be enacted.  Thank you.   

l have had frozen shoulder in both shoulders and I am a diabetic. I've been through surgery and had limited mobility. There was days my pain levels were a 10. I don't want to deal with steroids due to the diabetes. The only relief I got was by dry needling. Don't go changing anything that is working perfectly fine. We should have that right to choose.

Thank You

I am suffering from muscular tension, strain and spasms in my upper legs caused by arthritis in my hip joints. I had several months of traditional physical therapy with stretching and strengthening the muscles. The traditional physical therapy helped some, but was very slow in relief from the muscle pain, so my orthopedic doctor recommended dry needling. Dry needling has increased my ability to reach greater function in my legs muscles. My upper leg muscles were in a constant state of contraction, leaving hard knots in my leg muscles. Dry needling helped in far less time than I experienced with regular physical therapy. The systematic dry needling sessions were strategic in targeting the contracted, knotted muscles providing immediate and long lasting relief from the pain, allowing me to stretch and strengthen the affected muscles. Within a few hours after the dry needling treatments, the muscle pain and strain subsided, allowing me a great increase in my range of motion, flexibility, strength, and mobility. I thought I would have to learn to live with the pain, but after dry needling, I have experienced positive long-term effects of pain relief in my leg muscles. What an amazing treatment! I wish I had learned of dry needling a long time ago so I would not have had to deal with so much pain.

I write as both a Physical Therapist and as a patient, in support of the most of the DN (Dry Needling) legislation that is pending.  I do not feel that it is necessary for a DPT to require a MD or DO oral or written permission/prescription to perform any physical therapy treatment if that practioner has the qualified training.  The continuing education required for potential practitioners of dry needling is extensive and exhaustive, in order to, first and foremost, protect the patient from harm.  As a patient who has experienced DN as administered by a qualified PT, I can also report that its effects are remarkable, and serve to decrease muscle tension, making ongoing related PT treatment more effective.  Regarding the comparison to acupuncture, I have experienced both (though for different conditions), and the clinical rationale & clinical application are much different. Only the needle used in the treatment are similar in nature. 

I support the passage of this legislation, so that qualified and well-trained Physical Therapists can continue to provide this valuable treatment, but would like to see that the requirement for physician permission removed from the regulations.

Dr. Eric Jorde

While I am in full support of PTs performing DN, I am bothered by the fact that a physician referrral is still required. In the state of Virginia, since we have expanded direct access, that should cover all treatment "modalities" that we deem appropriate for the patient, in accorance with informed consent from the patient. A physician referral should not be required for DN and only adds to a bearocratic issue that often serves only to delay treatment. Most physicians have little to no understanding of the practice of DN. We are an autonomous profression that needs to get out from under the thumb of the medical "establishment" if we truly are to push forward. 

As a long time physical therapy patient of a practice in Southside Virginia, I have had a variety of treatment methods utilized to assist me with pain, sensation, mobility, and post surgical recovery. At the suggestion of my DPT, I tried dry needling and found it to be helpful during my lengthy and on-going rehabilitation process.  Though my orthopaedic surgeon provided specific orders for my DPT, I did ask him specifically if he had an issue with the use of dry needling during my post surgical recovery process. He was not in opposition, but I feel that he was skeptical about the anticipated outcomes. I call it the "I'm the cutter, you're merely the laborer" syndrome. Many MDs don't understand the practice and how it works; this leads to skepticism amongst the medical field. I believe if a PT patient has proven outcomes from dry needling and has a certified DPT who is educated, technically superior, confident, and compassionate the decision should be between the patient and the DPT. I support the concept that there should not be a need for a referral by a physician in order to receive access to dry needling in a physical therapy clinic. An educated patient and a well-trained DPT should be able to make the decisions necessary to improve quality of life.

i have

1. Physical Therapists are highly educated and trained healthcare professionals who specialize in treating the neurological, muscular and skeletal movement systems via many modalities and dry needling is one such modality.  Physical Therapists possess the anatomical, physiological and clinical knowledge to perform trigger point dry needling safely and effectively. 
2. A recent study by the Federation of State Boards of Physical Therapy found that 86% of the knowledge and skills required to perform trigger point dry needling is obtained in the entry level education of Physical Therapists when they graduate from an accredited program.  The post-graduate training that is required by the regulations fulfills the remaining education needed to obtain certification and practice safely and effectively.
3. Trigger point dry needling is distinctly different from acupuncture as the treatment goal and method is different.  While both practices may use a similar implement or device, the clinical reasoning, technique, and goal of the treatment are different.  Trigger point dry needling specifically addresses hyperirritable loci in the muscle tissue to elicit a physiological response in the muscle tissue to enhance and progress treatments performed by Physical Therapists.  This response is similar to the response elicited by other treatment modalities.
4. I have had great success treating patients who suffer from pain and loss of function with dry needlig as part of their treatment regime. 

As a physician, I am writing in support of the proposed regulatory action regarding dry needling as an adjunct to physical therapy treatment. There is ample scientific evidence in support of myofascial trigger point needling, which is distinctly different from acupuncture. It is widely accepted and often of great benefit to patients. Physical therapy training is stringent, and standards for dry needling training are exacting.  I have seen benefit among my own patients and have personally benefited from it as well. More importantly, it is proven to be safe and effective in numerous studies and we need to make it accessible for patients. I fully support passage of this legislation, so that qualified and well-trained physical therapists can continue to provide this useful treatment.

I fully support dry needling by physical therapists in the state of Virginia.

As a Physical Therapist within the Commonwealth of Virginia, I am fully in support of 18VAC112-20-121 governing the practice of Dry Needling. 

While I do not currently utilize this modality in my own practice within an inpatient hospital setting, I myself have received Dry Needling from a Physical Therapist that undoubtedly enhanced my recovery from a musculoskeletal injury. Dry Needling is an important tool within the Therapist's 'toolbox' to allow for improved quality of life in our patients. In addition, this form of treatment has been shown via evidence based practice to alleviate pain and loss of function in countless numbers of patients. 

Support Dry Needling as it has benefited so many of my patients and myself.  After being Certified in this technique 10 years ago, I was Dry Needled on the right side of my C-section scar and it eliminated my Right quadrant pain after 18 years. It has changed so many lives by eradicating their Pain!

1. Physical Therapists are highly educated and trained healthcare professionals who specialize in treating the neurological, muscular and skeletal movement systems via many modalities and dry needling is one such modality.  Physical Therapists possess the anatomical, physiological and clinical knowledge to perform trigger point dry needling safely and effectively. 
2. A recent study by the Federation of State Boards of Physical Therapy found that 86% of the knowledge and skills required to perform trigger point dry needling is obtained in the entry level education of Physical Therapists when they graduate from an accredited program.  The post-graduate training that is required by the regulations fulfills the remaining education needed to obtain certification and practice safely and effectively.
3. Trigger point dry needling is distinctly different from acupuncture as the treatment goal and method is different.  While both practices may use a similar implement or device, the clinical reasoning, technique, and goal of the treatment are different.  Trigger point dry needling specifically addresses hyperirritable loci in the muscle tissue to elicit a physiological response in the muscle tissue to enhance and progress treatments performed by Physical Therapists.  

Dry Needling is the best method for trigger point therapy.  I've had major pain issues caused by trigger points that several doctors prescribed pain killers.  Due to Dry Needling, I'm no longer on pain meds. 

Most effective therapy for removing trigger point pain.  I have used pain killers, massage therapy and weight lifting to assist with removal of trigger point pain and non could compare to the Dry Needling pain relief that I have received.  

I was a 1st year clinician fresh out of a DPT program when I obtained additional training for Trigger Point Dry Needling (TPDN). I felt very prepared to attain and apply this training clinically. Being a new graduate my recall of the specific muscles was fresh and has helped me maintain the specificity of individual muscles and not just movement groups while in a busy clinic.

Dry needling has been a useful modality to address chronic and acute muscular pain. I have also used it to increase patient awareness for neuromuscular education and activation, as well as a clinical differential diagnostic tool to rule in/out specific muscle groups as contributors to the patient's primary impairment. As a modality I find it to be more specific and often more effective than ultrasound to assist in the relase of chronic contracted muscles or estim in eliciting activation of specific muscle groups.

I have had multiple patients that are amazed at the immediate change in muscle behavior and dynamic change in pain or restriction. Patient have been responsive to the education provided on the role and evolution of TPDN and how it truly seeks a different result to promote healing than accupunture eventhough the tools are very similar. Dry needling, when used correctly, has the potential to expidite healing and resolution of chronic musculoskeletal issues and should continue to be utilized by competently trained PTs.

- Christy DeSpain, PT, DPT

As a patient, I fully support the use of dry needle therapy for Physical Therapists.  I have benefitted from this procedure and appreciate the accessabilty of methods that provide relief from pain and which often preclude the need for medicine, espcially pain relievers.  

I am a military PT currently stationed overseas, my license is through VA. 

1. PTs have appropriate levels of training to utilize dry needling as a treatment option. Entry level PTs + post graduate training fulfill the regulatory requirement for certification and safe use of this therapy. As such, a specific written referral from a physician/provider should be unnecessary. 

2. Dry needling is distinct from acupuncture and has a growing body of literature to support its use in conjunction with existing therapies. 

3. With all due respect to Dr. Geoffrey Bove and Dr. John Quintner (previous commenters). The comments that dry needling has no scientific basis are unfounded. Dry needling has literature to support its use and will continue to be refined as a treatment in conjunction with existing therapies.

I have been getting TDN with Annetta Haddox at PRO PT in Wnchester for almost ten years.  The relief I get from this treatment is unparalleled with any other preventative treatments, including medication.  I continually recommend this treatment to others with migraines and with any other muscular problems.  I tried acupuncture and this treatment is entirely different in outcome.  Physical Therapists in VA should be allowed to practice TDN after obtaining the specialized training.  My quality of life would be diminished if I didn't have access to this treatment.

Physical Therapists are well qualified and highly trained when performing this technique. Undergraduate education emphasizes palpation and anatomy and post graduate training in dry needling is comprehensive with both practical and written examinations. It has been an excellent additional manual therapy technique with exceptional patient outcomes.

 Since dry needling is within the scope of a Physical Therapist's practice,  I do not feel that it is necessary for a DPT to need a written order specifically for dry needling if that practioner has the qualified training. Dry needling certification requires extensive training with written and practical examinations. 

"With all due respect to Dr. Geoffrey Bove and Dr. John Quintner (previous commenters). The comments that dry needling has no scientific basis are unfounded. Dry needling has literature to support its use and will continue to be refined as a treatment in conjunction with existing therapies."

As I am mentioned in this comment, I have taken the opportunity to briefly respond. 

The assertion that dry needling has a scientific basis does need to be supported by scientific evidence. To the best of my knowledge, no such evidence exists.

The extensive literature that I have reviewed is logically flawed by the respective authors simply "begging the question" as to the existence of myofascial (and other) trigger points as primary sources of nociceptive input. Such a neurophysiological phenomenon has never been demonstrated.

Here is the link to my recently republished article on "Body in Mind" that casts considerable doubt upon the validity of the Myofascial Pain/Trigger point construct: http://www.bodyinmind.org/evaluating-trigger-point/

Realizing that this is not a venue for discussion, but since I am mentioned by name in another comment I am responding.  I have reviewed the biomedical literature related to this topic thoroughly, and for years.  All studies claiming to show effects have design flaws that make it impossible to attribute any response to be specific to "dry needling."  There is no animal model to study "trigger points," because there has been nothing revealed in humans that is consistent with their existence as a local pathophysiology (there is no doubt that there are consistency differences in muscles).  But, dry needling in animals is used for produce two pathology models.  There is no interexaminer reliability for the detection of "trigger points," including David Simons (manuscript referenced in our article.  These are snippets: all considered, the evidence does not support the practice.  I believe that it was contrived by people not licensed to to perform acupuncture and "wet" needling (two other practices that have also dramatically failed to show specific effects). So, why consider using it, let alone licensing it?