I am a licensed acupuncturists practicing in Reston, Virginia. I am writing today to oppose the current draft of the proposed regulation 18VAC112-20-121 – Practice of dry needling put forth by the Virginia Board of Physical Therapy.

The Virginia Board of Physical Therapy has adamantly defended itself against claims that dry needling is the practice of acupuncture by stating that these techniques differ in treatment goals and methods.

This is clearly not the case.

The Commonwealth of Virginia defines the practice of acupuncture in Chapter 29 of Title 54.1, Section 2900 of the Code of Virginia Medicine as “the stimulation of certain points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain ailments or conditions of the body and includes techniques of electroacupuncture, cupping, and moxibustion.”

The Analysis of Competencies for Dry Needling by Physical Therapists, a practice analysis referenced by the Virginia Board of Physical Therapy in their agency statement dated June 8, 2016 as a means to justify their decision to disregard minimum training requirements for PTs practicing dry needling, defines the practice of dry needling as “using filiform needles to penetrate the skin and/or underlying tissues to affect change in body structure and functions for the evaluation and management of neuromuscular conditions, pain, movement impairments, and disabilities.”

As you can see, these definitions are nearly identical. Dry needling is the practice of acupuncture and, in order to practice acupuncture in the Commonwealth of Virginia, you must be a licensed acupuncturists or qualified practitioner. Therefore, any physical therapist performing acupuncture as dry needling, is in clear violation of the law.

Furthermore, the Virginia Board of Physical Therapy in its agency statement dated June 8, 2016, responded to 1,266 comments opposing dry needling by physical therapists because it is the practice of acupuncture by stating that dry needling is a “modality to address hyperirritable loci or trigger points in muscles to elicit physiological response.”

Again, this is clearly the practice of acupuncture as you are normalizing physiological function by penetrating the skin with needles to control pain. Acupuncture therapy includes the treatment strategy of dry needling as acupuncturists have been puncturing and stimulating reactive, painful points (also known as hyperirritable loci or trigger points) throughout the body for the purpose of relieving musculoskeletal and connective tissue disorders for over 1,000 years.

A consistent argument made by physical therapists, including the Virginia Board of Physical Therapy, is that dry needling differs from acupuncture because acupuncture “focuses on energy flow and meridians from a holistic approach to practice.” This quote is also found in the Board’s agency statement from June of 2016.

This is a gross misrepresentation of acupuncture. If the Board cared to put minor effort into researching the modern, scientific interpretation of acupuncture theory and application, they would find that acupuncture channel theory is based on fascial, neurological, circulatory, and muscular maps of the body as it relates to anatomy and physiology. The 300 to 400 points often depicted on acupuncture charts is just a sample of the acupuncture points that traverse the body. What is uncharted is the countless empirical, motor, trigger, and reactive points acupuncture students spend years learning and needling. Acupuncture therapy is not a system that begins and ends at the termination of its standardized channel system.

Trivializing the training needed to use an invasive tool such as a filiform needle in order to safely practice therapeutic techniques is negligent. In the hands of an undertrained professional, acupuncture needles can and do cause injury. Knowledge of anatomy and physiology is not enough to declare competency. There must be extensive hands-on training followed by extensive, supervised clinical training. Acupuncture students throughout the country spend an average of 1,365 hours on acupuncture-specific training including 705 hours of acupuncture-specific didactic material and 660 hours of supervised clinical training. Even medical doctors with extensive training in the use of invasive medical devices need 300 hours of training in acupuncture including 100 hours of clinical training.

The practice of dry needling is acupuncture. Therefore, the dry needling regulation submitted by the Virginia Board of Physical Therapy not only encourages the unlawful, unlicensed practice of acupuncture but ignores public safety by precluding the necessity for proper training of its professionals.

Thank you.

Aubry L. Fisher, L.Ac.
1800 Town Center Drive
Reston, VA