This is written to oppose the practice of dry needling by physical therapists and any regulations that would have the effect of legitimizing this practice.  As a physician and practitioner of medical acupuncture in Virginia for the past 17 years as well as a senior instructor at Helms Medical Institute (which trains 90% of physicians practicing acupuncture in the United States), I feel I am qualified to comment. 

Any procedure involving percutaneous insertions is invasive by definition.  A variety of complications, unintended consequences and therapeutic misadventures can and do occur.  Extensive training and practice are necessary to minimize the incidence of adverse events, and significantly, to know what to do if problems arise. 

Pneumothorax can and does occur with needling over the thoracic cavity and pericardial puncture is also possible.  Adverse sequelae also include hematoma, nerve injury, vascular injury and infection.  Among the commonly occurring and potentially serious complications of percutaneous needle insertion is the phenomenon of ‘needle shock’ which is a form of vasovagal syncope.  Patients can become rapidly hypotensive and may even lose consciousness in this situation.  It requires long clinical training to know how to safely handle these problems.    

‘Dry needling’ is none other than ‘trigger point deactivation’, a procedure described and advocated by Janet Travell, M.D. in the 1940s and 1950s.  In the acupuncture context, it is a ‘local procedure’ the value of which is greatly enhanced in medical acupuncture practice by the concurrent use of regional, global and reflex microsystems (auricular) inputs.  Trigger point deactivation is appropriately utilized by physicians and licensed acupuncturists who have had years of training in the risks and management of invasive procedures.  Such procedures are outside the scope of practice of physical therapists as is the recognition and management of shock and pneumothorax.  Furthermore, dry needling is indeed acupuncture with the intention of myofascial release and to allege otherwise is just nonsense.  ‘Weekend courses’ such as those widely offered to physical therapists wishing to practice dry needling are no substitute for lengthy and comprehensive training leading to board certification.  This is indeed an issue of public safety.