Action | Practice of dry needling |
Stage | Proposed |
Comment Period | Ended on 2/24/2017 |
Corie Tillman Wolf
Executive Director
Board of Physical Therapy
Department of Health Professions
9960 Mayland Drive, Suite 300
Richmond, VA 23233
February 24, 2017
Ms. Wolf:
The Maryland Acupuncture Society (“MAS”) writes to express our concerns regarding Proposed Regulations 18VAC112-20-121. Practice of dry needling submitted by the Board of Physical Therapy currently under review.
We OPPOSE these regulations as written and offer below amendments to the process.
The State of Maryland has recently undergo a similar rulemaking process to clarify the practice of dry needling; one which has been ongoing since 2009 when our Attorney General issued an opinion directing our Board of Physical Therapy Examiners that they must undergo the formal rulemaking process if the practice of dry needling were to carry legal effect.
Over the many years of this process, multiple draft regulations were proposed by the board and rejected because it was agreed by the Secretary of our Department of Health and Mental Hygiene that the insufficiencies of the regulations constituted a risk to public safety.
Having reviewed your current regulations, we have grave concern that your regulations as written will at best cause patients to receive ineffective treatment from undertrained professionals and at worst cause a significant increase in life-threatening injuries.
Dry Needling is a style of needling treatment within the greater field of acupuncture. The practice of “acupuncture” includes any insertion of an acupuncture needle for a therapeutic purpose. Anatomically, “trigger points” and “acupuncture points” are synonymous, and acupuncture has targeted trigger points for over 2,000 years. “Dry needling” is indistinguishable from acupuncture since it uses the same FDA-regulated medical device specifically defined as an “acupuncture needle,” treats the same anatomical points, and is intended to achieve the same therapeutic purposes as acupuncture.
As such, we feel that permitting physical therapists to perform an invasive procedure for which they do not receive education in their primary schooling constitutes a scope expansion that only the legislature, not the Board of Physical Therapy, has the authority to permit.
We also feel that any such scope expansion that is permitted by the legislature must include certain safeguards which these regulations lack.
Such safeguards should include but not be limited to:
We strongly suggest that any legislature condoned scope expansion include regulations that specify minimum hours of training, all of which should be completed subsequent to completion of physical therapy schooling as the anatomy and physiology training a physical therapist completes in school is not sufficient for knowledge of performing invasive, internal procedures such as needling.The mechanical devices taught in physical therapy schooling are used either on the surface, and do not penetrate the skin barrier, or are used to remove dead tissue from the surface of the skin. None of their regular coursework includes intervention that breaks the skin barrier into live muscular and intramuscular tissue.
Over the many years that Maryland has worked to better regulate this procedure, we have witnessed “dry needling” classes that constitute less than 12 – 24 hours of large group lecture with little to no hands-on supervised practice.Class participants are then given needle packages at the end of the weekend and encouraged to immediately begin offering this service in their own clinics.These classes are often offered in the Washington DC metro area, and it is no doubt to us that your own licensees in the Northern Virginia area may be drawn to taking such insufficient training courses.
We suggest that your regulations include a requirement that coursework and practicum supervision be offered only through accredited programs; that instructors have practiced this procedure for a minimum length of time, and that examinations administered outside the required training hours be passed before any providers is permitted to perform this procedure.
We therefore strongly recommend that your regulations restrict licensees from performing additional needling procedures that extend into the broader field of acupuncture. We ask that you redefine the definition of dry needling to more specifically restrict dry needling to only neuromuscular trigger points rather than anywhere “linked” to neuromuscular or musculoskeletal impairments.
As research continues to confirm the evidence based benefits of acupuncture needling procedures, so too will the desire of the health occupations wishing to offer this effective service to their patients grow. We have no doubt that you will receive multiple comments encouraging you to pass these regulations because the writer has experienced a benefit from "dry needling" because we know that dry needling is acupuncture; and we know that acupuncture works!
But it is critical to protect the health and safety of our citizens by assuring that anyone who offers acupuncture needling, by any name, is sufficiently trained to do so.
Thank you,
David Blaiwas Tracy E. Soltesz
President Vice President of External Affairs
Maryland Acupuncture Society Maryland Acupuncture Society